A Case Report of Lipid-Rich Carcinoma of the Breast Including Histological Characteristics and Intrinsic Subtype Profile

A 57-year-old Japanese woman with schizophrenia, who had received long-term treatment with neuroleptics, noticed a painless, pea-sized lump in her right breast. She was admitted to our hospital and a malignant tumor was diagnosed. The patient underwent a conservative radical mastectomy (Patey's operation). The excised tumor measured 2.0 × 1.2 × 1.1 cm in diameter, and its cut surface was grayish-white. Histologically, tumor cells with clear to foamy cytoplasm were invariably Oil Red O-positive and periodic acid Schiff-negative with or without diastase digestion. The tumor was diagnosed as a lipid-rich carcinoma accompanied by an in situ component. Neuroleptics increase serum prolactin levels by interfering with dopaminergic inhibition of prolactin secretion. Immunohistochemical analysis revealed that, although prolactin was not detected, the tumor cells expressed prolactin receptor, indicating prolactin as the genesis of this neoplasm. In immunohistochemical intrinsic subtype analysis, the tumor was negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 1 and 2, and basal cytokeratins (CK5, CK6, and CK14), indicating an unclassified (all-marker negative) subtype. Axillary lymph nodes were free of metastasis (stage I), and the patient has been well for 20 years without any evidence of recurrence

Noninvasive vessel-selective perfusion imaging with intravenous myocardial contrast echocardiography

Background Intravenous myocardial contrast echocardiography (MCE) cannot identify each perfusion area of coronary vessels separately. However, by destroying microbubbles passing through a specific vessel using high-power ultrasound during intravenous MCE, vessel-selective perfusion imaging (VSPI) may be feasible. Methods In 10 open-chest dogs, intermittent short-axis images were obtained during contrast agent infusion using an ultrasound system. For VSPI, a probe coupled to another ultrasound machine was placed on the proximal left circumflex coronary artery (LCx). High-power ultrasound pulses were transmitted to destroy bubbles passing through the LCx. A negative contrast area on VSPI was considered to represent the perfusion area of the LCx (LCx-VSPI). A negative contrast area on conventional MCE during LCx occlusion and a region without staining by Evans blue dye were used as gold standards for defining the LCx perfusion area. LCx-VSPI was compared with a negative contrast area on conventional MCE during LCx occlusion and a region without staining by Evans blue dye. Results Despite lack of LCx occlusion, high-power destructive pulses produced a definite area of negative contrast on the LCx region. Decreased power of ultrasound pulses resulted in disappearance of the negative contrast area. An excellent relationship was demonstrated between both LCx-VSPI and a negative contrast area on conventional MCE during LCx occlusion (r = 0.93, P < .0001), and LCx-VSPI and a region without staining by Evans blue dye (r = 0.92, P = .0002). Conclusion: VSPI during intravenous MCE may be feasible for noninvasive assessment of perfusion areas associated with specific vessels.Asanuma T, Fujihara T, Otani K, Miki A, Ishikura F, Beppu S. Noninvasive vessel-selective perfusion imaging with intravenous myocardial contrast echocardiography. J Am Soc Echocardiogr. 2004 Jun;17(6):654-8. doi: 10.1016/j.echo.2004.03.011

C2C12筋管細胞においてモリンはデキサメタゾン誘導性の酸化ストレスと筋萎縮を抑制する

Glucocorticoids are the drugs most commonly used to manage inflammatory diseases. However, they are prone to inducing muscle atrophy by increasing muscle proteolysis and decreasing protein synthesis. Various studies have demonstrated that antioxidants can mitigate glucocorticoid-induced skeletal muscle atrophy. Here, we investigated the effect of a potent antioxidative natural flavonoid, morin, on the muscle atrophy and oxidative stress induced by dexamethasone (Dex) using mouse C2C12 skeletal myotubes. Dex (10 μM) enhanced the production of reactive oxygen species (ROS) in C2C12 myotubes via glucocorticoid receptor. Moreover, Dex administration reduced the diameter and expression levels of the myosin heavy chain protein in C2C12 myotubes, together with the upregulation of muscle atrophy-associated ubiquitin ligases, such as muscle atrophy F-box protein 1/atrogin-1, muscle ring finger protein-1, and casitas B-lineage lymphoma proto-oncogene-b. Dex also significantly decreased phosphorylated Foxo3a and increased total Foxo3a expression. Interestingly, Dex-induced ROS accumulation and Foxo3a expression were inhibited by morin (10 μM) pretreatment. Morin also prevented the Dex-induced reduction of myotube thickness, together with muscle protein degradation and suppression of the upregulation of atrophy-associated ubiquitin ligases. In conclusion, our results suggest that morin effectively prevents glucocorticoid-induced muscle atrophy by reducing oxidative stress

