In recent years, numerous molecular-targeted drugs have become available for the perioperative therapy of breast cancer, bringing about a revolution in breast cancer treatment. Based on comprehensive gene expression analysis, breast cancer is classified into four subtypes, and there are limitations regarding the drugs that can be used depending on the subtype and the cancer progression. Therefore, it is necessary to identify and select the appropriate drugs for each subtype. This review explores the expanded indications of four recently available molecular-targeted drugs in breast cancer treatment.

Background: The head-down position used in laparoscopic surgery considerably influences cardiac function. However, few studies have examined systolic and diastolic functions, such as the ejection fraction (EF), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and early diastole/atrial kick ratio, in the head-down position.

Methods: This study was registered at the University Hospital Medical Information Network (UMIN; Registration No.: 46067; Date: November 13, 2021). We used transthoracic echocardiography to examine the systolic and diastolic functions of the left and right ventricles after maintaining first horizontally and next head-down positions (30°) for 5 min in 31 adult volunteers.

Results: Mean blood pressure increased by 6.4%, while left ventricular EF decreased from 70% to 63%. Similarly, MAPSE, which is strongly correlated with left ventricular EF, decreased by 11.3%. TAPSE, which correlated with right ventricular EF, increased by 8.7%. No change was observed in the early diastole/atrial kick ratio or E/E´, which reflects left ventricular diastolic function.

Conclusions: In the head-down position, the EF, percentage fractional shortening, and MAPSE, which reflect contractility, decreased, whereas TAPSE increased. No significant differences were found in the measurement items reflecting diastolic capacity.

Background: Some patients with immunoglobulin A (IgA) vasculitis develop severe disease, with severe abdominal symptoms that necessitate prolonged fasting. Moreover, no biomarkers that can predict severe disease have been clearly established.

Methods: We analyzed the data of 65 children with IgA vasculitis who were admitted to our department between 2010 and 2015. Seven patients with severe abdominal symptoms who required fasting for at least one week were classified into the fasting group, and the remaining 58 patients were classified into the non-fasting group. The clinicopathological factors were compared between the two groups.

Results: Significant differences in peripheral blood neutrophil-to-lymphocyte ratio (NLR), plasma D-dimer levels, and coagulation factor XIII activity at admission were observed between the two groups. Logistic regression analysis revealed that the NLR showed the highest odds ratio for severe abdominal symptoms (odds ratio, OR: 1.67; 95% confidence interval, CI: 1.14-2.45). The results of receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.89 for the NLR, and an optimum cutoff value of 2.8 was associated with a sensitivity of 100% and specificity of 72.5%.

Conclusion: The NLR at diagnosis is a useful marker for predicting the severity of abdominal symptoms in patients with IgA vasculitis.

Background: Acinetobacter species are environmental microorganisms that inhabit the skin and can become opportunistic pathogens in immunocompromised hosts. This study investigated the pathogenicity of proteins released extracellularly by Acinetobacter radioresistens (A. radioresistens), isolated from the small intestine of two patients with severe Kawasaki disease, in a mouse model.

Methods: The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of culture supernatants derived from Acinetobacter species showed large variations in protein compositions among species and strains. The biological effects of soluble proteins secreted by A. radioresistens were evaluated in mice by intraperitoneal injection of culture supernatants.

Results: The administration of culture supernatant derived from A. radioresistens caused weight loss, electrolyte imbalance, and decreased aldosterone levels. The sustained infiltration of the inflammatory mononuclear cells was observed in the liver of mice 6 weeks after the last administration.

Conclusions: A. radioresistens expressed virulence through its extracellular proteins, leading to acute adrenal gland insufficiency and chronic inflammation of the livers.

Background: This study aimed to analyze the characteristics and challenges of whole slide imaging (WSI) system guidelines in Japan, the United States, and Europe.

Methods: Information disseminated by academic societies in Japan, the United States, and Europe was extracted from their websites, and the WSI system guidelines were identified. Based on the classification criteria, the guidelines were grouped into six categories, and their characteristics and issues were analyzed through comparison.

Results: A total of 24 guidelines were identified: eight in Japan, 12 in the United States, and four in Europe. The first WSI system guidelines were issued in the United States, and only one was issued by a regulatory authority. While the guidelines in the United States and Europe cover all six categories, those in Japan lack coverage of funding strategies.

