Multiple metastases of human epidermal growth factor receptor 2­positive, hormone receptor­positive, pT1a pN0 breast cancer within 1 year after surgery: A case report.

Adjuvant chemotherapy is usually not considered for pT1a pN0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer due to its low recurrence rate. The present report describes a case of pT1a hormone receptor-positive HER2-positive breast cancer with multiple recurrences in the axillary lymph nodes and liver within 1 year after radical surgery. A 58-year-old woman underwent left total mastectomy and sentinel lymph node biopsy for left breast cancer with pathological stage IA (pT1a pN0). The subtype corresponded to luminal B-like breast cancer with a nuclear grade of 3 and a Ki-67 labeling index of 37%. An aromatase inhibitor (letrozole) was planned to be administered for 5 years after surgery, but the patient was diagnosed with multiple liver and axillary lymph node metastases 11 months after surgery. After 1 year of chemotherapy (paclitaxel) in combination with anti-HER2 therapy (pertuzumab and trastuzumab), liver metastases resolved. A complete response of the liver lesion has been maintained 4 years after the anti-HER2 therapy initiation. The present case exhibited two poor prognostic factors: High Ki-67 labeling index and nuclear grade 3. Based on the 'Predict' tool, the present case would be expected to have a cancer-related mortality rate of 6% 10 years after surgery with adjuvant endocrine therapy. Although this value may be controversial for postoperative anti-HER2 therapy, the present case should not be considered to be a low-risk case. When the identification of high-risk pT1a pN0 HER2-positive breast cancer is possible, postoperative anti-HER2 therapy plus chemotherapy would be effective in decreasing the rate of recurrence.

Idiopathic myointimal hyperplasia of mesenteric veins: radiological evaluation using CT angiography.

A 44-year-old man presented with a chief complaint of constipation. Initial contrast-enhanced CT showed extensive bowel wall thickening, mainly in the left colon, with a thin cord-like inferior mesenteric vein (IMV), in contrast to ectatic mesenteric venous branches, suggesting bowel ischaemia owing to venous stasis. One month later, at the time of symptom exacerbation, CT angiography showed a cord-like IMV and ectatic mesenteric venous branches with early enhancement, suggesting the presence of an arteriovenous fistula (AVF). Owing to the progression of bowel ischaemia and necrosis with peritonitis, emergency surgery was performed. Surgical specimens showed focal myointimal hyperplasia of the proximal mesenteric veins in both ischaemic and non-ischaemic lesions of the resected colon, thus leading to the diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) when combined with the clinical and imaging findings. IMHMV is a bowel ischaemic disease caused by non-thrombotic venous obstruction that requires bowel resection and has been suggested to be associated with AVF. Cord-like IMV and AVF in the mesentery are important CT findings that characterize IMHMV. CT angiography is useful in diagnosing IMHMV.

Chemical interaction of 4-META with enamel in resin-enamel bonds.

X-ray photoelectron spectroscopy (XPS) is used to analyze 4-META resin and enamel that are debonded at an adhesive interface. The XPS spectra showed two chemical states for Ca: one resulted from Ca of hydroxyapatite and the other, an unknown chemical state, suggested that Ca was chemically bonded with 4-META. We postulate that for a chemical reaction of 4-META and hydroxyapatite, the chemical structure of carboxyl groups will resemble that of calcium phthalate. Hence, calcium phthalate was used as a reference material. Additionally, the spectra obtained from the adhesive interface and the mixture of calcium phthalate with hydroxyapatite particles were compared using peak deconvolution analysis. XPS analysis revealed that the chemical bond of 4-META with enamel resembled the chemical state of Ca in calcium phthalate. Consequently, we suggest that Ca of the enamel and the carboxyl group of 4-META were chelate-bonded at the interface.

Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization.

Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension. METHODS: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg. RESULTS: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH. CONCLUSIONS: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

Practical and reliable synthesis of 2',3',5',5″-tetradeuterated uridine derivatives.

Deuterated drugs are valuable in the fields of drug discovery and medicinal chemistry. 2',3',5',5″-tetradeuterated uridine derivatives were synthesised from 2,3,5,5'-selectively tetradeuterated ribose using Sajiki's H-D exchanged Ru/C-H2-D2O-NaOH system and silyl-Hilbert-Johnson methods. The total deuterium content of the tetradeuterated uridines was over 92% using either basic or acidic reaction conditions. These derivatives would be expected as building blocks for the synthesis of deuterium-substituted nucleic acid probes for tracking the pharmacokinetics of nucleic acid drugs.

