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Previous studies of human papillomavirus (HPV)16/18 genome methylation have concluded that methylation status of the L1 gene might act as a biomarker for cervical intraepithelial neoplasia (CIN).We investigated the correlation between methylation status in the L1 gene and the long control region (LCR) of HPV52/58 and CIN.Exfoliated cervical cells were taken from 54 HPV52-positive and 41 HPV58-positive women. The HPV genome was examined using bisulfite modification, polymerase chain reaction amplification, and sequencing.The CpGs were unmethylated or hypomethylated in the HPV52/58 LCR. In contrast, the methylation status of the HPV52 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 15%, 34%, and 52% for cervicitis/CIN1, CIN2, and CIN3, respectively (P0.05). Methylation status of the HPV52 L1 gene was also correlated with the prognosis of CIN1/2, with median percentages of 15% and 35% for regression and persistence/progression, respectively (P0.05). The methylation status of the HPV58 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 12%, 38%, and 61% for cervicitis/CIN1, CIN2, and CIN3, respectively (P0.05).The increased methylation at the CpG sites in the HPV52/58 L1 gene was correlated with the severity of cervical neoplasia, similar to HPV16/18 in previous studies. These data suggest that HPV methylation status of the L1 gene is a candidate biomarker of CIN for detecting CIN2 and CIN3.

[Purpose] Diversity of gut microbiome has been recently reported to be lost in inflammatory bowel disease. We have previously reported that the Dai-kenchu-to (DKT) prevented the bacterial translocation through suppression of cytokine and apoptosis in rat’s fast stress model. The aim of this study was to evaluate the effect of DKT on maintenance of microbial diversity in rat’s intestine with inflammation. [Method] Wister rats were received the fast stress for 5 days. In DKT group, rats were administered with DKT (300 mg/kg/day) during the fast stress (DKT-group). The gut microbiomes were analyzed at before- and after- fast stress, and the effect of DKT for on microbial diversities of the gut were evaluated by the PCR-clone library method targeting the 16 S ribosomal RNA gene. [Result] In Control-group, Erysipelotrichaceae increased to 86% in after fast stress, OTU of before-fast stress was 111 and after fast stress was only 9 (changing rate : 58%). The diversity of microbiome was severely decreased. On the other hand, in DKT-group, diversity of microbiome was kept after fast stress (Lachnospiraceae : Ruminococcaceae : Coriobacteriales 54%, 22%, 5%), Operational taxonomic units of before fast stress was 52 and after fast stress was 55 (changing rate : 6%). Family Lachnospiraceae which includes butyrate-producing Clostridia (Clostridium IV and XIVa). [Conclusion] DKT prevented the reduction of diversity of microbiome in rat’s fast stress model. Our data suggested the new anti-inflammatory mechanism of DKT through gut microbiome.

A 52-year-old woman presented with redness and swelling with a peau d'orange appearance in the whole right breast. Ultrasound revealed elevated subcutaneus fat density and a diffuse hypoechoic area. She was diagnosed with inflammatory breast cancer(T4dN2M0, Stage III B of the HER2 subtype). After 4 courses of EC treatment as primary systemic therapy, the hypoechoic area was still present. Subsequent chemotherapy with pertuzumab, trastuzumab, and docetaxel was effective, as hypoechoic area was not observed on ultrasound. She underwent mastectomy and axillary dissection, and pathological examination revealed pCR. At present, 2 years after surgery, the patient is alive with no reccurence.

The aim of the study was to clarify the prevalence and severity rates of symptoms and investigate whether symptoms varied in relation to body mass index (BMI).The study group composed of 1,969 women, aged 40 to 60 years, who presented at our department from 1993 through 2014. The participation rate was 98%. The presence or absence of symptoms was evaluated by having the participants complete the Keio Questionnaire, a self-administered questionnaire. To allow the results to be compared according to ovarian function, serum levels of follicle-stimulating hormone and estradiol were measured. Participants were classified into three groups according to BMI: underweight, normal weight, and overweight. Symptoms were also compared among these subgroups.The most common symptom was general fatigue. Vasomotor symptoms differed significantly between pre- and postmenopause status. When symptoms were analyzed according to BMI, the severity rates of the following symptoms were significantly higher in the overweight group than in the normal weight and underweight groups: hot flushes, sweats, joint pain, numbness, and incontinence. On the contrary, the underweight group had significantly higher severities of cold constitution, nervousness, and wrinkled skin than did the other groups. In addition, an increase in BMI was associated with an increased severity of vasomotor symptoms.The prevalence and severities of shoulder stiffness, considered a characteristic symptom in Japanese women, were high. Increased BMI was shown to be associated with a higher severity of vasomotor symptoms, joint pain, nervousness, and urinary symptoms.

Background The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort. Methods We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death. Results Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis. Conclusions Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.

