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We assessed the long-term oncologic safety of nipple-sparing mastectomy (NSM) compared to skin-sparing mastectomy (SSM) for primary breast cancer patients with immediate reconstruction.Data of stage 0-III primary breast cancer patients undergoing NSM (n = 190) or SSM (n = 729) from June 2006 to December 2012 were retrospectively collected. Nipple-tumor distance (NTD) was measured on pretreatment mammography, magnetic resonance imaging, or ultrasonography findings. NSM patients with NTD 1 cm were excluded. Locoregional recurrence (LRR) rates were compared between groups. Disease-free survival (DFS) and overall survival (OS) according to surgical procedure were assessed.The median (range) follow-up period for NSM and SSM was 71 (10-131) months and 79 (9-140) months, respectively. LRR developed in 11 patients with invasive ductal carcinoma (5.8%) for NSM and 44 (42 in patients with invasive ductal carcinoma and 2 in patients with ductal carcinoma-in-situ) (6.0%) for SSM. Hormone receptor and HER2 status were not associated with LRR in either group. DFS and OS rates did not differ between groups (DFS: 89.3% for NSM, 89.3% for SSM, P = .87; OS: 98.4% for NSM, 94.5% for SSM, P = .43).NSM with immediate reconstruction was as safe as SSM for primary breast cancer with respect to prognosis and local control, regardless of the presence of invasive carcinoma or breast cancer subtype.

This study assessed the diagnostic accuracy of ultrasound in detecting axillary lymph node metastases in women with breast cancer and atopic dermatitis. We retrospectively reviewed the records of 91 breast cancer patients with a history of atopic dermatitis and compared the dimensions of the lymph nodes on ultrasonographic images of women with and without lymph node metastases diagnosed using histology. Using a major-axis length of ≥5 mm, a short-axis length of ≥5 mm and a cortical thickness of ≥2.3 mm as the criteria for diagnosing axillary lymph node metastases, the specificity was 12.7%, 41.3% and 58.7%, respectively. The low specificity of the ultrasound criteria makes ultrasound unsuitable for diagnosing axillary lymph nodes metastases in breast cancer patients with atopic dermatitis.

Background: Inflammatory breast cancer (IBC) is the most aggressive form of primary breast cancer. Case Report: A 40-year-old woman was referred to our hospital for evaluation of an induration in the right breast, suspected to be breast cancer. The tumor was diagnosed as estrogen receptor-negative, progesterone receptor-negative, HER2-positive, T4dN3cM0 stage IIIc IBC with axillary lymph node metastasis. Rather than surgical intervention, we chose a systemic treatment approach with pertuzumab, trastuzumab, and docetaxel (PTD) combination therapy which was shown to be effective for HER2-positive IBC in the NeoSphere trial. After 4 cycles of treatment, the patient had a partial response, allowing mastectomy of the right breast and axillary lymph node dissection to achieve local control. We review this case because of the success of PTD combination neoadjuvant chemotherapy for HER2-positive IBC. Conclusion: To improve the poor prognosis of IBC, combined modality therapy is required, including chemotherapy and local treatment such as surgery and/or radiation therapy. In this case, combination neoadjuvant chemotherapy with PTD for HER2-positive IBC was effective, and this regimen may contribute to further improvements in the cure rate for this malignancy.

A 76-year-old male who had already been diagnosed with ischemic heart disease and severe aortic stenosis was transferred to our hospital in a state of cardiogenic shock. We finally diagnosed him with severe aortic stenosis. We decided to perform emergency balloon aortic valvuloplasty (BAV) as a bridge treatment to surgical repair. We first performed BAV with a double balloon technique, and next with a triple balloon technique. As a result, the blood pressure recovered, and surgical aortic valve repair could thus be successfully performed.

CO2-EOR is one of the proven enhanced oil recovery (EOR) techniques and has been used commercially. However, in field applications, unfavorable sweep efficiency is often reported. In order to improve the sweep efficiency of CO2 flooding, we investigated an applicability of CO2 micro bubbles. To evaluate the applicability of CO2 micro bubbles for CO2-EOR, we conducted core flooding experiments using CO2 micro bubbles and the results were compared with the normal CO2 flooding. Previous study confirmed the generation of CO2 micro bubbles by using a specially developed porous filter. Using this filter, core flooding experiments were conducted. During the experiment, flooding behavior was monitored by a medical X ray CT system, and recovered oil and water were collected to make a quantitative comparison with normal CO2 flooding. From the images taken by the medical X ray CT, we observed that CO2 micro bubbles flowed over both upper and lower parts of core samples, while normal CO2 flowed only upper part of core samples. As a result, a delay of CO2 break-through was confirmed in CO2 micro bubble flooding case. The time series of medical X ray CT images indicates improvement in sweep efficiency by using the CO2 micro bubbles. In addition to this, the material balance calculation during the core floodings revealed 3% of additional oil recovery compared to the normal CO2 flooding. From the experiments, differences in flooding behavior were clearly observed between the normal CO2 and the CO2 micro bubbles injection. We consider the differences would lead to the improvement of both vertical and areal sweep efficiencies. Although this technique is still in a stage of fundamental research, since the technique only requires the special filter and it is considered that it can be easily installed at the down hole, it may provide a novel option to improve the CO2-EOR performance.