Noviherbaspirillum denitrificans sp. nov., a denitrifying bacterium isolated from rice paddy soil and Noviherbaspirillum autotrophicum sp. nov., a denitrifying, facultatively autotrophic bacterium isolated from rice paddy soil and proposal to reclassify Herbaspirillum massiliense as Noviherbaspirillum massiliense comb. nov.

Thirty-nine denitrifying bacterial strains closely related to one another, represented by strains TSA40T and TSA66T, were isolated from rice paddy soils. Strains TSA40T and TSA66T were Gram-stain-negative, slightly curved rod-shaped, and motile by means of polar flagella. They were able to reduce nitrate, nitrite and nitrous oxide, but unable to fix atmospheric N2. While strain TSA66T was able to grow autotrophically by H2-dependent denitrification, strain TSA40T could not. Phylogenetic analysis suggested that they belong to the family Oxalobacteraceae, the order Burkholderiales in the class Betaproteobacteria. Major components in the fatty acids (C16 : 0, C17 : 0 cyclo, C18 : 1ω7c and summed feature 3) and quinone (Q-8) also supported the affiliation of strains TSA40T and TSA66T to the family Oxalobacteraceae. Based on 16S rRNA gene sequence comparisons, strains TSA40T and TSA66T showed the greatest degree of similarity to Herbaspirillum massiliense JC206T, Noviherbaspirillum malthae CC-AFH3T, Noviherbaspirillum humi U15T, Herbaspirillum seropedicae Z67T and Paucimonas lemoignei LMG 2207T, and lower similarities to the members of other genera. Average nucleotide identity values between the genomes of strain TSA40T, TSA66T and H. massiliense JC206T were 75-77 %, which was lower than the threshold value for species discrimination (95-96 %). Based on the 16S rRNA gene sequence analysis in combination with physiological, chemotaxonomic and genomic properties, strains TSA40T (=JCM 17722T=ATCC TSD-69T) and TSA66T (=JCM 17723T=DSM 25787T) are the type strains of two novel species within the genus Noviherbaspirillum, for which the names Noviherbaspirillum denitrificans sp. nov. and Noviherbaspirillum autotrophicum sp. nov. are proposed, respectively. We also propose the reclassification of Herbaspirillum massiliense as Noviherbaspirillum massiliense comb. nov.

Analysis of fracture surface of titanium-porcelain bonding by electron spectroscopy for chemical analysis.

Three commercially available porcelains bonded to titanium were evaluated to determine the weakest zone of the titanium-porcelain bonding structures. Tensile bond tests were performed for these specimens (NO, DU, and VI) and for Ni-Cr alloy-porcelain bonding samples that served as controls. The maximum bond strengths between porcelain and titanium and the Ni-Cr alloy subjected to different metal surface treatments were compared. Sand blasting effectively increased bond strengths in titanium-porcelain bonding materials. No statistically significant differences in the maximum bond strengths were found between the NO sample and a control; however, sample NO exhibited greater maximum bond strength than DU and VI samples. The bond strengths increased with increasing area fractions of porcelain failure on fracture surfaces. The weakest zones were investigated based on the oxygen chemical states determined by electron spectroscopy for chemical analysis, which include bridging oxygen (Si-O-Si), nonbridging oxygen (Si-O(-) M(+)), and titanium oxide (O(2-)) states. We concluded that the titanium oxide layer is the weakest zone of titanium-porcelain bonding structures.

Visualization study on distortion of a metal frame by polymerization shrinkage and thermal contraction of resin.

Three types of metal specimens (ring-shaped, plate-shaped, and a simulated anterior arch) for distortion observations were made from Au-Ag-Pd-Cu alloy. Distortion due to polymerization shrinkage and thermal contraction of a heat-curing acrylic resin containing 4-META (4-methacryloyloxyethyl trimellitate anhydride, 4-META resin) could be visualized for the ring-shaped specimen, which showed increasing distortion of the metal frame upon adhesion of the resin to the outer metal surface. Distortion of the plateshaped specimen adhering to 4-META resin decreased with increasing thickness of the cured resin. The distortion of the metal frame simulating an anterior arch of a six-unit bridge with a facing composite resin showed that the curvature of the metal frame was larger after curing of the facing composite resin. However, it recovered most of its original curvature with an associated increase in the number of cracks between the crowns after trimming the resin to a tooth profile.

Analysis of residual stress in the resin of metal-resin adhesion structures by scanning acoustic microscopy.

