Infantile outcome at 3 years of age among monochorionic twins with Type-II or -III selective fetal growth restriction with isolated oligohydramnios who underwent fetoscopic laser photocoagulation.

OBJECTIVE: This study aimed to examine infantile outcomes at 3 years of age with selective fetal growth restriction (sFGR) Types II and III with isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP). METHODS: This multicenter prospective cohort study included monochorionic diamniotic twins who underwent FLP for sFGR between 16 and 25 weeks of gestation. The indication for performing FLP was in cases of sFGR Type II or III with oligohydramnios, where the maximal vertical pocket was ≤2 cm among twins with FGR. This was done in the absence of a typical twin-twin transfusion syndrome diagnosis. The primary outcome was the intact survival (IS) rate of infants at the corrected age of 40 weeks and 3 years. IS at the corrected age of 40 weeks was defined as survival without grade III or IV intraventricular hemorrhage or cystic periventricular leukomalacia, and IS at 3 years of age was defined as survival without neurodevelopmental morbidity, including cerebral palsy, neurodevelopmental impairment with a total developmental quotient of ≤70, bilateral deafness, or bilateral blindness. RESULTS: Among 45 patients with sFGR, 30 (66.7%) were classified as having Type II and 15 (33.3%) as Type III sFGR. The prevalence of IS at the corrected age of 40 weeks was 51.1% (n=23) in FGR twins and 95.5% (n=42) in larger twins. The prevalence of IS at 3 years of age was 46.7% (n=21) in FGR twins and 86.4% (n=38) in larger twins. Among the 24 FGR twins who were not diagnosed with IS at 3 years of age, 91.7% (22 of 24 cases) suffered fetal or infantile demise other than miscarriage and neurodevelopmental impairment. All larger twins who were not diagnosed with IS at 3 years of age (n=6, 13.6%) had neurological morbidity, in addition to one case of miscarriage. CONCLUSIONS: FGR twins and larger twins, when subjected to FLP due to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type II or III sFGR with oligohydramnios may be a feasible and preferable management option. This article is protected by copyright. All rights reserved.

Factors predictive of the presence of a CSF1R mutation in patients with leukoencephalopathy.

BACKGROUND AND PURPOSE: The purpose was to identify statistically factors that correlate with the presence of a colony-stimulating factor 1 receptor (CSF1R) mutation and to reevaluate the accuracy of the current diagnostic criteria for CSF1R-related leukoencephalopathy. METHODS: CSF1R testing was conducted on 145 consecutive leukoencephalopathy cases who were clinically suspected of having adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. From these, 135 cases whose detailed clinical information was available were enrolled. Forward logistic stepwise regression was performed to generate a probability model to predict a positive CSF1R mutation result. The current diagnostic criteria were also applied to our cohort and their sensitivity and specificity were calculated. RESULTS: Twenty-eight CSF1R-mutation-positive cases and 107 CSF1R-mutation-negative cases were identified. Our probability model suggested that factors raising the probability of a CSF1R-mutation-positive result were younger onset, parkinsonism, thinning of the corpus callosum and diffusion-restricted lesions. It also showed that involuntary movements and brainstem or cerebellar atrophy were negative predictors of a CSF1R-mutation-positive result. In our cohort, the sensitivity and specificity for 'probable' or 'possible' CSF1R-related leukoencephalopathy were 81% and 14%, respectively. CONCLUSIONS: Clinical and brain imaging features predictive of the presence of a CSF1R mutation are proposed. Consideration of these factors will help prioritize patients for CSF1R testing.

Assessment of diastolic function of normal fetal heart using dual-gate Doppler.

OBJECTIVES: The ratio of mitral peak early diastolic filling to early diastolic mitral annular velocity (E/e') reflects diastolic cardiac function in adults. Dual-gate Doppler (DD) enables measurements of E/e' in the same heart beat. This study was designed to assess the utility of the DD method for measurement of fetal E/e' and determine reference ranges for normal fetuses. METHODS: This prospective study comprised normal singleton pregnancies undergoing fetal echocardiography between 16 and 36 weeks of gestation. According to the DD method, E-wave velocity on pulsed-wave Doppler and e'-wave on tissue Doppler imaging were measured simultaneously on an apical or basal four-chamber view, and fetal E/e' was calculated. Spearman's correlation coefficient was used to assess the relationship between gestational age (GA) and E-wave and e'-wave velocities and E/e'. RESULTS: A total of 133 pregnancies were included in this study and all E/e' measurements were successful. Significant correlation was observed between GA and both left ventricular (LV) E/e' (r s  = -0.666, P < 0.001) and right ventricular (RV) E/e' (r s  = -0.607, P < 0.001). The regression equations for bilateral E/e' were: LV-E/e' = 17.341 - 0.631GA + 0.008 × GA2 (mean ± SD, R 2  = 0.440 ± 1.333); and RV-E/e' = 19.156 - 0.794GA + 0.012GA2 (R 2  = 0.419 ± 1.329). CONCLUSIONS: Bilateral E/e' of normal fetuses, measured using the DD method, decreased with GA, which is considered to be related to myocardial maturity. DD is a useful and convenient method for evaluating fetal E/e' in order to assess diastolic function in the prenatal period. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Integrated-fin gasket for palm cubic-anvil high pressure apparatus.

