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Purpose: The aim of this study was to clarify the frequency of malignancy and the histopathological characteristics of the lesions in patients undergoing magnetic resonance imaging (MRI)-guided vacuum-assisted biopsy (VAB).Materials and Methods: A retrospective review of 100 consecutive patients with 102 lesions who had undergone MRI-guided VAB was performed. The biopsies were performed on a 1.5-T MR scanner using a commercially available biopsy system. None of the lesions seen with MRI could be detected by mammography or second-look ultrasonography.Results: The average lesion sizes of the focus, mass, and nonmass lesions before the biopsy were 4.5, 8.2, and 21 mm, respectively. Twelve patients (12%) had lesions located in the deep portion of the breast, close to the pectoral muscle. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in 6 (6%), in situ carcinoma in 28 (27%), and high-risk and benign in 68 (67%). Two high-risk lesions were upgraded to ductal carcinoma in situ (DCIS), and three DCIS lesions were upgraded to invasive ductal carcinoma at surgical excision.Conclusion: The high rate of DCIS might be a unique feature among Japanese women. However, MRI-guided VAB is necessary for MRI-only visible suspicious lesions in Japan. [ABSTRACT FROM AUTHOR]

We present a case of a 44-year-old woman with rectal cancer(cT2N3M0, cStage Ⅲb)treated with 4 capecitabine-oxaliplatin( CAPOX)therapy courses, followed by laparoscopic intersphincteric resection. The patient received 7 postoperative, adjuvant CAPOX therapy courses. After 16 months since the final CAPOX administration, computed tomography(CT) revealed multiple liver tumors, showing early enhancement, and a jejunal mesenteric mass suspected to be a gastrointestinal stromal tumor(GIST). To overcome the percutaneous needle biopsy limitation, laparoscopic partial hepatectomy and laparoscopic- assisted partial intestinal resection were performed. Two liver lesions were diagnosed as nodular regenerative hyperplasia( NRH)with sinusoidal obstruction syndrome(SOS), supported by the hyperplasia and sinusoidal dilatation pathological findings, consequential to using oxaliplatin. Considering the rarity of NRH, using oxaliplatin may be proven vital in the differential diagnosis.

New materials with a low environmental load are expected to be generated through synthetic biology. To widely utilize this technology, it is important to create cells with designed biological functions and to control the expression of multiple enzymes. In this study, we constructed a cell-free evaluation system for multiple protein expression, in which synthesis is controlled by T7 promoter variants. The expression of a single protein using the T7 promoter variants showed the expected variety in expression levels, as previously reported. We then examined the expression levels of multiple proteins that are simultaneously produced in a single well to determine whether they can be predicted from the promoter activity values, which were defined from the isolated protein expression levels. When the sum of messenger ribonucleic acid (mRNA) species is small, the experimental protein expression levels can be predicted from the promoter activities (graphical abstract (a)) due to low competition for ribosomes. In other words, by using combinations of T7 promoter variants, we successfully developed a cell-free multiple protein synthesis system with tunable expression. In the presence of large amounts of mRNA, competition for ribosomes becomes an issue (graphical abstract (b)). Accordingly, the translation level of each protein cannot be directly predicted from the promoter activities and is biased by the strength of the ribosome binding site (RBS); a weaker RBS is more affected by competition. Our study provides information regarding the regulated expression of multiple enzymes in synthetic biology., (© The Author(s) 2022. Published by Oxford University Press.)