The Effect of Touching a Dolphin on the EEG Slow Waves hi Children

Among animal-facilitated therapies, dolphin-facilitated therapy has been shown to beneficially affect human behavior, emotion and speech ability. We recently showed that touching a dolphin reduced the respiratory rate and state anxiety in healthy children. In this study, we collected electroencephalographic data (EEG), widely used for examining various brain functions, before and after touching dolphins. We examined the relationship between EEG power spectra and individual trait anxiety scores. The results showed that the appearance of slow waves in the frontal area increased significantly after touching a dolphin. Furthermore, the difference in slow wave activity was negatively, but significantly, correlated with trait anxiety in the frontal area. This negative correlation showed that slow wave power was greater in subjects with lower trait anxiety, indicating that touching a dolphin may be more effective for subjects with low trait anxiety than those with high trait anxiety. However, even though the increase in slow wave power was lower in subjects with high trait anxiety, touching a dolphin appeared to affect brain rhythms by increasing slow waves

Effects of Viewing Ikehana on Breathing in Humans

Flower arrangements are widely used for decoration, but also for emotional healing. Ikebana is the Japanese art of flower arrangement, dating back over 600 years. Although ikebana has been used for psychological rehabilitation, no research has examined its effect on physiological responses in individuals. We examined the effect of viewing photos of ikebana on anxiety and respiratory responses. For controls, we used photos of ikebana that were artificially changed from real, beautiful photos to non-beautiful altered photos. Participants\u27 sense of beauty was measured by a visual analogue scale (VAS). Values were significantly higher while viewing the real photos compared to altered photos (P < 0.05). The VAS score differences between the real and altered photos were also significantly higher in subjects with low trait anxiety (P < 0.05). There was no significant change in respiratory rate (RR) between subjects viewing real and retouched photos. However, the mean difference in RR when viewing real photos compared to retouched photos was higher in subjects with low trait anxiety scores. There was no correlation between VAS score differences and trait anxiety scores. However, differences in RR when viewing real photos compared to viewing retouched photos had a significantly negative correlation (P < 0.05). Results indicated that RR was slower when viewing photos of ikebana in subjects with higher trait anxiety. Our findings suggest that viewing beautiful things may relax individuals who have high anxiety

N -Ethyl- N -Nitrosourea Induces Retinal Photoreceptor Damage in Adult Rats

Seven-week-old male Lewis rats received a single intraperitoneal injection of N-ethyl-N-nitrosourea (ENU) (100, 200, 400 or 600 mg/kg), and retinal damage was evaluated 7 days after the treatment. Sequential morphological features of the retina and retinal DNA damage, as determined by a TUNEL assay and phospho-histone H2A.X (γ-H2AX), were analyzed 3, 6, 12, 24 and 72 hr, 7 days, and/or 30 days after 400 mg/kg ENU treatment. Activation of the nuclear enzyme poly (ADP-ribose) polymerase (PARP) was analyzed immunohistochemically by poly (ADP-ribose) (PAR) expression in response to DNA damage of the retina. All rats that received ≥ 400 mg/kg of ENU developed retinal degeneration characterized by the loss of photoreceptor cells in both the central and peripheral retina within 7 days. In the 400 mg/kg ENU-treated rats, TUNEL-positive signals were only located in the photoreceptor cells and peaked 24 hr after ENU treatment. The γ-H2AX signals in inner retinal cells appeared at 24 hr and peaked at 72 hr after ENU treatment, and the PAR signals selectively located in the photoreceptor cell nuclei appeared at 12 hr and peaked at 24 hr after ENU treatment. However, degeneration was restricted to photoreceptor cells, and no degenerative changes in inner retinal cells were seen at any time points. Retinal thickness and the photoreceptor cell ratio in the central and peripheral retina were significantly decreased, and the retinal damage ratio was significantly increased 7 days after ENU treatment. In conclusion, ENU induced retinal degeneration in adult rats that was characterized by photoreceptor cell apoptosis through PARP activity

