A 71-year-old woman was admitted with severe back pain. She was diagnosed of type A dissecting aortic aneurysm and two-vessel coronary disease by CT scan and angiography. An acute-phase operation was started 32 hours after onset, performing replacement of ascending aorta and a two-vessel bypass. The affected aortic wall was so thin and fragile that the cut ends of these wall were treated with 25% solution of glutaraldehyde, a fastacting crosslinking agent, for 7min. As a result, a sufficient degree of reinforcement was obtained to complete the anastomotic procedure safely. She made a good recovery of cardiac function after the surgery, but was left with such complications as permanent complete atrioventricular block and a little aortic regurgitation. Following pacemaker insertion she was discharged and has returned to her normal activity. It appears that when treating the affected aortic wall with glutaraldehyde, a piece of gauze placed in the left ventricular cavity stopped up the aortic valve by half. As a result, glutaraldehyde was perhaps transferred from the gauze to the aortic valve and a part of the conduction system, causing injury to them. If meticulous care is exercised during the procedure to avoid unnecessary invasion of surrounding tissues, this technique will provide a useful means to accomplish safe anastomoses of cardiac vessels.

We investigated tte effects of Bukuryoshigyaku-to on cxperimental hemorrhagic shock. Twelve mongrel dogs, which were anesthetized with 26mg/kg of pentobarbital were used, Bukuryoshigyaku-to was given to six dogs and saline solution alone was given to six dogs as a control. Under artificial respiration management, a hemorrhagic shock model was created by modified Wiggers method. The drug was administered by enema immediately after the compensatory phase. Bukuryoshigyaku-to, consistied of 4g Bukuryo (Hoelen), 2g of Kanzo (Glycyrrhizae Radix), 2g Kankyo (Zingiberis Siccatum Rhizoma), 2g of Ninjin (Ginseng Radix) and 2g of Bushi (Aconiti Tuber), which were extracted by boiling for approximately 30 minutes.
The results showed no statistical differences in the changes in the mean arterial pressure and central venous pressure between the two groups. However, the cardiac index was significantly higher in the observation phase in the Bukuryoshigyaku-to group than in the control group. A drop in body pressure was prevented in the traditional Bukuryoshigyaku-to group.
These findings suggest the effectiveness of Bukuryoshigyaku-to in the treatment of hemorrhagic shock.

Adenocarcinoma currently accounts for 10–25% of all uterine cervical carcinomas and has a variety of histopathological subtypes. Among them, mucinous carcinoma gastric type is not associated with high-risk human papillomavirus (HPV) infection and a poor prognosis, while villoglandular carcinoma has an association with high-risk HPV infection and a good prognosis. They show relatively characteristic imaging findings which can be suggested by magnetic resonance imaging (MRI), though the former is sometimes difficult to be distinguished from lobular endocervical glandular hyperplasia. Various kinds of other tumors including squamous cell carcinoma should be also differentiated on MRI, while it is currently difficult to distinguish them on MRI, and HPV screening and pathological confirmation are usually necessary for definite diagnosis and further patient management.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Mass Screening ; Prognosis ; Uterine Cervical Neoplasms ; Uterus

Since late 2013 through March 2014, Japan experienced a rapid rise in measles cases. Here, we briefly report on the ongoing situation and share preliminarily findings, concerns and challenges and the public health actions needed over the coming months and years.

Measles is a notifiable disease in Japan based on nationwide case-based surveillance legally requiring physicians to report all clinically diagnosed and laboratory-confirmed cases within seven days, but preferably within 24 hours. After a large outbreak in 2007–2008 (more than 11 000 cases reported in 2008 alone) and a goal of elimination by April 2015, a catch-up programme using the bivalent measles-rubella (MR) vaccine was offered for grades seven and 12 (ages 12–13 and 17–18 years) from April 2008 through March 2013. During this period, there was an estimated 97% decline in measles notifications, and the cumulative number of reported cases has been steadily declining over the last five years (732 cases in 2009, 447 cases in 2010, 439 cases in 2011, 293 cases in 2012 and 232 cases in 2013). However, since late 2013 through March 2014, the country experienced a resurgence only a year after a large rubella outbreak.

Objective: The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1. Methods: PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint). Results: Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11–1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16–2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab. Conclusion: Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer.

Background:Capecitabine and irinotecan combination therapy (XELIRI) has been examined at various dose levels to treat metastatic colorectal cancer (mCRC). Recently, in the Association of Medical Oncology of the German Cancer Society (AIO) 0604 trial, tri?weekly XELIRI plus bevacizumab, with reduced doses of irinotecan (200mg/m2 on day 1) and capecitabine (1600mg/m2 on days 1–14), repeated every 3weeks, has shown favorable tolerability and effcacy which were comparable to those of capecitabine and oxaliplatin (XELOX) plus bevacizumab. The doses of capecit?abine and irinotecan in the AIO trial are considered optimal. In a phase I/II study, XELIRI plus bevacizumab (BIX) as second?line chemotherapy was well tolerated and had promising effcacy in Japanese patients. Methods:The Asian XELIRI ProjecT (AXEPT) is an East Asian collaborative, open?labelled, randomized, phase III clinical trial which was designed to demonstrate the non?inferiority of XELIRI with or without bevacizumab versus standard FOLFIRI (5?lfuorouracil, leucovorin, and irinotecan combination) with or without bevacizumab as second?line chemo?therapy for patients with mCRC. Patients with 20years of age or older, histologically conifrmed mCRC, Eastern Coop?erative Oncology Group performance status 0–2, adequate organ function, and disease progression or intolerance of the ifrst?line regimen will be eligible. Patients will be randomized (1:1) to receive standard FOLFIRI with or with?out bevacizumab (5mg/kg on day 1), repeated every 2weeks (FOLIRI arm) or XELIRI with or without bevacizumab (7.5mg/kg on day 1), repeated every 3weeks (XELIRI arm). A total of 464 events were estimated as necessary to show non?inferiority with a power of 80% at a one?sided α of 0.025, requiring a target sample size of 600 patients. The 95% conifdence interval (CI) upper limit of the hazard ratio was pre?speciifed as less than 1.3. Conclusion:The Asian XELIRI ProjecT is a multinational phase III trial being conducted to provide evidence for XELIRI with or without bevacizumab as a second?line treatment option of mCRC.