Among portosystemic shunts, splenorenal shunts can cause increased portal pressure, which in turn can bring about hyperammonemia, resulting in hepatic encephalopathy. In recent years, it has been reported that oxaliplatin(OX), a key chemotherapy drug in colorectal cancer, can precipitate splenorenal shunts due to sinusoidal injury. We report a case of hyperammonemia post oxaliplatin therapy. A 72-year-old male patient who had undergone surgical resection for(RS)rectal cancer with hepatic metastasis had been receiving capecitabine plus OX(CAPOX)as adjuvant chemotherapy. During his 7th course of treatment, he visited the outpatient clinic with complaints of weakness, dysarthria, and urinary incontinence. Laboratory findings showed an elevated NH3 level (200 μg/dL), and subsequent abdominal computed tomography revealed a splenorenal shunt, which was attributed to OX. Balloon-occluded retrograde transvenous obliteration(BRTO)was then performed. The patient has been routinely followed up in the outpatient clinic and has had no recurrence of hyperammonemia or cancer 14 months after the procedure. In retrospect, the splenorenal shunt was present on his first visit, therefore, hyperammonemia could have been prevented at the time of commencement of chemotherapy. We report our case, along with the relevant literature.

Introduction: Glucocerebrosidase gene (GBA) variants are associated with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The molecular mechanisms underlying these diseases with GBA variants, however, are not well understood. In order to determine the effect of a deletion mutation in GBA, we performed a neuroimaging, genetic, and enzymatic study in a Japanese family with a gross deletion of exons 3 to 11 in GBA., Methods: We performed [ 123 I] FP-CIT SPECT and [ 123 I] N-isopropyl-p-iodoamphetamine SPECT (IMP-SPECT), and determined GBA expression and glucocerebrosidase (GCase) activity in leukocytes in two GBA-associated PD patients and nine unaffected individuals (including four mutation carriers) in a Japanese family with a heterozygous gross deletion mutation in the GBA gene., Results: The two PD patients and two of the four clinically unaffected carriers showed decreased [ 123 I] FP-CIT uptake. IMP-SPECT showed a pattern like that in DLB in one patient. When we compared PD patients with GBA mutations with clinically unaffected carriers, there was a poor correlation between the development of PD and the expression level of GBA or GCase activity., Conclusion: We confirmed the gross deletion mutation in the GBA gene, which appeared to be associated with the PD or reduced [ 123 I] FP-CIT in this family. However, since we cannot conclude whether a reduction of GCase activity is directly correlated with the pathogenesis of PD or not, longitudinal follow-up of this family is needed., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Prolamines are alcohol-soluble proteins classified as either cysteine-poor (CysP) or cysteine-rich (CysR) based on whether they can be alcohol-extracted without or with reducing agents, respectively. In rice esp1 mutants, various CysP prolamines exhibit both reduced and normal amounts of isoelectric focusing bands, indicating that the mutation affects only certain prolamine classes. To examine the genetic regulation of CysP prolamine synthesis and accumulation, we constructed a high-resolution genetic linkage map of ESP1. The ESP1 gene was mapped to within a 20 kb region on rice chromosome 7. Sequencing analysis of annotated genes in this region revealed a single-nucleotide polymorphism within eukaryotic peptide chain release factor (eRF1), which participates in stop-codon recognition and nascent-polypeptide release from ribosomes during translation. A subsequent complementation test revealed that ESP1 encodes eRF1. We also identified UAA as the stop codon of CysP prolamines with reduced concentration in esp1 mutants. Recognition assays and microarray analysis confirmed that ESP1/eRF1 recognizes UAA/UAG, but not UGA. Our results provide convincing evidence that ESP1/eRF1 participates in the translation termination of CysP prolamines during seed development., (Copyright © 2018 Elsevier B.V. All rights reserved.)

A 35-year-old male was admitted to our hospital because of suspected myelitis. T 2 -weighted spinal MRI revealed a high intensity area at Th7-9. On admission, he showed mild weakness of the lower extremities and hyperreflexia of all extremities. Therefore, he was diagnosed with having spastic paraplegia. He presented no trismus or opisthotonos. There was pleocytosis in the cerebral spinal fluid. Dysuria, constipation and spasticity of the bilateral legs worsened, even though we administered methylprednisolone pulse therapy. Nonetheless, the symptoms had progressed on the 11th hospital day, opisthotonus and optic hyperesthesia were presented. On the 13th hospital day, we suspected local tetanus and administered tetanus toxoid. After one month, his symptoms had gradually improved. In the case of spastic paraplegia showing a subacute progression course and a faint abnormality on spinal MRI, the possibility of local tetanus should be considered.

