[Hyponatremia Causing a Tonic-Clonic Seizure after Breast Cancer Surgery-The Medical Safety Perspective].

A 61-year-old woman was found to have calcifications in the CD region of the left breast. She had previously undergone total hysterectomy and bilateral oophorectomy for endometriosis at the age of 37 years. Since age 59 years, she had been attending an otorhinolaryngology clinic because of vertigo. Blood tests showed no abnormal findings. Left breast cancer (cT1N0M0, stage Ⅰ)was diagnosed, and left mastectomy and sentinel lymph node biopsy were performed. She developed postoperative nausea, and at 37 hours postoperatively, she was unable to communicate and exhibited suspected delirium. At 43 hours postoperatively a tonic-clonic seizure occurred. Hyponatremia, with serum sodium of 114 mEq/L, was present. Sodium supplementation was provided, and the patient became capable of communication 8 hours after seizure onset(Na 121 mEq/L). A hyponatremic tonic-clonic seizure is extremely rare after breast cancer surgery, and the abnormal behavior of the present patient 31 hours after surgery was also highly unusual. With such an unusual presentation, the possibility that something specific is happening must be considered. This case gave us the opportunity to review patient management after breast cancer surgery, emergency response and preparations, and nursing education from the medical safety perspective.

[Locally Advanced HER2-Positive Breast Cancer Successfully Treated with Trastuzumab Emtansine].

Although the prognosis of HER2-positive breast cancer(BC)has been improving than before, that of locally advanced cases is not satisfactory. A 41-year-old female presented with a huge breast lump and massive lymphadenopathy, which was diagnosed as HER2-positive, unresectable, locally advanced BC. The first treatment, consisting of docetaxel, trastuzumab and pertuzumab, had only a limited and temporary effect, with subsequent mass regrowth. After initiation of the second treatment, trastuzumab emtansine(TDM1), the mass gradually shrank, and mastectomy and axillary lymphadenectomy were performed successfully. Histologically, several tiny invasive foci were observed in the mammary gland. No lymph node metastases were observed. The patient subsequently underwent radiation therapy and a 1-year course of TDM1 treatment. The patient has been in remission for 5 years. HER2-positive, locally advanced BC can be successfully treated with multimodal therapy, including anti-HER2 therapy, timely surgery and radiation therapy.

[Breast Cancer Metastasis to the Mesentery Diagnosed Via Laparoscopic Biopsy-A Case Report].

Breast cancer can metastasize to organs all over the body, but isolated mesenteric metastases are rare. A 72-year-old female, with a history of invasive lobular carcinoma of the breast treated with breast-conserving therapy and axillary lymphadenectomy 7 years previously and 5 years of endocrine therapy, presented with asymptomatic elevated serum carcino- embryonic antigen. Computed tomography(CT)revealed no obvious distant metastasis, but showed increased adipose tissue density around the pancreas suggestive of acute pancreatitis. During follow-up, in addition to the abnormality around the pancreas, mild thickening of the mesentery was observed on CT. Definitive diagnosis of mesenteric metastasis of invasive lobular carcinoma was confirmed via laparoscopic biopsy. It was supposed that the breast cancer had first metastasized to the retroperitoneum via the hematogenous route, and had then directly infiltrated the mesentery. Laparoscopic biopsy is effective for diagnosis of intra-peritoneal metastases.

Change in the chemical composition of infalling gas forming a disk around a protostar.

IRAS 04368+2557 is a solar-type (low-mass) protostar embedded in a protostellar core (L1527) in the Taurus molecular cloud, which is only 140 parsecs away from Earth, making it the closest large star-forming region. The protostellar envelope has a flattened shape with a diameter of a thousand astronomical units (1 AU is the distance from Earth to the Sun), and is infalling and rotating. It also has a protostellar disk with a radius of 90 AU (ref. 6), from which a planetary system is expected to form. The interstellar gas, mainly consisting of hydrogen molecules, undergoes a change in density of about three orders of magnitude as it collapses from the envelope into the disk, while being heated from 10 kelvin to over 100 kelvin in the mid-plane, but it has hitherto not been possible to explore changes in chemical composition associated with this collapse. Here we report that the unsaturated hydrocarbon molecule cyclic-C3H2 resides in the infalling rotating envelope, whereas sulphur monoxide (SO) is enhanced in the transition zone at the radius of the centrifugal barrier (100 ± 20 AU), which is the radius at which the kinetic energy of the infalling gas is converted to rotational energy. Such a drastic change in chemistry at the centrifugal barrier was not anticipated, but is probably caused by the discontinuous infalling motion at the centrifugal barrier and local heating processes there.

