Joint Symptoms, Aromatase Inhibitor-Related Adverse Reactions, Are Indirectly Associated with Decreased Serum Estradiol

Background. Joint symptoms (JSs) are problematic adverse drug reactions (ADRs) of aromatase inhibitors (AIs). Involvement of decreased serum estradiol (SE) has been suggested. Patients and Methods. 104 postmenopausal breast cancer patients administered an AI were prospectively investigated regarding various clinical parameters, JS and hot flashes as ADRs, and the SE level. Results. JS manifested in 31.7% of patients and hot flashes in 18.3%. Chi-square testing showed a significantly higher incidence of JS in several patient strata: <55 years old, decreased SE, and elevated total cholesterol (TC). In univariate analysis, JS correlated significantly with a pre-AI % YAM of ≥80%, decreased SE, and elevated TC. Eight (7.7%) patients maintained SE at ≥5 pg/mL for >6 consecutive months, with no JS. In chi-square testing, hot flashes showed a significantly higher incidence in patients <55 years old. Conclusion. AI-ADRs occurred more readily in younger patients. Decreased SE may be indirectly involved in JS

A case of advanced breast cancer with spinal palsy due to cervical bone metastasis who was improved a quality of life by emergent multidisciplinary oncological salvage

A ６０s female complained of right thigh pain caused by bone metastasis from advanced breast cancer. She was introduced to our ward for systemic therapy with palliative radiation to painful osteolytic lesion in the right femur. She suddenly complained of serious pain and motility disturbance in the right upper-extremity two days after her admission. Magnetic resonance imaging（MRI）suggested bone metastasis in the ３rd cervical vertebra which compressed spinal cord. We discussed about an optimal treatment with the orthopedic surgeon and the radiation therapeutic physician, and laminectomy was scheduled promptly. She also had a right femur fracture a day before her planed laminectomy, so she underwent osteosynthesis of the femur together with laminectomy of the cervical vertebra. She also received the irradiation to the ３rd cervical vertebra and the shaft of right femur. She became able to eat with a spoon by herself and her activity of daily living（ADL）have fully recovered by daily rehabilitation. She is receiving chemotherapy in our out-patient clinic now. We recognized that an emergent oncological treatment for the spinal decompression by the bone metastasis could improve the patients’ quality of life（QOL）to avoid the permanent paralysis and also their prognoses

Actual condition of lymphedema prevention behavior of postoperative breast cancer patients without lymphedema

本研究では，リンパ浮腫未発症の乳がん術後患者におけるリンパ浮腫予防行動の実態調査を行った．対象者は乳房部分切除および腋窩リンパ節郭清を行った乳がん術後患者で，現在外来通院中のリンパ浮腫未発症患者４０名に構成的質問紙調査と，その内の２１名に面接調査を実施した．結果，リンパ浮腫に関する知識の「リンパ浮腫の病因」，「リンパ浮腫の治療」，「リンパ浮腫の改善方法」，「生活上の注意」，「リンパ浮腫をみた経験」の知識に関して知っているかどうかにより「リンパ浮腫予防法実施状況」で有意差が認められ，継続できるか否かに差があることが示された．また，「リンパ浮腫予防法の数」との間でも有意差が認められ，知識に関して知っているかどうかにより予防法の数に差があることが示された．リンパ浮腫に対する認識および予防行動に対する認識において，それぞれ４つのカテゴリーが抽出された．以上の結果より，未発症患者であるからこそ，自身の体に関心を向け継続していく力をいかにつけていくことが重要となる．そのためにも，患者が体験する日常生活の中から予防法を考案していくことや，実感を伴いながら，知識を意味づけられる予防行動に関する指導を考案していくことが継続の支援に必要である．In the present study, a survey of the actual condition of the lymphedema prevention behavior in postoperative breast cancer patients who had not developed lymphedema was performed．A structured questionnaire survey was conducted involving ４０ postoperative breast cancer patients currently receiving outpatient care, and who had undergone partial mastectomy and axillary lymph node dissection, but had not developed lymphedema； ２１ of these patients were also interviewed．The results showed significant differences in the “status of implementation of measures for preventing lymphedema” based on “knowing” or “not knowing” information regarding lymphedema, specific information regarding “etiology of lymphedema”， “ treatment of lymphedema”， “methods for improving lymphedema”， “precautions in lifestyle”, and “noticing signs of lymphedema”, with differences in whether these measures could be continued．In addition, significant differences were also observed for “number of measures for preventing lymphedema”, with differences being observed in the number of preventive measures based on “knowing” or “not knowing” the information．A total of four categories each was identified for awareness of lymphedema and awareness of preventive measures．These results indicate that finding ways to develop the ability to continue self-care is important in patients who have not developed lymphedema for the very reason that they have not yet developed lymphedema．It is also important to provide both support for continuation by devising prevention methods based on the patients’ daily lives and guidance related to prevention behavior that attaches actual feelings

