Thirty years' experience of open-repair surgery for pectus excavatum: development of a metal-free procedure.

OBJECTIVE: Throughout the history of surgery for pectus excavatum (PE), the Nuss procedure and open repair have been performed with many modifications, with most of these procedures using a metal bar. However, the use of a metal bar has several drawbacks. Thus, we aimed to develop a procedure that did not require a metal bar. METHODS: Through our experience of 426 pediatric cases that underwent various procedures for open repair of PE at Nagoya City University, we arrived at the current procedure that we describe herein. We have evaluated this procedure by review of clinical results and deformity indices (Haller's, steepness, excavation volume, and asymmetry index). RESULTS: The latest and current procedure that supports the sternum with a bridge constructed by the 4th or 5th costal cartilages is associated with fewer complications, a lower re-operation rate, and striking improvement in the indices examined. CONCLUSIONS: Our current open-repair procedure that does not require a metal bar is recommended for correction of deformities of PE in children.

Molecular analysis of endoderm regionalization.

We have engaged in a number of studies in our laboratory that have focused on the molecular mechanisms underlying gut formation, with particular attention being paid to the establishment of regional differences found in the entire gut and within each digestive organ. We have found from our analyses that the presumptive fate of the endoderm in the embryos of vertebrates is determined quite early during development, but the realization of this fate often requires molecular cues from the neighboring tissues such as the lateral plate mesoderm and the mesenchyme derived from it. The mesenchyme seems often to exert instructive or supportive induction effects and, in some cases, a completely inhibitory role during the differentiation of the endodermal epithelium. In addition, many reports on the formation of the stomach, intestine, liver and salivary gland in vertebrates, and of Drosophila gut, all indicate that the morphogenesis and cytodifferentiation of these organs are regulated by the regulated expression of genes encoding growth factors and transcription factors. We have further shown that the epithelium can regulate the differentiation of the mesenchyme into the connective tissue and the smooth muscle layers, thus demonstrating the occurrence of literally interactive processes in the development of the digestive organs.

Distinct roles of presynaptic dopamine receptors in the differential modulation of the intrinsic synapses of medium-spiny neurons in the nucleus accumbens.

BACKGROUND: In both schizophrenia and addiction, pathological changes in dopamine release appear to induce alterations in the circuitry of the nucleus accumbens that affect coordinated thought and motivation. Dopamine acts principally on medium-spiny GABA neurons, which comprise 95% of accumbens neurons and give rise to the majority of inhibitory synapses in the nucleus. To examine dopamine action at single medium-spiny neuron synapses, we imaged Ca2+ levels in their presynaptic varicosities in the acute brain slice using two-photon microscopy. RESULTS: Presynaptic Ca2+ rises were differentially modulated by dopamine. The D1/D5 selective agonist SKF81297 was exclusively facilitatory. The D2/D3 selective agonist quinpirole was predominantly inhibitory, but in some instances it was facilitatory. Studies using D2 and D3 receptor knockout mice revealed that quinpirole inhibition was either D2 or D3 receptor-mediated, while facilitation was mainly D3 receptor-mediated. Subsets of varicosities responded to both D1 and D2 agonists, showing that there was significant co-expression of these receptor families in single medium-spiny neurons. Neighboring presynaptic varicosities showed strikingly heterogeneous responses to DA agonists, suggesting that DA receptors may be differentially trafficked to individual varicosities on the same medium-spiny neuron axon. CONCLUSION: Dopamine receptors are present on the presynaptic varicosities of medium-spiny neurons, where they potently control GABAergic synaptic transmission. While there is significant coexpression of D1 and D2 family dopamine receptors in individual neurons, at the subcellular level, these receptors appear to be heterogeneously distributed, potentially explaining the considerable controversy regarding dopamine action in the striatum, and in particular the degree of dopamine receptor segregation on these neurons. Assuming that post-receptor signaling is restricted to the microdomains of medium-spiny neuron varicosities, the heterogeneous distribution of dopamine receptors on individual varicosities is likely to encode patterns in striatal information processing.

Adenovirus-mediated WGA gene delivery for transsynaptic labeling of mouse olfactory pathways.