The residual stress caused by polymerization shrinkage and thermal contraction of a heat-curing resin containing 4-META on a metal-resin structure was measured by a scanning acoustic microscope. The tensile residual stress in the resin occurred within 70 µm of the adhesion interface with a flat plate specimen. The maximum tensile stress was about 58 MPa at the interface. On a metal plate specimen with retention holes, ring-like cracks in the resin occurred around the retention holes with the adhesive specimen and many linear cracks occurred in the resin vertical to the longitudinal direction of the metal frame with the non-adhesive specimens. There was tensile residual stress on the resin surface at the center of the retention holes of the adhesion specimen, indicating that the stress in the specimen with surface treatment for adhesion was higher than in that without surface treatment.

Identification and isolation of active N2O reducers in rice paddy soil.

Dissolved N(2)O is occasionally detected in surface and ground water in rice paddy fields, whereas little or no N(2)O is emitted to the atmosphere above these fields. This indicates the occurrence of N(2)O reduction in rice paddy fields; however, identity of the N(2)O reducers is largely unknown. In this study, we employed both culture-dependent and culture-independent approaches to identify N(2)O reducers in rice paddy soil. In a soil microcosm, N(2)O and succinate were added as the electron acceptor and donor, respectively, for N(2)O reduction. For the stable isotope probing (SIP) experiment, (13)C-labeled succinate was used to identify succinate-assimilating microbes under N(2)O-reducing conditions. DNA was extracted 24 h after incubation, and heavy and light DNA fractions were separated by density gradient ultracentrifugation. Denaturing gradient gel electrophoresis and clone library analysis targeting the 16S rRNA and the N(2)O reductase gene were performed. For culture-dependent analysis, the microbes that elongated under N(2)O-reducing conditions in the presence of cell-division inhibitors were individually captured by a micromanipulator and transferred to a low-nutrient medium. The N(2)O-reducing ability of these strains was examined by gas chromatography/mass spectrometry. Results of the SIP analysis suggested that Burkholderiales and Rhodospirillales bacteria dominated the population under N(2)O-reducing conditions, in contrast to the control sample (soil incubated with only (13)C-succinate). Results of the single-cell isolation technique also indicated that the majority of the N(2)O-reducing strains belonged to the genera Herbaspirillum (Burkholderiales) and Azospirillum (Rhodospirillales). In addition, Herbaspirillum strains reduced N(2)O faster than Azospirillum strains. These results suggest that Herbaspirillum spp. may have an important role in N(2)O reduction in rice paddy soils.

Relationship between the metallurgical structure of experimental titanium miniscrew implants and their torsional properties.

The aims of this study were to investigate the torsional properties of three experimental titanium miniscrew implants for orthodontic anchorage and to determine the relationship between the torsional properties and metallurgical structures. Experimental miniscrew implants with a diameter of 1.4 mm were fabricated from commercially pure (CP) titanium (alpha-titanium), Ti-4Al-4V (duplex alpha-beta-titanium), and Ti-33Nb-15Ta-6Zr (beta-titanium). Micro-X-ray diffraction (XRD) was performed to identify phases, and microstructures of etched cross-sections were obtained with scanning electron microscopy (SEM). Implants were loaded in torsion (n = 5), and mean moments and twist angles at fracture were statistically compared using the Kruskal-Wallis and Mann-Whitney U-tests. Cyclic torsional moment for fracture of starting square wires (2 × 2 × 30 mm) was measured (n = 3). At fracture, the Ti-4Al-4V and Ti-33Nb-15Ta-6Zr implants demonstrated significantly higher mean torque than the CP titanium implant, while the Ti-33Nb-15Ta-6Zr implant had a significantly higher mean twist angle than the other two implants. The CP titanium and Ti-33Nb-15Ta-6Zr implants displayed good fatigue performance and excellent ductility. Ti-33Nb-15Ta-6Zr beta-titanium alloy is suitable for manufacturing miniscrew implants since it has excellent torsional properties.

Wear of opposing teeth by posterior composite resins--evaluation of newly developed wear test methods.

In the present study, enamel wear against indirect composite resins was evaluated using two newly designed wear test methods: a rotating sliding wear test and a buff wear test. For the composite resins investigated in this study, their surface morphologies were examined using a scanning probe microscope after buff-polishing. After the wear tests, enamel was worn down by hard fillers that protruded from the abraded resin matrices. Notably, enamel wear was induced by composite materials with a Vickers hardness number (VHN) greater than 45 and that the amount of enamel wear increased with increasing hardness of the composite material. Therefore, 45 VHN was the critical hardness value for composite resins at which antagonistic enamel wear would occur. Besides, the D-value obtained from the buff wear test indicated not only the relative wear resistance of the composite resin itself, but also its potential risk to induce antagonistic enamel wear.

