[Abnormal Nipple Discharge].

BACKGROUND: Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. Ductography and fiberoptic ductoscopy have beenadvocated as the mainprocedures inpatien ts with nipple discharge. METHODS: We investigated the usefulness of microdochectomy(MD)by using indocyanine green(ICG)fluorescence imaging. ICG and indigo carmine were injected into the mammary duct. A periareolar incision was made, and a fluorescence image of the demarcated mammary duct segment was obtained. CONCLUSION: MD using indocyanine green fluorescence imaging is a useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

[Local Control by Mastectomy in Advanced Breast Cancer with Liver Metastasis after Chemotherapy, Radiotherapy, and Hyperthermia - A Case Report].

Advanced breast cancer has a poor prognosis compared to early breast cancer; however, quality of life and radical operation can be improved in some case by using multidisciplinary treatment. A 54-year-old woman was examined at the hospital because of an enlarging tumor in the left breast. She was aware of a lump for 3 years. Results of the initial examination indicated invasive ductal carcinoma with liver metastasis. She first received chemotherapy(AC followed by weekly paclitaxel). After 4 courses of weekly paclitaxel, computed tomography revealed axillary lymph nodes involved in the axillary vein. Operation was difficult and conversion therapy was administered. The patient underwent radiotherapy, hyperthermia, and hormone therapy. After 1 year from the start of hormone therapy, the metastasis had disappeared and the patient underwent operation in our unit. Eight months after operation, no recurrence was observed.

[Serous Carcinoma of the Peritoneum with Metastases to the Breast and Axillary Lymph Nodes].

Metastasis of peritoneal serous carcinoma to the breast and axillary lymph nodes is rare. We present a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes. A 72-year-old woman was diagnosed with Stage III peritoneal serous carcinoma in November 2009; she was treated with 6 courses of paclitaxel and carboplatin. In December 2015, she had a palpable mass(2×2 cm)and enlarged axillary lymph nodes. Mammography did not reveal any mass(C1)and ultrasonographic examination demonstrated a partially ill-defined hypoechoic mass with a diameter of 8.7× 7.1 mm. Cytological examination of the axillary lymph node revealed malignancy; breast carcinoma metastasis was suspected and the patient underwent breast-conserving surgery. Histopathological examination of the specimens(breast and axillary lymph nodes)revealed adenocarcinoma, and immunohistochemistry analysis showed that the specimens were CK7(+), CK20(-), CA125(+), PAX8(+), and GCDFP15(-). Taken together, the results indicated peritoneal serous carcinoma metastases to the breast and axillary lymph nodes. CONCLUSION: We report a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes.

[A Case of Gallbladder Carcinoma and Breast Cancer Associated with Pancreaticobiliary Maljunction].

We report a case of gallbladder cancer and right breast cancer associated with pancreaticobiliary maljunction.The patient was a 74-year-old woman who presented with abdominal pain due to cholecystitis.Abdominal CT detected a gallbladder tumor and right breast tumor.Enhanced CT and MRCP examination revealed gallbladder cancer and right breast cancer associated with pancreaticobiliary maljunction.We performed a gallbladder bed resection, bile duct resection, and right total mastectomy.The histopathological diagnosis of the gallbladder was moderately tubular adenocarcinoma and that of the breast tumor was scirrhous carcinoma.The patient remains recurrence-free 8 months after surgery.

[A Case of Local Recurrence of Bile Duct Cancer Completely Responding to Chemoradiotherapy with S-1].

An 80-year-old man with common bile duct cancer was treated by pancreaticoduodenectomy with D2 lymph node dissection in October 2005. The patient presented with frequent episodes of bloody-mucous rectal discharge in July 2009. An abdominal CT demonstrated local recurrence at the hepatoduodenal ligament. We treated him with concurrent chemoradiotherapy (CRT) with single-dose S-1 chemotherapy. After 6 months, we diagnosed a complete response (CR) by follow-up CT. The patient was treated with S-1 for 3 years after the diagnosis of a CR. He is alive without disease 6 years after the diagnosis of the recurrence. Concurrent CRT with S-1 chemotherapy may be the therapy of choice for recurrence of bile duct cancer.

