Oral Health Management of Three Head and Neck Cancer Patients Performed by Dental Hygienists

Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.

The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in early phase of cutting maneuvers in female athletes

Background:Combined knee valgus and tibial internal rotation(VL+IR)moments have been shown to stress the anterior cruciate ligament(ACL)in several in vitro cadaveric studies.To utilize this knowledge for non-contact ACL injury prevention in sports,it is necessary to elucidate how the ground reaction force(GRF)acting point(center of pressure(CoP))in the stance foot produces combined knee VL+IR moments in risky maneuvers,such as cuttings.However,the effects of the GRF acting point on the development of the combined knee VL+IR moment in cutting are still unknown.Methods:We first established the deterministic mechanical condition that the CoP position relative to the tibial rotational axis differentiates the GRF vector’s directional probability for developing the combined knee VL+IR moment,and theoretically predicted that when the CoP is posterior to the tibial rotational axis,the GRF vector is more likely to produce the combined knee VL+IR moment than when the CoP is anterior to the tibial rotational axis.Then,we tested a stochastic aspect of our theory in a lab-controlled in vivo experiment.Fourteen females performed 60˚cutting under forefoot/rearfoot strike conditions(10 trials each).The positions of lower limb markers and GRF data were measured,and the knee moment due to GRF vector was calculated.The trials were divided into anterior-and posterior-CoP groups depending on the CoP position relative to the tibial rotational axis at each 10 ms interval from 0 to 100 ms after foot strike,and the occurrence rate of the combined knee VL+IR moment was compared between trial groups.Results:The posterior-CoP group showed significantly higher occurrence rates of the combined knee VL+IR moment(maximum of 82.8%)at every time point than those of the anterior-CoP trials,as theoretically predicted by the deterministic mechanical condition.Conclusion:The rearfoot strikes inducing the posterior CoP should be avoided to reduce the risk of non-contact ACL injury associated with the combined knee VL+IR stress.

Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the ho-moscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital’s own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.

Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of Length of Hospital Stay for Type 2 Diabetes Patients by Individual Hospital

We evaluated the effects of the 2010 revision of the medical payment system on the length of stay (LOS). In this analysis, we assessed not only the average length of stay (ALOS), but also variance of LOS at individual hospitals. We used a dataset of 18,641 type 2 diabetes patients collected from 51 general hospitals. The variables found to affect LOS were age, comorbidities, complications, acute hospitalization, introduced by other hospitals, winter, one-week hospitalization, specific hospitalization period, and principal diseases coded E11.5, E11.6 and E11.7. Although the effect was marginal, the 2010 revision did reduce ALOS, and the reduction was larger as ALOS became longer. On the other hand, we did not find that the variance of LOS within hospitals became smaller. The results of the study suggest that new incentives and assistance to hospitals to help them make efficient use of medical information are needed.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease,accompanied by oral inflammation and pathological changes in the microbiome,induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease(NAFLD).A subgroup of NAFLD patients have a severely progressive form,namely nonalcoholic steatohepatitis(NASH),which is characterized by histological findings that include inflammatory cell infiltration and fibrosis.NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma.The oral microbiota may serve as an endogenous reservoir for gut microbiota,and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis.Gut dysbiosis increases the production of potential hepatotoxins,including lipopolysaccharide,ethanol,and other volatile organic compounds such as acetone,phenol and cyclopentane.Moreover,gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall,leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation.In particular,many animal studies support that oral administration of Porphyromonas gingivalis,a typical periodontopathic bacterium,induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis.NAFLD,also known as the hepatic phenotype of metabolic syndrome,is strongly associated with metabolic complications,such as obesity and diabetes.Periodontal disease also has a bidirectional relationship with metabolic syndrome,and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively.In this review,we will describe the link between periodontal disease and NAFLD with a focus on basic,epidemiological,and clinical studies,and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome.In conclusion,it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease,gut microbiota,and metabolic syndrome.Thus,the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics,prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo

Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed;CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms;the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%;7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.

