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A 61-year-old man presented with dyschezia, and further examination revealed squamous cell carcinoma of the lower rectum invading the bladder and seminal vesicles. The clinical diagnosis was squamous cell carcinoma of the lower rectum, cT4b(bladder and seminal vesicle)N0M0, cStage Ⅱc. Neoadjuvant chemoradiotherapy was administered with external irradiation of the entire pelvis(50.4 Gy/28 Fr)and chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin(FOLFOX). Once tumor shrinkage was observed 3 months after chemoradiotherapy, laparoscopic total pelvic exenteration with TaTME approach was performed. The patient was discharged on the 26th postoperative day without any postoperative complications. Histopathological examination showed only squamous cell carcinoma component with Grade 1a histological treatment effect. The pathological diagnosis was ypT4b(bladder, seminal vesicle)ypN0cM0, ypStage Ⅱc. The patient was alive without any recurrence 6 months after surgery.

We present a case of thoracic SMARCA4-deficient undifferentiated tumor that needed to be differentiated from malignant lymphoma owing to multiple lymph node swelling and marrow involvement. A 52-year-old man developed multiple lymphadenopathies along with anorexia, general fatigue, fever, and sweating 2 months prior to admission. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan revealed a mass lesion on the right upper lung, generalized lymph node swelling, and bone metastasis, indicating the presence of suspicious lung cancer; therefore, he was referred to our hospital. Malignant lymphoma was suspected at the time of admission because of elevated levels of lactate dehydrogenase (11,977 U/l) and soluble interleukin 2 receptor (2,152 U/ml) as well as marrow infiltration of large abnormal cells. On day 11, the patient died from rapid respiratory failure. Histological and immunohistochemical features of the pleural effusion cell block led to the diagnosis of thoracic SMARCA4-deficient undifferentiated tumor. Thoracic SMARCA4-deficient undifferentiated tumor was recently introduced in the 2021 World Health Organization classification of lung tumors, with most patients being young adults with a history of heavy smoking and poor prognosis. Because of the multiple lymph node swelling and marrow involvement, this undifferentiated tumor should be distinguished from malignant lymphoma.

A 73-year-old man underwent pancreatoduodenectomy 5 years previously, and portal vein stenosis was observed immediately after surgery. A collateral vein with varices around the hepaticojejunostomy gradually developed. The patient experienced repeated episodes of melena that required transfusion. Enteroscopy confirmed varices around the hepaticojejunostomy, caused by portal vein stenosis, which was the source of intestinal bleeding. Varices were treated by placing an expandable metallic stent in the stenotic portal vein through a percutaneous transhepatic route. Although the portal vein stenosis was severe, the guidewire was successfully maneuvered into the superior mesenteric vein and stent placement was successful. Subsequently, the collateral vein disappeared and no further melena was observed.

Macrophages have been discovered more than 100 years ago. Recent studies indicated that monocytes and macrophages can be categorized into several distinct phenotypes and their respective differentiation mechanisms are known. We also reported that the Jmjd3 is critical for the macrophage subtype activated by allergic stimuli and that the tissue resident macrophage subtype in adipose tissue, which is controlled by Trib1, is responsible for maintaining homeostasis of peripheral tissues such as adipocyte. Thus, it is considered that various macrophage/monocyte subtypes corresponding to certain disorders were existed in our body. Furthermore, in order to investigate the relationship between macrophage subtype and disease, we focused on fibrosis as the next target disease. Its pathogenesis is poorly understood, and there are few effective therapies. Previously we found that a new macrophage/monocyte subtype, which their markers are Msr1 + Ceacam1 + Ly6C - Mac1 + F4/80 - monocyte and share granulocyte characteristics, involved in development of fibrosis was accumulated in the affected area in the lungs at the beginning of fibrosis. We termed the monocyte/ macrophage subtype segregated-nucleus-containing atypical monocytes (SatM). Towards understanding the mechanism of fibrosis onset, we next focused on investigation of non-haematopoietic cells involved in activation of immune cell such as SatM during fibrotic phase.

