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Peritoneal dissemination is a predominant pattern of metastasis in patients with advanced ovarian cancer. Despite recent progress in the management strategy, peritoneal dissemination remains a determinant of poor ovarian cancer prognosis. Using various histological types of patient-derived ovarian cancer organoids, the roles of the apicobasal polarity of ovarian cancer cell clusters in peritoneal dissemination were studied. First, it was found that both ovarian cancer tissues and ovarian organoids showed apicobasal polarity, where zonula occludens-1 (ZO-1) and integrin beta 4 (ITGB4) served as markers for apical and basal sides, respectively. The organoids in suspension culture, as a model of cancer cell cluster floating in ascites, showed apical-out/basal-in polarity status, while once embedded in extracellular matrix (ECM), the organoids switched their polarity to apical-in/basal-out. This polarity switch was accompanied by the SRC kinase family (SFK) phosphorylation and was inhibited by SFK inhibitors. SFK inhibitors abrogated the adherence of the organoids onto the ECM-coated plastic surface. When the organoids were seeded on a mesothelial cell layer, they cleared and invaded mesothelial cells. In vivo, dasatinib, an SFK inhibitor, suppressed peritoneal dissemination of ovarian cancer organoids in immunodeficient mice. These results suggest SFK-mediated polarity switching is involved in peritoneal metastasis. Polarity switching would be a potential therapeutic target for suppressing peritoneal dissemination in ovarian cancer.

Key Clinical Message We present the first case of the patient with skeletal metastasis of uterine cervical cancer which invaded the vertebral body and spinal canal, with consequent paralysis of the lower extremities.

Peritoneal inclusion cysts (PICs) often develop in post-operative patients. Since the incidence of adhesions is lower with laparoscopic surgery than with open surgery, PICs are less likely to occur in the former. Although post-operative adhesions or PICs rarely develop after laparoscopic surgery (such as total laparoscopic hysterectomy: TLH), we encountered two cases of giant PICs with abdominal pain after TLH. In Case 1, strong adhesion was already present when TLH was performed. Therefore, this case may have been predisposed to the development of adhesions in the abdominal cavity. However, no adhesions were observed during TLH in case 2, and there were no risk factors, such as pre-operative adhesions and endometriosis. Therefore, adhesions and PICs may develop even after TLH, and approaches need to be considered for their prevention.

Women in the reproductive age group diagnosed with cervical cancer can receive radical trachelectomy in case they wish to preserve fertility. However, the indication for this procedure in infertile women with cervical cancer is controversial depending on the underlying cause of infertility. Here, we present a case of a successful pregnancy following myomectomy accompanied with abdominal radical trachelectomy for an infertile woman with early cervical cancer. The patient was a 38-year-old nulliparous woman with a significant past medical history of infertility of unknown origin. She had been undergoing treatment with assisted reproductive technologies including artificial insemination and in vitro fertilization for over four years. During her treatment for infertility, she was diagnosed with stage IB1 cervical squamous cell carcinoma. She received abdominal radical trachelectomy and abdominal myomectomy in the same surgical procedure. Six months after the surgery, she went for the first embryo transfer and became pregnant. At 26 weeks of pregnancy, a male baby weighing 980 g was delivered with an Apgar score of 3/5/7 by cesarean section due to chorioamnionitis. The baby has received general care in a neonatal intensive care unit for four months and weighed 4520 g when discharged.

Uterine mesenchymal tumors other than leiomyosarcoma, carcinosarcoma, and endometrial stromal sarcomas are extremely uncommon. We describe a case of epithelioid angiosarcoma of the uterus and review previous literature on such rare tumors. A 48-year-old woman presented with a 1-year history of abdominal fullness and 10kg weight loss. Pelvic magnetic resonance imaging (MRI) revealed a huge (30×18cm) uterus accompanied by degeneration and necrosis. She underwent supracervical hysterectomy and right salpingo-oophorectomy. We postoperatively diagnosed the mass as an epithelioid angiosarcoma arising from a leiomyoma. Vasodilatation was observed within the range of 2 cm × several mm in the leiomyoma, and proliferation of atypical cells was observed covering the surface of the luminal side. The tumor showed a partly fine vascular structure and was associated with obvious nuclear atypia and mitotic figures. She received 6 courses of adjuvant chemotherapy with paclitaxel, epirubicin, and carboplatin, and there have been no signs of recurrence for 10 months.

•Malignant peritoneal mesothelioma, particularly the sarcomatoid type, is rare and aggressive.•Accurate diagnosis by ascites cytology is difficult.•Histological examination such as laparoscopy aids in diagnosis.•There is no clear consensus treatment for MPM and an extensive research program is needed.