An Econometric Analysis of Hospital Length of Stay for Cataract Operations in Japan by the Box-Cox Transformation Model and Hausman Tests: Evaluation of the 2010 Revision of the Medical Payment System

The Japanese medical costs for cataract treatments reached 270 billion yen in fiscal year 2012. Since the length of stay (LOS) in hospital is much longer than other major countries, controlling the medical costs by reducing LOS becomes an important issue in Japan. In this paper, we evaluated the effects of the 2010 revision of the Japanese medical payment system (DPC/PDPS) on LOS for cataract operations. The Box-Cox transformation model, Nawata’s estimators and Hausman tests were used in the analysis. To evaluate the effects, we analyzed a dataset obtained from 34 DPC hospitals (Hp1-34) where one-eye cataract operations were performed both before (April 2008-March 2010) and after (April 2010-March 2012) the 2010 revision and there were more than 500 patients. The dataset contained information from 32,593 patients. We did not admit the effect of the 2010 revision in this study, and there were large differences LOS among hospitals, even after removing the influences of factors such as patient characteristics and types of principal diseases.

Dental Implant Patients Grouped by the Brinkman Index: Their Attitude toward Smoking, Nicotine Dependence, and Knowledge of Peri-Implantitis

Purpose: This study investigated the attitude of patients, grouped by the Brinkman index, towards smoking by using the Kano Test for Social Nicotine Dependence (KTSND) and their knowledge of peri-implantitis. Methods: The participants were 3093 new patients who visited the Tokyo Medical and Dental University Hospital from January 2012 to December 2013 for an oral implant. The methodology included a questionnaire about sex, age, smoking status, daily average number of cigarettes, years of smoking, knowledge of peri-implantitis, and the KTSND. The patients were grouped according to their smoking status by calculating their Brinkman index (over 200 or not): current smokers with the possibility of nicotine dependence (BI(+)CS), current smokers with no possibility of nicotine dependence (BI(-)CS), ex-smokers (ES), and non-smokers (NS). The Brinkman index is obtained by multiplying one’s daily average number of cigarettes by the number of years they have been smoking. Results: Data were collected from 2182 respondents (response rate = 71%). The KTSND scores of BI(+)CS (16.89 ± 4.26) were significantly higher than the scores of ES (11.99 ± 4.52) and NS (11.53 ± 5.01). In current smokers, there were no significant differences between BI(+)CS and BI(-)CS. The patients replied “I don’t know” about peri-implantitis most often in all groups;however, there were no significant differences between the groups. Discussion: BI(+)CS were more dependent on nicotine in social situations than the other groups were. In Japan, a Brinkman index over 200 is required for a nicotine-dependence management fee to be instituted for health insurance treatment. This is a major concern for young smokers, who may be excluded from treatment because their years of smoking are substantially less. Results revealed that there were no significant differences between BI(+)CS and BI(-)CS. Therefore, it was suggested that the Brinkman index did not sufficiently group the participants.

Phylobone: a comprehensive database of bone extracellular matrix proteins in human and model organisms

The bone extracellular matrix(ECM) contains minerals deposited on highly crosslinked collagen fibrils and hundreds of noncollagenous proteins. Some of these proteins are key to the regulation of bone formation and regeneration via signaling pathways,and play important regulatory and structural roles. However, the complete list of bone extracellular matrix proteins, their roles, and the extent of individual and cross-species variations have not been fully captured in both humans and model organisms. Here, we introduce the most comprehensive resource of bone extracellular matrix(ECM) proteins that can be used in research fields such as bone regeneration, osteoporosis, and mechanobiology. The Phylobone database(available at https://phylobone.com) includes 255proteins potentially expressed in the bone extracellular matrix(ECM) of humans and 30 species of vertebrates. A bioinformatics pipeline was used to identify the evolutionary relationships of bone ECM proteins. The analysis facilitated the identification of potential model organisms to study the molecular mechanisms of bone regeneration. A network analysis showed high connectivity of bone ECM proteins. A total of 214 functional protein domains were identified, including collagen and the domains involved in bone formation and resorption. Information from public drug repositories was used to identify potential repurposing of existing drugs. The Phylobone database provides a platform to study bone regeneration and osteoporosis in light of(biological) evolution,and will substantially contribute to the identification of molecular mechanisms and drug targets.