Background: Regorafenib(Rego)is the salvage line standard treatment for metastatic colorectal cancer(mCRC), which often causes severe toxicities, such as hand-foot syndrome. Previously, we reported that in phase Ⅱ study, S-1 plus bevacizumab( Bev)(SB)showed favorable anticancer activity and feasibility as a salvage line. The aim of this study was to evaluate 2 treatments for mCRC as salvage line., Patients and Methods: In this multicenter phase Ⅱ study, the patients were randomly assigned(1:1)to the Rego or SB group. In the Rego group, Rego 160 mg/kg body weight was orally administered every 28 days for 21 days. In the SB group, S-1 was orally administered every 42 days for 28 days, according to body surface area, and Bev 5 mg/kg was administered by intravenous infusion on days 1, 15, and 29. Administration of S-1 every 21 days for 14 days and Bev 7.5 mg/kg on day 1 was also permitted. The primary endpoint was overall survival(OS), and the planned sample size was 86., Results: This study was ended prematurely due to poor accrual. Overall, 8 patients were enrolled from 6 institutions between Oct 2013 and May 2015. Although 4 patients were assigned to each group, one patient in the Rego group was excluded after enrollment. The median OS in the Rego and SB groups was 30.2 months and 6.6 months, respectively(hazard ratio: 0.205, p=0.123). The median progression-free survival in the Rego and SB groups was 3.7 months and 1.6 months, respectively. The disease control rate in the Rego and SB groups was 100% and 75%, respectively. The Grade 3 or 4 adverse events were increased, including AST/ALT(n=1, 25%), hyponatremia(n=1, 25%), hand-foot syndrome(n=1, 25%), hypertension(n=1, 25%), and proteinuria(n=1, 25%)in the Rego group and colitis( n=1, 25%)in the SB group; the treatment was discontinued., Conclusion: Despite the fact that data could only be collected from a small number of patients, SB is not recommended as salvage line for mCRC.

A 62-year-old man presented to our hospital with difficulty in swallowing. Physical examination and subsequent diagnostic tests identified hypopharyngeal and esophageal carcinoma with tracheal invasion. The patient underwent gastric fistula placement, radiotherapy, and chemotherapy. Palliative care was initiated after recurrence. The patient was later hospitalized for neck pain, and during a routine exchange of the gastric fistula, two large bezoars were found. The enteral nutrient gel was discontinued, cola was administered, and the bezoars gradually reduced. He continued to receive home care, and later when he was hospitalized for mediastinal abscess, no bezoars were identified. This case highlights the possibility of bezoar formation as a rare complication of enteral nutrition gel administration.

Recent research has revealed that macrophages and monocytes comprise various subtypes. Previously, we demonstrated that JMJD3 is vital for macrophage differentiation in response to allergic stimuli. Moreover, we substantiated that Trib1 controls the differentiation of tissue-resident macrophages in peripheral organs, such as adipose tissue. This study aims to elucidate that Ceacam1 + Msr1 + Ly6C - F4/80 - Mac1 + monocytes are essential for the development of fibrosis. Remarkably, these cell types harbor bilobed-like nucleus and some granules in the cytoplasm. Thus, we named these as cell segregated-nucleus-containing atypical monocytes (SatM). The results revealed that NFIL6 is critical for the differentiation of SatM, and the lack of this protein causes a complete deficiency of SatM. Furthermore, the development of fibrosis was prevented in NFIL6 -/- chimeric mice and the adoptive transfer of SatM into NFIL6 -/- chimeric mice resulted in fibrosis. Thus, macrophage and monocytes comprised multiple subtypes with functional diversity.

A 65-year-old woman who had been diagnosed with dermatomyositis presented to the hospital with a small bowel mass. She had tested positive for fecal occult blood test and anemia at a medical checkup;therefore, computerized tomography (CT) was performed at the previous hospital and it had revealed thickening of the intestinal wall. Abdominal contrast-enhanced CT, single-balloon assisted enteroscopy, and biopsy led to a diagnosis of poorly differentiated jejunal adenocarcinoma. The patient underwent laparoscopic segmental resection of the jejunum with dissection of mesenteric lymph nodes. A histological examination revealed that the tumor was neuroendocrine carcinoma (NEC), large-cell type of the jejunum, pT3, pN0, sM0, and pStage IIA. Immunohistochemically, the NEC component was positive for chromogranin A and negative for neural cell adhesion molecule and synaptophysin. The MIB-1 index was 60%. Four courses of postoperative chemotherapy using cisplatin and etoposide were administered. The patient is currently doing well without any recurrence or metastasis. To the best of the author's knowledge, this is the first report of dermatomyositis associated with primary jejunal NEC.

