Oral Iron Absorption of Ferric Citrate Hydrate and Hepcidin-25 in Hemodialysis Patients: A Prospective, Multicenter, Observational Riona-Oral Iron Absorption Trial.

Oral ferric citrate hydrate (FCH) is effective for iron deficiencies in hemodialysis patients; however, how iron balance in the body affects iron absorption in the intestinal tract remains unclear. This prospective observational study (Riona-Oral Iron Absorption Trial, R-OIAT, UMIN 000031406) was conducted at 42 hemodialysis centers in Japan, wherein 268 hemodialysis patients without inflammation were enrolled and treated with a fixed amount of FCH for 6 months. We assessed the predictive value of hepcidin-25 for iron absorption and iron shift between ferritin (FTN) and red blood cells (RBCs) following FCH therapy. Serum iron changes at 2 h (ΔFe2h) after FCH ingestion were evaluated as iron absorption. The primary outcome was the quantitative delineation of iron variables with respect to ΔFe2h, and the secondary outcome was the description of the predictors of the body's iron balance. Generalized estimating equations (GEEs) were used to identify the determinants of iron absorption during each phase of FCH treatment. ΔFe2h increased when hepcidin-25 and TSAT decreased (-0.459, -0.643 to -0.276, p = 0.000; -0.648, -1.099 to -0.197, p = 0.005, respectively) in GEEs. FTN increased when RBCs decreased (-1.392, -1.749 to -1.035, p = 0.000) and hepcidin-25 increased (0.297, 0.239 to 0.355, p = 0.000). Limiting erythropoiesis to maintain hemoglobin levels induces RBC reduction in hemodialysis patients, resulting in increased hepcidin-25 and FTN levels. Hepcidin-25 production may prompt an iron shift from RBC iron to FTN iron, inhibiting iron absorption even with continued FCH intake.

Greenwood frequency-position relationship in the primary auditory cortex in guinea pigs.

Although orderly representation of sound frequency over space is a hallmark feature of the primary auditory cortex (A1), the quantitative relationship between sound frequency and cortical position is unclear. We examined this relationship in the guinea pig A1 by presenting a series of stimulus tones with a wide frequency range, and recording the evoked cortical responses using an optical imaging technique with high spatial resolution. We identified the cortical positions of three best-frequency indices for each tone: the onset response position, the peak amplitude position, and the maximum rise rate position of the response. We found a nonlinear log frequency-position relationship for each of the three indices, and the frequency-position relationship was always well described by a Greenwood equation, with correlation coefficients greater than 0.98. The cortical magnification factor, measured in octave/mm, was found to be a function of frequency, i.e. not a constant. Our results are novel in that they demonstrate a quantitative relationship between sound frequency and cortical position in the guinea pig A1, as described by the Greenwood equation.

Deficiency of sphingomyelin synthase-1 but not sphingomyelin synthase-2 causes hearing impairments in mice.

Sphingomyelin (SM) is a sphingolipid reported to function as a structural component of plasma membranes and to participate in signal transduction. The role of SM metabolism in the process of hearing remains controversial. Here, we examined the role of SM synthase (SMS), which is subcategorized into the family members SMS1 and SMS2, in auditory function. Measurements of auditory brainstem response (ABR) revealed hearing impairment in SMS1−/− mice in a low frequency range (4­16 kHz). As a possible mechanism of this impairment, we found that the stria vascularis (SV) in these mice exhibited atrophy and disorganized marginal cells. Consequently, SMS1−/− mice exhibited significantly smaller endocochlear potentials (EPs). As a possible mechanism for EP reduction, we found altered expression patterns and a reduced level of KCNQ1 channel protein in the SV of SMS1−/− mice. These mice also exhibited reduced levels of distortion product otoacoustic emissions. Quantitative comparison of the SV atrophy, KCNQ1 expression, and outer hair cell density at the cochlear apical and basal turns revealed no location dependence, but more macrophage invasion into the SV was observed in the apical region than the basal region, suggesting a role of cochlear location-dependent oxidative stress in producing the frequency dependence of hearing loss in SMS1−/− mice. Elevated ABR thresholds, decreased EPs, and abnormal KCNQ1 expression patterns in SMS1−/− mice were all found to be progressive with age. Mice lacking SMS2, however, exhibited neither detectable hearing loss nor changes in their EPs. Taken together, our results suggest that hearing impairments occur in SMS1−/− but not SMS2−/− mice. Defects in the SV with subsequent reductions in EPs together with hair cell dysfunction may account, at least partially, for hearing impairments in SMS1−/− mice.