Initiation of peritoneal dialysis in a patient with chronic renal failure associated with tetralogy of Fallot: a case report.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital heart disease. Patients with the condition have a high risk of developing chronic kidney disease. Treatment of kidney disease in patients with complex hemodynamics presents unique challenges. However, there are very few reports on the treatment of end-stage renal failure in patients with tetralogy of Fallot. CASE PRESENTATION: We present a rare case of peritoneal dialysis in a 47-year-old man with tetralogy of Fallot who had not undergone intracardiac repair. Peritoneal dialysis successfully removed fluids and solutes without adversely affecting the patient's hemodynamics. Our patient was managed with peritoneal dialysis for 5 years before he succumbed to sepsis secondary to digestive tract perforation. CONCLUSIONS: In this paper, we discuss the importance of monitoring acid-base balance, changes in cyanosis, and hyperviscosity syndrome during peritoneal dialysis in patients with tetralogy of Fallot. Lower leg edema and B-type natriuretic peptide level were useful monitoring parameters in this case. This case illustrates that with attention to the patient's unique requirements, peritoneal dialysis can provide successful renal replacement therapy without compromising hemodynamics in patients with tetralogy of Fallot.

[A Case of Esophageal Cancer Achieving a Pathological Complete Response after Preoperative Docetaxel, Cisplatin, and 5-Fluorouracil Therapy].

A 66-year-old man with middle thoracic esophageal squamous cell carcinoma with supraclavicular lymph node metastasis visited our hospital. He underwent 3 courses of preoperative chemotherapy with docetaxel, cisplatin, and 5-FU(DCF)with a clinically-determined partial response. Minimally-invasive esophagectomy with 3-fieldlymphad enectomy was subsequently performed. Histopathologic examination revealedno viable tumor cells in the resectedesophagus andsupraclavicular lymph node. DCF is a promising preoperative chemotherapy regimen for locally advanced esophageal cancer because of its higher complete response rate comparedto that for cisplatin plus 5-FU.

[Chemoresistance in Microsatellite Instability-High Gastric Cancer-A Case Report].

A 74-year-old woman with cT4aN2M0, cStage ⅢB gastric cancer underwent neoadjuvant chemotherapy comprising 2 courses of S-1 plus cisplatin, and the clinical response was determined as non-CR/non-PD according to RECIST ver 1.1. Although distal gastrectomy with D2 lymphadenectomy was planned, the tumor was considered as unresectable with peritoneal metastases during laparotomy. After the subsequent chemotherapy with 1 course of capecitabine plus cisplatin, tumor bleeding, and obstruction due to rapid tumor progression occurred. We performed palliative distal gastrectomy; however, the patient died 17 days after gastrectomy. A comprehensive genomic analysis using cancer-gene panel identified the tumor as a microsatellite instability-high(MSI-H). Recently post hoc analysis of the large-scale clinical trials showed no clinical benefit of perioperative chemotherapy in MSI-H gastric cancer. MSI status has a potential to optimize the perioperative treatment strategy in gastric cancer.

Discovery of coesite and stishovite in eucrite.

Howardite-eucrite-diogenite meteorites (HEDs) probably originated from the asteroid 4 Vesta. We investigated one eucrite, Béréba, to clarify a dynamic event that occurred on 4 Vesta using a shock-induced high-pressure polymorph. We discovered high-pressure polymorphs of silica, coesite, and stishovite originating from quartz and/or cristobalite in and around the shock-melt veins of Béréba. Lamellar stishovite formed in silica grains through a solid-state phase transition. A network-like rupture was formed and melting took place along the rupture in the silica grains. Nanosized granular coesite grains crystallized from the silica melt. Based on shock-induced high-pressure polymorphs, the estimated shock-pressure condition ranged from ∼8 to ∼13 GPa. Considering radiometric ages and shock features, the dynamic event that led to the formation of coesite and stishovite occurred ca. 4.1 Ga ago, which corresponds to the late heavy bombardment period (ca. 3.8-4.1 Ga), deduced from the lunar cataclysm. There are two giant impact basins around the south pole of 4 Vesta. Although the origin of HEDs is thought to be related to dynamic events that formed the basins ca. 1.0 Ga ago, our findings are at variance with that idea.

Evaluation of irradiation effects of near-infrared free-electron-laser of silver alloy for dental application.