Isolation and characterization ofβ-transducin repeat-containing protein ligands screened using a high-throughput screening system

β-transducin repeat-containing protein(β-TrCP)is an F-box protein subunit of the E3 Skp1-Cullin-F box(SCF)type ubiquitin-ligase complex,and provides the substrate specificity for the ligase.To find potent ligands ofβ-TrCP useful for the proteolysis targeting chimera(PROTAC)system usingβ-TrCP in the future,we developed a high-throughput screening system for small moleculeβ-TrCP ligands.We screened the chemical library utilizing the system and obtained several hit compounds.The effects of the hit compounds on in vitro ubiquitination activity of SCFβ-TrCP1 and on downstream signaling pathways were examined.Hit compounds NPD5943,NPL62020-01,and NPL42040-01 inhibited the TNFα-induced degradation of IκBαand its phosphorylated form.Hence,they inhibited the activation of the transcription activity of NF-κB,indicating the effective inhibition ofβ-TrCP by the hit compounds in cells.Next,we performed an in silico analysis of the hit compounds to determine the important moieties of the hit compounds.Carboxyl groups of NPL62020-01 and NPL42040-01 and hydroxyl groups of NPD5943 created hydrogen bonds withβ-TrCP similar to those created by intrinsic target phosphopeptides ofβ-TrCP.Our findings enhance our knowledge of useful small molecule ligands ofβ-TrCP and the importance of residues that can be ligands ofβ-TrCP.

Distribution of splenic artery lymph nodes and splenic hilar lymph nodes

BACKGROUND Total gastrectomy with splenectomy is the standard treatment for advanced proximal gastric cancer with greater-curvature invasion.As an alternative to splenectomy,laparoscopic spleen-preserving splenic hilar lymph node(LN)dissection(SPSHLD)has been developed.With SPSHLD,the posterior splenic hilar LNs are left behind.AIM To clarify the distribution of splenic hilar(No.10)and splenic artery(No.11p and 11d)LNs and to verify the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical standpoint.METHODS Hematoxylin&eosin-stained specimens were prepared from six cadavers,and the distribution of LN No.10,11p,and 11d was evaluated.In addition,heatmaps were constructed and three-dimensional reconstructions were created to visualize the LN distribution for qualitative evaluation.RESULTS There was little difference in the number of No.10 LNs between the anterior and posterior sides.For LN No.11p and 11d,the anterior LNs were more numerous than the posterior LNs in all cases.The number of posterior LNs increased toward the hilar side.Heatmaps and three-dimensional reconstructions showed that LN No.11p was more abundant in the superficial area,while LN No.11d and 10 were more abundant in the deep intervascular area.CONCLUSION The number of posterior LNs increased toward the hilum and was not neglectable.Thus,surgeons should consider that some posterior No.10 and No.11d LNs may remain after SPSHLD.

Using choroidal thickness to detect myopic macular degeneration

AIM:To explore the usage of choroidal thickness measured by swept-source optical coherence tomography(SS-OCT)to detect myopic macular degeneration(MMD)in high myopic participants.METHODS:Participants with bilateral high myopia(≤−6 diopters)were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.SS-OCT was performed to determine the choroidal thickness,and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia(META-PM)Classification.Presence of MMD was defined as META-PM category 2 or above.RESULTS:A total of 568 right eyes were included for analysis.Eyes with MMD(n=106,18.7%)were found to have older age,longer axial lengths(AL),higher myopic spherical equivalents(SE),and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study(ETDRS)grid sector(P<0.001).The area under the receiver operating characteristic(ROC)curves(AUC)for subfoveal choroidal thickness(0.907)was greater than that of the model,including age,AL,and SE at 0.6249,0.8208,and 0.8205,respectively.The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD(AUC of 0.928 and 0.923,respectively).An outer nasal sector choroidal thickness of less than 74μm demonstrated the highest odds of predicting MMD(OR=33.8).CONCLUSION:Choroidal thickness detects the presence of MMD with high agreement,particularly of the inner and outer nasal sectors of the posterior pole,which appears to be a biometric parameter more precise than age,AL,or SE.