Impact of seizures on developing dendrites: implications for intellectual developmental disabilities.

Childhood epilepsy can be severe and even catastrophic. In these instances, cognition can be impaired-leading to long-term intellectual disabilities. One factor that could potentially cause cognitive deficits is the frequent seizures that characterize intractable epilepsy. However, it has been difficult to separate the effects seizures may have from those of preexisting neuropathologies and/or the effects of ongoing anticonvulsant therapies. Therefore, important questions are: Do early life seizures produce the learning deficits? And if they do, how do they do it? Results from recent animal models studies reviewed here show that recurrent seizures in infancy stop the growth of CA1 hippocampal dendrites. We speculate that the molecular mechanisms responsible for seizure-induced growth suppression are homeostatic/neuroprotective, used by the developing nervous system in an attempt to limit neuronal and network excitability and prevent the continued generation of seizures. However, by preventing the normal growth of dendrites, there is a reduction in CA1 glutamatergic synapses that supports long-lasting forms of synaptic plasticity thought to be the cellular basis of learning and memory. Therefore, dendrite growth suppression would reduce the neuroanatomic substrates for learning and memory, and in so doing could contribute in important ways to spatial learning and memory deficits that may be relevant to the cognitive deficits associated with childhood epilepsy.

Region-dependent Millisecond Time-scale Sensitivity in Spectrotemporal Integrations in Guinea Pig Primary Auditory Cortex.

Spectrotemporal integration is a key function of our auditory system for discriminating spectrotemporally complex sounds, such as words. Response latency in the auditory cortex is known to change with the millisecond time-scale depending on acoustic parameters, such as sound frequency and intensity. The functional significance of the millisecond-range latency difference in the integration remains unclear. Actually, whether the auditory cortex has a sensitivity to the millisecond-range difference has not been systematically examined. Herein, we examined the sensitivity in the primary auditory cortex (A1) using voltage-sensitive dye imaging techniques in guinea pigs. Bandpass noise bursts in two different bands (band-noises), centered at 1 and 16 kHz, respectively, were used for the examination. Onset times of individual band-noises (spectral onset-times) were varied to virtually cancel or magnify the latency difference observed with the band-noises. Conventionally defined nonlinear effects in integration were analyzed at A1 with varying sound intensities (or response latencies) and/or spectral onset-times of the two band-noises. The nonlinear effect measured in the high-frequency region of the A1 linearly changed depending on the millisecond difference of the response onset-times, which were estimated from the spatially-local response latencies and spectral onset-times. In contrast, the low-frequency region of the A1 had no significant sensitivity to the millisecond difference. The millisecond-range latency difference may have functional significance in the spectrotemporal integration with the millisecond time-scale sensitivity at the high-frequency region of A1 but not at the low-frequency region.

Seizures in early life suppress hippocampal dendrite growth while impairing spatial learning.

Impaired learning and memory are common in epilepsy syndromes of childhood. Clinical investigations suggest that the developing brain may be particularly vulnerable to the effects of intractable seizure disorders. Magnetic resonance imaging (MRI) studies have demonstrated reduced volumes in brain regions involved in learning and memory. The earlier the onset of an epilepsy the larger the effects seem to be on both brain anatomy and cognition. Thus, childhood epilepsy has been proposed to interfere in some unknown way with brain development. Experiments reported here explore these ideas by examining the effects of seizures in infant mice on learning and memory and on the growth of CA1 hippocampal pyramidal cell dendrites. Fifteen brief seizures were induced by flurothyl between postnatal days 7 and 11 in mice that express green fluorescent protein (GFP) in hippocampal pyramidal cells. One to 44days later, dendritic arbors were reconstructed to measure growth. Spatial learning and memory were also assessed in a water maze. Our results show that recurrent seizures produced marked deficits in learning and memory. Seizures also dramatically slowed the growth of basilar dendrites while neurons in littermate control mice continued to add new dendritic branches and lengthen existing branches. When experiments were performed in older mice, seizures had no measureable effects on either dendrite arbor complexity or spatial learning and memory. Our results suggest that the recurring seizures of intractable childhood epilepsy contribute to associated learning and memory deficits by suppressing dendrite growth.