In the application of lasers in dentistry, there is a delicate balance between the benefits gained from laser treatment and the heat-related damage arising from laser irradiation. Hence, it is necessary to understand the different processes associated with the irradiation of lasers on dental materials. To obtain insight for the development of a safe and general-purpose laser for dentistry, the present study examines the physical effects associated with the irradiation of a near-infrared free-electron laser (FEL) on the surface of a commonly used silver dental alloy. The irradiation experiments using a 2900-nm FEL confirmed the formation of a pit in the dental alloy. The pit was formed with one macro-pulse of FEL irradiation, therefore, suggesting the possibility of efficient material processing with an FEL. Additionally, there was only a slight increase in the silver alloy temperature (less than 0.9 °C) despite the long duration of FEL irradiation, thus inferring that fixed prostheses in the oral cavity can be processed by FEL without thermal damage to the surrounding tissue. These results indicate that dental hard tissues and dental materials in the oral cavity can be safely and efficiently processed by the irradiation of a laser, which has the high repetition rate of a femtosecond laser pulse with a wavelength around 2900 nm.

[A Case of Simultaneous Multiple Gastric Cancers Showing Differences of Response after Neoadjuvant Chemotherapy with Docetaxel, CDDP, and S-1].

A 63-year-old man with epigastralgia was referred to our hospital and diagnosed with simultaneous multiple gastric cancers. One lesion was type 2 advanced and the other was type 0- II c early gastric cancer. CT examination revealed 4 regional lymph node metastases. Neoadjuvant chemotherapy(NAC)with docetaxel/CDDP/S-1was administered. After 2 courses of NAC, total gastrectomy with D2(-No. 10), lymphadenectomy was performed. The pathological response to NAC was judged to be Grade 3 for advanced gastric cancer and Grade 0 for early gastric cancer. The patient is alive with no evidence of disease during the 10 months after the operation.

[Efficacy of serum immunoglobulin free light chain and 18F-FDG PET/CT for therapeutic evaluation in a case with multiple plasmacytoma of bone].

Solitary/multiple plasmacytoma of bone, a rare disease as compared to multiple myeloma, is characterized by monoclonal proliferation of plasma cells in local legion (s) of bone, with no bone marrow abnormalities. Monoclonal gammagloblinemia is often absent in these conditions, and useful examinations allowing evaluation of responses to treatment are as yet lacking. Recently, 18F-FDG PET/CT (PET/CT) was reported to be useful for detecting bone lesions. PET/CT is also valuable for predicting the outcomes of patients with solitary plasmacytoma, when applied in combination with the serum free light chain (sFLC) κ/λ ratio. We present a 62-year-old male with multiple plasmacytoma of bone (MPB), in whom PET/CT and the sFLC κ/λ ratio were useful for evaluating the response to treatment. The patient was diagnosed with MPB, with PET/CT showing multiple abnormal tracer uptakes in the scapula, spine, and ribs. The sFLC ratio was markedly elevated, with the κ chain level being especially high. We administered bortezomib and dexamethasone, after which the abnormal uptakes on PET/CT disappeared. The sFLC ratio and the FLC value also normalized, and have remained stable for more than one year, to date, since treatment. In our case, PET/CT and the sFLC κ/λ ratio were found to be extremely useful for monitoring treatment responses.

Natural dissociation of olivine to (Mg,Fe)SiO3 perovskite and magnesiowustite in a shocked Martian meteorite.

We report evidence for the natural dissociation of olivine in a shergottite at high-pressure and high-temperature conditions induced by a dynamic event on Mars. Olivine (Fa(34-41)) adjacent to or entrained in the shock melt vein and melt pockets of Martian meteorite olivine-phyric shergottite Dar al Gani 735 dissociated into (Mg,Fe)SiO(3) perovskite (Pv)+magnesiowüstite (Mw), whereby perovskite partially vitrified during decompression. Transmission electron microscopy observations reveal that microtexture of olivine dissociation products evolves from lamellar to equigranular with increasing temperature at the same pressure condition. This is in accord with the observations of synthetic samples recovered from high-pressure and high-temperature experiments. Equigranular (Mg,Fe)SiO(3) Pv and Mw have 50-100 nm in diameter, and lamellar (Mg,Fe)SiO(3) Pv and Mw have approximately 20 and approximately 10 nm in thickness, respectively. Partitioning coefficient, K(Pv/Mw) = [FeO/MgO]/[FeO/MgO](Mw), between (Mg,Fe)SiO(3) Pv and Mw in equigranular and lamellar textures are approximately 0.15 and approximately 0.78, respectively. The dissociation of olivine implies that the pressure and temperature conditions recorded in the shock melt vein and melt pockets during the dynamic event were approximately 25 GPa but 700 °C at least.

Anomalous 13C isotope abundances in C3S and C4H observed toward the cold interstellar cloud, Taurus Molecular Cloud-1.