Background Preoperative hypercapnia and hypoxemia are reportedly risk factors for postoperative complications. This study aimed to establish the long-term survival risk associated with abnormal preoperative arterial blood gases (ABGs) in patients with non-small cell lung cancer (NSCLC). Methods This study involved 414 patients with stage I NSCLC who underwent lobectomy/bilobectomy with mediastinal lymph node dissection. The patients were divided into groups with normal (n = 269) and abnormal (n = 145) ABGs. Results The patients in the normal ABG group (median age 67 years) were significantly younger than those in the abnormal ABG group (median age 70 years). There were no significant differences between the groups in gender, performance status, pathological stage, histology, postoperative complications, or preoperative comorbidity, except for chronic obstructive pulmonary disease/pulmonary fibrosis. The 3-, 5- and 10-year survival rates in the normal and abnormal ABG groups were 87, 77 and 56, and 78 , 63 and 42 %, respectively (p = 0.006). According to multivariate analysis, age, gender, performance status, non-adenocarcinoma, differentiation of resected tumor, pathological stage, any prior tumor and abnormal ABGs (risk ratio, 1.61) were independent prognostic factors. Conclusions Abnormal ABGs predict long-term survival risk in patients with NSCLC, which is important for planning therapeutic strategies.

Chemoradiotherapy (CRT) has been used to improve local control and survival in patients with advanced rectal carcinoma. However, a significant proportion of patients show poor response to adjuvant CRT. We thus investigated the usefulness of survivin expression as a predictive marker of the CRT response and its characteristics. Forty-three patients with lower rectal cancer who underwent CRT were investigated. All patients received preoperative CRT consisting of TS-1 concurrent with 40 Gy of pelvic irradiation followed by curative resection. The relationship between clinical response, or pathological response, and the expression of survivin of pre-CRT biopsy specimens was evaluated by immunohistochemistry and compared with post-CRT expression. Positive expression of survivin was observed in 26 of 43 patients (60 %) in pre-CRT specimens. Survivin was positively expressed in 77 % of stable disease cases, and 43 % of partial response (p

Background and Objectives A significant prognostic difference exists among metastatic colorectal cancer (CRC) patients despite of any treatments. We identify the specific cytokines related to prognosis of metastatic CRC and assess their prognostic significance. Methods Stage IV CRC patients were divided into two groups according to their prognosis. Difference in serum cytokine level between these groups was determined by the cytokine array. Among the specific cytokines, macrophage inflammatory protein-3 alpha (MIP-3a) was measured using an enzyme-linked immunosorbent assay (ELISA) in the sera of 242 CRC patients. Results Several cytokines related to prognostic difference in stage IV CRC were identified. The median MIP-3a level (28.2 pg/ml) was used as a cut-off value. Increased MIP-3a was significantly associated with synchronous liver metastases and age. In univariate analysis, high MIP-3a was correlated with poor prognosis (P

Introduction The feasibility of laparoscopic surgery for clinically staged T3 and T4 rectal cancer has not been clearly defined specifically in cases following preoperative chemoradiation therapy (CRT). Our aim was to investigate the feasibility of laparoscopic surgery after preoperative CRT for clinically staged T3 and T4 rectal cancer. Methods Between May 2003 and June 2009, 57 patients (T3: n = 50, T4: n = 7) who underwent preoperative CRT for rectal cancer were identified. Forty-three patients with laparoscopic surgery (Lap group) were compared with 14 patients who underwent open surgery (Open group). Perioperative data including postoperative morbidity were assessed between the two groups. Results All patients underwent complete laparoscopic operations, and none was converted to laparotomy. Operating time was longer in the Open group (331 vs 375 min, P

Esophageal squamous cell cancer (ESCC) is one of the most common lethal tumors in the world, and development of new diagnostic and therapeutic methods is needed. In this study, cancer‐testis antigen, BORIS, was isolated by functional cDNA expression cloning using screening technique with serum IgG Abs from ESCC patients. BORIS was previously reported to show cancer‐testis antigen like expression, but its immunogenicity has remained unclear in cancer patients. BORIS was considered to be an immunogenic antigen capable of inducing IgG Abs in patients with various cancers, including four of 11 ESCC patients. Immunohistochemical study showed that the BORIS protein was expressed in 28 of 50 (56%) ESCC tissues. The BORIS expression was significantly associated with lymph node metastasis in ESCC patients with pT1 disease (P = 0.036). Furthermore, the patients with BORIS‐positive tumors had a poor overall survival (5‐year survival rate: BORIS‐negative 70.0% vs BORIS‐positive 29.9%, log‐rank P = 0.028) in Kaplan–Meier survival analysis and log‐rank test. Multivariate Cox proportional hazard model demonstrated that BORIS expression was an independent poor prognostic factor (hazard ratio = 4.158 [95% confidence interval 1.494–11.57], P = 0.006). Downregulation of BORIS with specific siRNAs resulted in decreased cell proliferation and invasion ability of ESCC cell lines. BORIS may be a useful biomarker for prognostic diagnosis of ESCC patients and a potential target for treatment including by BORIS‐specific immunotherapy and molecular target therapy.