[Introduction and PDCA-Management of a Liaison-Clinical Pathway with Cancer Patients after a Curative Operation].

Our hospital was appointed as an Osaka designated cancer care hospital in April 2012. At that time, we introduced the same liaison-clinical pathway with cancer patients after a curative operation in all of Osaka. Based on the management of the plan-do-check-act cycle, we found problems in the clinical pathway. These problems included the following: the clinical pathway was not known, was complicated, was troubling for patients, and not well understood by doctors. To solve these problems, we planned and carried out the following five measures. The first was public information, followed by practice processes, informed consent, patient referral documents, and clinical pathway investigation reports. We were able to promote the use of the liaison-clinical pathway by constantly improving these measures.

A computational and experimental approach reveals that the 5'-proximal region of the 5'-UTR has a Cis-regulatory signature responsible for heat stress-regulated mRNA translation in Arabidopsis.

Translation of specific plant mRNAs is differentially regulated under certain abiotic stress conditions such as heat, oxygen deprivation and dehydration. The majority of transcripts exhibit varying degrees of translational repression, whereas a subset of transcripts escape such repression and remain actively translated. The underlying mechanisms that mediate this control, and in particular the identities of the regulatory RNA elements involved, remain poorly understood. Using a combined computational and experimental approach, we identified a novel cis-regulatory element in the 5'-untranslated region (5'-UTR) that affects differential translation in response to heat stress (HS) in Arabidopsis thaliana. First, we selected a set of genes with distinct translational responses to HS, based on our previously reported genome-wide data regarding changes in polysome loading induced by HS in A. thaliana cultured cells. We evaluated the 5'-UTRs of these messages for their ability to mediate expression, when fused to reporter mRNAs, in protoplasts under HS. The data from the reporter assay and the nucleotide sequences of the 5'-UTRs tested were used to define regulatory elements in the 5'-UTRs, with the help of a partial least square (PLS) regression model. The computational analysis using PLS and subsequent experimental characterization of a series of 5'-UTR mutants provided evidence that the 5'-proximal sequence of the 5'-UTR is a primary and position-dependent determinant of 5'-UTR-mediated differential translation in response to HS. Finally, we discuss the possible mechanism underlying HS regulation of differential mRNA translation.

[Multiple hepatic metastases from colon cancer successfully treated with irinotecan and S-1 plus panitumumab as second-line therapy-a case report].

The patient was a 55-year-old man who had been diagnosed as having liver metastases (S3, S4, S5, S6, and S7) from sigmoid colon cancer in March 2010. In June 2010, he underwent sigmoid colon cancer resection, followed by local ablation therapy for the liver tumors( S4, S5, and S6) and hepatic segmentectomy( S3 and S7). Subsequently, adjuvant chemotherapy with S-1 and oxaliplatin( SOX) was initiated. After 6 courses, hepatic metastasis from colon cancer recurred. Thus, primary treatment with SOX plus bevacizumab for advanced metastatic colorectal cancer was initiated. However, progressive disease was diagnosed after 10 postoperative courses of chemotherapy, and therefore, chemotherapy with irinotecan and S-1 (IRIS) plus panitumumab was initiated as secondary treatment. Tumor marker levels reduced with this treatment, and diagnostic imaging indicated a partial response. We report herein a case of a patient who was successfully treated with IRIS plus panitumumab. This therapeutic regimen is useful as second-line treatment because it has the advantage of not requiring a pump for administration and treatment can be tailored to an individual patient's condition, for example, according to pathology and the patient's lifestyle needs.

Relationship between lymphangiogenesis and exudates during the wound-healing process of mouse skin full-thickness wound.

