Impact of FOXA1 Expression on the Prognosis of Patients with Hormone Receptor-Positive Breast Cancer

Background  

Assessing indications for adjuvant chemotherapy (CT) in patients with hormone receptor (HR)-positive/human epidermal receptor 2 (HER2)-negative breast cancer remains a challenge for oncologists. In this study, we evaluated whether forkhead-box protein A1 (FOXA1) expression was a prognostic and predictive marker for HR-positive breast cancer.     

Prognostic value of dipyridamole stress echocardiography in hypertensive patients with left ventricular hypertrophy, chest pain and resting electrocardiographic repolarization abnormalities

BACKGROUND: Hypertension is a major cardiovascular risk factor in the development of coronary artery disease (CAD); therefore, evaluating the presence of CAD is a primary clinical goal. However, the noninvasive tests that are commonly used have poor diagnostic specificity, particularly in patients with left ventricular hypertrophy. OBJECTIVES: To assess the prognostic value of dipyridamole stress echocardiography (DET) for ischemic events in a subset of patients with hypertension with left ventricular hypertrophy, chest pain and resting electrocardiographic repolarization abnormalities. PATIENTS AND METHODS: Eighty-two patients (48 men and 34 women; average age 65+/-7.2 years with left ventricular hypertrophy documented echocardiographically (left ventricular mass index greater than 50 g/h(2.7)), and resting ST segment shift of 0.1 mV or more from baseline at 80 ms after J point in at least two contiguous leads, were submitted to DET according to high-dosage protocol and coadministered with atropine. RESULTS: The follow-up period was 25.11+/-8.3 months. The stress test produced positive results in 30 patients (36.5%); 16 (53%) and three (5%) cardiac events occurred in positive and negative stress test groups, respectively. At multivariate analysis, only positive DET response (P=0.000002), left ventricular mass index (P=0.028) and a family history of CAD (P=0.037) were independent predictors. The two-year event-free survival rates were 95% and 47% (log-rank 21.093, P=0.00001) for negative and positive stress test results, respectively. CONCLUSIONS: DET is a useful tool in the prognostic assessment of coronary events in this particular subgroup of patients with hypertension.     

Surgical strategies for esophageal cancer associated with head and neck cancer

Esophageal cancer is frequently associated with squamous cell carcinoma in the head and neck. Both cigarette smoking and alcohol consumption are risk factors for multiple cancers of the head and neck, as well as the esophagus. Routine screening and close follow-up for second cancers are important in patients with esophageal cancer or head and neck cancer. For this purpose, endoscopy with Lugol’s staining, as well as narrow-band imaging combined with magnifying endoscopy, is a powerful tool for the early detection of esophageal cancer. Multimodal therapy is essential for patients with double cancers. When considering surgical treatment, the curability of both cancers must be carefully evaluated. If both tumors are potentially curable, each lesion should be treated individually. In patients with metachronous double cancers, the prior treatment of the first primary carcinoma often affects the treatment of the second cancer. Close cooperation among medical staff members is essential for complicated surgeries for double cancers. Techniques that are appropriate for each case must be adopted, such as careful dissection, staged operations, muscular flaps and microvascular anastomosis.     

Effects of sevoflurane on electrocorticography in patients with intractable temporal lobe epilepsy.

Fentanyl-droperidol technique is the choice for epilepsy surgery. It requires intraoperative electrocorticography (ECoG), but a large dose of fentanyl is needed for this technique. On the other hand, sevoflurane reportedly may be beneficial for intraoperative ECoG. To reveal whether the combined technique with fentanyl and sevoflurane is beneficial for epilepsy surgery, we investigated ECoG in 10 patients with intractable temporal lobe epilepsy without sevoflurane, with 0.5 minimum alveolar concentration (MAC) sevoflurane, and with 1.5 MAC sevoflurane under fentanyl-based anesthesia. The mean number of spikes for 1 minute decreased from 38.3 to 14.1 after 1.5 MAC sevoflurane was induced, which was statistically significant ( P <.05). Our results showed that balanced technique with neurolepto-analgesia (NLA) and sevoflurane is not suitable for epilepsy surgery requiring intraoperative ECoG. When epilepsy surgeries are performed under sevoflurane anesthesia, it is important to consider that sevoflurane may suppress electric activities when it is used with other anesthetic agents.     

Flash Visual Evoked Potentials of Various Derivations in Dementia of the Alzheimer Type and Vascular Dementia

Background : Recently, evoked potentials have been used for objective monitoring of the cortical function in dementia. The aim of this study was to distinguish dementia of the Alzheimer type (DAT) from vascular dementia (VaD) using flash visual evoked potentials of various derivations.
Methods : A total of 70 patients consulting Tachikawa Medical Center Kashiwazaki Kosei Hospital were divided into four groups, normal adult (29.5 ± 8.5 years, n=16), normal elderly (77.2 ± 4.7 years, n=17), VaD (81.1 ± 8.1 years, n=17) and DAT (77.4 ± 5.6 years, n=20). Red flash stimulation was provided by a pair of goggles. Visual evoked potentials (VEPs) to flash were recorded in accordance with the International 10–20 Electrode System.
Results : The latencies of N130 and P190 of frontal and central derivations were significantly reduced in DAT compared with all other groups (p<0.05). The N130 and P190 latencies were markedly delayed in the normal elderly group compared with the normal adult group (p<0.05). The P3 (P100) latency of occipital derivation was significantly delayed in normal elderly, VaD and DAT groups compared with the normal adult group (p<0.05). In the DAT group, the P190 latency was shortened at central and frontal derivations compared with that at occipital derivation (p<0.05).
Conclusions : The N130 and P190 latencies decreased at frontal and central derivations in DAT. While the reason is still unclear, dysfunction in the central visual system induced by the degeneration of neuronal populations in DAT may cause the apparently reduced latency. Flash VEPs of frontal and central derivations may be useful for the differential diagnosis of DAT from VaD.