Crystal growth by restorative filling materials.

This study examined the activity and ability of materials to mineralize teeth in gaps, simulating microleakage between the materials and teeth. Three restorative materials (two glass ionomer cements and a compomer) were used in this study. Cured disks of restoratives were placed over flat human tooth surfaces (enamel and dentin), separated by a standardized 20-µm interfacial space, and stored in water for 24 h or 1 yr. After the water-storage period, the materials were detached from the teeth and the opposing surfaces were examined by scanning electron microscopy (SEM) and electron probe micro analysis (EPMA).Hemispherical-shaped precipitations, composed of minute semicircle plate-like crystals, were observed by SEM on the enamel surface after 1 yr of water storage for glass ionomer cement. The amount of crystal growth with the chemical-cured type of glass ionomer cement was greater than with the dual-cured type of glass ionomer cement. However, there was no crystal formation in the compomer. Moreover, no structural changes were observed on dentin surfaces for any material in water after 1 yr. The elements detected in the crystals by EPMA were calcium (Ca), phosphorus (P), and aluminum (Al). The two glass ionomer cements tested have the ability to induce crystals whose composition might be derived from cured glass ionomers.

Ten-years degradation of resin-dentin bonds.

The purpose of this study was to evaluate the durability of resin-dentin bonds in 10-yr water-storage testing. Resin-dentin bonded bulk specimens were prepared using six commercially available resin adhesives. The resin-dentin bonded specimens were stored in water for 24 h (control group) or for 10 yr (experimental groups). After each storage period, the specimens were sectioned to make specimen beams and then subjected to a microtensile bond test. After the bond test, fractured surfaces were examined by scanning electron microscopy (SEM). In addition, interfacial observation of silver nanoleakage was performed using the backscatter electron mode of SEM. The bond strengths of four of the six adhesive systems tested decreased significantly after 10 yr. However, no significant bond-strength reduction was recorded for the other two systems. The interfacial observations showed water tree propagation in the bonding resin layer as a typical morphological change after aging for five of the six adhesives tested. Water tree propagation may be a symptom of degradation in the resin bonding layer of resin-dentin bonds.

Effect of monomer composition on crystal growth by resin containing bioglass.

This study evaluated the effect of resin monomer composition on crystal growth at the interface between the resin/bioglass composites and water. Light-cured resin that contained 2-bis[4(2-hydroxy-3-methacryloyloxy-propyloxy)-phenyl], 2-hydroxyethyl methacrylate, and triethylene glycol dimethacrylate with different compositions were used. Resin/bioglass composites were prepared with 40 mass% bioglass and 60 mass% resin. The resin/bioglass composites were stored in deionized distilled water for 24 h (control group) or 3-12 months (experimental groups). After water storage, the disk surfaces were examined by light- and scanning electron microscopy. Chemical states of the crystals were analyzed by laser-Raman spectroscopy and micro-X-ray diffractometry. The microscopic analysis showed crystal on the resin disks surface after six months of water storage for hydrophilic resins. However, there was no crystal formation in the control and the experimental groups of specimens of hydrophobic resins. Raman analysis showed the chemical states of the crystals formed on the resin matrix and bioglass to be different. The micro-X-ray analysis of crystals on resin disks identified them to be calcium carbonate. This crystal formation occurred in water instead of simulated body fluid. In conclusion, the resin monomer compositions affected the ability to induce crystal growth on the surfaces of disks containing bioglass.

Corrosion behavior of ion implanted nickel-titanium orthodontic wire in fluoride mouth rinse solutions.

This study investigated the corrosion properties of ion implanted nickel-titanium wire (Neo Sentalloy Ionguard) in artificial saliva and fluoride mouth rinse solutions (Butler F Mouthrinse, Ora-Bliss). Non ion implanted nickel-titanium wire (Neo Sentalloy) was used as control. The anodic corrosion behavior was examined by potentiodynamic polarization measurement. The surfaces of the specimens were examined with SEM. The elemental depth profiles were characterized by XPS. Neo Sentalloy Ionguard in artificial saliva and Butler F Mouthrinse (500 ppm) had a lower current density than Neo Sentalloy. In addition, breakdown potential of Neo Sentalloy Ionguard in Ora-Bliss (900 ppm) was much higher than that of Neo Sentalloy although both wires had similar corrosion potential in Ora-Bliss (450 and 900 ppm). The XPS results for Neo Sentalloy Ionguard suggested that the layers consisted of TiO(2) and TiN were present on the surface and the layers may improve the corrosion properties.