We report here the clinical presentation and subsequent autopsy of a 90-year-old man who developed small papules with pain and swelling in his right ear. On admission, he exhibited right facial nerve paralysis, neck stiffness and Kernig's sign. The cell count was elevated and the varicella-zoster virus-PCR was positive in the CSF. Brain magnetic resonance imaging showed hyperintense lesions in the left pons and left temporal lobe, in FLAIR images. We diagnosed the patient with Ramsay Hunt syndrome and meningoencephalitis due to varicella-zoster virus. Although the symptoms of meningitis improved following treatment with intravenous acyclovir (750 mg/day initially, raised to 1,125 mg/day), 16 days after admission, he died suddenly due to gastrointestinal hemorrhage. The autopsy findings included lymphocytic infiltration of the leptomeninges and perivascular space of the cerebrum, and slight parenchyma in the left temporal lobe and insula, as the main histological features. Encephalitis due to varicella zoster virus has been recognized as a vasculopathy affecting large and small vessels. Pathological confirmation is rare in varicella zoster virus meningoencephalitis.

Background: The detailed pathophysiology of limb coldness in multiple system atrophy (MSA) is unknown., Methods: We evaluated cutaneous vasomotor neural function in 18 MSA patients with or without limb coldness, and in 20 healthy volunteers as controls. We measured resting skin sympathetic nerve activity (SSNA) and spontaneous changes of the sympathetic skin response (SSR) and skin blood flow (skin vasomotor reflex: SVR), as well as SVR and reflex changes of SSNA after electrical stimulation. The parameters investigated were the SSNA frequency at rest, amplitude of SSNA reflex bursts, absolute decrease and percent reduction of SVR, recovery time, and skin blood flow velocity., Results: Both the resting frequency of SSNA and the amplitude of SSNA reflex bursts were significantly lower in the MSA group than the control group (p<0.001 and p<0.05, respectively). There were no significant differences between the two groups with regard to the absolute decrease or percent reduction of SVR volume. The recovery time showed no significant difference between all MSA patients and control groups, but it was significantly prolonged in six MSA patients with limb coldness compared with that in the control group and that in MSA patients without limb coldness (p<0.01). The skin blood flow velocity was significantly slower in the MSA group than in the control group (p<0.001)., Conclusion: In MSA patients, limb coldness might occur due to impairments of the peripheral circulation based on prolongation of vasoconstriction and a decrease of skin blood flow velocity secondary to combined pre- and postganglionic skin vasomotor dysfunction., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Cytochrome c (cyt c) forms oligomers by domain swapping. It exchanges the C-terminal α-helical region between protomers, and the Met80‒heme iron bond is perturbed significantly in domain-swapped oligomers. The peroxidase activity of cyt c increases by Met80 dissociation from the heme iron, which may trigger apoptosis. This study elucidates the effect of the Met80 heme coordination on cyt c domain swapping by obtaining oligomers for both wild-type (WT) and M80A human cyt c by an addition of ethanol to their monomers, followed by lyophilization and dissolution to buffer, and investigating their dimer properties. The absorption and circular dichroism spectra of WT and M80A cyt c exhibited similar changes upon dimerization, indicating that Met80 does not affect the oligomerization process significantly. According to differential scanning calorimetric measurements, Met80 coordination to the heme iron had an effect on the stabilization of the monomer (ΔH = 16 kcal/mol), whereas no large difference was observed between the dimer-to-monomer dissociation temperatures of WT and M80A cyt c (61.0 °C). The activation enthalpy values were similar and relatively large for the dissociation of both WT and M80A cyt c dimers (WT, 120 ± 10 kcal/mol; M80A, 110 ± 10 kcal/mol), indicating that the dimers suffered large structural changes upon dissociation to monomers independent of the Met80 coordination to the heme iron. These results indicate that cyt c domain swapping may occur regardless of the Met80 coordination, whereas the monomer is stabilized by Met80 but the domain-swapped dimer structure and stability are less affected by the Met80 coordination.