Detailed knowledge of neuronal connectivity patterns is indispensable for studies of various aspects of brain functions. We previously established a genetic strategy for visualization of multisynaptic neural pathways by expressing wheat germ agglutinin (WGA) transgene under the control of neuron type-specific promoter elements in transgenic mice and Drosophila. In this paper, we have developed a WGA-expressing recombinant adenoviral vector system and applied it for analysis of the olfactory system. When the WGA-expressing adenovirus was infused into a mouse nostril, various types of cells throughout the olfactory epithelium were infected and expressed WGA protein robustly. WGA transgene products in the olfactory sensory neurons were anterogradely transported along their axons to the olfactory bulb and transsynaptically transferred in glomeruli to dendrites of the second-order neurons, mitral and tufted cells. WGA protein was further conveyed via the lateral olfactory tract to the olfactory cortical areas including the anterior olfactory nucleus, olfactory tubercle, piriform cortex and lateral entorhinal cortex. In addition, transsynaptic retrograde labeling was observed in cholinergic neurons in the horizontal limb of diagonal band, serotonergic neurons in the median raphe nucleus, and noradrenergic neurons in the locus coeruleus, all of which project centrifugal fibers to the olfactory bulb. Thus, the WGA-expressing adenovirus is a useful and powerful tool for tracing neural pathways and could be used in animals that are not amenable to the transgenic technology.

Demonstration of sucrase immunoreactivity of the brush border induced by duodenal mesenchyme in chick stomach endoderm.

When stomach endoderm of chick embryos was recombined and cultured with duodenal mesenchyme, the endoderm developed a brush border structure over a large area and also differentiated into mucous cells in a small area according to its own developmental fate. In the present investigation, we examined whether the induced brush border structure expressed sucrase antigen by immunoelectron microscopy using the antiserum raised against chicken sucrase. Sucrase immunoreactivity could be detected as ferritin particles in the region where the brush border was induced, whereas it was never detected on microvilli of endodermal cells which differentiated into the mucous cells. Thus, almost all of the endodermal cells could be identified as either small intestine-type cells possessing the sucrase antigen or stomach-type cells possessing mucous granules but not the sucrase antigen. The results indicate that stomach endodermal cells of chick embryos can differentiate not only morphologically but also functionally into typical intestinal epithelial cells under the inductive influence of the duodenal mesenchyme.

Analysis of Epithelial Protein Profiles of Prostatic Glands Induced Heterotypically in the Bladder Epithelium of the Rat: (mesenchymal-epithelial interaction/prostate-specific/heterotypic differentiation/urinary bladder/urogenital sinus).

When urinary bladder epithelia of rats were grown in association with fetal urogenital sinus mesenchyme, prostatic morphogenesis was induced. The epithelial proteins were examined by HPLC fractionation followed by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE). More than 500 bands of silver-stained epithelial proteins were analyzed. The glandular epithelia induced from both adult and fetal bladder epithelia lost all of the 7 bladder-specific bands (BE 1-7) in most recombinants and expressed a number of prostate-specific bands. Among the 18 bands commonly found in all prostatic lobes, 13 (PE 4, 7-18) were constantly and 3 (PE 1-3) were sporadically detected, while the other 2 (PE 5 and 6) bands were not detected when the adult epithelium was used in recombination. Among the 7 prostatic lobe-specific bands (vPE 14, dPE 1-3), most of them were detected when the fetal epithelium was used, while few of them when the adult epithelium was used. These results demonstrate that prostatic morphogenesis induced in the bladder epithelium was associated with most of biochemical features of prostate. In addition to the biochemical study, histological examination revealed that the prostatic differentiation was more complete in the fetal bladder epithelium than the adult one.

Heterotypic induction of stomach-like glands in the urogenital sinus endoderm under the influence of stomach mesenchyme of foetal rats.

Urogenital sinus endoderm of 16.5-day rat foetuses was combined with stomach mesenchyme and the recombinants were either treated with testosterone and grown in vitro or cultured beneath the kidney capsule of adult male rats of the same strain. It was found that testosterone stimulated mitosis in the urogenital endoderm. In recombinants grown under the kidney capsule a stratified squamous epithelium and stomach-like glands were induced under the influence of the forestomach and glandular stomach mesenchymes. However, the induced glands expressed neither rat pepsinogen nor rat ventral prostatic antigen. They did not produce mRNA for the prostatic steroid-binding protein C1. Thus, stomach mesenchyme of rat foetuses induces organ-specific morphogenesis but not functional differentiation in the heterologous endoderm, indicating that cytodifferentiation does not always accompany morphogenesis.

Epithelial Metaplasia Induced Amnionic Ectoderm by the Dermis of Chicken Embryos1 : (mesenchymal-epithelial interaction/feather/scale/skin/keratin).