Background E-cadherin expression has been associated with an outcome in patients with colorectal cancer, and serum levels of soluble E-cadherin (sE-cadherin) are significantly elevated in patients with malignant disease. However, the prognostic value of serum sE-cadherin level has not been demonstrated in colorectal cancer. Methods Serum samples were collected from 186 patients with colorectal cancer and 21 normal volunteers. Serum sE-cadherin levels were measured using an enzyme-linked immunosorbent assay kit. We investigated the relationship between serum sE-cadherin level and clinicopathologic findings. Results Mean serum sE-cadherin levels were significantly higher in CRC patients than in controls. Mean sE-cadherin levels were significantly correlated with hepatic metastasis, UICC classification, and poor prognosis. Elevated serum sE-cadherin level was an independent risk factor for predicting poor prognosis, and was an independent marker for predicting hepatic metastasis. Among patients with synchronous hepatic metastases, the prognosis was significantly worse in patients with elevated serum sE-cadherin levels than in those with lower levels. Conclusions Preoperative elevated sE-cadherin level is associated with poor prognosis in colorectal cancer. Measuring serum sE-cadherin may provide valuable information for predicting prognosis in patients with hepatic metastasis.

A relation between preparation conditions of polymer-stabilised optically isotropic liquid crystals and their electro-optical properties was investigated based on a cyclic voltammetric (CV) method. The polymer-stabilised optically isotropic liquid crystals were prepared by an in-situ photo-polymerisation of a precursor consisting of a chiral liquid crystalline mixture with monomers in an isotropic phase with a metal halide lamp. The CV response of the cell filled with the sample showed an asymmetric profile and a symmetric profile between the positive and negative applied voltages when the cell was irradiated with the metal halide lamp without filter and with a cut-off wavelength filter (> 390 nm), respectively. The CV response profile depends on a distributed state of the polymer generated in the cell. The residual birefringence of the polymer-stabilised optically isotropic phase was suppressed when the CV profile showed a symmetric profile.

Laparoscopy-assisted gastrectomy (LAG) is becoming widely used for early gastric cancer. However, how the curability and long-term prognosis of LAG and open gastrectomy (OG) for early and advanced gastric cancer compare remains unclear. This study assessed short- and long-term outcomes after LAG with lymph node dissection in early and advanced gastric cancer.A total of 332 patients who underwent LAG or OG for early and advanced gastric cancer from January 2001 through December 2010 were reviewed retrospectively. The mean operating time, estimated mean blood loss, number of dissected lymph nodes, and survival rates were compared between LAG and OG for early and advanced gastric cancer.Overall, 47.6% (158/332) of patients underwent LAG; D1, D1+ lymph node dissection was carried out in 77.2%, with D2 dissection in 22.8%. Only one patient required conversion to OG. Comparing LAG and OG with D1, D1+ lymph node dissection for early gastric cancer (EGC), mean operating time was significantly longer, estimated mean blood loss was significantly smaller, and the average number of retrieved lymph nodes was significantly greater with LAG. The rate of specific postoperative morbidity was 17.2% for LAG patients and 25.0% for OG patients, with no postoperative mortality. Survival and recurrence rates were not significantly different. Comparing LAG and OG with D2 lymph node dissection for advanced gastric cancer (AGC), mean operating time was significantly longer and estimated mean blood loss was significantly smaller with LAG, while the average number of retrieved lymph nodes, specific postoperative morbidity and mortality, and survival and recurrence rates were not significantly different.LAG with D1, D1+ lymph node dissection for EGC is safe and equivalent to open gastrectomy in curability. Moreover, LAG with D2 lymph node dissection for AGC is comparable to OG with D2 lymph node dissection with regard to short- and long-term results.

Clinical skills laboratories have been established in medical institutions as fa- cilities for simulation-based medical education (SBME). SBME is believed to be superior to the traditional style of medical education from the viewpoint of the active and adult learning theories. SBME can provide a learning cycle of debriefing and feedback for learn- ers as well as evaluation of procedures and competency. SBME offers both learners and patients a safe environment for practice and error. In a full-environment simulation, learners can obtain not only technical skills but also non-technical skills, such as lead- ership, team work, communication, situation awareness, decision-making, and awareness of personal limitations. SBME is also effective for integration of clinical medicine and basic medicine. In addition, technology-enhanced simulation training is associated with beneficial effects for outcomes of knowledge, skills, behaviors, and patient-related out- comes. To perform SBME, effectively, not only simulators including high-fidelity man- nequin-type simulators or virtual-reality simulators but also full-time faculties and in- structors as professionals of SBME are essential in a clinical skills laboratory for SBME. Clinical skills laboratory is expected to become an integrated medical education center to achieve continuing professional development, integrated learning of basic and clini- cal medicine, and citizens' participation and cooperation in medical education. J. Med. Invest. 59 : 28-35, February, 2012