Identification and characterization of an insular auditory field in mice.

We used voltage-sensitive-dye-based imaging techniques to identify and characterize the insular auditory field (IAF) in mice. Previous research has identified five auditory fields in the mouse auditory cortex, including the primary field and the anterior auditory field. This study confirmed the existence of the primary field and anterior auditory field by examining the tonotopy in each field. Further, we identified a previously unreported IAF located rostral to known auditory fields. Pure tone evoked responses in the IAF exhibited the shortest latency among all auditory fields at lower frequencies. A rostroventral to dorsocaudal frequency gradient was consistently observed in the IAF in all animals examined. Neither the response amplitude nor the response duration changed with frequency in the IAF, but the area of activation exhibited a significant increase with decreasing tone frequency. Taken together, the current results indicate the existence of an IAF in mice, with characteristics suggesting a role in the rapid detection of lower frequency components of incoming sound.

Postnatal development of subfields in the core region of the mouse auditory cortex.

The core region of the rodent auditory cortex has two subfields: the primary auditory area (A1) and the anterior auditory field (AAF). Although the postnatal development of A1 has been studied in several mammalian species, few studies have been conducted on the postnatal development of AAF. Using a voltage-sensitive-dye-based imaging method, we examined and compared the postnatal development of AAF and A1 in mice from postnatal day 11 (P11) to P40. We focused on the postnatal development of tonotopy, the relative position between A1 and AAF, and the properties of tone-evoked responses in the subfields. Tone-evoked responses in the mouse auditory cortex were first observed at P12, and tonotopy was found in both A1 and AAF at this age. Quantification of tonotopy using the cortical magnification factor (CMF; octave difference per unit cortical distance) revealed a rapid change from P12 to P14 in both A1 and AAF, and a stable level from P14. A similar time course of postnatal development was found for the distance between the 4 kHz site in A1 and AAF, the distance between the 16 kHz site in A1 and AAF, and the angle between the frequency axis of A1 and AAF. The maximum amplitude and rise time of tone-evoked signals in both A1 and AAF showed no significant change from P12 to P40, but the latency of the responses to both the 4 kHz and 16 kHz tones decreased during this period, with a more rapid decrease in the latency to 16 kHz tones in both subfields. The duration of responses evoked by 4 kHz tones in both A1 and AAF showed no significant postnatal change, but the duration of responses to 16 kHz tones decreased exponentially in both subfields. The cortical area activated by 4 kHz tones in AAF was always larger than that in A1 at all ages (P12-P40). Our results demonstrated that A1 and AAF developed in parallel postnatally, showing a rapid maturation of tonotopy, slow maturation of response latency and response duration, and a dorsal-to-ventral order (high-frequency site to low-frequency site) of functional maturation.

Dynamic changes of timing precision in timed actions during a behavioural task in guinea pigs.

Temporal precision is a determinant of performance in various motor activities. Although the accuracy and precision of timing in activities have been previously measured and quantified, temporal dynamics with flexible precision have not been considered. Here, we examined the temporal dynamics in timed motor activities (timed actions) using a guinea pig model in a behavioural task requiring an animal to control action timing to obtain a water reward. In well-trained animals, momentary variations in timing precision were extracted from the temporal distribution of the timed actions measured over daily 12-h sessions. The resampling of the observed time of action in each session demonstrated significant changes of timing precision within a session. Periods with higher timing precision appeared indiscriminately during the same session, and such periods lasted ~ 20 min on average. We conclude that the timing precision in trained actions is flexible and changes dynamically in guinea pigs. By elucidating the brain mechanisms involved in flexibility and dynamics with an animal model, future studies should establish more effective methods to actively enhance timing precision in our motor activities, such as sports.

Obstructive rectal endometriosis treated by robot-assisted laparoscopic surgery: a case report.