Amnionic ectoderm of 6.8-day chicken embryos was associated with 6.8-day dorsal dermis or 13-15-day scale dermis and cultured on host chorio-allantoic membrane for 8 days. The amnionic ectoderm, recombined and cultured with the dorsal dermis, developed feather filaments consisted of a feather root, a horny sheath, and barb ridges. With several feather keratin-specific monoclonal antibodies (4E12 and 1F3), these structures in the induced feather filaments were shown to express feather-specific keratin antigens. The amnionic ectoderm, recombined and cultured with the shank dermis, became stratified squamous and developed scales. The scales were keratinized and their surface reacted only weakly with the monoclonal antibodies specific for the feather keratins. However, 1F3 reacted with two polypeptides in the cytoskeletal fraction of the scales, but not of the feather filaments. The results confirm our previous findings from in vitro experiments with the proamnionic ectoderm (Mizuno, 1970, 1972).

Developmental changes in the ability to express embryonic pepsinogen in the stomach epithelia of chick embryos.

The avian stomach is subdivided into two parts, the proventriculus and the gizzard. It has been shown that the gizzard epithelium can express embryonic chick pepsinogen (ECPg) antigen, a marker protein of the proventricular epithelium, as well as normal proventricular epithelium, under the appropriate experimental conditions. To study the possible mechanisms involved in the suppression of ECPg synthesis in the gizzard epithelium during normal development, we carried out heterotypic and heterochronic recombination experiments of the epithelium and mesenchyme of these two organ rudiments. When recombined and cultured with 6-day proventricular mesenchyme, gizzard epithelium of 3.5- to 12-day embryos expressed pepsinogen at all stages tested. However, the ratio of ECPg-positive cells to total epithelial cells in the gizzard epithelium decreased rapidly when epithelium older than 7 days was cultured with proventricular mesenchyme. In contrast to proventricular mesenchyme, 6-day gizzard mesenchyme did not allow ECPg expression in associated proventricular epithelium of 3.5- to 7-day embryos. These results indicate that gizzard epithelium does not express pepsinogen in normal development because of both a decrease in ability to express the enzyme in itself in the course of development and a repressive influence of gizzard mesenchyme.

Pepsinogen Induction in Chick Stomach Epithelia by Reaggregated Proventricular Mesenchymal Cells In Vitro: (stomach/organ culture/pepsinogen/induction/epithelial-mesenchymal interaction).

In vitro organ culture system which permits embryonic chick proventriculus (glandular stomach) to synthesize pepsinogen de novo was developed. Explants of the proventricular rudiment were cultured on Millipore filters in Medium 199 with Earle's salts supplemented with 50% 12-day embryo extract at 38°C in 95% air and 5% CO2 . In these culture conditions, pepsinogen, a functional marker protein of proventriculus, was first detected after 3 days of cultivation of 6-day chick proventricular rudiment. When recombined and cultured with 6-day proventricular mesenchyme, 6-day oesophageal, proventricular or gizzard (muscular stomach) epithelium expressed pepsinogen while small intestinal epithelium did not. These results were consistent with the previous results obtained by chorioallantoic membrane (CAM) grafting, and showed that the culture conditions are permissive for pepsinogen expression. When recombined and cultured with reaggregated mesenchymal cells isolated from 6-day proventricular mesenchymal fragments, both 6-day proventricular and gizzard epithelia formed glandular structure and expressed pepsinogen. This indicates that the proventricular mesenchymal cells retain the ability to induce morphogenesis and cytodifferentiation of the proventricular epithelium even if the normal organization of proventricular mesenchyme is once destroyed.

Immunological Relationships among Embryonic and Adult Chicken Pepsinogens: A Study with Monoclonal and Polyclonal Antibodies: (chicken pepsinogens/development/antibodies/immunocytochemistry/immunoblotting).

To investigate the immunological relationships of pepsinogen isozymes present in embryonic and adult chicken proventriculi, we obtained monoclonal and polyclonal antibodies to these pepsinogens. Zymograms and immunoblots demonstrated that monoclonal antibody Y37 reacted with both embryonic and slow-migrating adult pepsinogens, while polyclonal antibodies against embryonic pepsinogen and fast-migrating adult pepsinogen were specific for these respective antigens. Shift from embryonic to adult-type pepsinogen occurred at about the time of hatching and the localizations of embryonic and adult-type pepsinogens within proventricular gland cells were found to differ by the indirect immunofluorescence method. Results with these antibodies revealed the immunological relations of these pepsinogens and the unique properties of embryonic chicken pepsinogen.

Gizzard epithelium of chick embryos can express embryonic pepsinogen antigen, a marker protein of proventriculus.