We have studied the abundances of the (13)C isotopic species of C3S and C4H in the cold molecular cloud, Taurus Molecular Cloud-1 (Cyanopolyyne Peak), by radioastronomical observations of their rotational emission lines. The CCCS/(13)CCCS and CCCS/C(13)CCS ratios are determined to be >206 and 48 ± 15, respectively. The CC(13)CS line is identified with the aid of laboratory microwave spectroscopy, and the range of the CCCS/CC(13)CS ratio is found to be from 30 to 206. The abundances of at least two (13)C isotopic species of C3S are thus found to be different. Similarly, it is found that the abundances of the four (13)C isotopic species of C4H are not equivalent. The CCCCH/(13)CCCCH, CCCCH/C(13)CCCH, CCCCH/CC(13)CCH, and CCCCH/CCC(13)CH ratios are evaluated to be 141 ± 44, 97 ± 27, 82 ± 15, and 118 ± 23, respectively. Here the errors denote 3 times the standard deviation. These results will constrain the formation pathways of C3S and C4H, if the nonequivalence is caused during the formation processes of these molecules. The exchange reactions after the formation of these two molecules may also contribute to the nonequivalence. In addition, we have confirmed that the (12)C/(13)C ratio of some species are significantly higher than the interstellar elemental (12)C/(13)C ratio of 60-70. The observations of the (13)C isotopic species provide us with rich information on chemical processes in cold interstellar clouds.

Sound velocity of hexagonal close-packed iron to the Earth's inner core pressure.

Here we determine the compressional and shear wave velocities (vp and vs) of hexagonal close-packed iron, a candidate for the main constituent of the Earth's inner core, to pressures above 300 gigapascals using a newly designed diamond anvil cell and inelastic X-ray scattering combined with X-ray diffraction. The present results reveal that the vp and vs of the Preliminary reference Earth model (PREM) inner core are 4(±2)% and 36(±17)% slower than those of the pure iron, respectively at the centre of the core. The density and sound velocity of the PREM inner core can be explained by addition of 3(±1) wt% silicon and 3(±2) wt% sulphur to iron‒5 wt% nickel alloy. Our suggested inner core composition is consistent with the existing outer core model with oxygen, as the growth of the inner core may have created a secular enrichment of the element in the outer core.

In situ X-ray and acoustic observations of deep seismic faulting upon phase transitions in olivine.

The activity of deep-focus earthquakes, which increases with depth from ~400 km to a peak at ~600 km, is enigmatic, because conventional brittle failure is unlikely to occur at elevated pressures. It becomes increasingly clear that pressure-induced phase transitions of olivine are responsible for the occurrence of the earthquakes, based on deformation experiments under pressure. However, many such experiments were made using analogue materials and those on mantle olivine are required to verify the hypotheses developed by these studies. Here we report the results of deformation experiments on (Mg,Fe)2SiO4 olivine at 11-17 GPa and 860-1350 K, equivalent to the conditions of the slabs subducted into the mantle transition zone. We find that throughgoing faulting occurs only at very limited temperatures of 1100-1160 K, accompanied by intense acoustic emissions at the onset of rupture. Fault sliding aided by shear heating occurs along a weak layer, which is formed via linking-up of lenticular packets filled with nanocrystalline olivine and wadsleyite. Our study suggests that transformational faulting occurs on the isothermal surface of the metastable olivine wedge in slabs, leading to deep-focus earthquakes in limited regions and depth range.

Degradation of Lignin by Infrared Free Electron Laser.

Lignin monomers have attracted attention as functional materials for various industrial uses. However, it is challenging to obtain these monomers by degrading polymerized lignin due to the rigid ether linkage between the aromatic rings. Here, we propose a novel approach based on molecular vibrational excitation using infrared free electron laser (IR-FEL) for the degradation of lignin. The IR-FEL is an accelerator-based pico-second pulse laser, and commercially available powdered lignin was irradiated by the IR-FEL under atmospheric conditions. Synchrotron-radiation infrared microspectroscopy analysis showed that the absorption intensities at 1050 cm-1, 1140 cm-1, and 3400 cm-1 were largely decreased alongside decolorization. Electrospray ionization mass chromatography analysis showed that coumaryl alcohol was more abundant and a mass peak corresponding to hydrated coniferyl alcohol was detected after irradiation at 2.9 µm (νO-H) compared to the original lignin. Interestingly, a mass peak corresponding to vanillic acid appeared after irradiation at 7.1 µm (νC=C and νC-C), which was supported by our two-dimensional nuclear magnetic resonance spectroscopy analysis. Therefore, it seems that partial depolymerization of lignin can be induced by IR-FEL irradiation in a wavelength-dependent manner.