Nanoparticle albumin–bound paclitaxel (nab-paclitaxel) is delivered to tumors and increases antitumor activity compared with solvent-based paclitaxel. However, in a clinical trial, higher and lower rates of peripheral neuropathy and neutropenia were observed. In this study, we compared the effects of nab-paclitaxel and standard paclitaxel on pain behaviors in rats. Repeated administration of nab-paclitaxel dose-dependently induced both mechanical and cold allodynia, and the effects of nab-paclitaxel on pain behaviors tended to be stronger than that of standard paclitaxel at the doses used clinically. These results suggest that closer attention must be paid to the neuropathy when administering nab-paclitaxel in clinical settings. Keywords:: nanoparticle albumin–bound paclitaxel, paclitaxel, peripheral neuropathy

Supplemental Digital Content is available in the text, In young children, infrequent antigen exposure, which is partly characterized by fewer vaccinations, may be a factor impairing the immunogenicity of inactivated influenza vaccine. We assessed the effects of prior vaccinations on age-specific immune responses in Japanese children aged 6 months to 3 years, using data from a cohort study with 266 children who had received 2 doses (0.25 mL/dose for < 3 years old, 0.5 mL/dose for 3 years old) in the 2006/2007 season. Serological measures, primarily seroprotection rates, between previously vaccinated and vaccine-naïve children were compared within 1-year age strata. The seroprotection rate was defined in 2 ways as the proportion of subjects who achieved an antibody titer of 1:40 or 1:160. Multivariate logistic regression was also performed to estimate the independent effect of prior vaccination on seroprotection rate. After the first dose, seroprotection rates with the threshold of 1:40 in vaccine-naïve 1-year-olds remained low (28% for AH1, 26% for AH3, 2% for B), similar to those of 0-year-olds. In contrast, seroprotection rates in previously vaccinated 1-year-olds (77% for AH1, 86% for AH3, 18% for B) were significantly higher than those in vaccine-naïve 1-year-olds. These seroprotection rates for AH1 and AH3 were comparable with those in previously vaccinated 2- and 3-year-olds. Although seroprotection rates for B remained low in every age stratum even after the second dose, seroprotection rate in previously vaccinated 1-year-olds (50%) was similar to that in 3-year-olds. After adjustment for age, baseline antibody titer and experience of acute febrile respiratory illness in the preceding season, odds ratios showed a significant independent positive effect of prior vaccination on seroprotection rate for every strain. After the seroprotection threshold was changed from 1:40 to 1:160, the results of the effects of prior vaccinations on immunogenicity were similar or became more evident, which demonstrate the robustness of our findings. Our study found that prior vaccinations improved poor immunogenicity among young children, especially in 1-year-olds.

Ryo Fujiki,1,2 Kiichiro Morita,1,2 Mamoru Sato,1,2 Yuji Yamashita,1,2 Yusuke Kato,1,2 Yohei Ishii,2 Yoshihisa Shoji,1,2 Naohisa Uchimura1 1Department of Neuropsychiatry, Kurume University, 2Cognitive and Molecular Research Institute of Brain Diseases, Kurume University School of Medicine, Kurume-City, Japan Abstract: Neuroimaging studies have been conducted using word generation tasks and have shown greater hypofrontality in patients with schizophrenia compared with healthy subjects. In this study, we compared the characteristics of oxygenated hemoglobin changes involved in both phonological and categorical verbal fluency between 35 outpatients with schizophrenia and 35 healthy subjects during a Japanese “shiritori” task using single-event-related near-infrared spectroscopy. During this task, the schizophrenic patients showed significantly smaller activation in the prefrontal cortex area than the controls. In addition, a significant positive correlation was obtained between oxygenated hemoglobin changes (prefrontal cortex area, inferior parietal area) and the severity of positive psychiatric symptoms. It is possible that hypofrontality of patients may be a diagnostic assistance tool for schizophrenia, and that the relationship between activation and positive syndrome scores may be of help in predicting functional outcome in patients. Keywords: word production task, single-event-related near-infrared spectroscopy, schizophrenia, hypofrontality, biological marker