Background : The safety and usefulness of the SILS-TAPP (transabdominal preperitoneal) procedure remain unclear. The aim of this study was to clarify the safety and usefulness of the SILS-TAPP procedure compared with standard laparoscopic TAPP and TEPP (totally extra-peritoneal pre-peritoneal) procedures. Patients and methods : 85 patients underwent laparoscopic inguinal hernia repairs (TEPP, 30 patients ; TAPP, 20 patients ; SILS-TAPP, 35 patients) from 2007 to 2011. The operative outcomes of the three groups were compared. Results : There was no difference in the patients’ characteristics among the three groups. The TEPP Group had a longer operation time. One patient in the SILS-TAPP group had an intraoperative complication. One patient in the TAPP group had a postoperative complication, and one patient had ileus and one had an umbilical hernia in the SILS-TAPP group. The postoperative hospital stay was not significantly different among the three groups. There were no recurrences in the TEPP group, 1 case of recurrence (5.0%) in the TAPP group, and 1 case (2.9%) in the SILS-TAPP group. Conclusions : The present findings show that the SILS-TAPP repair is safe and feasible for the repair of adult inguinal hernia.

Many previous studies have shown that rorqual whales (Balaenopteridae), including the blue whale (Balaenoptera musculus), fin whale (B. physalus), sei whale (B. borealis), Bryde's whale (B. edeni), minke whale (B. acutorostrata), and humpback whale (Megaptera novaeangliae), employ a strategy called lunge feeding to capture a large amount of krill and/or fish for nourishment [1]. Lunge feeding entails a high energetic cost due to the drag created by an open mouth at high speeds [1,2]. In the upper Gulf of Thailand, Bryde's whales, which feed on small fish species [3], predominantly anchovies, demonstrated a range of feeding behaviors such as oblique, vertical, and lateral lunging. Moreover, they displayed a novel head-lifting feeding behavior characterized by holding the vertical posture for several seconds with an open mouth at the water surface. This study describes the head-lifting feeding by Bryde's whales, which is distinct from the typical lunge feeding of rorqual whales. Whales showing this behavior were observed on 58 occasions, involving 31 whales and including eight adult-calf pairs. Whales caught their prey using a series of coordinated movements: (i) lifting the head above the water with a closed mouth, (ii) opening the mouth until the lower jaw contacted the sea surface, which created a current of water flowing into the mouth, (iii) holding their position for several seconds, (iv) waiting for the prey to enter the mouth, and (v) closing the mouth and engulfing the prey underwater (Figure 1A-F, Movie S1 in Supplemental Information published with this article online). When a whale kept its upper jaw above the sea surface, many anchovies in the targeted shoal appeared to lose orientation and flowed passively into the mouth of the whale by the current created by the lower mandible breaking the surface of the water. We measured the duration of feeding events when the whales had a wide-open mouth mostly above the sea surface. The mean and maximum feeding durations were 14.5 ± 5.4 (SD; n = 58 events) and 32 s, respectively. Deployment of animal-borne data loggers yielded approximately 44 minutes of recordings from a single whale. The acceleration data showed that stroke rates, including tail beat and whole-body movements during feeding, were faster (approximately 0.7 s cycle) than during a cruising swim (approximately 3 s cycle) (Figure 1G). The swimming speed was lower than that in the stall speed (0.2 m s-1) of the device during the feeding phase, suggesting that thrust force was used to hold the head up and to stabilize body posture (Figure 1G). Stable positioning using the fluke and flipper was confirmed by video data for both the downward and upward direction of the whale (Figure S1). According to the visual and behavioral data, we named the head-lifting feeding as 'tread-water feeding'. Generally, all species of baleen whale, including rorqual whales, show active chasing and feeding, i.e., skimming, suction, and engulfing with lunging [1]. Tread-water feeding is considered passive feeding as compared with other feeding behaviors because the whales do not swim forward in pursuit of prey during the period from mouth opening to closing, and although they need thrust force to stabilize their posture, the head does not actively move. To the best of our knowledge, this discovery of tread-water feeding in Bryde's whales represents the first report of passive feeding in baleen whales, which indicates their flexible capacity to modify their foraging strategy in relation to variable environments.

CD133 and CD44 have been considered as markers for colorectal cancer stem cells (CSCs). The association of CD133 and CD44 expression with radiation has not been fully examined in rectal cancer. Both CD133 (PROM) and CD44 mRNA levels were measured in post-chemoradiotherapy (CRT) specimens of 52 rectal cancer patients using real-time RT-PCR and compared to clinicopathological variables and clinical outcome. Their protein levels were examined in the radiation-treated HT29 human colon cancer cell line. Post-CRT CD133 in residual cancer cells was significantly higher than matched pre-CRT CD133 in biopsy specimens (n=30). By contrast, CD44 was significantly lower in post-CRT specimens (P

