Accurate prediction of the metastatic status of lymph nodes is clinically important for selecting treatment strategies in patients with early gastric carcinoma with submucosal invasion （GCSM）. However, theclinicopathological significance of lymph node micrometastasis （LNMM） remains unclear. In this study, we aimed to determine the clinicopathological risk factors for LNMM in patients with early differentiated-type GCSM. A total of 2,773 lymph nodes resected from 103 patients with early differentiated-type GCSM who underwent curative gastrectomy from 1994 to 2006 at Showa University Hospital, were immunostained with CAM 5.2 monoclonal antibody to detect LNMM. The tumor differentiation phenotype was determined by examining the expression of human gastric mucin （HGM）, MUC6, MUC2 and CD10 in all tumors. Clinicopathological risk factors for LNMM were analyzed by univariate and multivariate logistic regression analysis. Also, the association between tumor differentiation phenotype and the status of LNMM was investigated. LNMM was detected in 14 patients （13.6％）. As a result, lymph node metastasis, including LNMM, was detected in 20 patients （19.4％） of the 103 patients. A multivariate analysis revealed that a mixed-type histology （odds ratio＝6.862） and the presence of lymphatic vessel invasion detected using D2-40 immunostaining （odds ratio＝8.907） were independent risk factors for LNMM. There was no correlation between tumor differentiation phenotype and the status of LNMM. A mixed-type histology and lymphatic vessel invasion are important risk factors for predicting the presence of LNMM in patients with early differentiated-type GCSM.

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Persistent trophoblastic disease （PTD） is known to develop after molar pregnancy in general, but there is a possibility for development in any kind of gestation. We report a case of PTD after treatment of ectopic pregnancy. A 35-year-old woman, G1P1, was underwent salpingectomy and wedge resection of right side uterine cornea, due to the rupture and continuous hemorrhaging in the abdomen. Chorionic villi were obtained from the bleeding mass in the abdominal cavity microscopically, and no abnormality was seen, such as a hydatidiform mole. Serum human chorionic gonadotropin （hCG） was once decreased to 568mIU/ml at 5 days after surgery, but it was elevated to 3,093mlU/ml within 3 weeks. Pelvic MRI and whole body CT scan were performed to determine a focus of abnormality because continuously elevated hCG was indicated. No abnormal findings were found, and PTD was finally diagnosed. We also performed DNA polymorphism analysis and confirmed biparental diploid. Single agent chemotherapy with methotrexate was administrated and hCG was decreased week by week. The levels of hCG became negative after 4 cycles of chemotherapy, and were maintained below the cut-off level thereafter. PTD has a possibility to develop from any type of gestation. It might be more important to examine serial serum hCG in order to detect development of PTD in patients with not only hydatidiform mole but also miscarriage and ectopic pregnancy.

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In type 1 diabetes mellitus （T1DM） it is said that 90％ of patients at first visit have polyuria / polyuria and 50％ of patients have weight loss, but infant type 1 diabetes often exhibits nonspecific symptoms, and it takes a time until diagnosis. We experienced infant type 1 diabetes diagnosed with poor weight gain. A case is a girl of 1 year and 6 months. She was diagnosed with diabetes mellitus at 1 year and 10 months, although it was pointed out that poor weight gain was pointed out at the medical examination and it was observed as a follow - up despite accepting multiple drinking in addition to weight loss at 1 year and 8 months. At the time of diagnosis, it was hyperosmolar hyperglycemia （HHS）. If you are aware of uncertain weight gain defects in the growth phase, you need to make inquiries carefully and actively measure blood glucose with type 1 diabetes in mind.

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This report outlines orthodontic treatment with extraction of traumatized maxillary central incisors in a patient with maxillary protrusion; this treatment led to a successful outcome based on both occlusal function and esthetic balance viewpoints. The patient, a 24-year-old man, had Angle Class Ⅱ division 1 with crowding, and had an injury in the maxillary anterior teeth about 1 year previously. His maxillary left central incisor had a history of avulsion, but a treatment plan for extraction of upper and lower premolars was considered because of favorable progress. However, the maxillary left central incisor was a pulpless tooth. Thus, after consultation with the patient, we decided to perform expedient extraction of the maxillary left and right central incisors, given the risks during and after orthodontic treatment. After the orthodontic treatment, the shape of the maxillary anterior teeth were corrected by direct filling with composite resin. The present case suggests that orthodontic treatment with low invasiveness and long-term stability may be feasible by considering teeth other than premolars, including even those that can be preserved, for expedient extraction, while maintaining balance with the patient’s aesthetic demand.

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