Four pediatric clinics in Fukuoka, Japan, collected 822 cases of nasopharyngeal specimens from patients with influenza-like symptoms from 1 October 2002 to 31 March 2003. Age distribution of these cases was 6 months to 15 years old and mean age was 5.98 years old. Two hundred seventy-eight cases were positive for influenza type A(H3N2) and 176 cases for type B. When compared with virus culture, the sensitivity of the rapid detection kits for type A(H3N2) was 89.4% by nasal swab and 78.8% by throat swab, while type B testing revealed 75.7% positive by nasal swab and 78.3% by throat swab. Comparison of sensitivity of rapid detection kits to virus culture from the onset of influenza-like illness showed testing at 6 h from onset yielded the highest sensitivity (89.3%) in A(H3N2) (p

A series of studies were performed to investigate the ability of rapid antigen-detection kits in diagnosis of influenza. Clinical specimens were collected from a total of more than 3000 cases of influenza-like illness who visited out-patient clinics in Sendai and Fukuoka, Japan, during the 2001–2002 and 2002–2003 influenza seasons. Each clinical specimen was examined with a kit and virus isolation, and results were analyzed retrospectively by several points of interest: sensitivity of the kits based on the virus isolation and the sensitivity by type and subtype of influenza, kinds of specimens, the time course of influenza, and variation of sources of the specimens. Thus, the sensitivities of a kit were 83%, 52% and 58% in general for influenza A(H3N2), A(H1N1), and B, respectively, and those of another kit were 76%, 71%, and 62%, respectively, in 2001–2002 influenza season. The sensitivity using nasal swabs was better than that using throat swab, though only 5% up. Specimens tended to be less sensitive when collected shortly after the onset of illness, and the sensitivity seemed quite varied (17–92%) by source of specimens: staff who collect the specimens, and/or by population of the patients.

In Japan, the routine immunization program with oral polio vaccine (OPV) has been suspended since September 2012, when a program with 4 doses of inactivated monovalent polio vaccine (IPV) or quadrivalent vaccine against diphtheria, pertussis, and tetanus with IPV (DTaP-IPV) was introduced. The aim of this study was to examine the interchangeability among these 3 types of polio vaccines.We conducted a prospective cohort study at 5 pediatric clinics in Japan. A total of 153 infants were assigned to 1 of the 4 groups by considering the vaccination history of OPV and trivalent vaccine against DTaP. Eleven infants with a history of OPV received 3 doses of DTaP-IPV; 49 infants with a history of OPV and DTaP received 3 doses of IPV; 50 polio vaccine-naive infants received 2 doses of IPV followed by 2 doses of DTaP-IPV; and 43 polio vaccine-naive infants received 2 doses of DTaP-IPV followed by IPV. The immunogenicity after polio vaccination was evaluated among these 4 groups.After 2 doses of polio vaccination, more than 80% of the infants exhibited a neutralization antibody titer ≥1:8 for all Sabin strains and wild strains in all groups. After the third dose, the seroprotection proportion (i.e., a neutralization antibody titer ≥1:8) reached about 100%. After the fourth dose, a neutralization antibody titer exceeded the required protective levels (i.e., a neutralization antibody titer ≥1:8) considerably in all groups.Four doses of polio vaccines induced a sufficient level of immunity in Japanese infants, irrespective of vaccine combinations or order.

Background/aimsTreatment with antiviral neuraminidase inhibitors suppresses influenza viral replication and antigen production, resulting in marked attenuation of mucosal immunity and mild suppression of systemic immunity in mice. This study investigated the effects of immunomodulator clarithromycin (CAM) supplementation on mucosal and systemic immunity in pediatric patients with influenza treated with neuraminidase inhibitors.MethodsA retrospective, non-randomized case series study was conducted among five treatment groups of 195 children aged 5.9±3.3 years infected with influenza A in 2008/2009 season. The five treatment groups were oseltamivir (OSV), zanamivir (ZNV), OSV+CAM, ZNV+CAM and untreated groups. Anti-viral secretory IgA (S-IgA) levels in nasal washes and IgG levels in sera were measured. The re-infection rate was analyzed among the same five treatment groups in the 2009/2010 season.ResultsTreatment of influenza with OSV and ZNV for 5 days attenuated the induction of anti-viral S-IgA in nasal washes and anti-viral IgG in serum, compared with the untreated group. The combination of CAM plus OSV or ZNV boosted and restored the production of mucosal S-IgA and systemic IgG. The re-infection rates in the subsequent season were significantly higher in the OSV and ZNV groups than the untreated, while CAM+OSV and CAM+ZNV tended to reduce such rate.ConclusionsCAM restored the attenuated anti-viral mucosal and systemic immunity and reduced the re-infection rate in the subsequent year in pediatric patients with influenza treated with OSV and ZNV.