Reactive oxygen species stimulate lymphatic metastasis by accelerating epithelial-to-mesenchymal transition and lymphangiogenesis in the tumor microenvironment. Hence, systemic oxidative stress level may correlate with nodal involvement in patients with a malignant tumor. We examined 46 patients with clinical stage I lung adenocarcinoma who had undergone pulmonary resection with mediastinal lymph node dissection. Serum reactive oxygen metabolite (ROM) level was measured as an indicator of systemic oxidative stress. We investigated the association between nodal involvement and clinicopathological factors. Preoperative serum carcinoembryonic antigen (CEA; P = 0.045), cytokeratin 19 fragment (CYFRA21–1; P = 0.038), and ROM (P = 0.007) levels were significantly higher in patients with nodal involvement than in those without nodal involvement. A receiver operating characteristic curve was constructed to determine whether patients with and without nodal involvement could be differentiated on the basis of their serum ROM levels. The area under curve was 0.763 and the prognostic cut-off value was set at 318 Carratelli units. In univariate analysis, clinical stage IB (odds ratio [OR] = 4.55; P = 0.033), CEA-positive (OR = 5.56, P = 0.018), and ROM-positive (OR = 10.46, P = 0.006) were significant predictive factors for nodal involvement. In multivariate analysis, ROM-positive was an independent predictive factor for nodal involvement (OR = 6.22, P = 0.045). Preoperative serum ROM level was an independent significant predictive factor for nodal involvement in patients with clinical stage I lung adenocarcinoma. Hence, serum ROM level may be a useful biomarker for staging of lung adenocarcinoma.

After adopting preoperative assessment of the perigastric vessels using 3D-CT and standardization of the procedures, obesity still influences smooth laparoscopy assisted gastrectomy (LAG). We evaluated the impact of body mass index (BMI) and area of visceral fat tissue on the risks of LAG.Sixty-six patients who underwent LAG for gastric cancer were included. The patients were divided into two groups by BMI (25 BMI-L group: n = 53; ≥25 BMI-H group: n = 13) and area of intraperitoneal fat tissue (100 cm(2) AF-L group: n = 35; ≥100 cm(2) AF-H group: n = 31), respectively. Fat scan(®), which was computer software operating on abdominal CT, was used to measure the visceral fat areas (VFA). The incidence of postoperative complications, operation time, intraoperative blood loss, and number of dissected lymph nodes were compared between each two groups.The incidence of postoperative complications of BMI-L and BMI-H groups was 11.3% and 30%, respectively (p = 0.18). The mean blood loss was 85 and 134 g, respectively (p = 0.21). There were no significant differences in operation time and the number of retrieved LNs. The incidence postoperative complications (29%) and mean blood loss (148 g) of then VFA-H group were significantly higher than those of the VFA-L group (5.7%, 48 g). The number of retrieved LNs of the VFA-H group (n = 25) was significantly lower than that of the VFA-L group (n = 34). There was no significant difference in operation time.In the VFA-H group, the incidence of postoperative complications and intraoperative blood loss increased, and the dissected number of LNs decreased. The area of visceral fat tissue was useful to predict risks of LAG and postoperative complications with higher precision compared with BMI.

A 58-year-old man underwent surgery for the treatment of lung adenocarcinoma at our hospital. He had a history of spinal caries at the age of 3 and frequent recurrent asthma-like symptoms thereafter. Chest plain radiography revealed an irregularly shaped mass in the left hilum and a thoracic cage severely deformed by kyphosis. A pulmonary function test demonstrated a severe restrictive ventilation pattern. He underwent a left upper lobectomy without mediastinal dissection. His asthma-like symptoms were exacerbated by difficulty in expectoration of sputum for several days after surgery, but the symptoms disappeared without any medical care. Dyspnea, hemoptysis, and intrathoracic hemorrhage were observed on the 8th postoperative day. Computed tomography revealed torsion of the residual left lower lobe, but the symptoms spontaneously disappeared in a week. The patient had complained of frequent coughing and mild dyspnea on exertion for years, but his quality of life was unchanged after the lobectomy. Bone metastasis was detected 3 years after the surgery, and the patient then underwent chemotherapy. However, he died of the disease 4 years 2 months after the surgery.

Oxaliplatin is now considered a standard treatment for advanced or unresectable colorectal cancer, but its main dose-limiting toxicity is sensory neuropathy. The OPTIMOX (stop and go) approach offers a reasonable strategy, but the preventive agent is not established. It is reported that the Kampo medicine, Goshajinkigan (GJG), has recently been considered an effective agent for the neuropathy of taxanes and for vibration sensation in patients with diabetic neuropathy. The aim of this study was to clarify the efficacy of GJG for peripheral neuropathy associated with oxaliplatin therapy.From 2007, 45 patients treated with modified FOLFOX6 for non-resectable or recurrent colorectal cancer participated in the study. Twenty-two patients (GJG group) received oral administration of 7.5 g/day of GJG every day during mFOLFOX6 therapy and 23 patients (control group) did not receive GJG. Neuropathy was evaluated during every course according to DEB-NTC (Neurotoxicity Criteria of Debiopharm).The median number of cycles per patient in the GJG group was 13 (range 4-32), and in the control group was 12 (range 4-28). The cumulative dose of oxaliplatin was 1105 mg/m(2) (GJG group) and 1120 mg/m(2) (control group). The incidence of grade 3 peripheral neuropathy in the GJG group was significantly lower than in the control group (p 0.01, log-rank test). The incidence of grade 3 peripheral neuropathy after 10 courses was 0% in the GJG group and 12% in the control group, and after 20 courses was 33% in the GJG group and 75% in the control group. The percentage of grade 2 and 3 peripheral neuropathy in the GJG group was lower than that in the control group. There were no differences in adverse effects between the two groups except for peripheral neuropathy and influence on tumor response.The Kampo medicine, Goshajinkigan, is useful in preventing neuropathy in non-resectable or recurrent colorectal cancer patients treated with a FOLFOX regimen.