イデンセイ ニュウガン ニツイテ

Hereditary breast cancer and/or ovarian cancer （HBOC） has been closed up in Japan. But few were known about the disease. HBOC is known as a syndrome that causes breast and ovarian cancer at exceptionally high rate in patients who have genetic mutations in BRCA １ or ２. The population of the Genetic/familial high risk breast and/or ovarian cancer is not low rate even in Japan if compared with the Western population. Important thing is recognize the fact that HBOC is not rare in Japan and perform a screening detailed family history if the patient has family history. We can evaluate the risk by genetic test and offer the preventive strategies like an intensive screening with MRI, chemoprevention and prophylactic mastectomy before the occurrence of cancer for the carrier. Genetic counseling service by the authorized doctor and counselor has been started in our institute. Genetic screening of BRCA１/２ mutation can be taken in Tokushima University Hospital

A multidisciplinary approach in palliative care for the patient with advanced phyllodes tumor

The case subject was a woman in her５０s who consulted her local clinic for the chief complaint of pain extending from the left buttock to the lower leg. A sacral lesion and giant mass in the right breast were observed, and thus on suspicion of breast cancer the subject was referred to our department. The results of needle biopsy led to the definite diagnosis of malignant phyllodes tumor. At the start of treatment the subject presented markedly reduced activities of daily living due to the pain, and upon the introduction of opioids, and performing palliative irradiation for the sacral metastasis, the pain was successfully alleviated relatively quickly. During this period, the primary lesion became ulcerated and progression of anemia was also observed, and therefore upon applying metronidazole ointment and commencing irradiation for the right breast, therapeutic effects such as tumor regression and control of anemia progression were observed. After the initial consultation the subject expressed severe anxiety, and thus intervention was requested from a nurse specialist in cancer care, who sat with the patient when her condition was explained, and listened closely to her anxiety. Thereafter, ２ courses of epirubicin and cyclophosphamide therapy as systemic chemotherapy were administered, however the disease progressed. The subject desired to receive care at a local medical institution, and thus it was decided with the help of a social worker that she be transferred to a hospice in the short-term

Thirty percent of ductal carcinoma in situ of the breast in Japan is extremely low-grade ER(+)/HER2(-) type without comedo necrosis

Background Overdiagnosis in mammography (MMG) is a problem. Combination of MMG and ultrasonography for breast cancer screening may increase overdiagnosis. Most cases of overdiagnosis are low-grade ductal carcinoma in situ (LGD), but no reports have focused on them. Materials and methods We immunostained 169 ductal carcinoma in situ (DCIS) cases for ER, PgR, HER2 and Ki67 and classified them into 4 subtypes : ER(+)/ HER2(-), ER(+)/HER2(+), ER(-)/HER2(-) and ER(-)/HER2(+). The Ki67 index was used to evaluate the grade of malignancy and examined for correlations with each ER/HER2 subtype and the nuclear grade (NG), with/without comedo necrosis. Results The Ki67 index correlated significantly with NG, both with/without comedo necrosis, and reliably evaluated the grade of malignancy. The index for ER(+)/HER2(-) (n=117, 69.2%) was 7.45±7.10, which was significantly lower than for each of the other types. The index was 5.71±6.94 for ER(+)/HER2(-) without comedo necrosis (n=52, 30.8%), which was significantly lower than with comedo necrosis. This was considered LGD, characterized by absence of microcalcification in MMG and either presence of a solid mass or cystic lesion or absence of hypoechoic areas in ultrasound. Conclusion In Japan, ER(+)/HER2(-) without comedo necrosis accounts for about 30% of DCIS and is LGD. This may be being overdiagnosed

Erlotinib デ induction therapy オ オコナッタ IIIAキ ヒショウサイボウ ハイガン ノ 1シュジュツレイ

［Background ］Erlotinib, epidermal growth factor receptor-tyrosine kinase inhibitor（EGFR-TKI）, is effective for advanced and metastatic non-small cell lung cancer（NSCLC）with EGFR mutation. However, the report of Erlotinib as induction therapy is rare. We report a surgical case of NSCLC with Erlotinib as induction therapy. ［Case ］A４１-years-old man, diagnosed left lung adenocarcinoma with EGFR mutation（exon１９deletion）, was referred to our hospital. CT showed that the tumor was ３５mm in S８ of the left lung and ＃７ lymphnode was swelling markedly（cT２aN２M０ stage ⅢA）. He took Erlotinib（１５０mg／day）for１２weeks at first because of EGFR mutation positive. The evaluation of Erlotinib was partial response in RESIST. He could take radical operation as lower lobe and lingual segment resection, because CT showed bulky ＃７got smaller significantly. There was no postoperative complication. The pathological finding was adenocarcinoma（papillary& acinartype）, PL０, v（＋）, ly（＋）, br（－）, pa（－）, pv（－）, Ef :１b,（ypT１aN２M０stage ⅢA）. He has taken adjuvant therapy（Erlotinib１５０mg／day）for２８weeks. There is no recurrence six months after operation. ［Conclusion ］It is possible that Erlotinib as induction-therapy is very effective in patients with EGFR mutation like this case ; however there is no evidence of EGFR-TKI as induction therapy. It is necessary to validate the effectiveness of Erlotinib as induction therapy