The patient was a 52-year-old man who had a positive fecal occult-blood test on a medical check-upi n April 2015 and was referred to our hospital in June. Detailed preoperative examinations resulted in a diagnosis of cancer of the lower rectum, multiple liver metastases, and clinical Stage IV . A biopsy showed moderately differentiated tubular adenocarcinoma. All-RAS was wild type, and the patient was asymptomatic. Unresectable advanced rectal cancer was diagnosed, and the patient was scheduled to receive systemic chemotherapy. The patient received a total of 16 courses of combination chemotherapy with 5- fluorouracil, Leucovorin, and oxaliplatin(FOLFOX)plus panitumumab, starting in October 2015. In July 2016, Colonoscopy showed scar findings at the site of the primary rectal cancer lesion. A biopsy revealed no cancer cells. It was difficult to identify the primary lesion on computed tomography, and there was no evidence of clinically significant lymphadenopathy. Positronemission tomography and computed tomography showed shrinkage of the liver metastases, with no accumulation of tracer in the primary lesion or lymph nodes. The primary lesion had a clinical complete response(CR), and the metastatic lesions had a clinical partial response(PR). In October 2016, laparoscopic partial hepatectomy was performed to treat the liver metastases. Histologic examination showed that the liver metastases were from rectal cancer. It is currently under observation.

Prostate cancer incidences in most Asian populations have rapidly increased, and prostate cancer ranks as the highest incidence of male cancer in Japan since 2015. Androgen depriva- tion therapy (ADT) remains the main first-line treatment for patients with metastatic prostate cancer (mPCa). However, treatment benefits last for 3-5 years when disease transforms into metastatic castration-resistant prostate cancer (mCRPC). Currently, management paradigms for mPCa are dramatically changing. Two multicenter, randomized trials have redefined first-line treatment, with the demonstration of improved overall survival with the addition of docetaxel chemotherapy to ADT. Several data have re- ported the impact on survival of radiotherapy of the prostate even in patients diagnosed with mPCa. The objective of this review is to summarize an overview of current multidisciplinary approaches for mPCa and mCRPC.

More than 100 years ago, macrophages was discovered. So far, we thought that these are no subtype of macrophages in out body. However, recent studies of these cell types indicate that more than two types of macrophages are existed, and each cell types has inherent functions. In this review, we describe the functional diversity of various type of disorder-specific macrophages and its differentiation mechanism.

Small bowel carcinoma has poor prognosis. The basis of treatment is surgical resection. There are no established guidelines for chemotherapy. We report a case in which we performed surgical resection of recurrent jejunal carcinoma. A 62-year-old woman underwent laparoscopic partial resection of the small intestine for primary jejunal carcinoma. The final diagnosis was T3N0M0, fStage II A. After 16 months of follow-up, she developed abdominal pain and vomiting. We diagnosed recurrence of jejunal carcinoma in the ileum and right ovary. Single-port laparoscopic small intestinal resection and right ovariectomy were performed. The patient underwent curative resection for recurrent lesions. The type of tumor in the ileum and right ovary was consistent with primary jejunal carcinoma by histopathological examination, and was diagnosed as recurrence of jejunal carcinoma. She is now on adjuvant chemotherapy with XELOX.

A 73-year-old man with a hepatocellular carcinoma was admitted to our hospital. He suffered from recurrent severe hypoglycemia. An autopsy was performed after his death. Anti-insulin-like growth factor II (IGF-II) monoclonal antibody immunostaining of the hepatocellular carcinoma was positive. Western immunoblot analysis of the serum revealed highly elevated IGF-II. Therefore, we diagnosed this case as a non-islet cell tumor hypoglycemia caused by a big IGF-II-producing hepatocellular carcinoma.