症例は70歳代の女性で，直腸癌で腹腔鏡下低位前方切除術を施行された（Ra，3.3×3.0cm，2型，SS，N0，H0，P0，M0，StageII）．術後adjuvant chemotherapyとしてUFT+PSKを投与しながら外来でfollow up中であった．術後6カ月目の腹部CT検査で，腸間膜に約16mm大までの小結節が数個出現したが腫瘍マーカーは正常範囲内で経過観察とした．術後1年目の腹部CT検査では腸管膜小結節の増大を認めた．腫瘍マーカー，炎症所見は正常範囲内であったが，diffusion MRIでもhigh intensity lesionとして認めたため，腹膜播種の可能性が高いと考え，腸管膜に病変が限局していることから外科的切除を行った．病理診断では慢性炎症細胞浸潤を伴った線維芽細胞の増殖でmesenteric panniculitis（sclerosing mesenteritis）の像であった．直腸癌術後に発症した腹膜播種と鑑別が困難であった炎症性腫瘤を経験したので，若干の文献的考察を加えて報告する．

A method of videothoracoscopy-assisted extended thymectomy procedure performed through a movable small access window is introduced. The access window can be moved stepwise and longitudinally alongside full sternotomy to be upon the dissection site. The majority of the thymectomy procedure can be directly viewed and operated from the moving window. However, partial and complete thoracoscopic maneuvers are required for dissection of the lateral-most region near the phrenic nerve and the upper poles of the thymus, respectively.

1. Breath-hold divers are widely assumed to descend and ascend at the speed that minimizes energy expenditure per distance travelled (the cost of transport (COT)) to maximize foraging duration at depth. However, measuring COT with captive animals is difficult, and empirical support for this hypothesis is sparse. 2. We examined the scaling relationship of swim speed in free-ranging diving birds, mammals and turtles (37 species; mass range, 0·5-90,000 kg) with phylogenetically informed statistical methods and derived the theoretical prediction for the allometric exponent under the COT hypothesis by constructing a biomechanical model. 3. Swim speed significantly increased with mass, despite considerable variations around the scaling line. The allometric exponent (0·09) was statistically consistent with the theoretical prediction (0·05) of the COT hypothesis. 4. Our finding suggests a previously unrecognized advantage of size in divers: larger animals swim faster and thus could travel longer distance, search larger volume of water for prey and exploit a greater range of depths during a given dive duration. 5. Furthermore, as predicted from the model, endotherms (birds and mammals) swam faster than ectotherms (turtles) for their size, suggesting that metabolic power production limits swim speed. Among endotherms, birds swam faster than mammals, which cannot be explained by the model. Reynolds numbers of small birds (

Unreduced gamete formation is significant in the evolutionary development of complex polyploidy series found in wild strawberry, genus Fragaria (Rosaceae). Also, it is important for genetics and breeding in strawberry plants to elucidate the mechanism of unreduced gamete formation. The objective of this study was to search for ploidy anomalies resulting from artificial diploid × octoploid crosses, and examine the mechanism through which these unreduced gametes were produced. Five everbearing cultivars of Fragaria vesca L. diploid (2n = 2x = 14) were crossed with pollen from six June-bearing cultivars of Fragaria × ananassa Duch., octoploid (2n = 8x = 56). A total of 3000 mature seeds, 100 from each of the 30 parental combinations were sown at 23 °C/20 °C (day/night) under artificial lighting with a 16 h day. The seedlings were transplanted to pots and grown in a greenhouse. Reproductive and morphological observations, flow cytometry analyses, chromosome counts and DNA analyses using CAPS markers were performed to identify the genetic background of the offspring. Most of the seed (79%) did not germinate or died soon after germination. Of the seedlings produced, 7% seemed to be pure F. vesca based on morphological characteristics, flow cytometry analyses and chromosome counts; 14% were pentaploids (2n = 5x = 35), 0.1% were hexaploids (2n = 6x = 42), and 0.03% (one individual) was aneuploid (2n = 8x + 2 = 58). Electrophoresis banding patterns obtained by CAPS marker analysis were heterozygotic in the 8x pollen parent but homozygotic in the aneuploid progeny. Judging from the chromosome counts and the CAPS marker analysis, the aneuploid was the result of a homozygous unreduced pollen grain (8x) crossed with an incomplete chromosome compliment from the egg. Because of the homozygosity, the unreduced male gamete must have been derived from second division restitution (SDR) in the octoploid pollen parent.

TPS5603Background: Patients with metastatic or recurrent CC who are not amenable to curative treatment with surgery or radiation have a poor prognosis, and systemic chemotherapy is regarded as a st...