We described an integrated-fin gasket technique for the palm cubic-anvil apparatus specialized for the high-pressure and low-temperature measurements. By using such a gasket made from the semi-sintered MgO ceramics and the tungsten-carbide anvils of 2.5 mm square top, we successfully generate pressures over 16 GPa at both room and cryogenic temperatures down to 0.5 K. We observed a pressure self-increment for this specific configuration and further characterized the thermally induced pressure variation by monitoring the antiferromagnetic transition temperature of chromium up to 12 GPa. In addition to enlarge the pressure capacity, such a modified gasket also improves greatly the surviving rate of electrical leads hanging the sample inside a Teflon capsule filled with the liquid pressure-transmitting medium. These improvements should be attributed to the reduced extrusion of gasket materials during the initial compression.

Immunohistochemical analysis of gastrin-releasing peptide receptor (GRPR) and possible regulation by estrogen receptor ßcx in human prostate carcinoma.

Gastrin-releasing peptide (GRP) belongs to the family of bombesin-like peptides. GRP was demonstrated to stimulate the proliferation and invasiveness of androgen-independent prostate carcinoma. GRP mediates its action through the membrane-bound receptor, GRP receptor (GRPR), which is characterized by a high-affinity binding for both GRP and bombesin. In human prostate cancer tissue, GRPR mRNA was reported to be detectable in more than 90% but its immunolocalizaition has not been reported. Therefore, in this study we immunolocalized GRPR in 51 human prostate cancer cases and correlated the findings with several clinicopathological parameters in order to better understand the function and regulation of GRPR in human prostate cancer. GRPR was immnolocalized in carcinoma cells and their values were significantly associated with Gleason score and immunoreactivity of estrogen receptor ßcx (ERßcx) that is one of splicing variants of ligand dependent transcription factor, ERß, and considered to be prognostic factor of prostate cancer patients. The amounts of GRPR and ERßcx mRNA in three prostate cancer cell lines PC-3, DU-145 and LNCaP evaluated by quantitative RT-PCR (qPCR) analysis were also significantly correlated. In addition, we established stable transformants of prostate carcinoma cell line PC-3 introduced with ERßcx, and confirmed that GRPR mRNA was induced in ERßcx over-expressing PC-3 cells by qPCR analysis. These results also suggest that ERßcx contributes to prostate cancer development possibly through mediating GRPR expression in carcinoma cells.

Association of habitual long-distance running with the thickness of skeletal muscles and subcutaneous fat in the body extremities and trunk in middle-aged men.

AIM: We investigated the association of habitual long-distance running with the thickness of skeletal muscles and subcutaneous fat in the body extremities and trunk in middle-aged men using ultrasonography. METHODS: Three groups of healthy middle-aged men [mean (SD), 62.1 (2.8) years] took part in this investigation: a high-level group of 11 master runners who had competed in a 42.195 km race and run 51.6 (21.7) km every week, an intermediary-level group of 10 master runners who had competed in a 5-20 km race and run 9.3 (4.9) km every week, and a low-level group of 7 untrained men who continued to do no systematic training. The muscle thickness at 8 sites and the subcutaneous fat thickness at 10 sites were measured by B-mode ultrasonography, and were compared among the 3 groups. RESULTS: The high-level group had 10.0(-1)5.2% higher values for muscle thickness at the erector spinae, hamstrings, tibialis anterior, and triceps surae, compared with the intermediary-level and the low-level groups (p<0.05-0.001). The thickness of the subcutaneous fat about the rectus abdominis and external oblique was lower in the high-level group than in the intermediary-level and the low-level groups (p<0.05). CONCLUSIONS: Middle-aged male master athletes who habitually run at a high level have more muscle thickness in the lower extremities and trunk, and less subcutaneous fat thickness in the central regions of the body than do middle-aged men who habitually run at an intermediary level or do not run at all.