Prostate cancer is now the most commonly diagnosed cancer in Japanese men. In 2015, it is estimated 98,400 new cases are diagnosed. In addition, bone is the most common site for metastasis in prostate cancer, and many patients will develop bone metastases during the natural course of their disease. However, current advances in the diagnosis/treatment of metastatic prostate cancer, lead to change treatment strategy dramatically. In fact, bone metastasis has been changed 'palliative' to 'targeted organ', aimed to extend overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). We review the multiple issues involved in current diagnosis and the multidisciplinary approach to the treatment of bone metastases in patients with prostate cancer, and future directions.

In Japan, physical therapists have usually been involved in physical therapy for patients with functional disorders associated with cerebrovascular or orthopedic diseases in hospitals. With the aging of Japanese society, the number of diseased people will progressively increase; thus, it is important to pay much more attention to disease prevention. In this regard, physical therapists are expected to play a new role in the field of preventive medicine. Metabolic syndrome or central obesity with multiple cardiometabolic risks is associated with a high risk of type 2 diabetes or cardiovascular diseases and is now a central target for early detection and intervention for disease prevention. The incidence of metabolic syndrome increases with age, and men showed a higher incidence of metabolic syndrome than women in all generations. We have been involved in the guidance of workers with metabolic syndrome for a long time, and we conducted a multicenter study to establish effective guidance for these worker. In this paper, we will use our evidence to discuss the role of physical therapists in providing guidance for preventing metabolic syndrome. We are now conducting worksite supporting exercise intervention for workers who were resistant to conventional lifestyle guidance. In addition, the unique role of physical therapists in this new trial will be introduced.

Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and perirenal tissue. A 72-year-old female patient with uncontrolled diabetes mellitus was admitted to a hospital with loss of consciousness and, fever. Laboratory data suggested acute inflammation and hyperosmolar hyperglycemic syndrome. The left EPN was accurately diagnosed after abdominal computed tomographic (CT) scan revealed renal parenchymal gas and fluid within the subcutaneous tissue and mediastinum. The patient was transferred to our institution and underwent emergent open surgical drainage. However, a CT scan performed 3 days after the drainage revealed the presence of fluid in the left perinephric space. CT-guided drainage of the left perinephric fluid was performed. The patient was finally discharged after complete recovery from severe inflammation.

Cancer has been viewed as a heterogeneous population of cells.While the large majority of cells that constituting tumors are differentiated, and eventually stop dividing, only a minority population of cells, termed cancer stem cells, is capable of unlimited self-renewal and multi-differentiation, just like somatic stem cells in normal tissues.Cancer stem cells have been identified in a variety of cancers of the blood, brain, stomach, colon, and pancreas.In this review we present current evidence supporting the cancer stem cell model of tumor progression, and discuss the experimental and therapeutic implications.

The evolution of insulin therapy from animal insulin to recombinant human regular insulin has improved diabetes treatment. Generating of rapid-acting insulin analogs, mimicking physiologic insulin action enables us to provide better control of post-prandial glucose level and lower incidence of hypoglycemia compared with human regular insulin. These rapid-acting insulin analogs show lower susceptibility of insulin precipitation and catheter occlusions, and are suitable for insulin pump therapy of continuous subcutaneous insulin infusion. Insulin lispro and insulin aspart are also applicable for diabetic patients with pregnancy, requiring excellent glycemic control. In some studies, stepwise addition of prandial insulin, as well as full basal-bolus regimen can improve glycemic control with less hypoglycemia. Treatment intensification with rapid-acting insulin analogs may offer a proper method to reach glycemic goals.

It is expected that incidence of gastrointestinal cancers in elderly would increase. However limited data for chemotherapy is available for such patients. Elderly patients with good condition are considered as candidates for standard chemotherapy. Prolonged survival is expected even in elderly patients same as young with caution for toxicity. Decisions to deliver combination chemotherapy are to be dependent on status of comorbidity. Personalized approach is highly recommended because of insufficiency of organic functions, which is not apparent with standard examinations. For some patients to start with one level reduced dosage is reasonable with intent to escalation and de-escalation based on adverse events. Importance of prospective randomized trial would never diminish for elderly.