Gemella morbillorum, a Gram-positive coccus facultative anaerobe, is part of the normal flora of the mucous membranes of the oropharynx, upper respiratory, gastrointestinal, and female genital tracts. However, this species can also cause serious infection. We herein report on a case of bacteremia, accompanied by peritonitis and pleuritis, in a 46-year-old immunocompetent female following a total laparoscopic hysterectomy for endometrial cancer. The case was successfully treated with antibacterial and antifungal agents.

Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases.

Background: Atypical squamous cells of undetermined significance (ASCUS) feature a wide variety of cervical cells, including benign and malignant examples. The management of ASCUS is complicated. Guidelines for office gynecology in Japan recommend performing a high-risk human papillomavirus (HPV) test as a rule. The guidelines also recommend repeat cervical cytology after 6 and 12 months, or immediate colposcopy. The purpose of this study was to determine the clinical significance of ASCUS. Materials and Methods: Between January 2012 and December 2014, a total of 162 patients underwent cervical conization for cervical intraepithelial neoplasia grade 3 (CIN3), carcinoma in situ, squamous cell carcinoma, microinvasive squamous cell carcinoma, and adenocarcinoma in situ at our hospital. The results of cervical cytology prior to conization, the pathology after conization, and high-risk HPV testing were obtained from clinical records and analyzed retrospectively. Results: Based on cervical cytology, 31 (19.1%) of 162 patients were primarily diagnosed with ASCUS. Among these, 25 (80.6%) were positive for high-risk HPV, and the test results of the remaining 6 patients (19.4%) were uncertain. In the final pathological diagnosis after conization, 27 (87.1%) and 4 patients (12.9%) were diagnosed with CIN3 and carcinoma in situ, respectively. Conclusions: Although ASCUS is known as a low-risk abnormal cervical cytology, approximately 20% of patients who underwent cervical conization had ASCUS. The relationship between the cervical cytology of ASCUS and the final pathological results for CIN3 or invasive carcinoma should be investigated statistically. In cases of ASCUS, we recommend HPV tests or colposcopic examination rather than cytological follow-up, because of the risk of missing CIN3 or more advanced disease.

The first phase of the Urban air quality Model InterComparison Study in Japan (UMICS) has been conducted to find ways to improve model performance with regard to elemental carbon (EC). Common meteorology and emission datasets are used with eight different models. All the models underestimate the EC concentrations observed in Tokyo Metropolitan Area in the summer of 2007. Sensitivity analyses are conducted using these models to investigate the causes of this underestimation. The results of the analyses reveal that emissions and vertical diffusion are dominant factors that affect the simulated EC concentrations. A significant improvement in the accuracy of EC concentrations could be realized by applying appropriate scaling factors to EC emissions and boundary concentrations. Observation data from Lidar and radiosonde suggest the possible overestimation of planetary boundary layer height, which is a vital parameter representing vertical diffusion. The findings of this work can help to improve air quality models to that they can be used to develop more effective strategies for reducing PM2.5 concentrations.

Venous thromboembolic events (VTE) may occur before the diagnosis of cancer, and VTE can be a predictor of the subsequent diagnosis of cancer. Stroke as well as VTE may be the first manifestation of a subsequent diagnosis of cancer. We report two cases of patients showing cerebral infarction as the first manifestation of clear cell carcinoma of the ovary. The first case is a 55-year-old woman, who had no significant past medical history, lost her consciousness and was diagnosed with bilateral thalamic infarction according to magnetic resonance imaging results. After the diagnosis of infarction, advanced ovarian clear cell carcinoma was diagnosed at the interval of 4 months. Although an operation for ovarian cancer and 6 cycles of subsequent chemotherapies were executed, a recurrent disease occurred in the abdominal cavity. There also were relapses of infarction accompanied by ovarian cancer progression, and she died of ovarian cancer. The second case was a 62-year-old woman, who had repeated infarction episodes, and at the second infarction episode, her respiratory state also worsened. Computed tomography demonstrated swelling of her left ovary, venous thrombosis in the left femoral vein, and pulmonary arterial embolism. An operation for ovarian cancer was performed and early stage clear cell adenocarcinoma of the left ovary was confirmed by pathology. She has remained without evidence of recurrent cancer for 2 years after the completion of chemotherapy. Once cerebral infarction is diagnosed, a comprehensive search for unknown malignant disease should be performed, particularly ovarian clear cell carcinoma.

