Evaluation of complex physical therapy for lymphedema of the unilateral lower limbs

We evaluated the effectiveness of the complex physical therapy (CPT) for lymphedema of the unilateral lower limbs of eleven patients who had been admitted to Tokushima Rehabilitation Hospital. Ten patients were of secondary lymphedema, nine of which were after treatment of uterine cancer and one was of primary lymphedema. Our CPT consited of skin care, manual lymph drainage (MLD), compression therapy with elastic bandages or elastic stockings, and exercise therapy under compression. MLD functionally operates to enhance the lymph drainage more proximally in both contralateral and ipsilateral truncal quadrants of the torso, then in the proximal limb, and only thereafter from the distal to proximal portion of the edematous extremity. Swelling ratio of all patients on admission was 26.9± 11.8% and that at discharge was 16.8±9.4%. Edema reduction ratio (ERR) of the entire patients was 41.5± 16.5%, and 81.8% of cases were recognized as effective, in which ERR showed more than 30% at discharge. In a consensus document about the diagnosis and treatment of peripheral lymphedema in 1995, the International Society of Lymphology Executive Committee reported that most operations designed to alleviate peripheral lymphedema have not as yet been perfected or usually are still inferior to combined physiotherapy. At present lymphedema should be accurately diagnosed in the early stage and be treated with CPT correctly by clinicians who understand lymphedema thoroughly and are well trained

フクマク ハシュ オ トモナッタ コウド シンコウ イガン ニ タイスル TS 1 ニヨル ジュツゼン カガク リョウホウ ノ ユウヨウセイ

TS -１ is an oral anticancer agent developed by utilizing biochemical modulation. We used TS -１in neoadjuvant chemotherapy for a patient with highly advanced gastric cancer that was accompanied by peritoneal dissemination. This enabled us to resect tumor. This patient was a６０-year-old woman. Fluoroscopic upper gastrointestinal series revealed a circumferential, type４lesion extending from the middle of the corpus to the antrum. This was diagnosed by endoscopy as poorly differentiated adenocarcinoma. CT showed ascites, thickening of the gastric wall, and direct infiltration into the head of the pancreas. In endoscopy of the large bowel, a strawberry jelly-like elevation was detected at the ileum. This was diagnosed as poorly differentiated adenocarcinoma, and considered a metastatic lesion produced by dissemination. Chest CT showed a single metastasis in the upper lobe of the right lung. We gave her３cycles of combined TS-１and low-dose CDDP for neoadjuvant chemotherapy. On laparotomy, we found that there was no ascites, and miliary scars were present at several sites near the ascending colon. The antrum of the stomach firmly adhered to the head of the pancreas, and scarred. We judged that the tumor was resectable, and performed distal gastrectomy（D２）plus ileocecal resection（D２）． In histopathological examination, poorly differentiated adenocarcinoma was detected only on a part of the muscular layer in the lesser curvature and posterior wall of the corpus, and marked fibrosis was observed in the submucosal layer. The effect of chemotherapy was histologically evaluated as grade２. The tumor was diagnosed as poorly differentiated adenocarcinoma（por）, with muscularis propria（mp）, lymph invasion２（ly２），vein invasion ０（v０）and degree of lymph node metastasis２（+）［n２（+）］. Tubular adenocarcinoma was detected in a part of the submucosal layer of the ileum. The patient was alive with cancer as of２７months after operation

チョメイナ ノウホウ ケイセイ オ トモナッタ カンサイボウ ガン ノ 1ジケンレイ

It is said that in hepatocellular carcinoma, necrosis is liable to occur in the center and the percentage of cystic formation is comparatively low, but as we have experienced one case of hepatocellular carcinoma associated with marked cystic formation, we reported it. The patient was a female aged７０years. Because general fatigue and anorexia occurred, Abdominal CT test was conducted and hepatic mass was pointed out. Contrast-CT test showed a tumor of６cm in diameter in the medial segment of the left lobe of the liver. As the border was stained with arterial phase, the center was not imaged and the tumor was diagnosed as vascular proliferating type hepatic tumor associated with marked cystic change. MRI test showed that the border of the tumor was lobular and part thereof was of septal structure. The tumor was diagnosed as hepatocellular carcinoma associated with bleeding in tumor, hepatic cystadenocarcinoma or hepatic sarcoma. Abdominal angiography showed not only marked vascular proliferation and tumor stain in the area of the middle hepatic artery but also early venous return, and the middle hepatic vein was clearly imaged. The tumor size was ５×５×４cm in size and was in contact with the middle hepatic vein but it did not invade the vein. Left hepatic lobectomy was performed. Histopathologically the center of the tumor was cystic with colliquative necrosis. The tumor had the trabecular structure and the tumor cell was consisted of clear cell. The tumor was thus diagnosed as poorly differentiated hepatocellular carcinoma. Postoperative course was good and the patient was discharged from our hospital on the１９th day after operation. At the moment when１９ months have passed since the operation, the patient is alive without any recurrence of carcinoma

G-quadruplex structures mark human regulatory chromatin

G-quadruplex (G4) structural motifs have been linked to transcription, replication and genome instability and are implicated in cancer and other diseases. However, it is crucial to demonstrate the bona fide formation of G4 structures within an endogenous chromatin context. Herein we address this through the development of G4 ChIP-seq, an antibody-based G4 chromatin immunoprecipitation and high-throughput sequencing approach. We find ∼10,000 G4 structures in human chromatin, predominantly in regulatory, nucleosome-depleted regions. G4 structures are enriched in the promoters and 5' UTRs of highly transcribed genes, particularly in genes related to cancer and in somatic copy number amplifications, such as $\textit{MYC}$. Strikingly, $\textit{de novo}$ and enhanced G4 formation are associated with increased transcriptional activity, as shown by HDAC inhibitor-induced chromatin relaxation and observed in immortalized as compared to normal cellular states. Our findings show that regulatory, nucleosome-depleted chromatin and elevated transcription shape the endogenous human G4 DNA landscape.European Molecular Biology Organization (EMBO Long-Term Fellowship), University of Cambridge, Cancer Research UK (Grant ID: C14303/A17197), Wellcome Trust (Grant ID: 099232/z/12/z