Rheumatoid arthritis (RA) is a typical autoimmune disease of connective tissue, with the synovial joints as the main site of the disease. Bone erosion occurs in the initial stage. A key factor in treating and understanding the prognosis of the disease is to determine which stage of the lesion is caused by rheumatoid arthritis. In order to assess bone erosion and determine the degree of synovial proliferation, ultrasonography has come into the spotlight as a method of visualizing the rheumatoid arthritis lesion, which cannot be distinguished superficially from the cutaneous condition. Joint ultrasonography is a relatively inexpensive procedure that can be used to examine patients repeatedly; therefore, we can compare serial data from such patients. The joint lesion, which we focused on, can be understood in real time and is superior in many respects. However, at present, there are problems with examiner bias and the lack of a standard assessment method, because joint ultrasonography alone does not provide objective imaging findings. Now, joint ultrasonography is also useful as a supportive method to clarify mobility around the articular region. Ultrasonography might be used as a supportive method for the early diagnosis, assessment of disease activity, evaluation of the drug efficacy, prognosis, and as part of the differential diagnosis.

It is considered that cancer stem cells have the same characteristics as normal stem cells, such as drug-resistance, self-renewal, differentiation, and tissue-formation. Normal stem cells depend on their surroundings, a niche. Cancer stem cells may also depend on their own niche. Because cancer stem cells are resistant to present remedies, it is important to find a remedy targeting cancer stem cells. The remedy must not only target cancer stem cells themselves but also target the niche surrounding the cancer stem cells.

Aim: Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA., Methods: The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥ 12 and abnormal ≤ 11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each., Results: The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases., Conclusions: The combination of 'weight loss during the last 3 months' and initial BMI ≥ 23/CC <31 cm along with a positive wall-occiput test was a useful and valuable SF screening test for malnutrition in elderly outpatients.

Purpose: To establish a specific quality of life (QOL) questionnaire for Japanese allergic conjunctival disease (ACD) (Japanese allergic conjunctival disease QOL questionnaire: JACQLQ)., Subjects and Methods: A multicenter study was conducted in 521 patients with ACD and 127 healthy volunteers (total 648 cases). The JACQLQ ver. 0 was developed by modifying the Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ). The participants were asked to complete the questionnaire, and objective scores were determined by an ophthalmologist using a slit lamp. To confirm validity, item and factor analyses were conducted and correlation coefficients were calculated., Results: The items were grouped into four subscales (Daily activity, Psychological well-being, Eye symptoms, Nasal symptoms) after factor analysis. The JACQLQ had good item-internal consistency (Cronbach's alpha: 0.846-0.934). QOL scores were correlated with eye itching, eye irritation and tearing. Objective scores were correlated with eye redness, eye itching and eye irritation. Face scores were correlated with eye itching, eye irritation and eye redness., Conclusion: The JACQLQ is a useful tool for assessing disease specific QOL in ACD.

Functional heterogeneity occurs in tumor withs a hierarchy in which tumor growth is driven by a small subset of cancer stem cells (CSCs). Like normal tissue stem cells, which are capable of self-renewal and multi-differentiation, CSCs have the ability to reconstitute tumors. CSCs also have the ability to resist chemoradiotherapy and give rise to cancer metastasis and recurrence. Therefore, eradication of CSCs will lead to complete cancer cure. In the process of developing CSC-targeted therapy, it is necessary to identify CSC-specific molecules, for which it is essential to identify definitive CSC markers and isolate CSCs with high accuracy. Although the targeting and regulation of CSCs have not yet been fully established, some reports showed that it is possible to target CSCs using molecules on which they are highly dependent or using differentiation induction similar to the normal tissue differentiation mechanism. It is expected that novel therapeutic molecules with high specificity and effectiveness will be found in the near future. In addition, the CSC concept has itself been evolving. It is necessary to clarify the exact nature of CSCs to establish a treatment strategy against them.

A previously healthy black man presented with acute kidney injury wtih nephrotic syndrome. His serum creatinine and albumin concentrations were 8.0 mg/dL and 0.4 g/dL, respectively. Renal ultrasound demonstrated an enlarged kidney with an extremely high echogenic cortex. Human immunodeficiency virus (HIV) was serologically positive, and kidney biopsy revealed a collapsing variant of focal segmental glomerulosclerosis with interstitial nephritis. He was diagnosed as having HIV-associated nephropathy (HIVAN). Although there have been only a few cases with characteristic HIVAN features in Japan, the number of patients with HIVAN who need dialysis treatment is relatively high globally, and is expected to increase even in Japan. The rapid clinical course of HIVAN, along with its characteristic histology and the direct pathogenesis of HIV on podocytes, is noteworthy. We described this case with reference to some recent findings.