Impairment of spatial memory and changes in astroglial responsiveness following loss of molar teeth in aged SAMP8 mice.

In order to evaluate the mechanism(s) responsible for senile impairment of cognitive function as a result of reduced mastication, the effects of the loss of the molar teeth (molarless condition) on the hippocampal expression of glial fibrous acidic protein (GFAP) and on spatial memory in young adult and aged SAMP8 mice were studied using immunohistochemical and behavioral techniques. Aged molarless mice showed a significantly reduced learning ability in a water maze test compared with age-matched control mice, while there was no difference between control and molarless young adult mice. Immunohistochemical analysis showed that the molarless condition enhanced the age-dependent increase in the density and hypertrophy of GFAP-labeled astrocytes in the CA1 region of the hippocampus. These effects increased the longer the molarless condition persisted. When the extracellular K+ concentration ([K+]o) was increased from 4 to 40 mM for hippocampal slices in vitro, the mean increase in the membrane potential was about 57 mV for fine, delicate astrocytes, the most frequently observed type of GFAP-positive cell in the young adult mice, and about 44 mV for the hypertrophic astrocytes of aged mice. However, there was no significant difference in resting membrane potential between these cell types. The data suggest that an impairment of spatial memory and changes in astroglial responsiveness occur following the loss of molar teeth in aged SAMP8 mice.

The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction.

The objective of this study was to elucidate how cryotherapy after anterior cruciate ligament reconstruction affects intraarticular temperature and clinical results. A prospective and randomized study was performed on 21 knees of 21 patients. The ligament reconstruction was performed by single-incision arthroscopy using autogenous hamstring tendon. On completion of the surgery, thermosensors were implanted in the suprapatellar pouch and the intracondylar notch, and the intraarticular temperature was monitored while the joint was cooled. Cooling was performed in one group at 5 degrees C (N = 7) and in another at 10 degrees C (N = 7), for 48 hours. A control group (N = 7) did not undergo cryotherapy. The cooled groups showed three temperature phases: a low-temperature phase immediately after the ligament reconstruction, followed by a temperature-rising phase and a thermostatic phase. The control group had no low-temperature phase and immediately entered a thermostatic phase. During the low-temperature phase in the treated groups, the temperature of the suprapatellar pouch and of the intercondylar notch were significantly lower than the body temperature. The pain score and the number of times an analgesic had to be administered were both significantly lower in the 10 degrees C group than in the control group. Blood loss was significantly less in the 5 degrees C group than in the control group.

Epstein-Barr virus infection of the colon with inflammatory bowel disease.

OBJECTIVE: Epstein-Barr virus (EBV)-infected cells can evoke severe host immune responses, as shown in infectious mononucleosis and EBV-associated gastric carcinoma. To investigate the possible pathological role of EBV in inflammatory bowel disease (IBD), we tested for the presence of EBV in the colon in IBD patients. METHODS: Surgically resected colonic specimens of 11 patients with Crohn's disease, five patients with ulcerative colitis, nine noninflammatory controls (disease-free area of the colorectal carcinoma), and 10 appendicitis cases were tested using highly sensitive in situ hybridization for EBV-encoded small RNA1 (EBER-1). RESULTS: EBER-1 was detected in 63.6% of Crohn's disease cases and 60% of ulcerative colitis cases, but not at all in noninflammatory controls and appendicitis cases. EBER-1-positive cells were very rare in the noninflammatory areas of colonic specimens from IBD patients. EBER-1-positive cells were nonepithelial cells (mainly B lymphocytes and a few histiocyte-shaped cells) located in erosive or ulcerative areas of the colonic specimens. CONCLUSION: The limited presence of EBV-infected cells in the diseased areas of IBD colonic specimens indicated that EBV infection may be related to such diseases.

Origin of primary sensory neurons innervating the buccal stretch receptor.