Measurements of volatile compound contents in resins using a moisture analyzer.

The contents of volatile adhesive compounds, such as water, solvents, and residual unpolymerized monomers, affect the integrity and durability of adhesive bonding. However, there is no method available that can be used to rapidly assess the residual solvent or water contents of adhesive resins. This study examined the effectiveness of a digital moisture analyzer to measure the volatile compound contents of resins. Five self-etching adhesives and seven experimental light-cured resins prepared with different contents (0, 10, and 20% by weight) of water or solvents (acetone and ethanol) were examined in this study. The resins were prepared using different methods (with and without air blast or light-curing) to simulate the clinical conditions of adhesive application. Resin weight changes (% of weight loss) were determined as the residual volatile compound contents, using the moisture analyzer. After the measurements, the resin films were examined using a scanning electron microscope. The weight changes of the resins were found to depend on the amount of water or solvents evaporating from the resin. Water and solvents were evaporated by air blast or light-curing, but some of the water and solvents remained in the cured resin. The moisture analyzer is easy to operate and is a useful instrument for using to measure the residual volatile compound contents of adhesive resin.

Effect of dentinal water on bonding of self-etching adhesives.

This study examined the effect of dentinal water on bonding, comparing one-bottle and two-step self-etching adhesives using microtensile bond test and scanning electron microscope. The bond strength of resin to dentin was measured for wet dentin (control) and dry dentin substrates. Wet dentin is the normal substrate for bond testing, whereas dry dentin was dehydrated in a desiccator at different drying times (5 to 60 min) before bonding. After bond testing, the fractured surfaces were examined. Although no correlation was found for two-step self-etching adhesives, the bond strength of the dry-dentin was significantly increased with the increase in the drying-time for one-bottle adhesives. With increased drying-time, the amount of water-bubbles was decreased for one-bottle adhesives; however, no bubble formation was seen in two-step adhesives in any group. The hydrophilic resin adhesive may entrap the water from dentin by osmosis during and after bonding. This effect may depend on the "hydrophilicity" of adhesives.

In vitro degradation of resin-dentin bonds with one-bottle self-etching adhesives.

The purpose of this study was to evaluate the durability of one-bottle self-etching adhesive during long-term water-storage testing. Resin-dentin bonded specimens were prepared using four commercially available one-bottle self-etching adhesives. The specimens were sectioned perpendicular to the adhesive interface to produce beam-shaped specimens that were stored in water for 24 h (control group) and 100, 200, and 300 d (experimental groups). After each storage period, the beams were subjected to a microtensile bond test. After the bond test, fractured surfaces were examined using a scanning electron microscope. In addition, interfacial observations of the silver tracer were performed using the secondary and back-scatter modes of the scanning electron microscope. The bond strength of all tested adhesives decreased significantly after 100 or more days in water. The interfacial observations showed an oxygen-inhibition zone as electron lucent in the adhesive-composite border in control specimens, displaying silver impregnation with breakage after aging. The deterioration of the oxygen-inhibition zone in the adhesive-resin composite junction resulted in a decrease in bond strength after 100 d in water for one-bottle self-etching adhesives.

A novel prosthetic resin composite containing fine enamel particles.

Finely powdered enamel was used to develop a prosthetic resin composite that has good mechanical properties and no potential to abrade opposing tooth structure. Bovine teeth were ground into powder and then the enamel particles were separated from the powder by centrifugation in bromoform-ethanol solution. The resin matrix consisted of UDMA (60 mole %) and Tri-EDMA (40 mole %). Camphorquinone (0.5 mass %) was added to the monomer as a photo-initiator. Fillers were incorporated directly into the resin matrix in amounts of 80 or 85 mass %. The flexural strength and Vickers hardness (Hv) were measured. The average flexural strength and Hv values for specimens having 85 mass % filler that had been subjected to heat treatment at 100 degrees C after light-curing were 95.2 and 109.8 MPa, respectively, which are higher than those for most commercial prosthetic resin composites. These findings suggest that a novel prosthetic resin composite with good mechanical properties can be made by loading finely powdered enamel into the resin matrix.