The lysosomal protease cathepsin D is associated with tumor progression in malignant tumors, but its presence in pre-malignant dysplastic cells has not been established. The purpose of this study is to evaluate the expression patterns of the cathepsin D, Ki-67, and p53 proteins in dysplastic cells in uterine cervical intraepithelial neoplasias (CINs) . In 52 patients with uterine CINs, expression of the cathepsin D, Ki-67, and p53 proteins was assessed in dysplastic cells by immunohistochemistry with monoclonal antibodies against cathepsin D, Ki-67, and p53. Immunohistochemical analysis revealed high levels of cathepsin D (>10% cathepsin D-positive dysplastic cells) in 3 of 17 cervical intraepithelial neoplasia (CIN) 1 specimens, 16 of 20 CIN2 specimens, and in all 15 CIN3 specimens. Cathepsin D expression was significantly higher in CIN2 and CIN3 specimens than in CIN1 specimens (P < 0.01) . but did not differ significantly between CIN2 and CIN3 specimens. The proportion of dysplastic cells that expressed nuclear Ki-67 was 26.41% in CIN1 specimens, 50.35% in CIN2 specimens, and 76.33% in CIN3 specimens. Ki-67-positive dysplastic cells were significantly increased in CIN2 and CIN3 specimens as compared to CIN1 specimens (P < 0.01), and in CIN3 specimens as compared to CIN2 specimens (P < 0.01) . High expression of nuclear p53 (>10% p53-positive dysplastic cells) was detected in 4 of 17 CIN1 specimens, 12 of 20 CIN2 specimens, and in 11 of 15 CIN3 specimens. Nuclear p53 expression was significantly higher in CIN2 and CIN3 specimens than in CIN1 specimens (P < 0.01), but did not differ significantly between CIN2 and CIN3 specimens. Compared to dysplastic cells in CIN1, dysplastic cells in CIN2 have an increased invasive growth potential, as shown by their increased expression of cathepsin D, a higher proliferating potential as shown by their increased expression of Ki-67, and a higher p53 expression.

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To estimate how the time taken for ophthalmological examination of outpatients varies with different ocular conditions. We recorded the start and finish times of face-to-face examinations carried out by an experienced ophthalmologist during seventy-two consecutive sessions in a general ophthalmology clinic. The survey included all regular visits of established patients ; the ocular conditions were classified into eleven groups. The analysis spanned 1557 visits. The average examination time was 4.9 min. Exminations of patients with diabetes (3.9 min) or cataract (4.0 min) were the shortest, whereas examinations of patients with strabismus / amblyopia (6.6 min) or uvea problems (6.5 min) were the lengthiest. Both diabetes and cataract are chronic diseases requiring simple regular follow-up on an annual or semiannual basis. In contrast, the ophthalmologist must take time to explain orthoptics and prognosis to strabismus / amblyopia patients. Similarly, patients with uvea problems need a detailed examination of fundus and biomicroscopy, and an explanation of their medication. Data obtained from the survey indicate that there is a characteristic amount of time spent by the ophthalmologist in patient examinations depending on the ocular condition. The variability in examination time associated with the various ocular conditions may be due to numerous factors.

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The aim of this study was to evaluate the relationship between congestive heart failure (CHF) and atrial fibrillation (AF) using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphic imaging. Ninety-two AF patients (47 male and 45 female patients ; mean age, 67±13 years) who did not suffer from structural heart disease or myocardial ischemia underwent MIBG scintigraphy. Global MIBG uptake was assessed by measuring the heart-to-mediastinal ratio (H/M) and washout rate (WR) on planar images, and the abnormal score (AS) was calculated on delayed MIBG single photon emission computed tomography images. Echocardiography was performed within a week after MIBG scintigraphy, to measure left ventricular ejection fraction (EF) and deceleration time (DT) . The AF patients were divided into four groups : patients with permanent AF with (n = 23, group A) or without (n = 19, group B) a history of CHF, and patients with paroxysmal AF with (n =19, group C) or without (n = 39, group D) a history of CHF. Results : The H/M ratio was significantly lower in group A than in other groups (2.0 ± 0.6 vs. group B : 2.7 ± 0.6, group C : 2.3 ± 0.5, and group D : 2.6 ± 0.8, P < 0.05), and in group C than in group D (P < 0.05) . Similarly, the WR was significantly higher in group A than in groups B and C (45.9 ±2.0 vs. group B : 38.9 ± 1.9 and group C : 38.4 ± 2.3, P < 0.05) . The AS was the highest in group A (19.7 ± 8.2 vs. group B : 7.1 ± 6.6, P < 0.01; group C : 11.6 ± 10.6 and group D : 13.5 ± 9.0, P < 0.05) . The DT was significantly longer in group A than in groups B and D (222.0 ± 59.4 vs. group B : 179.5 ± 49.1, P < 0.05 and group D : 177.9 ± 37.1, P < 0.01), but did not differ between groups A and C (222.0 ± 59.4 vs. 197.4 ± 51.1) . There was no difference in EF among the groups. Although CHF with AF is associated with diastolic dysfunction, the progression to permanent AF from paroxysmal AF with CHF might be caused mainly by sympathetic nerve abnormality.

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The current study was undertaken to examine the correlation between serum levels of inhibin A or inhibin B and prenatal growth. The study population consisted of 53 infants born at 25-30 weeks gestation and weighing 400-3060g (29 boys and 24 girls) . Serum inhibin A and inhibin B were determined by sandwich enzyme-linked immunosorbent assay (ELISA) at 1-18 postnatal months of age. To assess the independent association of serum inhibin A and inhibin B with all other evaluated variables, we used a backward stepwise multiple regression analysis. Independent variables were postnatal age, body weight standard deviation (SD) score at blood sampling, gestational age, birth weight and its SD score for gestational age. In male infants, birth weight SD score and postnatal months of age were associated with inhibin B concentration after adjustment for other factors (β = 0.331, P = 0.044; β = -0.513, P = 0.03) . The serum levels of inhibin B in female infants were negatively correlated with postnatal age (β = -0.524, P < 0.01) . On the other hand, there was no relationship between inhibin A and any variable of prenatal growth. These results suggest that postnatal inhibin B secretion in male infants may be affected by prenatal growth.

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In patients with two or more neoplastic lesions with similar histological features, the differentiation between primary and metastatic lesions is difficult but is essential for the determination of the appropriate treatment. We report a case of an 80-year-old man with metastatic cancer to the breast from gastric cancer without other visceral metastasis. Gastric cancer was identified by gastroendoscopy and a biopsy, and aspiration cytology from a nodular breast lesion revealed a poorly differentiated adenocarcinoma which resembled the gastric cancer. Computed tomography (CT) and magnetic resonance imaging (MRI) showed no other lesions within the body. Our initial diagnosis was double cancer of the male breast and stomach. Total gastrectomy and breast excisional biopsy with resection of the lymph nodes was performed. Histologically, there was necrosis in the center of the breast lesion, and no mammary gland tissue was present near or around the lesion. Immunohistochemical staining revealed the breast lesion was positive for carcinoembryonic antigen (CEA) and negative for the estrogen receptor (ER) and progesterone receptor (PgR), suggesting the cancer was more likely derived from the stomach. Our final diagnosis was metastasis to the breast from gastric cancer. Careful microscopic examination of cytological and histological specimens using immunohistochemical staining technology can aid the differential diagnosis of primary and metastatic carcinomas.

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