E2FBP1 antagonizes the p16^(INK4A)-Rb tumor suppressor machinery for growth suppression and cellular senescence by regulating promyelocytic leukemia protein stability

Cellular senescence is an irreversible cell cycle arrest triggered by the activation of oncogenes or mitogenic signaling as well as the enforced expression of tumor suppressors such as p53, p16INK4A and promyelocytic leukemia protein （PML） in normal cells. E2F-binding protein 1 （E2FBP1）, a transcription regulator for E2F, induces PML reduction and suppresses the formation of PML-nuclear bodies, whereas the down-regulation of E2FBP1 provokes the PML-dependent premature senescence in human normal fibroblasts. Here we report that the depletion of E2FBP1 induces the accumulation of PML through the Ras-dependent activation of MAP kinase signaling. The cellular levels of p16INK4A and p53 are elevated during premature senescence induced by depletion of E2FBP1, and the depletion of p16INK4A, but not p53 rescued senescent cells from growth arrest. Therefore, the premature senescence induced by E2FBP1 depletion is achieved through the pl6INK4A-Rb pathway. Similar to human normal fibroblasts, the growth inhibition induced by E2FBP1 depletion is also observed in human tumor cells with intact p16INK4A and Rb. These results suggest that E2FBP1 functions as a critical antagonist to the pI6INK4A-Rb tumor suppressor machinery by regulating PML stability.

VEGFR-3 ligand-binding and kinase activity are required for lymphangiogenesis but not for angiogenesis

尽管 VEGFR-3 缺乏破坏血脉管的开发在早 embryogenesis 期间，内在的机制不是清楚的。在 angiogenesis 和 lymphangiogenesis 描绘它的函数，我们在这研究雇用了二个遗传上修改的鼠标模特儿，与一个 inactivation 点变化(Vegfr3TKmut ) 为 ligand 有约束力的域(Vegfr3 螖 L BD ) 或酷氨酸 kinase 域指向编码区域。我们证明淋巴的生长在 Vegfr3 螖 L BD/螖 L BD 和 Vegfr3TKmut/TKmut 老鼠被破坏，但是血容器在胚胎和蛋黄囊通常发展了。有趣地在 Vegfr3 螖 L BD/螖 L BD 然而并非 Vegfr3TKmut/TKmut 老鼠，淋巴囊是在场的，但是有发芽的 lymphangiogenic 的缺乏。我们进一步证明 VEGFR-3 的野类型、变异的形式能与 VEGFR-2 形成 heterodimers，并且减少在 endothelial 房间的 phospho-VEGFR-2 和下游的 phospho-Erk1/2 的水平当他们与 VEGF 被对待时 -- 一。这些调查结果显示发信号由它的血缘的 ligands (VEGF-C/-D ) 经由 VEGFR-3 激活调停了没为 angiogenesis 被要求，并且那 VEGFR-3 可以由 modulating VEGFR-2-mediated 信号在这个过程起一个作用。

Association between Diabetes Mellitus and Oral Health Status in Japanese Adults

Aim The objective of this study was to analyze the oral health among Japanese adults, with and without diabetes mellitus. Methodology The subjects were 518 community residents aged 20 to 91 years in Japan, who participated in the ＂Akita health and nutrition survey＂ and the ＂Akita dental disease survey＂, conducted in 2006. The surveys comprised a self-administered questionnaire, along with medical and dental examinations. Results Using the community periodontal index （CPI）, the mean numbers of sextants presenting codes 0, 1 and 2 were significantly lower in diabetics than non-diabetics among the 59 years or younger age group. Although the mean numbers of sextants with codes 0, 1 and 2 among the 60 to 69 years age group were lower, and sextants with a code X among the 59 years or younger age group were higher in diabetics than non-diabetics, no statistically significant differences were detected. The tendency of lower mean numbers of natural teeth and functional tooth units in diabetics than non-diabetics was observed, however no differences were statistically significant. Conclusion The outcome of periodontal disease seemed to be influenced by the diabetic state to some degree, but a clear association between diabetes and oral health status was not found.