The majority of cases of symptomatic hydrosalpinx needing treatment are caused by sexually transmitted diseases. However, here, we present a rare case of a hydrosalpinx occurring in a sexually-inactive adolescent girl successfully treated with laparoscopy. A 17-year-old girl presenting with lower abdominal symptoms had a surgical history for an inguinal hernia at infancy. Transabdominal ultrasonography revealed a multicystic lesion in the pelvis, and magnetic resonance imaging suggested hydrosalpinx. Due to the abdominal pain and a suspicion of torsion, laparoscopic surgery was performed. After aspiration and resection of a cystic tumor, we confirmed that the left ovary was normal and that the tumor involved the left fallopian tube, which was twisted at the isthmus. Although relatively rare in postmenarchal sexually inactive adolescents, clinicians and surgeons must still consider hydrosalpinx as a possible diagnosis when encountering an adolescent patient with lower abdominal pain.

It is known that a large ovarian cyst will likely cause torsion. However, normal adnexal torsion is rare and occurs in premenarchal girls in most cases. This is a case of a reproductive woman. A 31-year-old woman suffering from acute abdominal pain in the lower and right side consulted her gynecologist. The next day she had a computed tomography performed and was suspected of ovarian torsion. She did not have fever, nausea, or leukocytosis, but her abdominal pain persisted. Diagnostic laparoscopy was performed and showed torsion of the right fallopian tube, which was swollen and looked like a hydrosalpinx with a normal ovary. We did detorsion and excision of the right tube. However, pathological findings showed that the right tube was not a hydrosalpinx but was swollen due to blood stasis. We determined that this case was torsion of normal adnexa. In such cases, diagnostic laparoscopy is very effective.

Finishing work greatly changes slab surface quality which influences floor performance. And, characteristics of concrete also greatly influence finishability. From such backgrounds, relations between mix proportion and finishiability were examined.60 kinds of mix proportion used on actual sites and prepared for the examination were set, and finishability of them were measured. As a result, those were shown that unit water content and admixture addition ratio influenced finishability directly, and finishability was predictable clearly by a combination of both. Moreover, it was generally thought that water-bond ratio and fluidity were causes, the combination turned out to be the direct cause.

The purpose of this study is to examine a relationship between loads of lower limbs during concrete finishing work and slab flatness. Experiments were taken with 5 different concretes and forms which were size of 2,700 mm &times 3,600 mm. Electromyogram (EMG) signals during work were recorded from 4 muscles of lower limb of skilled laborer and sensory tests about workability were taken. Slab flatness was measured with straightedge method. Results showed that at lower workability concrete, the integrated EMG were greater and slab flatness was low grade. It was suggested that the loads influenced slab flatness.

Experiments to measure durability of resin floor coatings against caster-load and thermal-shock were done. Then, in several specimens, resin floor coatings were separated from slabs by loads. At that time, slab surfaces seemed to be broken. And, resin floor coatings were easily separated when surface strength of slab were low. Finally the relation between the amount of loads until separation and surface strength of slab was quantitatively shown. This relation is regarded as one kind of barometers of slab surface quality, which is necessary to construct floors corresponding to quality required from users.

Growing teratoma syndrome (GTS) is defined as enlargement of a mature teratoma which arises during or after chemotherapy, caused by a malignant germ cell tumor. We managed a case of GTS in a 33-year-old woman who was successfully treated by laparoscopic surgery. She was diagnosed immature teratoma at the age of eighteen. Three and fifteen years after her initial surgery and chemotherapy, the mature teratoma recurred as pelvic masses without or with ovarian tumor. At the second recurrence, early recognition enabled us to perform laparoscopic surgery consisting of ovarian cystectomy and resection of a pelvic mass. Final histological evaluation documented only the mature teratoma. Her post-operative course was uneventful without recurrence for one year. Laparoscopic surgery was performed safely and considered to be an effective method in this case. Early recognition of GTS is important for its curative resection, especially to be completed by laparoscopic surgery. A long term follow-up is also essential because of the possibility of late recurrence.

Using one typical kind of free-access floor specimen, the behavior during seismic excitation by three-dimension input wave was compared with that by horizontal one-dimension input wave. As the conclusion, it was obtained that damage by real three-dimension seismic excitation could be estimated based on the result of the excitation test using one-dimension input wave, which was selected from two horizontal axes as the direction containing the maximum acceleration. The result of this study will be applied to establish the simple method to evaluate the seismic resistance of free-access floor, which will consist of one-dimension excitation test.

Even though the same concrete is used, the amount of execution effort affects on surface quality of floor groundwork and performance with covering material. In the previous thesis, covering materials are executed on groundworks with different surface quality. The thesis shows relations among execution effort of the groundwork, flatness and work for repairing and maintenance.This thesis reports in-depth consideration based on durability against caster-load and thermal-shock. The result shows that the total work of maintenance is cut down because the more effort of groundwork is spent, the higher durability is realized and the less work of maintenance is needed.