Research and development of an electron beam focusing system for a high-brightness X-ray generator.

A new type of rotating anticathode X-ray generator, where an electron beam of up to 60 keV irradiates the inner surface of a U-shaped Cu anticathode, has achieved a beam brilliance of 130 kW mm(-2) (at 2.3 kW). A higher-flux electron beam is expected from simulation by optimizing the geometry of a combined-function-type magnet instead of the fringing field of the bending magnet. In order to minimize the size of the X-ray source the electron beam has been focused over a short distance by a new combined-function bending magnet, whose geometrical shape was determined by simulation using the Opera-3D, General Particle Tracer and CST-STUDIO codes. The result of the simulation clearly shows that the role of combined functions in both the bending and the steering magnets is important for focusing the beam to a small size. FWHM sizes of the beam are predicted by simulation to be 0.45 mm (horizontal) and 0.05 mm (vertical) for a 120 keV/75 mA beam, of which the effective brilliance is about 500 kW mm(-2) on the supposition of a two-dimensional Gaussian distribution. High-power tests have begun using a high-voltage 120 kV/75 mA power supply for the X-ray generator instead of 60 kV/100 mA. The beam focus size on the target will be verified in the experiments.

Improvements in transfection efficiency with chitosan modified poly(DL-lactide-co-glycolide) nanospheres prepared by the emulsion solvent diffusion method, for gene delivery.

This study sought to evaluate the in vitro transfection efficiency of plasmid DNA (pDNA)-loaded chitosan-modified poly(DL-lactide-co-glycolide) nanospheres (CS-PLGA NS) in a gene-delivery system. Using the emulsion solvent diffusion (ESD) method, pDNA-loaded PLGA NS was prepared and the surface of the PLGA NS was modified by binding to CS. Gene transfection ability of CS-PLGA NS was examined in A549 cells. The luciferase gene was used as a reporter gene. The pattern of luciferase activity by pDNA-loaded CS-PLGA NS was initially weak, but gradually grew stronger before decreasing activity. These phenomena should be in accordance with the sustained-release profile of pDNA from PLGA NS in the cytosol and the pDNA protection against DNase. Positively charged CS-PLGA NS was found, by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt (MTS) assay, not to exhibit cytotoxicity on A549 cells. These results suggest that CS-PLGA NS are potential contributors to efficient pDNA delivery due to their increased interactions with cells and lack of cytotoxic effects.

Use of two population metrics clarifies biodiversity dynamics in large-scale monitoring: the case of trees in Japanese old-growth forests: the need for multiple population metrics in large-scale monitoring.

Many indicators/indices provide information on whether the 2010 biodiversity target of reducing declines in biodiversity have been achieved. The strengths and limitations of the various measures used to assess the success of such measures are now being discussed. Biodiversity dynamics are often evaluated by a single biological population metric, such as the abundance of each species. Here we examined tree population dynamics of 52 families (192 species) at 11 research sites (three vegetation zones) of Japanese old-growth forests using two population metrics: number of stems and basal area. We calculated indices that track the rate of change in all species of tree by taking the geometric mean of changes in population metrics between the 1990s and the 2000s at the national level and at the levels of the vegetation zone and family. We specifically focused on whether indices based on these two metrics behaved similarly. The indices showed that (1) the number of stems declined, whereas basal area did not change at the national level and (2) the degree of change in the indices varied by vegetation zone and family. These results suggest that Japanese old-growth forests have not degraded and may even be developing in some vegetation zones, and indicate that the use of a single population metric (or indicator/index) may be insufficient to precisely understand the state of biodiversity. It is therefore important to incorporate more metrics into monitoring schemes to overcome the risk of misunderstanding or misrepresenting biodiversity dynamics.

Observation of terahertz coherent edge radiation amplified by infrared free-electron laser oscillations.

A coupling device, which can extract coherent edge radiation (CER) from an optical cavity for a free-electron laser (FEL) without damaging the FEL due to diffraction loss, was developed at Nihon University. We successfully observed the CER beam with a power of 1 mW or more in the terahertz range during FEL oscillation. It is revealed that the CER power changed with the detuning of the optical cavity and the dependence of the CER power on the detuning length differs from that of the FEL power. The measured CER spectra indicate that the longitudinal electron distribution in a bunch is modulated by the FEL oscillation with a period corresponding to the FEL slippage length. We herein report the characteristics of the CER with FEL oscillation in detail. These results demonstrate that the CER is excellent tool to reveal the overall effect of FEL interaction on electron distribution in a bunch.