BACKGROUND: Rectal endometriosis is a rare disease. A definitive diagnosis prior to surgery is often difficult. We encountered a patient with rectal sub-obstructive endometriosis that was treated by robot-assisted laparoscopic low anterior resection. CASE PRESENTATION: A 43-year-old woman visited our hospital with suspected stenosis caused by upper rectal cancer. She had a 2-year history of constipation. We were unable to confirm the diagnosis through detailed examinations, including laparoscopy. Robot-assisted laparoscopic low anterior resection with D3 lymph node dissection was performed for both diagnosis and treatment. The postoperative specimen showed a submucosal tumor. The pathological examination confirmed rectal endometriosis. CONCLUSIONS: We herein describe a rare case of obstructive rectal endometriosis that we were unable to diagnose preoperatively. Robotic surgery was useful in this case, which involved extensive pelvic adhesion.

Organization of auditory areas in the superior temporal gyrus of marmoset monkeys revealed by real-time optical imaging.

The prevailing model of the primate auditory cortex proposes a core-belt-parabelt structure. The model proposes three auditory areas in the lateral belt region; however, it may contain more, as this region has been mapped only at a limited spatial resolution. To explore this possibility, we examined the auditory areas in the lateral belt region of the marmoset using a high-resolution optical imaging technique. Based on responses to pure tones, we identified multiple areas in the superior temporal gyrus. The three areas in the core region, the primary area (A1), the rostral area (R), and the rostrotemporal area, were readily identified from their frequency gradients and positions immediately ventral to the lateral sulcus. Three belt areas were identified with frequency gradients and relative positions to A1 and R that were in agreement with previous studies: the caudolateral area, the middle lateral area, and the anterolateral area (AL). Situated between R and AL, however, we identified two additional areas. The first was located caudoventral to R with a frequency gradient in the ventrocaudal direction, which we named the medial anterolateral (MAL) area. The second was a small area with no obvious tonotopy (NT), positioned between the MAL and AL areas. Both the MAL and NT areas responded to a wide range of frequencies (at least 2-24 kHz). Our results suggest that the belt region caudoventral to R is more complex than previously proposed, and we thus call for a refinement of the current primate auditory cortex model.

Non-familial juvenile polyposis of the stomach with gastric cancers: a case report.

BACKGROUND: Juvenile polyposis is an autosomal dominant inherited disease characterized by the development of numerous hamartomatous and nonneoplastic polyps of the gastrointestinal tract. Juvenile polyposis has also recently been reported as a predisposition for gastrointestinal cancer. CASE PRESENTATION: A 63-year-old man underwent esophagogastroduodenoscopy because of anemia and hypoalbuminemia during a follow-up for gastric polyposis, which showed multiple reddish polyps and two elevated lesions in the stomach. The elevated lesions were diagnosed as well-differentiated adenocarcinomas by biopsy. He had no specific physical findings or family history. Computed tomography showed gastric wall thickening without lymphadenopathy or distant metastasis. Colonoscopy showed an adenoma in the transverse colon. He underwent laparoscopy-assisted total gastrectomy with Roux-en-Y esophagojejunostomy. The resected specimen revealed numerous variously sized non-pedunculated polyps throughout the stomach, diagnosed histopathologically as hamartomatous polyps. The two elevated lesions were diagnosed as a well-differentiated adenocarcinoma restricted to the mucosa and a well-to-poorly differentiated adenocarcinoma invading the submucosa with prominent lymphatic permeation, respectively. Genetic analysis failed to identify any germline mutations in the genes usually associated with juvenile polyposis, including SMAD4 and BMPR1A. However, based on the few characteristic physical findings and histopathological features, the final diagnosis was juvenile polyposis restricted to the stomach. CONCLUSIONS: This patient represented a rare case of non-familial juvenile polyposis of the stomach with gastric cancers. Juvenile polyposis has malignant potential, and patients should therefore be carefully followed up. Surgical treatment, particularly total gastrectomy, is recommended as a standard treatment in patients with juvenile polyposis of the stomach with gastric cancer.

Benidipine attenuates glomerular hypertension and reduces albuminuria in patients with metabolic syndrome.