We considered the relationship among exudate, wound area, angiogenesis, lymphangiogenesis, and reepithelialization during wound healing. Full-thickness wounds were made on the dorsum of mice. The weight of exudate absorbed into the dressing as well as the wound area was determined daily. Sections of the wounds were stained with anti-LYVE-1 and CD31 antibodies. Indian ink was injected into the wound for observing the movement of the exudate on days 3, 5, and 7 after wounding. New epithelium completely covered the wound on day 11. The quantity of exudate peaked on day 1, and then rapidly decreased until it was undetectable on day 11. Most of the Indian ink injected into the wound was retained within the wound and did not flow into the surrounding tissue. New blood vessels showed a uniform distribution in the granulation tissue on day 5. New lymphatics appeared in the granulation tissue approximately 2 days later than the blood vessels and they were distributed toward the center of the granulation tissue on day 11. Thus, reduction of exudate from the wound appears to be related to blood vessels, not lymphatics. However, increasing lymphatics may play a role in the late phase of the wound-healing process.

Osteonecrosis of the jaw associated with everolimus: A case report.

Everolimus, a mammalian target of rapamycin inhibitor, has recently been approved for the treatment of metastatic estrogen receptor-positive breast cancer, at a daily dose of 10 mg in combination with exemestane. Osteonecrosis of the jaw (ONJ) is a rare but severe condition, characterized by exposed necrotic bone, and is associated with various drugs that are often used to treat advanced malignancies. We herein report the case of a patient with breast cancer who developed ONJ during treatment with everolimus, which improved after discontinuation of the drug. To the best of our knowledge, this is the first reported case of everolimus-associated ONJ in a patient receiving everolimus for metastatic breast cancer. In 2014, an 80-year-old woman was started on treatment with everolimus and exemestane for stage IIB estrogen receptor-positive breast cancer. Within 2 months, the left side of her face became edematous, with localized heat and tenderness of the left mandibular region and a 3-mm round area of exposed bone. There was purulent discharge and the surrounding gingiva was edematous and erythematous. The left mandible exhibited a low signal intensity area on T1-weighted magnetic resonance imaging. Treatment was discontinued and ONJ showed improvement after 2 months. Therefore, when prescribing everolimus for metastatic breast cancer, oncologists should be aware of the possibility of ONJ as a complication.

Measurement of dietary choline-phospholipid content by a novel phospholipase D-triiodide method.

We developed a novel method that conveniently measures dietary choline-phospholipid content. Crude lipids extracted from dietary samples were reacted with phospholipase D from Streptomyces chromofuscus. The choline liberated from this reaction was then reacted with potassium triiodide, yielding choline periodide, which could be measured spectrophotometrically at 365 nm. This method proved to be more convenient than conventional assays, such as thin layer chromatography and high performance liquid chromatography. Our novel method is suitable for measuring many samples in single experiments.

Effect of transpiration on plant accumulation and translocation of PPCP/EDCs.

The reuse of treated wastewater for agricultural irrigation in arid and hot climates where plant transpiration is high may affect plant accumulation of pharmaceutical and personal care products (PPCPs) and endocrine disrupting chemicals (EDCs). In this study, carrot, lettuce, and tomato plants were grown in solution containing 16 PPCP/EDCs in either a cool-humid or a warm-dry environment. Leaf bioconcentration factors (BCF) were positively correlated with transpiration for chemical groups of different ionized states (p < 0.05). However, root BCFs were correlated with transpiration only for neutral PPCP/EDCs (p < 0.05). Neutral and cationic PPCP/EDCs showed similar accumulation, while anionic PPCP/EDCs had significantly higher accumulation in roots and significantly lower accumulation in leaves (p < 0.05). Results show that plant transpiration may play a significant role in the uptake and translocation of PPCP/EDCs, which may have a pronounced effect in arid and hot climates where irrigation with treated wastewater is common.

Effects of soybean beta-conglycinin on body fat ratio and serum lipid levels in healthy volunteers of female university students.