2004年1月から2008年12月に縦隔リンパ節郭清を伴う肺葉切除を施行したc-1A期非小細胞肺癌症例131症例を対象とし，術後病理学的リンパ節転移陰性群と陽性群間の臨床病理学的因子を検討した．男性72例，女性59例，平均年齢67歳．腺癌107例，非腺癌24例であった．pN0症例113例，pN1症例6例，pN2症例12例であった．リンパ節転移陰性例（n＝113）および陽性例（n＝18）を比較検討すると術前血中SLX値の中央値はそれぞれ21.6U/mlおよび28.5U/mlであり，リンパ節転移陽性例で有意に高値であった（p＝0.001）．ROCカーブから血中SLX値についてカットオフ値（26U/ml）を決定し，臨床病理学的因子について多変量解析を行うと血中SLX値のみが独立予測因子であった（リスク比：3.527，p＝0.021）．c-1A期非小細胞肺癌症例において術前血中SLX値陽性例は術前精査，術式選択について慎重な検討が必要と考えられた．

Kinetics of cross-linking copolymerization of acrylate- and methacrylate-monomers in a liquid crystal blue phase to prepare the polymer-stabilized blue phase were investigated based on dynamic mechanical analysis. Although the polymerization rate of methacrylate-monomers is generally much lower than that of acrylate-ones, we found that a methacrylate cross-linker enhanced the cross-linking copolymerization and an acrylate one suppressed it when acrylate- and methacrylate-monomers were copolymerized with cross-linking. The order of copolymerization rate of monofunctional monomer/difunctional one was monoacrylate (mA)/dimethacrylate (dMA), mA/diacrylate (dA), monomethacrylate (mMA)/dMA, and mMA/dA. The synchrotron small-angle X-ray scattering measurements were carried out to evaluate the aggregated structure of polymer networks in the polymer-stabilized blue phase and found the regular polymer structure corresponding to the disclination lattice of the blue phase, indicating that the polymers were segregated preferentially in the disclination cores. The degree of the regularity of polymer networks was opposite order of copolymerization rate. We obtained a good correlation among the polymerization kinetics, the mechanical elastic constant and the polymer aggregation structure in the polymer-stabilized blue phases, leading to a novel strategy to control the structure and the performance of the polymer-stabilized blue phases.

本研究では，動物の行動を加速度記録から再現できるかどうか評価することを目的に，飼育下のキタオットセイに加速度データロガーを装着して得られた記録と，ビデオ記録による動物の動きを照合した。この結果，加速度記録から前ヒレの打ち下ろし（ストローク）の 93% を抽出することができ，餌追跡や捕食時には遊泳速度の上昇や，大きな体軸角度の変化，高いストローク頻度が記録できた。これらの知見を野生のアシカ類から得られた行動データに応用することで，遊泳コストの見積もり，餌追跡や捕食の回数を計測することができると考えられる。

症例は77歳の男性で，8年前より本態性血小板血症の診断でアスピリン，ヒドロキシカルバミドの内服で治療をされていた．心窩部の不快感を主訴に近医で胃内視鏡検査を施行したところ，U領域に胃癌が認められ手術目的に紹介となった．術前7日前よりアスピリンを中止し，ヘパリンの経静脈投与を開始し，ヒドロキシカルバミドを術前2日前に中止した．手術は腹腔鏡補助下胃全摘出術を施行した．術後はヘパリン，アスピリン，ヒドロキシカルバミドを投与し血小板をコントロールし，血栓などの合併症を引き起こすことなく退院となった．本態性血小板血症は血栓などの合併症の報告があるために，周術期には血小板のコントロールや厳重な抗凝固治療が重要である．検索した範囲では本態性血小板血症を合併した消化管癌に対して腹腔鏡での治療例は本例が1例目であった．

Background; MR images are considered to be highly effective to examine ovarian tumors. However, in some case, it is difficult to differentiate malignant ovarian tumors from benign ones.Methods; Five hundred eighty-nine cases of ovarian tumors were managed by laparoscopic surgery during a period of six years. Of these cases, 15 cases were diagnosed as borderline ovarian tumors after surgery, and MR images of these cases were retrospectively reviewed.Results; The mean age was 35 years old and the mean follow-up period was 36 months. Pathological results revealed ten cases of mucinous borderline tumors (67%), three cases of serous borderline tumors (20%), and the other two cases. In reviewing preoperative MR images, six cases showed solid parts within the tumor walls enhanced by contrast agents or huge tumor size (over 20 cm in diameter). Of ten cases of pathologically proven mucinous borderline tumors, five cases were interpreted as endometrial cysts before surgery.Conclusion; For the gynecologic laparoscopists, it is necessary to thoroughly understand the characteristic features of MR images for ovarian tumors. If MR images show any possibility of malignancy, proper strategies such as frozen section diagnosis should be considered.