To investigate the vasomotor regulation in multiple system atrophy (MSA), we simultaneously recorded muscle sympathetic nerve activity (MSNA), heart rate, and blood pressure in 14 MSA patients without syncope and 18 healthy subjects. Resting MSNA bursts were significantly less frequent in MSA patients than healthy subjects (p < 0.001), while the increase of MSNA bursts with head-up tilt was significantly greater in MSA patients (p < 0.01). In patients with MSA, orthostatic hypotension may be prevented by an augmented MSNA response.

Exome sequencing revealed a novel missense mutation (c.2152G>A, p.E713K) in the KIAA0196 gene in a Japanese patient with SPG8. To date, only 10 mutations in the KIAA0196 gene have been reported in the world. We describe the clinical and genetic findings in our patient with SPG8, which is a rare dominant hereditary spastic paraplegia. Notably, our patient showed mild upper limb ataxia, which is a relatively atypical symptom of SPG8. Thus, our patient showed a wide clinical spectrum of SPG8., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: In amyotrophic lateral sclerosis (ALS), not only impairment of motor neurons but also impairment of the autonomic nervous system has been demonstrated by previous physiological studies. Several investigators have reported a correlation between autonomic dysfunction and respiratory dysfunction in ALS. This study analyzed the relation between parameters of respiratory function and muscle sympathetic nerve activity (MSNA) in a large number of ALS patients., Methods: In 50 patients with ALS (mean age (SD): 62.1 (11.7) years), MSNA, heart rate (HR), and blood pressure (BP) were recorded simultaneously. The arterial oxygen content (PaO2), arterial carbon dioxide content (PaCO2), and forced vital capacity expressed as a percentage of the predicted value for healthy controls (%VC) were determined as parameters of respiratory function., Results: There were no significant correlations between MSNA and PaO2, PaCO2, %VC, or the disability score. Analysis of chronological changes in 14 patients examined twice showed that the disability score and PaCO2 were significantly increased, and %VC was significantly more decreased at the second examination compared with the first examination (p<0.01 and p<0.05, respectively). In contrast, HR, BP, burst rate of MSNA, and age-adjusted MSNA exhibited no significant changes between the first and second examinations., Conclusions: These findings show that gradual deterioration of respiratory function in ALS patients is not associated with changes of quantitative MSNA parameters, which may suggest that abnormality of the autonomic nervous system is a primary feature of ALS., (Copyright © 2015 Elsevier B.V. All rights reserved.)

For treatment of colorectal liver metastases, liver resection is recommended for resectable cases in the clinical guidelines for colorectal cancer. On the other hand, there are currently no data supporting the efficacy of radiation therapy as a topical treatment, and this treatment can therefore not presently be recommended. With CyberKnife®, it is possible to perform stereotactic radiation therapy using a linear accelerator with high accuracy, even for lesions in the trunk area such as liver metastases. Between December 2009 and September 2014 in our hospital, we performed radiation treatment using CyberKnife® for 14 cases with 22 colorectal liver metastases. As a result, we obtained response and local control rates of 76.2%and 81.0%, respectively. Moreover, no advanced adverse events were observed. Thus, we consider that CyberKnife® treatment for colorectal liver metastases is effective as a topical treatment, with low invasiveness and high safety.

A 54-year-old man was admitted due to progressive gait disturbance and cognitive impairment. On MRI, a hyperintense region was observed in the periventricular white matter on FLAIR imaging, with Gd-enhancement in the choroid plexus and periventricular wall. Cerebrospinal fluid (CSF) examination showed marked abnormalities including a high white blood cell count (WBC, 360 cells/mm(3). 83% lymphocytes), an elevated protein level (1,416 mg/dl), a low glucose level (12 mg/dl), and elevated cryptococcal antigen with positive Indian ink staining. Cryptococcal ventriculitis was diagnosed. The patient was initially treated with liposomal amphotericin B, fluconazole, voriconazole, and flucytosine for 38 weeks, followed by administration of itraconazole and fluconazole with some improvement. The brain MRI after one month showed septum formation in the posterior horn, which was suggestive of ventriculitis. Although ventriculitis is rare, we should pay attention to the presence of ventriculitis due to cryptococcal infection in the central nervous system.