The changes in body fat ratio and serum lipids induced by the ingestion of beta-conglycinin were examined in 41 healthy female university student volunteers. The trend of change in body fat ratio following the ingestion of beta-conglycinin differed between students with a baseline body fat ratio over 25% and those less than 25%. In the former group, the ingestion of beta-conglycinin suppressed the increase in body fat ratio. Moreover the six subjects who had a high total cholesterol level (5.72 mmol/L or higher) tended to have reduced levels of serum triglyceride, free fatty acid, total cholesterol and lipoprotein (a) after the ingestion of beta-conglycinin, although those levels did not change significantly. The number of subjects was only six, therefore it was inferred that significant changes were not observed. Thus, ingestion of soybean beta-conglycinin suppressed the increase in body fat ratio in individuals with a high baseline body fat ratio and reduced relatively high serum levels of lipids. Those results suggest that if soybean beta-conglycinin is ingested continuously (5 g daily), it will be effective in keeping body fat ratio and serum lipid levels normal and eliminating excessive lipids from the body.

[Amount of nitrate and nitrite in daily menus containing more than 350 g of vegetables].

The contents of nitrate and nitrite in menus containing more than 350 g of vegetables per day were investigated. The amounts of vegetables in menu A developed by female students and menu B taken from a recipe book were 350+/-2 g and 457+/-77 g, respectively. The average content of the nitrate was 321.0+/-139.3 mg (104.2-636.9 mg) in menu A, and 245.7+/-90.7 mg (140.1-507.3 mg) in menu B. Sixteen and thirteen samples exceeded the ADI in menus A and B, respectively. This may be because menu A contained more raw vegetables than menu B (menu A; 120+/-58 g, menu B; 72+/-71 g). The contents of nitrite in menu A and B were 1.2+/-0.3 mg (0.7-1.8 mg) and 2.8+/-0.9 mg (1.3-4.6 mg), respectively, and 6 samples in menu B exceeded the ADI. Intake of 350 g of vegetables or more in a day may require careful consideration of selection, frequency of use and cooking method, especially for vegetables with high nitrate content. A questionnaire to female students showed that 80% or more of students recognized that vegetables containing high contents of nitrate, such as spinach and komatsuna, should be boiled before eating them.

Stable immobilization of an oligonucleotide probe on a gold substrate using tripodal thiol derivatives.

We proposed an interface molecule for immobilization of DNA probes on solid substrates of DNA chips. We have designed and synthesized tripodal thiol derivatives for stable immobilization of oligonucleotide probes on a gold surface. On the basis of the tetrahedral structure of tripod, the tripodal thiol derivatives were bonded upright to the gold substrate, which would control the orientation of oligonucleotide probes. When the gold substrate with oligonucleotide probes tethered using the thiol derivatives was exposed to deionized water at higher temperatures, the tripodal interface molecules were attached to the gold surface more stably than the single contact molecules. The DNA chip platform combined with the functional interface molecule is suitable for a reproducible, inexpensive, and high-throughput detection system for genetic analyses in clinical diagnostics.

Cholesterol intake is associated with lecithin intake in Japanese people.

Many dietary recommendations for the prevention of heart disease and hyperlipidemia include restriction of cholesterol intake. However, limiting cholesterol intake might also affect the intake of other nutrients. The daily intakes of cholesterol, lecithin, total fatty acids, and SFAs by 388 Japanese subjects (ages 6-59 y) were analyzed directly using the duplicate portion sampling technique. Intakes were 266.1 +/- 146.5 mg/d, 1.6 +/- 0.9 g/d, 39.3 +/- 16.8 g/d, and 12.8 +/- 6.9 g/d, respectively. There was a strong positive correlation between cholesterol and lecithin intakes (r = 0.864, P < 0.001), and when food intake was adjusted to 1 kg/d, the correlation remained high (r = 0.881, P < 0.001). In contrast, the correlation between total fatty acid and lecithin intakes was lower (r = 0.423, P < 0.001), and when food intake was adjusted to 1 kg/d, the correlation coefficient remained stable (r = 0.448, P < 0.001). These results strongly indicate that limiting cholesterol intake decreases lecithin intake. Lecithin intake can be estimated from the following regression equation: lecithin intake (g/d) = 0.005 x cholesterol intake (mg/d) + 0.16 (R2= 0.747, P < 0.001). Furthermore, the intake of choline derived from lecithin can be estimated by the following equation: choline (mg/d) = 0.724 x cholesterol (mg/d) + 21.5.