Basophils represent less than 1% of peripheral blood leukocytes. Under physiological conditions, basophils principally circulate in peripheral blood, while mast cells reside in peripheral tissues. Like mast cells, they express the high-affinity IgE receptor on their cell surface and release chemical mediators. Because of morphological and functional similarities, basophils have long been considered to be redundant "circulating mast cells" and minor (probably negligible) players in inflammation. Mouse and human basophils cannot be stained in routinely processed histological specimens, and thus, our understanding of tissue basophils in allergic inflammation had been limited. However, recent studies in mice have revealed that basopihls play non-redundant roles from mast cells. Basophils function as a source of IL-4, IL-13, and CCL22, thereby contributing Th2 immunity. They are also capable of presenting antigens. Basophils are essential for the development of IgE-mediated chronic allergic skin inflammation in mice. Recent immunohistochemical studies with an basophil-specific antibody revealed that, in humans, varying numbers of basophils infiltrate skin lesions of inflammatory diseases, such as atopic dermatitis, urticaria, prurigo, and eosinophilic pustular folliculitis. Basophils may play important roles in a variety of inflammatory skin diseases than previously thought.

Familial Blau syndrome and sporadic early-onset sarcoidosis (EOS) are both systemic granulomatous diseases evoked by the spontaneous activation of mutated NOD2. In Japan, the R334W amino acid substitution is more frequently identified, whereas the R334Q mutation is rare and, in contrast to western countries where disease causing mutations are typically hereditary, most Japanese cases derive from sporadic mutations. Recently, a case with a six-base deletion in the NOD2 gene was reported. This Blau syndrome/EOS patient presented with the unpainful soft swelling of the dorsal side of the wrist and ankles, as well as flexion contracture at the proximal interphalangeal joint that gradually appeared during their clinical course. These features are useful for the differential diagnosis of Blau syndrome/EOS from juvenile idiopathic arthritis. Owing to their characteristic clinical symptoms, Blau and EOS patients can be identified earlier if medical experts become more acquainted with these distinctions. Even though specific treatment based on pathophysiologic mechanism has not been explored yet, early diagnosis will prevent the progression to severe impairment, which can severely affect patients' lives.

Bone metastasis is a frequent complication of malignant cancer. Previous clinical trials of bone metastasis have largely focused on skeletal related events (SREs) as objective end-points. However, a subjective health-related outcome such as quality of life (QOL) is also a first-priority principle for all patients with malignant cancer. In response to the need for a comprehensive module to evaluate bone metastasis-specific QOL, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has developed a Quality of Life Questionnaire for patients with Bone Metastases (EORTC QLQ-BM22). In this study, we introduce the official Japanese version of the EORTC QLQ-BM22 as a module to evaluate QOL in patients with bone metastasis. This module has been developed to be used together with the EORTC QLQ-C30, a QOL scale for patients with cancer, or with its shortened version, EORTC QLQ-C-15-PAL.

A 42-year-old man who had no local or systemic symptoms presented with a yellowish tumor in the foreskin of his penis. He had travelled to Hokkaido to harvest insects, and recognized this tumor after returning home. Since it did not disappear after several days, he visited our hospital. The tumor was suspected to be due to an arthropod. En bloc resection including the arthropod was performed. Pathological findings demonstrated that the arthropod was Ixodes persulcatus. There were no symptoms after the surgery during the follow up. Ixodes persulcatus is a source of Lyme disease. Approximately ten patients develop Lyme disease per year, half of which are from Hokkaido in Japan. The case reported here was of a very rare tick-bite disease in the penis.