Background: Oxaliplatin is an important drug used in the treatment of colorectal cancer. However, it frequently causes severe acute and chronic peripheral neuropathies. We recently reported that repeated administration of oxaliplatin induced cold hyperalgesia in the early phase and mechanical allodynia in the late phase in rats, and that oxalate derived from oxaliplatin is involved in the cold hyperalgesia. In the present study, we examined the effects of Ca2+ channel blockers on oxaliplatin-induced cold hyperalgesia in rats. Methods: Cold hyperalgesia was assessed by the acetone test. Oxaliplatin (4 mg/kg), sodium oxalate (1.3 mg/kg) or vehicle was injected i.p. on days 1 and 2. Ca2+ (diltiazem, nifedipine and ethosuximide) and Na+ (mexiletine) channel blockers were administered p.o. simultaneously with oxaliplatin or oxalate on days 1 and 2. Results: Oxaliplatin (4 mg/kg) induced cold hyperalgesia and increased in the transient receptor potential melastatin 8 (TRPM8) mRNA levels in the dorsal root ganglia (DRG). Furthermore, oxalate (1.3 mg/kg) significantly induced the increase in TRPM8 protein in the DRG. Treatment with oxaliplatin and oxalate (500 μM for each) also increased the TRPM8 mRNA levels and induced Ca2+ influx and nuclear factor of activated T-cell (NFAT) nuclear translocation in cultured DRG cells. These changes induced by oxalate were inhibited by nifedipine, diltiazem and mexiletine. Interestingly, co-administration with nifedipine, diltiazem or mexiletine prevented the oxaliplatin-induced cold hyperalgesia and increase in the TRPM8 mRNA levels in the DRG. Conclusions: These data suggest that the L type Ca2+ channels/NFAT/TRPM8 pathway is a downstream mediator for oxaliplatin-induced cold hyperalgesia, and that Ca2+ channel blockers have prophylactic potential for acute neuropathy.

Clinical, radiological and surgical studies have been made of 57 farmers who were operated upon for degenerative lumbar canal stenosis (Group A) and degenerative spondylolisthesis (Group B). The improvement rate was excellent in both groups.(Group A: 75.6%, Group B: 71.7%). The improvement rate in abdominal and back muscle strength was lower in cases with postoperative kyphosis than in those with postoperative lordosis. Cases with a slip angle of less than 0 degrees postoperatively showed less improvement and a lower abdomminal and back muscle strength than those with an angle of 0 degrees or more. Disappearance of lumbar lordosis, local kyphotic alignment, low strength of abdominal and back muscles are unfavourable factors influencing return to farm work.

The aim of the present study was to investigate the influenza vaccine effectiveness among young children in Japan. Study subjects were recruited from 43 pediatric clinics. Influenza-like illness (ILI) was defined as an acute febrile illness with respiratory symptoms; ILI with a fever of > or =39 degrees C was considered to be severe ILI (SILI). The adjusted OR of vaccination significantly decreased to 0.75 for SILI. Influenza vaccination for young children had a protective effect on the occurrences of SILI. This study also indicated that three key tools (case surveillance with equal scrutiny, confining observation to the peak epidemic period, and adoption of strict criteria for ILI) could minimize outcome misclassification and thus provide adequate methodology for monitoring vaccine effectiveness without laboratory confirmation.