We report on a patient who underwent total gastrectomy with D2 lymph node dissection for metastatic gastric cancer. We administered S-1 at 60 mg/m² as postoperative adjuvant chemotherapy. Six months after surgery, recurrence was detected in the para-aortic lymph node. As a first-line treatment for the recurrent cancer, the patient underwent capecitabine/CDDP therapy(capecitabine 1,800 mg/m², CDDP 60 mg/m²). A significant reduction in the recurrent lymph nodes was observed by CT after 6 months of administration, resulting in 24 months of progression-free survival. S-1/CDDP therapy is recommended as a first-line chemotherapy for recurrent gastric carcinoma in the Japanese gastric cancer treatment guidelines. Likewise, single agent S-1 administration is recommended as postoperative adjuvant chemotherapy for advanced gastric cancer patients. However, in cases of recurrence after S-1 therapy, there is insufficient evidence on the efficacy of S-1/CDDP; thus, the type of administration and time to recurrence could be considered for optimization. We identified a case of gastric cancer showing response to first-line capecitabine/CDDP therapy after lymph node recurrence following the administration of S-1 as postoperative adjuvant chemotherapy. Since capecitabine and S-1 differ in their mechanisms of action and as predictive factors for therapeutic effect, capecitabine may be an efficient option in cases of S-1 failure. The present case suggests that capecitabine/CDDP therapy may be an effective treatment for S-1 pretreated patients with advanced or metastatic gastric cancer.

To date, four families with spinocerebellar ataxia type 5 (SCA5) with four distinct mutations in the spectrin, beta, nonerythrocytic 2 gene (SPTBN2) have been reported worldwide. In the present study, we identified the first Japanese family with SCA5, and analyzed this family clinically and genetically. The clinical features of the five patients in this family revealed late-onset autosomal-dominant pure cerebellar ataxia. We collected DNA samples from the majority of the family members across two generations, and exome sequencing combined with Sanger sequencing revealed a novel heterozygous three-nucleotide in-frame deletion mutation (c.2608&#95;2610delGAG) in exon 14 of the SPTBN2 gene. This mutation cosegregated with the disease in the family and resulted in a glutamic acid deletion (p.E870del) in the sixth spectrin repeat, which is highly conserved in the SPTBN2 gene. This is the first three-nucleotide in-frame deletion mutation in this region of the beta-3 spectrin protein highly likely to be pathogenic based on exome and bioinformatic data.

Mineral balance and salt stress are major factors affecting plant growth and yield. Here, we characterized the effects of rice (Oryza sativa L.) reduced culm number1 (rcn1), encoding a G subfamily ABC transporter (OsABCG5) involved in accumulation of essential and nonessential minerals, the Na/K ratio, and salt tolerance. Reduced potassium and elevated sodium in field-grown plants were evident in rcn1 compared to original line 'Shiokari' and four independent rcn mutants, rcn2, rcn4, rcn5 and rcn6. A high Na/K ratio was evident in the shoots and roots of rcn1 under K starvation and salt stress in hydroponically cultured plants. Downregulation of SKC1/OsHKT1;5 in rcn1 shoots under salt stress demonstrated that normal function of RCN1/OsABCG5 is essential for upregulation of SKC1/OsHKT1;5 under salt stress. The accumulation of various minerals in shoots and roots was also altered in the rcn1 mutant compared to 'Shiokari' under control conditions, potassium starvation, and salt and d-sorbitol treatments. The rcn1 mutation resulted in a salt-sensitive phenotype. We concluded that RCN1/OsABCG5 is a salt tolerance factor that acts via Na/K homeostasis, at least partly by regulation of SKC1/OsHKT1;5 in shoots., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