三重県南島町の若いウバメガシ林の物質生産

三重県南島町で若いウバメガシ林分の物質生産について調査した。試料木11本を伐倒し,層別刈取り法で測定した。単位面積当たりの諸量は相対成長関係式と標準地の毎木調査結果とから計算した。本調査林分は林齢約25年生(樹齢10～39年生),優勢木平均樹高4.9mであった。地上部現存量(幹枝95.O t/haと葉9.05 t/ha)は多くないが,地上部現存量密度は2.1 kg/m3という高木林を凌ぐ大きな値を示した。葉現存量(9.60t/ha,シダ0.55 t/haを含む)は他のウバメガシ林と差がなかった。積上げ法で推定した地上部純生産量は21.2t/ha/yrに達した。この値は日本の照葉樹林の平均値と同じである。葉の垂直分布は,最上層に葉現存量の58%を占める最多層があり,その直下層を含めた厚さ2m層に96%の葉が集中した。典型的な広葉草本型生産構造を示した。SLA(1g当たり葉面積)の小さい葉がつく2層に葉現存量が集中するため,林分のLAI(4.83;シダは0.91)は小さかった。しかし,このような単層群落にもかかわらず高い純生産を示したことは注目される。炭素量に換算すると現存量が59 t C/ha(生体53tC/ha,リター6 t C/ha),純生産量11 t C/ha/yrと見積もられた。We quantified dry matter production in a young stand of Quercus phillyraeoides by destructively sampling the aboveground components of eleven trees and using the dry weight and weight growth rate of each component of each tree to develop relationships between DBH^2 and various tree components. These relationships were then applied to DBH data within a quadrat to quantify aboveground biomass and annual production rate for the stand. The weight growth rates of stem and branches were obtained from the bulk density and growth rates in volume measured by the stem analysis, that is, the measurement of the thinking growth between tree rings. The age of the sampled trees ranged from 10 to 39 yr with an arithmetic mean of 25 yr. Dominant tree height was 4.9 m. The aboveground biomass was relatively low at 104.1 t/ha. However, the aboveground biomass density (dry weight divided by the 3-D space occupied by the stand) was 2.1 kg/m3, which is higher than for mature stands of various tree species. Total leaf biomass for the stand (i.e., when understorey was included) was 9.60 t/ha, similar to leaf biomass values for mature Q. phillyraeoides stands. By summing the annual production rates of each component, we estimated the aboveground net production rate to be 21.2 t/ha/yr, which is typical for the lucidophyllous forests in Japan. Leaf biomass density of the stand was greatest in the top stratum (4.3-5.3 m aboveground) and 96% of the leaf biomass was concentrated in the top two strata (3.3-5.3 m). The leaf area index (LAI) value for the tree layer was low (4.83) because leaves were concentrated in the upper canopy in which had thick leaves or a low leaf area to dry weight ratio. Carbon storage was estimated at 59 t C/ha (53 t C/ha in live tissue, 6 t C/ha in litter) and carbon fixation at 11 t C/ha/yr

Novel Mouse Xenograft Models Reveal a Critical Role of CD4+ T Cells in the Proliferation of EBV-Infected T and NK Cells

Epstein-Barr virus (EBV), a ubiquitous B-lymphotropic herpesvirus, ectopically infects T or NK cells to cause severe diseases of unknown pathogenesis, including chronic active EBV infection (CAEBV) and EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH). We developed xenograft models of CAEBV and EBV-HLH by transplanting patients' PBMC to immunodeficient mice of the NOD/Shi-scid/IL-2Rγnull strain. In these models, EBV-infected T, NK, or B cells proliferated systemically and reproduced histological characteristics of the two diseases. Analysis of the TCR repertoire expression revealed that identical predominant EBV-infected T-cell clones proliferated in patients and corresponding mice transplanted with their PBMC. Expression of the EBV nuclear antigen 1 (EBNA1), the latent membrane protein 1 (LMP1), and LMP2, but not EBNA2, in the engrafted cells is consistent with the latency II program of EBV gene expression known in CAEBV. High levels of human cytokines, including IL-8, IFN-γ, and RANTES, were detected in the peripheral blood of the model mice, mirroring hypercytokinemia characteristic to both CAEBV and EBV-HLH. Transplantation of individual immunophenotypic subsets isolated from patients' PBMC as well as that of various combinations of these subsets revealed a critical role of CD4+ T cells in the engraftment of EBV-infected T and NK cells. In accordance with this finding, in vivo depletion of CD4+ T cells by the administration of the OKT4 antibody following transplantation of PBMC prevented the engraftment of EBV-infected T and NK cells. This is the first report of animal models of CAEBV and EBV-HLH that are expected to be useful tools in the development of novel therapeutic strategies for the treatment of the diseases