The primary sensory neurons innervating mechanoreceptors in oro-facial regions have their cell bodies in either the trigeminal ganglion or the mesencephalic nucleus of the trigeminal nerve. The buccal stretch receptor (BSR), a type of mechanoreceptor in the jaw of rodents, has recently been recognized as signaling the position of the mandible. The location of the primary afferent neurons innervating this receptor is unknown. To investigate the cell bodies of the BSR afferent neurons in rats, we applied wheat germ agglutinin-horseradish peroxidase (WGA-HRP) to the proximal stump of the severed nerve branch of the buccal nerve that supplied the BSR. HRP-labeled cell bodies were observed in the posterolateral portion of the ipsilateral trigeminal ganglion. None was found in the contralateral trigeminal ganglion or in the brainstem. All labeled cell bodies were oval or round and closely resembled pseudo-unipolar neurons. The mean diameter of the labeled somata ranged between 25.5 and 52.5 microm, with small (< or = 30 microm), medium (from 31 to 40 microm), and large somata (> or = 41 microm) accounting for 8.8%, 54.9%, and 36.3%, respectively. Among the myelinated nerve fibers in the branch in which WGA-HRP was applied, 78.5% terminated in the BSR and had larger fiber diameters than the rest, indicating that most of the medium and large HRP-labeled cell bodies were BSR afferents. From these results and the ontogenetic origin of this receptor, it is suggested that the BSR differentiated from the mechanoreceptors in the oral mucosa or the fascia of masticatory muscles.

Laparoscopic repair for perforation of duodenal ulcer with omental patch: report of initial six cases.

We report our initial experience with perforated duodenal ulcer treated by laparoscopic repair with omental patch in six patients, and the results are compared with those of other procedures retrospectively. The average operative time was 85.0 min, and the estimated blood loss was 13.7 ml. The estimated blood loss of laparoscopic repair was significantly less than that of gastrectomy (p < 0.01). However, although all patients with gastrectomy or open omental patch needed administration of analgesia, only half of patients require analgesia in laparoscopic repair. No postoperative complication was encountered, and the recurrence of ulcer was not recognized in a mean follow-up of 10 months. We recognized this procedure to be safe and feasible. Although a larger number of patients with longer follow-up is needed, this procedure may become one of the treatments for perforated duodenal ulcer.

Intra-operative assessment of lymph node metastasis for colorectal carcinoma.

We have evaluated the reliability of intra-operative diagnosis for lymph node metastases and assessed the clinical features affecting accuracy of the intra-operative diagnosis based on a review of operative and pathological records in 218 patients treated by curative surgery for colorectal carcinoma. The sensitivity and specificity for diagnosis of lymph node metastases was 74.2% and 54.5%, respectively. The clinically positive but pathologically negative [cN(+),pN(-)] lymph nodes group differed significantly from the cN(-),pN(-) group with respect to tumor size, gross appearance and depth of tumor invasion. In the cN(+),pN(+) group, the tumor was larger and depth of tumor invasion was more extensive than in the cN(-),pN(+) group. The postoperative survival curves showed a statistically significant difference between cN(-),pN(-) and cN(+),pN(-) groups (P<0.05). Our data suggest less than satisfactory results for the intra-operative diagnosis of lymph node metastases. Macroscopically, tumor size and gross appearance were important clinical characteristics affecting accuracy in the macroscopic diagnosis of lymph node metastases. Therefore, prophylactic lymph node dissection is recommended, regardless of intra-operative assessment of lymph node metastases.

Strip biopsy to treat esophageal granular cell tumor.

Esophageal granular cell tumors are rare neoplasms. We successfully treated a 35-year-old Japanese man with an esophageal granular cell tumor without any complications using strip biopsy. Endoscopic ultrasonography revealed a hypoechoic tumor with a diameter of 8 mm that was confined to the submucosal layer. A strip biopsy done with a two-channel endoscope completely resected the tumor. Six months later, no abnormal findings were recognized in the resected area. Therefore we propose that strip biopsy be considered as a viable alternative treatment for esophageal granular cell tumor, depending on the histologic character, tumor size, and depth of tumor infiltration.

Synchronous multiple colorectal adenocarcinomas.

BACKGROUND: The object of the present work was to characterize clinical features and the quality of preoperative examinations in patients with synchronous colorectal carcinomas, and to compare the incidence of associated benign polyps with our findings in patients with a single malignant lesion. METHODS: A retrospective evaluation of 225 patients with primary colorectal carcinoma revealed 9 cases (4.0%) of synchronous colorectal carcinomas. RESULTS: The synchronous colorectal carcinomas were located in the same anatomical segment in 7 patients and were divided into different segments in 2 patients. The accuracy of preoperative diagnosis was 55.6% by endoscopy alone and 66.7% by double contrast barium enema (DCBE) alone, while the rate was 77.8% when colonoscopy and DCBE were combined. There was a higher incidence of associated benign polyps in the group with synchronous colorectal carcinomas (55.6%) versus 28.7% for a single carcinoma (P < 0.05). The main reason why multiple lesions could not be identified preoperatively was that the distal lesions prevented examination of the proximal lesions. CONCLUSIONS: At the time of surgical resection, it is important to ascertain preoperatively whether or not a second lesion exists. If synchronous polyps are present in patients with synchronous colorectal carcinomas, they should be ablated to reduce the risk of metachronous colorectal carcinoma.