A 77-year-old female developed vertigo and dysarthria. Two months later, she was hospitalized with disorientation and ataxia. CSF showed increased levels of NSE, 14-3-3 protein and tau. EEG demonstrated periodic synchronous discharges (PSD). Brain MRI showed abnormal high intensity areas in the cerebral cortices, especially in the occipital lobes, putamen and caudate nucleus bilaterally, on DWI. Genetical analysis of prion protein revealed no specific mutation. She was diagnosed as having sporadic Creutzfeldt-Jakob disease (CJD). Cheyne-Stokes respiration (CSR) had been observed since an early stage, and decreased 5 months later coincident with attenuation of myoclonus and PSD. We should also pay attention to CSR in the diagnosis of CJD, although the complication is rare.

A 49-year-old man subacutely developed muscle weakness in four extremities over a few days. He had no past or family history of muscle weakness. His blood tests showed significant hypokalemia without endocrinological abnormalities. With the diagnosis of hypokalemic myopathy, potassium was administered orally, and his symptoms improved. The patient had been drinking a beverage containing green tea extract too much two weeks before the symptoms developed, in addition to taking a cold remedy for ten years. Thus, hypokalemia is considered to be induced by the excessive intake of caffeine that accompanies the excessive consumption of the beverage and cold remedy.

Background: In the United States and Europe, MR-guided vacuum-assisted biopsy (VAB) is required for MR-only visible suspicious lesions that cannot be identified with mammography or ultrasonography. However, it is controversial as to whether MR-guided VAB is essential or not in Japan. The purpose of this study was to clarify the frequency of malignancy among the patients that underwent MR-guided VAB, and to discuss the need for this technique in Japan., Methods: This study was approved by the Institutional Review Board of our hospital. A retrospective review was performed of 30 consecutive patients who had undergone MR-guided 11-gauge VAB. The biopsies were performed on a 1.5 T MR scanner using a commercially available biopsy system. All lesions seen with MRI could not be detected by mammography and second-look ultrasonography., Results: All 30 lesions were assessed as category 4 or 5. The average lesion size of a mass enhancement before biopsy was 0.7 cm, and the average lesion size of a non-mass-like enhancement was 2.3 cm. The average number of cores of VAB was 19. The median time required to perform the VAB procedure was 35 min. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in one (3%); ductal carcinoma in situ (DCIS) in seven (23%); and benign in 22 (73%). In one case, atypical ductal hyperplasia at VAB was upgraded to DCIS at surgical excision., Conclusion: MR-guided VAB can be performed safely and it is needed for MR-only visible suspicious lesions in Japan.

Background: When performing breast-conserving surgery (BCS), it is essential to achieve a complete resection of the tumor while preserving the cosmetic outcome. The aim of this study was to evaluate the accuracy of a MRI marking technique for planning of BCS., Methods: A retrospective review was performed of 14 consecutive patients who underwent MRI in the supine position (supine MRI) using a MRI marking technique. The preoperative histopathological diagnosis was ductal carcinoma in situ in 11 and invasive ductal carcinoma in 3. All of the patients with invasive ductal carcinoma were treated with neoadjuvant chemotherapy. The pills of Breath Care used as MRI markers were placed in the Penrose drain with 2-cm intervals, and drains were put on the resection lines as determined by ultrasonography (US). The final resection lines were modified using information obtained by supine MRI. The rate of the margin-tumor distance (RMTD: longer margin-tumor distance/shorter margin-tumor distance) was calculated., Results: Thirteen patients (93%) needed modification of the first resection line, whereas one patient (7%) needed no modification. Twelve patients (86%) had negative margins, but two patients (14%) had positive margins: one patient had a medial margin, while the other had a distal margin. One patient showed a pathologically complete response after chemotherapy; the RMTD was not evaluated. Among the 12 patients with medial and lateral negative margins, the medial and lateral margin-tumor distances ranged from 1.0 to 3.5 cm (average 2.1 cm), and the RMTD ranged from 1 to 3.0 (average 1.5)., Conclusion: Our MRI marking technique may be useful for evaluating the extent of the tumor as determined by the US examination in difficult cases.