Recent studies have shown that metabolic syndrome is associated with an increased risk for chronic kidney disease. We recently found that the prevalence of sodium-sensitive hypertension in patients with metabolic syndrome was significantly higher than that in patients with essential hypertension but without metabolic syndrome. We therefore assessed the effects of benidipine, a long-acting calcium channel blocker, on the sodium sensitivity of blood pressure and renal hemodymamics in 5 patients with metabolic syndrome. Glomerular hemodynamics were assessed using pressure-natriuresis curves, which were constructed by plotting the urinary excretion of sodium as a function of the mean arterial pressure, which was calculated as the mean of 48 values based on 24-h monitoring, during the intake of low (3 g NaCl daily) and relatively high (10 g NaCl daily) sodium diets. Under the relatively high sodium diet condition, benidipine significantly lowered systolic and diastolic blood pressure. The pressure-natriuresis curve was steeper after the administration of benidipine. Benidipine lowered glomerular capillary hydraulic pressure (P(GC)) levels (from 54.4+/-7.5 to 47.0+/-7.0 mmHg, p=0.0152) and reduced both the resistance of the afferent arterioles (from 10,338+/-2,618 to 9,026+/-2,627 dyn.s/cm5, p=0.047) and the resistance of the efferent arterioles (from 4,649+/-2,039 to 2,419+/-2,081 dyn.s/cm(5), p=0.003). The urinary albumin excretion rate also decreased after the administration of benidipine. These findings indicated that benidipine may be effective for reducing the risk of developing chronic kidney disease in patients with metabolic syndrome.

Iron status and the use of non-steroidal anti-inflammatory drugs in hemodialysis patients.

We examined whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) can affect the anemia and iron status of hemodialysis patients. We recruited patients from six dialysis centers who had undergone maintenance hemodialysis for at least four months. We examined the use of NSAIDs during the past three months based on their medical records and assigned the patients to three groups (group A, non-NSAID group; group B, aspirin group; and group C, non-aspirin NSAID group). Of the 446 patients, 95 (21.3%) were treated with aspirin and 103 (23.1%) were treated with non-aspirin NSAIDs. The serum iron level and transferrin saturation (TSAT) were significantly lower in group C patients than those in group A. However, the ratio of the patients who were administrated iron preparations during the past three months was significantly higher than that in the other two groups. The incidences of positive fecal occult blood tests did not differ substantially between the three groups. The ratios of the patients who were administrated recombinant human erythropoietin were the same between three groups. Using a multiple regression analysis, the administration of non-aspirin NSAIDs was identified as an independent factor for the decreased serum iron and the decreased TSAT levels. A multiple logistic regression analysis revealed that the patients using non-aspirin NSAIDs had an increased the requirement for iron preparation therapy (OR 2.03, 95% CI, 1.28-3.22). The use of non-aspirin NSAIDs may therefore increase the risk of the iron deficiency in patients undergoing hemodialysis.

The Impact of Electrographic Seizures on Developing Hippocampal Dendrites Is Calcineurin Dependent.

Neurobehavioral abnormalities are commonly associated with intractable childhood epilepsy. Studies from numerous labs have demonstrated cognitive and socialization deficits in rats and mice that have experienced early-life seizures. However, the cellular and molecular mechanisms underlying these effects are unknown. Previously, experiments have shown that recurrent seizures in infancy suppress the growth of hippocampal dendrites at the same time they impair learning and memory. Experiments in slice cultures have also demonstrated dendrite growth suppression. Here, we crossed calcineurin B1 (CaNB1) floxed and Thy1GFP-M mice to produce mice that were homozygous for the both the floxed CaNB1 and the Thy1GFP-M transgene. Littermates that were homozygous for wild-type CaNB1 and Thy1GFP-M served as controls. Hippocampal slice cultures from these mice were transfected with an AAV/hSyn-mCherry-Cre virus to eliminate CaNB1 from neurons. Immunohistochemical results showed that CaNB1 was eliminated from at least 90% of the transfected CA1 pyramidal cells. Moreover, the CaN-dependent nuclear translocation of the CREB transcription coactivator, CREB-regulated transcriptional coactivator 1 (CRTC1), was blocked in transfected neurons. Cell attach patch recordings combined with live multiphoton imaging demonstrated that the loss of CaNB1 did not prevent neurons from fully participating in electrographic seizure activity. Finally, dendrite reconstruction showed that the elimination of CaNB1 prevented seizure-induced decreases in both dendrite length and branch number. Results suggest that CaN plays a key role in seizure-induced dendrite growth suppression and may contribute to the neurobehavioral comorbidities of childhood epilepsy.