A novel glutamate-mediated inhibitory mechanism linked with Ca2+/calmodulin-dependent protein kinase II in identified Euhadra neurons.

The underlying mechanism(s) of the glutamate (Glu)-induced membrane hyperpolarizing response in identified Euhadra neurons was investigated using the voltage-clamp technique, pressure injection method, and pharmacologic agents. Under voltage-clamp conditions, bath-applied Glu elicits a slow outward potassium current (Glu current) accompanied by an increase in membrane conductance whose amplitude is dose dependent. Of the agonists tested, the Glu current was mimicked only by quisqualate (QA); its potency was approximately 10 times greater than that of Glu. Typical antagonists for the ionotropic type of Glu receptors and G protein inhibitors do not block this current. The Glu current is markedly enhanced by a specific inhibitor of Ca2+/ calmodulin-dependent protein kinase II (CaM-KII), KN-62 (1-[N,O-bis (1,5-isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenylpiperazine) in a dose-dependent manner, while intracellularly injected CaM-KII suppresses the current. The potent protein kinase A inhibitors, H-8 (N-[2-(methylamino)ethyl]-5-isoquinolinesulfonamide dihydrochloride) and H-89 (N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide) or the specific protein kinase C inhibitors staurosporine and K-252b had no effect on the Glu current. These results suggest the presence of a novel subtype of Glu receptor in Euhadra neurons, which may be coupled to the activation of potassium channels normally suppressed by CaM-KII.

Endoscopic ultrasonography of superficial esophageal cancers using a thin ultrasound probe system equipped with switchable radial and linear scanning modes.

BACKGROUND: Detailed information on the depth of invasion of superficial esophageal cancer is required for endoscopic mucosal resection. As a pretherapeutic diagnostic procedure, endoscopic ultrasonography using conventional 7.5 MHz systems has been ineffective at providing sufficient details. A newly developed, thin ultrasound probe system provides both radial and linear scanning for evaluation of superficial esophageal cancer. METHODS: Endoscopic ultrasonography was performed in 16 patients using a switchable probe driven at 20 MHz. Seventeen lesions of superficial esophageal cancer were evaluated for depth of invasion to discriminate mucosal from submucosal penetration. RESULTS: The overall accuracy of staging was 64.7%. In all six errors, mucosal cancers were overstaged as submucosal invasion. The diagnostic accuracy was 80% when the muscularis mucosae was visualized. CONCLUSION: A 20 MHz linear-radial switchable probe is a useful new method in the staging of superficial esophageal cancer.

Structural and functional maturation of the buccal stretch receptors in rats.

Postnatal functional and structural development of the buccal stretch receptor (BSR) of rats was investigated, using electrophysiological and morphological techniques. For functional analysis, sustained discharges in response to ramp-and-hold stretches were recorded from the BSRs isolated from animals aged 10 days to 10 weeks. The threshold amplitude of stretch for a sustained discharge fell significantly between 10 days and 3 weeks, reaching adult values at 5 weeks of age, while the static sensitivity increased conspicuously between 2 and 4 weeks after birth. On the other hand, between 1 and 4 weeks of age, apparent structural changes in the BSR were observed on the number of preterminal branches in a sensory unit, the size of the varicose-like swellings along the terminal axon, the density of collagen and elastic fibers around the core structure, and the content of the sub-capsular space. From these results, we suggest that the increase in the density of the connective tissue around the core structure is associated with an enhancement in the elasticity of the BSR in the early postnatal stages, decreasing the threshold amplitude of stretch for a sustained discharge. One possible explanation for the maturation of the static sensitivity of this receptor is growth of the sensory axon terminals filled with dense mitochondria.

Solitary Peutz-Jeghers type polyp of the duodenum containing a focus of adenocarcinoma.

The case of an 84-year-old woman with evidence of continuous gastrointestinal bleeding is presented. A barium study and endoscopy showed a 25 x 20 mm sized semipedunculated polyp in the second portion of the duodenum. No other lesion was found throughout the entire gastrointestinal tract, and endoscopic resection of the duodenal polyp was performed. The resected polyp showed typical histologic features of a Peutz-Jeghers type hamartomatous polyp, although the patient lacked any familial history and signs related to the Peutz-Jeghers syndrome. A focus of adenocarcinoma was also found within the polyp. The present case would appear to be the first demonstration of a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum containing a focus of adenocarcinoma.