Living overseas affects heath significantly. This needs to be addressed adequately for Japanese who live in the U. S. based on the existing evidence of negative impacts on health such as increased coronary heart disease mortality and stress. In addition to care at individual level as primary care providers, community-oriented primary care (COPC) provides primary care physicians with great potential to use as a tool of community medicine to improve their health at the community level. In this article, we report our case of COPC activity ; defining the community, choosing the health issue, implementing an intervention and its initial evaluation as well as the process of involving the community targeting Japanese in Pittsburgh, USA. The present article also includes a hypothesis-driven research question, measurement, analysis and the results followed by discussion with the lessons learned through our COPC activities. This article will not only inform readers of the COPC case but also provide practical and applicable insight to community medicine in readers' settings.

　　Case: A 62-year-old woman underwent high anterior resection and partial lobectomy for colon cancer and lung metastasis, respectively, and postoperative chemotherapy. During the follow-up period, she visited the Department of Otolaryngology at our hospital, complaining of expectoration of a mass. Laryngeal fiberscopy showed no abnormality, but thoracic computed tomography revealed nodular lesions protruding into the bronchial lumen. Bronchoscopy confirmed the presence of multiple granular nodules protruding from the bronchial wall. The nodules had a polyp-like appearance and were easily dissected or detached. Anti-cancer drug therapy was initiated for endobronchial metastases from colorectal cancer diagnosed in transbronchial biopsy. Conclusion: This was a rare case of endobronchial metastases that were discovered after expectoration of tumor masses. Bronchoscopic findings were extremely unusual, showing multiple tumors that were easily detached because of their extremely weak connection to the bronchial wall. The findings suggest that it is important to consider endobronchial metastasis from colorectal cancer and perform early diagnostic imaging and bronchoscopy when patients present with recurrent expectoration of masses after surgery for colon cancer.

PURPOSE: To determine the role of plasmacytoid dendritic cells (pDC) and myeloid dendritic cells (mDC) in priming effector T cells to induce allergy, and to evaluate the effect of immunostimulatory sequences (ISS, TLR9 agonist) on dendritic cells. METHODS: Cultured mDC and pDC with/without ISS were injected intratracheally into sensitized Balb/C mice. Mice were sacrificed, and then pulmonary function tests, bronchoalveolar lavage (BAL), cell counts, and cytokine levels were evaluated. Migration of dendritic cells was also evaluated after ISS administration. RESULTS: In mice injected with mDC, airway hyperresponsiveness, eosinophil counts, and Th2 cytokine levels in BAL increased with increasing numbers of mDC injected. However, in mice injected with pDC, none of these changed, suggesting poor priming of T cells by pDC. In addition, mDC pulsed with ISS inhibited asthmatic reactions, and ISS administration inhibited migration of DC to the lung. CONCLUSIONS: We suggest that pDC played a limited role in priming T cells in this asthma model and that mDC played a major role in inducing asthma. In addition, ISS inhibited migration of DC to the lung.
Animals ; Asthma ; Bronchoalveolar Lavage ; Cell Count ; Dendritic Cells ; Eosinophils ; Hypersensitivity ; Lung ; Mice ; Respiratory Function Tests ; T-Lymphocytes

Objective: Precursor lesions may be identified in fallopian tube tissue after risk-reducing salpingo-oophorectomy (RRSO) in patients with pathogenic variants of BRCA1/2. Serous tubal intraepithelial carcinoma (STIC) is considered a precursor of high-grade serous carcinoma, whereas the significance of the p53 signature remains unclear. In this study, we investigated the relationship between the p53 signature and the risk of ovarian cancer. Methods: We analyzed the clinicopathological findings and conducted DNA sequencing for TP53 variants of p53 signatures and STIC lesions isolated using laser capture microdissection in 13 patients with pathogenic variants of BRCA1/2 who underwent RRSO and 17 control patients with the benign gynecologic disease. Results: TP53 pathogenic variants were detected significantly higher in RRSO group than control (p<0.001). No difference in the frequency of p53 signatures were observed between groups (53.8% vs 29.4%; p=0.17). TP53 sequencing and next-generation sequencing analysis in a patient with STIC and occult cancer revealed 2 TP53 mutations causing different p53 staining for STICs and another TP53 mutation shared between STIC and occult cancer. Conclusion The sequence analysis for TP53 revealed 2 types of p53 signatures, one with a risk of progression to STIC and ovarian cancer with pathological variants in TP53 and the other with a low risk of progression without pathological variants in TP53 as seen in control.