Synthetic organic chemistry is a base of medicinal chemistry and the exploitation of new methods for carbon-carbon bond formation is of most importance in synthetic organic chemistry. Carbenes and carbenoids have long been known to be highly reactive carbon species that show a variety of unique reactivity. However, those reactive species are not fully used in organic synthesis. The reasons are as follows: one is the precursors for the generation of carbenes and carbenoids are quite limited and the other is that the reactivity of the species is too high to control. In order to solve the problem mentioned above, we used alpha-haloalkyl (or alkenyl) aryl sulfoxides as the precursors and used sulfoxide-magnesium exchange reaction for generation of much mild magnesium carbenoids. alpha-Haloalkyl (or alkenyl) aryl sulfoxides are quite easily synthesized in high overall yields. Magnesium carbenoids, cyclopropylmagnesium carbenoids, cyclobutylmagnesium carbenoids, magnesium beta-oxido carbenoids, and magnesium alkylidene carbenoids are generated at low temperature from the corresponding sulfoxides with a Grignard reagent in quantitative yields. They were found to be stable usually at below -60 degrees C for at least 30 min. The each magnesium carbenoids have their own unique reactivities and we could find many unprecedented reactions from these reactive species. Recent results for the developments of new synthetic methods based on the chemistry of magnesium carbenoids are described.

Sarcoma is a rare malignant lesion in the urinary bladder and remains unknown of its natural history. We report a case of primary bladder sarcoma with long-term follow-up. A 35-year-old man suddenly presented with severely gross hematuria. Computer tomography was showed solitary lesion at the anterior wall of the urinary bladder without distant metastases. Transurethral resection of the bladder tumor (TURBT) was performed. Pathologic findings demonstrated sarcoma in the urinary bladder without remnant lesions. Immunohistochemical staining using conventional antibodies was not classified as the origin of this sarcoma. There have been no signs of recurrence during twenty years' follow-up after the treatment.

Purpose: When smear test is positive for acid-fast bacilli, it is important to differentiate between Mycobacterium tuberculosis complex and nontuberculosis mycobacteria (NTM) in healthcare associated infection (HAI) control. The aim of this study is to evaluate between COBAS TaqMan48 (TaqMan) and COBAS Amplicor (COBAS)., Material and Method: Tenfold dilution series of 5 x 10(4) cfu/mL of Mycobacterium bovis (ATCC19210) were used for evaluating the limit of detection (LOD) and reproducibility. 73 frozen clinical specimens (34 M. tuberculosis complex and 39 NTM) stored at below -20 degrees C before its use that were treated with NALC-NaOH were used to determine the agreement between two methods. Divided reaction reagents (include Master mix solution, Internal control and Mg2+) of TaqMan for 3 and 6 tests per batch used to evaluate reagents stability., Result: The LOD of both kits were 5 X102 cfu/mL. Regarding reproducibility, the same result was obtained when tested 3 times. The agreement rate between TaqMan and culture method was 58.8%, and between COBAS and culture method was 67.6%. When limited to smear positive eleven specimens, the agreement between TaqMan and culture method was 81.8%, and between COBAS and culture method was 90.9%. Reagents divided for 3 tests and 6 tests and stored at 4 degrees C in dark, both test reagents stability was confirmed maximum for 16 days., Conclusion: As the results of the evaluation of TaqMan, the LOD, reproducibility and the agreement were similar to COBAS results. However, in low colony forming unit of clinical specimen raise the possibility that results may contain false negative.

We need a new investigation of the effect of not only toner but also of its by-products on human health, because of the generation of fine particles and the release of volatile organic compounds (VOC) in the process of photocopy. Therefore, we gathered epidemiological and animal data on toner and its by-products, and examined the occupational health management of toner. We examined the effect of carbonblack as the main component of toner, and titanium dioxide and amorphous silica as surface-adhesive nanomaterials, and VOC on human health, and reviewed them. We summarize the results as follows. 1) High sensitive c-reactive protein in serum, 8-hydroxydeoxyguanosine in urine, and heart rate variability (HRV) are useful for biological monitoring of exposure to toner and its by-products. 2) Particle number concentrations have been often measured by scanning mobility particle sizer (SMPS) compared with other apparatus, although this is not measurement gold standard. Taken together, we have examined whole occupational health management of toner and its by-products.

We report three patients with germ cell tumors whose diagnosis was confirmed in the progress of the first-line chemotherapy regimen as metastatic cancer in the lumbar vertebra. Two of the 3 cases were mixed-type nonseminoma, and the other case was an extragonadal tumor. After the first-line chemotherapy regimen, the patients underwent salvage chemotherapy using Paclitaxel either with or without irradiation. We confirmed the efficacy that the bone metastasis had completely been resolved and the lymph node metastasis was significantly reduced after the completion of all treatments.