Conclusions: WSI system guidelines in the United States contribute to establishing regulatory and technical requirements for the clinical use of the WSI system in Japan, the United States, and Europe. This study also suggests directions for funding strategies that could contribute to the widespread adoption of WSI systems in Japan, such as monetization through joint research with companies and the utilization of grants.

Background: Neuralgic amyotrophy (NA) typically develops with neuralgia in the upper limbs and causes localized muscle atrophy after pain subsides. NA is not well known; thus, many patients face delayed diagnosis and treatment.

Methods: We evaluated the initial symptoms, symptom duration, neurological findings, impaired nerves, treatment, and sequelae in patients with NA in our department between 2010 and 2020.

Results: Ten patients had upper-limb NA. The suprascapular nerve was the most commonly affected nerve (n = 9). Needle electromyography revealed abnormal findings in all patients, and fibrillations/positive sharp waves at rest were observed in seven patients. Nerve conduction studies showed reduced motor or sensory nerve action potential amplitudes in six patients. Brachial plexus magnetic resonance imaging (MRI) revealed abnormalities in five patients. The mean duration from symptom onset to diagnosis was 142 days (median: 130 days), and the mean duration from the first visit to our department to diagnosis was 41 days (median: 20 days). Sequelae were observed in patients diagnosed 200 days after symptom onset.

Conclusion: A combination of needle electromyography of the affected muscles, nerve conduction studies, and a special MRI technique (short tau inversion recovery MRI) may support the diagnosis of NA lesions, even in the subacute to chronic phase.

Background: Work engagement is an indicator of mental health. All previous studies on the relationship between job resources (i.e., job control, supervisor support, coworker support, and career opportunities) and work engagement among physicians have been conducted in Europe; no studies have been conducted exclusively among anesthesiologists. This cross-sectional study examined the association between job resources and work engagement among Japanese anesthesiologists.

Methods: An online questionnaire was administered to anesthesiologists practicing in all certified hospitals in Japan. We analyzed data from 546 respondents (318 males, mean age 46.7 years) and assessed job resources and work engagement using the New Brief Job Stress Questionnaire and the Japanese version of the Utrecht Work Engagement Scale, respectively. We also performed hierarchical multiple regression analysis.

Results: After adjusting for demographic characteristics, job control (β = 0.16, p < 0.001), supervisor support (β = 0.13, p = 0.006), and career opportunities (β = 0.37, p < 0.001) were significantly and positively associated with work engagement. In contrast, coworker support (β = 0.06, p = 0.19) was not associated with work engagement.

Conclusions: Job control, supervisor support, and career opportunities were associated with higher work engagement among Japanese anesthesiologists, whereas coworker support was not.

Background: Yoga is one of the most popular activities for improving health worldwide. However, the investigation of scientific evidence has only just begun.

Methods: This study investigated the effects of yoga using two psychological tests, the State-Trait Anxiety Inventory (STAI) and the Profile of Mood States (POMS), and gene expression analysis using quantitative real-time polymerase chain reaction (qPCR). Seven healthy individuals volunteered to participate in the yoga therapy program designed for this study. The participants' saliva was collected for gene expression analyses in a noninvasive manner.

Results: No adverse events were observed. The participants were categorized by stress levels (low, normal, or high) based on their psychological tests before the intervention. Participants with normal stress levels experienced the most effective changes in their health, including decreased expression of an inflammatory gene or increased expression of anti-inflammatory genes, after three months of yoga intervention. Those with low and high stress levels retained their initial physical conditions.

Conclusions: By using both psychological research and gene expression analysis in the same participants, our study revealed that yoga therapy has the potential to improve both psychological and physical health, especially among those with normal stress levels, with little physical discomfort. These effects should be carefully considered in future large-scale, long-term studies.

Myofunctional therapy (MFT) involves oropharyngeal exercise to improve oral hypofunction. Recently, the efficacy of mild-to-moderate obstructive sleep apnea syndrome has been reported. This is the first case report of MFT being effective for severe obstructive sleep apnea and oral hypofunction in an older adult patient.

MFT is expected to gain more attention as an alternative treatment option for individuals intolerant to treatments such as continuous positive airway pressure and oral appliances.