症例は慢性関節リューマチなどの慢性炎症性疾患の既往がない70歳代の男性で，上腹部痛を主訴に近医を受診した．腹部CT，MRI，positron emission tomography-CTにて直径5 cmの空腸腸間膜内に存在する嚢胞性腫瘤を疑い，開腹手術を行った．空腸腸間膜内に嚢胞性腫瘤が確認され，周囲には腫大したリンパ節が多発していた．摘出した嚢胞性腫瘤の内容は陳旧性の出血であった．病理組織学的検査では空腸粘膜下組織の血管壁にAA型アミロイドの沈着と広範な出血がみられた．腸間膜の脂肪織には虚血に起因する脂肪壊死を認め，リンパ節にも著明にアミロイドが沈着していた．腸間膜の嚢胞壁は肉芽組織で形成されており，血管壁の脆弱化による出血から嚢胞性病変を形成したと考えられた．腸間膜に出血性嚢胞を伴う消化管アミロイドーシスの報告はみられず，慢性炎症性疾患の既往のない症例でもアミロイドーシスの可能性を念頭におく必要があると考えられた．

症例は50歳代，男性．体重減少，上腹部腫瘤を主訴に受診．腹部CT検査，胃内視鏡下生検にて胃原発gastrointestinal stromal tumor(GIST)と診断した．左上腹腔を占める直径20cmの高リスクGISTであり，他臓器浸潤や，術中操作による播種を危惧し，イマチニブ400mg/日投与を開始した．投与開始後24日目から発熱，腹痛が出現し，翌日緊急入院．腹部CT検査では胃腫瘍は縮小していたが，腫瘍内に多量のairを認めた．腫瘍内への穿通，感染による発熱と判断し，緊急手術を施行した．腫瘍は左横隔膜へ浸潤し，大網内に転移を認めたが，肝臓，膵臓には浸潤していなかった．横隔膜に一部腫瘍を残存させ，胃全摘出術を施行した．腫瘍内は周辺の軟らかい実質成分と中心部の粘液で満たされた空洞がみとめられ，胃内腔と交通していた．イマチニブ投与後の穿通の報告はないが，特に巨大なGISTに投与する場合，急速な縮小に伴い，穿通，穿孔の可能性があり，注意を要する．

Integration of human papillomavirus DNAs into the host genome is crucial to the development of cervical cancer. Overexpression of the P16 protein has been reported in cervical intraepithelial neoplasia (CIN) as well as cervical cancer. Such molecular biomarkers have been utilized for ancillary testing of liquid-based cytology specimens; however, their clinical application remains controversial. To detect CIN 2 or more advanced lesions, 153 liquid-based cytology (LBC) specimens were investigated to determine the physical status of the human papillomavirus (HPV) DNA by in situ hybridization (ISH) and to detect overexpression of the P16 protein by immunocytochemistry combined with HPV genotyping by polymerase chain reaction. The combination of ISH, P16 immunocytochemistry, and LBC showed high sensitivity (89.3%) as well as high specificity (92.6%). We confirmed the usefulness of P16 immunocytochemistry combined with ISH and HPV genotyping as ancillary molecular-biological tests of LBC specimens for identifying patients at high risk of cervical cancer.

This study was designed to determine the clinical characteristics and verify the results of surgical treatment for non-small cell lung cancer (NSCLC) in patients with hepatocellular carcinoma (HCC), from the results of retrospective analysis of the cases. We retrospectively reviewed our database of 751 patients who underwent curative surgical intervention for NSCLC from January 1993 to December 2006 and found 11 patients with NSCLC with coexisting or previously treated HCC at a perioperative period of lung cancer surgery. Postoperative complications and long-term outcome were analyzed. All cases had coexisting liver cirrhosis. The overall morbidity was 27.2% (n = 3). All complications were considered to be the result of liver cirrhosis-related conditions, such as liver failure (n = 2), postoperative bleeding from the thoracic tube (n = 2), and gastrointestinal bleeding (n = 1). There was no operative mortality. The 1-, 3-, and 5-year survival rates of patients with lung cancer were 88.9%, 74.1%, and 74.1%, respectively. The 1-, 3-, and 5-year survival rates for death from hepatic causes were 79.5%, 79.5%, and 39.8%, respectively. Overall survival rates were 70.7%, 58.9%, and 29.5%, respectively. Preoperative indicators of liver function, such as serum values of total bilirubin (P

Nonbacterial pleuritis caused by rupture of a metastatic adenocarcinoma is extremely rare and has not yet been reported. A 59-year-old man with a history of rectal cancer surgery 6 years earlier presented with a solitary lung mass in the periphery of the right lower lobe on computed tomography. Transbronchial biopsy disclosed a suspected metastatic adenocarcinoma, and he was admitted for pulmonary metastasectomy. He had been asymptomatic, but 4 weeks after the diagnostic bronchoscopy, the patient suddenly complained of a right back pain and dyspnea at rest; shortly after that, he developed a fever of 39 degrees C. A chest X-ray showed right pleural effusion, collapse of the right lower lobe, and elevation of the right diaphragmatic dome, but without pneumothorax. Emergent video-assisted thoracoscopy revealed a perforated tumor in the collapsed lower lobe, and a right lower lobectomy was carried out. The postoperative course was uneventful, and he was well without recurrent disease 2 years after pulmonary resection.