We studied the immunogenicity of trivalent-inactivated influenza vaccine. Subjects were 259 children under 4 years old who visited six pediatric clinics to undergo influenza vaccination. Age distribution was 64 aged1.0, 65 aged 1.0-1.9, 64 aged 2.0-2.9, and 66 aged 3.0-3.9 years, including subjects who had been previously vaccinated within the last three years, 0% (0/64) aged1.0, 26% (17/65) aged 1.0-1.9, 72% (46/64) aged 2.0-2.9, and 77% (51/66) aged 3.0-3.9 years old. Two doses of vaccine were given subcutaneously four weeks apart. Dosage was 0.l mL for children under 1 year old, while for children aged one year or older, dosage was 0.2mL, based on standard Japanese recommendations. To measure hemagglutination inhibition (HI) antibody titer, triplet sera were obtained before vaccination (S0), 4 weeks after the first vaccination (S1), and 4 weeks after the second vaccination (S2). The geometric mean of HI antibody titer, the response proportion (titer riseor =4-fold), and the achievement proportion (postvaccination titeror =1 : 40) were calculated by age group. Analysis of variance was used to estimate the independent effect of age and prevaccination titer on antibody increase. The geometric means of HI antibody titer were lower among the two younger age groups than among the two older age groups, regardless of vaccine strain or when blood samples were collected. The achievement proportion after 2 doses of vaccine in the1.0, 1.0-1.9, 2.0-2.9, 3.0-3.9 year age groups were 38%, 58%, 89%, and 85% against A (HI) ; 52%, 54%, 81%, and 73% against A (H3) ; and 23%, 49%, 67%, and 71% against B. Regarding the analysis of variance, prevaccination titer consistently indicated strong effects on antibody increase, regardless of vaccine strain or combination of paired sera. After two doses of vaccine (S2/S0), significant effects of age on antibody induction were shown against A (H1) and B (p = 0.000 and 0.002). Thus, the immunogenicity of trivalent-inactivated influenza vaccine was strongly influenced by prevaccination titer and age. Even two doses of vaccine did not induce a protective antibody level in about 50 to 80% of subjects among infants aged1.0 year, and 40 to 50% among children 1.0-1.9 year old.

Diffuse neonatal hemangiomatosis is a rare disease with the distinctive features of multiple hemangiomas of the skin and visceral organs. These lesions have been treated with systemic corticosteroids, interferon-alpha, and their combination. We report a patient with diffuse neonatal hemangiomatosis who had multiple cutaneous and hepatic hemangiomas. Single therapy with the flashlamp pulsed dye laser was effective for cutaneous hemangiomas, whereas the hemangiomas of the liver remained stable and no liver dysfunction or hemorrhage has occurred so far, even with no treatment.

An imaging device supervision system stores data indicating, for instance, the number of sheets of paper supplied from each paper supply cassette in a copying machine, and/or the number of times the toner has been replenished, and the amount of toner cartridges in stock are stored in a copying machine supervision data base which is constructed, stored and maintained in a storage device, such as a hard drive. The supervision system updates the stock amounts for each size of paper based on the data indicating the number of sheets of paper supplied, and formulates a consumable item delivery plan according to delivery conditions set in a delivery schedule setting screen 91, to reduce the downtime due to stocks of consumable items being exhausted in an imaging device. Further, the amount of toner cartridges in stock are updated by means of the number of times the toner has been replenished, and the stock data are displayed on a status information screen 66.

Rhythm patterns are created by producing primitive data not having any fixed meaning and by associating the primitive data with desired creating parameters among a plurality of creating parameters for specifying meanings of the primitive data. The rhythm patterns may be created by storing a rule data base for associating a plurality of parameters specifying the features of rhythm and a plurality of rhythm patterns beforehand in a memory, entering the plurality of parameters, making reference to the rule data base on the basis of the plurality of input parameters, and creating the desired rhythm patterns by an inference system. It is also possible to create the rhythm patterns by extracting predetermined choices of at least some of a plurality of parameters specifying the features of desired rhythm for each part of a piece of music, creating rhythm patterns respectively for the parts of the piece of music from the choices extracted from the parameters for the parts of the piece of music and integrating the rhythm patterns for the entire piece of music.

Dynamic mechanical measurements on a series of poly(γ-alkyl L-glutamate)s in the solid state were carried out over a frequency range from 0.005 to 1.0 Hz at various temperatures covering the side-chain dispersion region in order to examine the effects of the side-chain length. Frequency dispersion curves of real and imaginary parts of complex shear modulus and loss tangent at various temperatures could be superposed on a set of master curves by performing a horizontal shift along the logarithmic frequency axis and the additional vertical shift along the logarithmic modulus axis, if necessary, for three polymers of poly(γ-octyl L-glutamate), poly(γ-heptyl L-glutamate), and poly(γ-hexyl L-glutamate). A unique set of horizontal and vertical shift factors could not be found for poly(γ-butyl L-glutamate), poly(γ-amyl L-glutamate), and poly(γ-ethyl L-glutamate). The temperature dependence of the horizontal shift factor is represented by the WLF equation with the conventional parameters. The distribution of the relaxation times was found to become sharper with an increase in the side-chain length. These results are discussed in terms of a two-phase model consisting of the rigid α-helical backbone embedded in the flexible side-chain region.