Endocytoscopic narrow-band imaging efficiency for evaluation of inflammatory activity in ulcerative colitis

AIM:To assess the efficacy of endocytoscopic narrowband imaging(EC-NBI)for evaluating the severity of inflammation in ulcerative colitis(UC).METHODS:This retrospective study was conducted at a single tertiary care referral center.We included UC patients who underwent colonoscopy with endocytoscopy from July 2010 to December 2013.ECNBI was performed,and the images were evaluated by assessing visibility,increased vascularization,and the increased calibers of capillaries and were classified as Obscure,Visible or Dilated.Obscure was indicative of inactive disease,while Visible and Dilated were indicative of acute inflammation.This study received Institutional Review Board approval.The primary outcome measures included the diagnostic ability of EC-NBI to distinguish between active and inactive UC on the basis of histological activity.The conventional endoscopic images were classified according to the Mayo endoscopic score.A score of 0 or 1 indicated inactive disease,whereas a score of 2 indicated active disease.RESULTS:Fifty-two patients were enrolled.There was a strong correlation between the EC-NBI findings and the histological assessment(r=0.871,P<0.01).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of EC-NBI for diagnosing acute inflammation were 84.0%,100%,87.1%,100%,and 92.3%,respectively,while those for the Mayo endoscopic score were 100%,40.7%,100%,61.0%,and 69.2%,respectively.Compared with conventional endoscopy,EC-NBI was superior in diagnostic specificity,negative predictive value,and accuracy(P<0.001,P=0.001 and P=0.047,respectively).CONCLUSION:The EC-NBI finding of capillaries in the rectal mucosa was strongly correlated with histological inflammation and aided in the differential diagnosis between active and inactive UC.

Acute development of collateral circulation and therapeutic prospects in ischemic stroke

In acute ischemic stroke,collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia,and in increasing the successful recanalization rate without hemorrhagic transformation.We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome,and it disappears promptly once the effective recanalization is achieved.Contrary to the belief that collateral vessels develop over time in chronic stenotic condition,there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress,which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries.We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1,which is a known shear-stress mechanosensing protein.

Adenomyoepithelioma of the breast with malignant transformation and repeated local recurrence:A case report

BACKGROUND Adenomyoepithelioma(AME)of the breast is a rare type of benign breast tumor.Many AMEs show benign behavior,but reports of the malignant type are rare.We present the case of a patient with AME with repeated local recurrences and further malignant transformation.CASE SUMMARY A 53-year-old woman visited our hospital with a 16-mm palpable mass in the right breast.A core needle biopsy was performed.The pathological diagnosis was AME.Lumpectomy with a safety margin was performed without axillary lymph node dissection(ALND).Two years later,local recurrence developed,and the patient again underwent lumpectomy with a safety margin.The pathology showed malignant AME,and the margin was negative.Eight months later,local recurrence developed again in the same location,and a total mastectomy was performed without ALND.The pathological diagnosis was malignant AME.The patient was disease-free for three years posttreatment.CONCLUSION The treatment of AME requires caution,as it may exhibit repeated recurrences after local excision as well as malignant transformation.

Evaluation of Length of Hospital Stay Joining Educational Programs for Type 2 Diabetes Mellitus Patients: Can We Control Medical Costs in Japan?

Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital for type 2 diabetes mellitus patients who participated in educational programs to determine factors affecting LOS. Data on 991 patients obtained from 28 Red Cross hospitals in 2008 were used. For the analysis, we used the Box-Cox transformation model and Hausman test. The results revealed that patients aged 75 years and above and those with comorbidities and complications were prone to longer LOS. The analysis also revealed significant differences in LOS across the hospitals, even after controlling for patient characteristics. Finally, we applied the least squares method to determine the effects of hospital and regional factors and revealed that patients’ LOS was affected by the region’s average LOS. Regional corporations and networks appeared to be important in improving educational programs.

A case of hemangiopericytoma of the soft palate with articulate disorder and dysphagia

We report a case of hemangiopericytoma of the soft palate of 60-year-old patient, who noticed a mass of the soft palate and experienced difficulty in speaking. We found a pediculate, hard, elastic mass measuring 38 mm （cross-sectional diameter）. Computed tomography （CT） scans and dynamic magnetic resonance imaging （MRI） confirmed irregularly shaped mass and revealed a heterogeneous internal composition, consistent with vascular tumors. We excised the tumor under general anesthesia. Histopathological diagnosis was based on positive immunoreactivity of CD99 and vimentin and weak, positive staining of CD34. Three and half years following tumor excision, there is no recurrence or metastasis.