Background: Breast MR imaging has emerged as a highly sensitive modality for the imaging of breast tumors. However, there have been no reports concerning the usefulness of bilateral breast MRI to evaluate the contralateral breast in Japan. The purpose of this study was to examine the frequency of primary bilateral breast cancer, and to investigate the role of bilateral breast MRI in the detection of contralateral breast cancer., Methods: A retrospective review was performed of 556 consecutive women who had undergone surgery for the primary breast cancer. MR imaging was performed on a 1.5-T system. Both the breasts were examined in the coronal plane on the first-, second-, and fourth-phase dynamic images, acquired at 30, 90 s, and 4.5 min, respectively. The affected single breast was sagittally examined on images obtained in the third phase at 3 min., Results: Twenty-four (4.3%) patients had bilateral breast cancer, 14 (2.5%) had synchronous cancer and 10 patients (1.8%) had metachronous cancer. In the 14 cases with synchronous cancer, bilateral breast malignancy was suspected at the time of the initial diagnosis in 6 cases. The detection rate of 18 contralateral breast cancer cases by only MMG, only US, MMG and US, and MRI were 50% (9/18), 67% (12/18), 78% (14/18) and 100% (17/17), respectively. For 8 of these cases with a second synchronous cancer, the corresponding rates were 75, 88, 100 and 100%, respectively. For the 10 cases with a second metachronous cancer, the rates were 30, 50, 60 and 100%, respectively., Conclusion: Bilateral breast MRI is a more sensitive for the detection of contralateral breast cancers compared with conventional imaging methods. In particular, bilateral MRI also allows detection of metachronous contralateral cancers at an earlier stage during the postoperative follow-up period.

Background: Breast MR imaging has emerged as a highly sensitive modality for the imaging of breast tumors. However, a standardized method of interpretation of lesions showing non-mass-like enhancement does not exist. The purpose of this study was to analyze the features of non-mass-like breast lesions detected by MRI, and to establish a standardized method of interpretation to allow categorization of these lesions., Methods: A retrospective review was performed for 102 consecutive nonpalpable mammographically occult, non-mass-like lesions detected by MRI that had undergone ultrasound-guided vacuum-assisted biopsy. MR imaging was performed on a 1.5-Tesla system. The distribution patterns were classified into three categories as follows: single quadrant/solitary lesion (linear), single quadrant/grouped lesion (focal, regional, segmental), and multiquadrant lesion (multiple regions, diffuse). The presence of a ductal pattern was assessed in the enhancing lesions after the tumor distribution had been decided. In addition to the BI-RADS-MRI descriptors, the presence of clustered ring enhancement was also assessed in heterogeneous enhancing lesions. We divided non-mass-like lesions into those with a small (category 3a), moderate (category 3b), or substantial (category 4) likelihood of malignancy., Results: The features with the highest positive predictive value (PPV) for cancer were clustered ring enhancement (67%) (P = 0.004), a branching-ductal pattern (38%) (P = 0.003), and clumped architecture (20%). The PPV for cancer of a linear-ductal pattern was 11% (1/9). All lesions showing multiquadrant distribution, linear-nonspecific lesion, non-branching pattern with homogeneous and stippled internal architectures, and heterogeneous lesion without clustered ring enhancement were diagnosed as benign., Conclusion: Non-mass-like breast lesions detected on MRI showing a clustered ring enhancement, a branching-ductal pattern, and clumped architecture should be evaluated further by biopsy (category 4), while lesions not showing these characteristics may be observed without unnecessary intervention (category 3a). Lesions showing a linear-ductal pattern may be followed carefully or evaluated by biopsy as needed (category 3b).