乳癌縮小手術患者の術式選択時の情報提供のための回復過程の比較

乳癌患者が術式選択を行う場合の情報提供の資料とすることを目的に，乳房温存術（温存術）・胸筋温存乳房切除術（切除術）を受け，術後回復状態を３カ月間縦断的に観察しえたケース３９例において，温存術群（２１例）と切除術群（１８例）の２群にわけ，その２群間の比較を肩関節可動域・握力・創部ドレーン抜去日・胸部の疼痛と日常生活動作で行った．その結果，肩関節可動域は，切除術群・温存術群ともに，前方挙上，後方挙上・側方挙上のすべてにおいて統計的に有意差を認めなかった．しかし，術後１週目には温存術・切除術ともに肩関節可動域は一番低下し，その後３カ月をかけ徐々に回復する経過をたどった．一方，握力は，切除術群の２週目に有意に低下し，切除術は上肢筋力に関して手術侵襲の影響がみられた．術式別の創部ドレーン抜去日および日常生活動作においては，有意差はなかった．術後４週目の創部の動作時の疼痛が，切除術群に比べ温存術群においては「ある」と回答したものが多く，放射線療法による影響が考えられた．乳癌術前患者の術式選択に際しては，単に生存率のみの情報だけでなく，２つの術式には術後の肩関節可動域の制限の程度には差がないこと，温存術に比べ侵襲の比較的大きい切除術では術後２週目に握力の低下を認めること，放射線療法をおこなう温存術では創部の動作時の疼痛の認める例があることなどの，術式により回復のプロセスの違いがある点も情報提示し，対象者のライフスタイルに合わせた術式選択が可能となるよう支援していくことが重要であると考える．The present study was undertaken to collect data to be utilized for informed choice of operative procedure by patients with breast cancer. The subjects of this study were 39 patients who were followed for 3 months after breast-conserving surgery (the breast conserving group, 21 cases) or pectoral muscle-conserving mastectomy (the mastectomy group, 18 cases). The shoulder joint ROM (range of motion), grip, length of time until withdrawal of the drain, chest pain and activity of daily living (ADL) were compared between the two groups. There was no significant difference in shoulder joint ROM in any direction (anterior, posterior or lateral elevation of the joint) between the breast conserving group and the mastectomy group. In both groups, the shoulder joint ROM was minimal one week after surgery and later recovered gradually over 3 months. Grip was significantly lower in the mastectomy group two weeks after surgery, as compared to the breast-conserving group, suggesting influence of operative stress on the arm muscle strength in the mastectomy group. In terms of the ADL and the length of time from surgery to withdrawal of the drain, there was no significant difference between the two groups. Four weeks after surgery, a higher percentage of patients in the mastectomy group answered to have pain during motion of the surgical wound, as compared to the breast-conserving group, probably reflecting the influence of radiotherapy. These results suggest that when providing information to patients with breast cancer to allow selection of an operative procedure, information should be provided not only concerning expected survival rates, but also about similarities and differences in postoperative recovery between the two procedures, including for example the following information :（1）the degree of restriction of shoulder joint ROM does not differ between the two procedures ; （2）grip may decrease two weeks after pectoral muscle-conserving mastectomy which is more invasive than breast-conserving surgery ; and（3）pain during motion of the wound is sometimes complained after breast-conserving surgery which is combined with radiotherapy. It seems essential to help individual patients select a procedure tailored to their life style on the basis of these pieces of information

乳癌縮小手術患者の肩関節可動域の回復遅延に関わる要因の分析

本研究は，乳癌で胸筋切除を伴わない縮小手術を受けた患者の肩関節の可動域の回復遅延ケースにおける，回復遅延に関わる要因を明らかにし，術後の機能回復訓練時の患者指導に活かすことを目的とした．対象は乳房温存術や胸筋温存乳房切除術を受けた乳癌術後患者３９名で，機能回復訓練を術後１２週間縦断的に観察しえたケースにおいて，肩関節可動域の回復状態を良好群と遅延群の２群にわけ，その２群間の比較を，肩関節可動域や疼痛・日常生活動作から観察した．その結果，遅延群ケースから肩関節可動域の回復に関わる主要因として，創部の動作時の疼痛が考えられ，２つめの要因としてこの動作時の疼痛の発生により術後必要とされる運動を行わないことで，さらに回復を遅延させていることが考えられた．よって，動作時の疼痛を訴え，肩関節可動域の回復の遅れを認める例には，機能回復訓練状態の観察と術後１２週目までの継続的な運動の必要性の指導のほかに，肩関節可動域訓練を看護師が患者とともに一緒に行うという確実な実施が，肩関節の可動域の回復遅延の予防となると考えられた．The present study was undertaken to identify factors responsible for delay in recovery of the shoulder joint ROM (range of motion) after minimally invasive surgery for breast cancer (i.e., surgery not involving pectoral muscle excision), with the goal of facilitating better postoperative rehabilitation. The subjects of this study were 39 patients who were followed during 12 weeks of functional rehabilitation after breast-conserving surgery or pectoral muscle-conserving surgery for breast cancer. They were divided into the good recovery group and the delayed recovery group according to the smoothness in recovery of shoulder joint ROM. Shoulder joint ROM, pain and activity of daily living (ADL) were compared between these two groups. Analysis of the data from the delayed recovery group allowed us to identify the pain during movement of the surgical wound as a leading factor affecting the recovery of shoulder joint ROM. Failure to practice exercise after surgery due to pain during motion of the wound was identified as the second leading cause for delayed recovery. These results suggest that in cases where postoperative recovery in should joint ROM is delayed, recovery may be facilitated by monitoring the progress of rehabilitation, advising the patient to continue exercise until day 12 after surgery and guiding the patient to practice shoulder joint ROM training with the help of the nurse