A light-emitting diode light source for imaging of neural activities with voltage-sensitive dyes.

We tested the possibility of using a high-power monochromatic InGaN light-emitting diode (LED) as an excitation light source for real-time optical imaging using the voltage-sensitive dye RH-795. Driven with a custom-designed, non-feedback-controlled constant-current circuit, the LED generated stable light with rapid on/off. The LED was comparable with commonly used halogen lamps in exciting RH-795. Acoustically evoked responses in the auditory cortex recorded with the two light sources were highly similar. Our results thus suggest that a high-power LED can be successfully used as an excitation light source for voltage-sensitive dyes, without the need of optical filters and shutters.

Comparative Effects of Direct Renin Inhibitor and Angiotensin Receptor Blocker on Albuminuria in Hypertensive Patients with Type 2 Diabetes. A Randomized Controlled Trial.

BACKGROUND: In patients with diabetes, albuminuria is a risk marker of end-stage renal disease and cardiovascular events. An increased renin-angiotensin system activity has been reported to play an important role in the pathological processes in these conditions. We compared the effect of aliskiren, a direct renin inhibitor (DRI), with that of angiotensin receptor blockers (ARBs) on albuminuria and urinary excretion of angiotensinogen, a marker of intrarenal renin-angiotensin system activity. METHODS: We randomly assigned 237 type 2 diabetic patients with high-normal albuminuria (10 to <30 mg/g of albumin-to-creatinine ratio) or microalbuminuria (30 to <300 mg/g) to the DRI group or ARB group (any ARB) with a target blood pressure of <130/80 mmHg. The primary endpoint was a reduction in albuminuria. RESULTS: Twelve patients dropped out during the observation period, and a total of 225 patients were analyzed. During the study period, the systolic and diastolic blood pressures were not different between the groups. The changes in the urinary albumin-to-creatinine ratio from baseline to the end of the treatment period in the DRI and ARB groups were similar (-5.5% and -6.7%, respectively). In contrast, a significant reduction in the urinary excretion of angiotensinogen was observed in the ARB group but not in the DRI group. In the subgroup analysis, a significant reduction in the albuminuria was observed in the ARB group but not in the DRI group among high-normal albuminuria patients. CONCLUSION: DRI and ARB reduced albuminuria in hypertensive patients with type 2 diabetes. In addition, ARB, but not DRI, reduced albuminuria even in patients with normal albuminuria. DRI is not superior to ARB in the reduction of urinary excretion of albumin and angiotensinogen.

Influence of a tumor necrosis factor gene polymorphism in Japanese patients with multiple system atrophy.

We studied promoter region polymorphisms in the tumor necrosis factor (TNF), interleukin (IL)-6, IL-10, and transforming growth factor (TGF)-beta1 genes in Japanese patients with multiple system atrophy (MSA) (n=122) and normal controls (n=277). The frequency of the TNF-1031C, a high producer allele of TNF, was increased significantly in MSA patients compared with controls (chi2=12.36, P=0.0021, Pc=0.0084). In contrast, there was no difference in the genotype or allele frequency in the other cytokine gene polymorphisms. We also failed to detect any difference in the disease onset between each genotype of the polymorphisms examined. Our findings suggest that TNF might have a toxic effect in MSA.

[Long-term survival in a case of large bowel cancer--efficacy of CPT-11-based chemotherapy].

A 77-year-old woman underwent an ileocecal resection and a partial resection of the small intestine for cecal cancer. However, ileus caused by a recurrence in the small intestine was detected two years and four months postoperatively, so an ileal resection was performed. Furthermore, metastases to the lungs, lymph nodes, and peritoneum were detected, and CPT-11-based chemotherapy was administered. The patient was initially treated by combination therapy with a small dose of CPT-11 and CDDP. The combination drugs were changed to MMC, 5'-DFUR, etc. while the appearance of adverse reactions was monitored. Three years of continuous treatment served to prevent the proliferation of tumors. At present, TS-1 chemotherapy is ongoing. The results suggest that CPT-11-based chemotherapy can be continued by changing the combination of concomitant drugs while monitoring adverse reactions. It thus may be an effective regimen for advanced and recurrent large bowel cancer.