We herein present a case of non-palpable ductal carcinoma in situ (DCIS) treated with successful breast-conserving surgery (BCS) using MR markers made with commercially available materials in the supine position. The patient was a 40-year-old woman found to have a non-mass lesion by routine screening ultrasonography (US). The margin of the lesion was unclear by the US examination, whereas contrast-enhanced MR mammography (MRM) revealed a clear margin of the lesion. After the resection line was determined by under US guidance, the area was marked by original markers for MRI using the pills of Breath Care inside a Penrose drain. MRM was performed in the supine position (supine MRM), which is similar to the posture used for surgery. The lesion was located within the resection area, but it was not at the center of the resection area; thus, the resection lines were modified using information obtained by MRM. The histological evaluation of the BCS specimen demonstrated a wide extension of the DCIS. The lesion was located at the center of the resection specimen, and the surgical margin was free. In conclusion, since our procedure can be performed easily, it is useful for evaluating the extent of the lesion as determined by the US examination in difficult cases.

Biopsy is required for definitive diagnosis of lesions detected by magnetic resonance (MR) imaging that are suspicious or highly suggestive of malignancy. We performed MR-guided vacuum-assisted biopsy (VAB) using a commercially available biopsy device without a nonmagnetic needle in 5 patients with 5 lesions that were occult according to mammographic and sonographic findings. Complete removal was seen in 3 cases and partial removal in two. The VAB procedures were very well tolerated, and no important side effects were observed. MR-guided VAB can be performed safely with a nonmagnetic needle.

Microtubule-associated protein MAP1A is expressed abundantly in mature neurons and is necessary for maintenance of neuronal morphology and localization of some molecules in association with the microtubule-based cytoskeleton. Previous studies indicated that its complementary expression together with MAP1B during nervous system development is regulated at the transcriptional level and that the mouse Map1A gene is transcribed under the control of 5' and intronic promoters. In this study, we investigated the regulatory mechanisms that govern the neuronal cell-specific activation of the MAP1A 5' promoter. We found that two regulatory factor for X box (RFX) binding sites in exon1 of both the mouse and human genes are important for effective transcriptional repression observed only in non-neuronal cells by reporter assays. Among RFX transcription factor family members, RFX1 and 3 mainly interact with repressive elements in vitro. Cotransfection studies indicated that RFX1, which is expressed ubiquitously, down-regulated the MAP1A 5' promoter activity in non-neuronal cells. Unexpectedly, RFX3, which is abundantly expressed in neuronal cells, down-regulated the transactivity as well, when it was expressed in non-neuronal cells. Both RFX1 and 3 did not down-regulate the transactivity in neuronal cells. These results suggest that RFX1 and 3 are pivotal factors in down-regulation of the MAP1A 5' promoter in non-neuronal cells. The cell type-specific down-regulation, however, does not depend simply on which RFX interacts with the elements, but seems to depend on underlying profound mechanisms.

We have previously reported the clinical effect of NF therapy (NCS 5,000 units and 5-FU 500 mg intravenously; twice a week) on patients with advanced carcinoma of the digestive system. In the present study, NFO therapy (NCS 2,000 units and 5-FU 500 mg intravenously, Picibanil 1-2K. E. intramuscularly; twice a week) was applied for those patients to take advantage over NF modality. Treated were 62 patients with NFO and 48 were evaluated for its clinical effects. In comparison of NFO and NF, the antitumor effects were noted in 9 of 48 patients (18.8%) for NFO, and 2 of 27 (7.4%) for NF therapy judged by Koyama & Saito's criterion. If the Karnofsky's criterion was applied, I-A category or more were obtained in 10 of 48 patients (20.8%) for NFO and in 2 of 27 (7.4%) for NF therapy. In particular, NFO therapy resulted in the advantageous clinical effects on patients with hepatic and pancreatic carcinomas irrespective of primary or metastatic. The adverse effects of NFO were not more frequent than those of NF therapy. From these results, a new combination regimen, NFO, is thought to bring about a considerable benefit in the treatment of advanced carcinoma of the digestive organs.