The avian stomach is composed of two distinct organs, the proventriculus and the gizzard. Pepsinogen expression in the proventricular and gizzard epithelia of chick embryos was investigated immunohistochemically with anti-embryonic chick pepsinogen (anti-ECPg) antiserum. In normal development, the ECPg antigen was expressed only in the glandular epithelial cells of the embryonic proventriculus from the 8th day of incubation onwards. However, both proventricular and gizzard epithelia of 6-day embryos expressed the ECPg antigen when recombined and cultured with the proventricular mesenchyme. Chronological studies revealed that the ECPg antigen was first detected in a few epithelial cells at 3 days of cultivation. The percentage of ECPg-positive cells among the total epithelial cells in each recombinant increased with the length of the culture period and all the glandular epithelial cells were positive at 9 days. During this process, the percentage of ECPg-positive cells in each cultured recombinant was similar in proventricular and gizzard epithelia. Moreover, both epithelia could express the ECPg antigen when recombined and cultured with the oesophageal or small-intestine mesenchyme for 9 days, though the percentage of ECPg-positive cells in each cultured recombinant was much lower than that in the cultured recombinant with the proventricular mesenchyme. These results indicate that the gizzard epithelium of 6-day chick embryos possesses a similar potential for pepsinogen expression as the proventricular epithelium of the same age.

Histogenesis of the Os Penis and Os Clitoridis in Rats: (chondrogenesis/bone formation/testosterone/genital tubercle).

The development of the os penis in normal male rats and the os clitoridis in the females treated with testosterone were studied histologically and histochemically. Alcian blue-positive materials, alkaline phosphatase activities and calcium deposit were detected. The os penis of the rats was composed of a proximal segment and a distal one. The proximal segment of the os penis was formed by the fusion of a membrane bone in its distal half and an ossifying hyaline cartilage in its proximal half. The distal segment of the os penis developed as a fibrocartilage bone. Two steps were demonstrated in the development of the os penis: the formation of the rudiments, and the differentiation of the proximal and distal segments. The treatment of newborn females with testosterone induced an os clitoridis homologous to the proximal segment of the os penis. The development of the os clitoridis was compared with that of the os penis.

DIFFERENTIATION OF THE DIGESTIVE TRACT EPITHELIUM UNDER THE INFLUENCE OF THE HETEROLOGOUS MESENCHYME OF THE DIGESTIVE TRACT IN THE BIRD EMBRYOS.

The endoderm of the oesophagus, proventriculus, gizzard or small intestine of the 5-day-old chick or quail embryo was cultivated in combination with homologous or heterologous mesenchyme on a WxxxOLFFyyy and HxxxAFFHNyyy medium for 7 to 21 days or on the chorio-allantoic membrane (CAM) for 8 days. With homologous mesenchyme the epithelium always differentiated homotypically. In association with heterologous mesenchyme, the differentiation of the epithelium was both homotypical and heterotypical depending on the region of the digestive tract. The oesophagus and small intestine differentiate mainly homotypically both in culture and on CAM, but the gizzard and proventriculus show heterotypic differentiation particularly on CAM. Thus, the endoderm of the digestive tract of the 5-day-old chick or quail embryo, though rather "determined", still reacts to the heterologous stimuli of the mesenchyme to some degree.

Heterotypic differentiation of chick allantoic endoderm under the influence of various mesenchymes of the digestive tract.

Dissociation and reassociation experimentsin vitro were carried out to investigate the differentiation potency of chick allantoic endoderm under the influence of digestive tract mesenchymes. 1. The allantoic endoderm, when cultured alonein vitro, shows no differentiation whatsoever. 2. The allantoic endoderm, when cultivated combined with the mesenchyme of oesophagus, can differentiate into a stratified cuboidal epithelium, similar to that of the embryonic oesophagus. 3. Cultivation of the allantoic endoderm combined with the proventricular mesenchyme causes differentiation of cylindrical epithelium and glands, which are characteristic of the embryonic proventriculus. 4. The combination of the allantoic endoderm and the gizzard mesenchyme results in the differentiation of pseudostratified columnar epithelium, the cells of which possess glycogen granules like those in the normal embryonic gizzard. 5. If the allantoic endoderm is cultured on the mesenchyme of the small intestine, the endodermal cells are converted into simple columnar epithelial cells similar to those of normal embryonic small intestine. 6. The competence for the heterotypic development of the allantoic endoderm appears to be a function of a developmental time sequence: it is highest in the youngest (3-day) allantoic endoderm, and gradually lost in older embryos. 7. In all combinations tested, there appear goblet cells in the epithelium when the explants are cultured more than 10 days. These cells are never observed in intact oesophagus, proventriculus and gizzard, whether in normal development or in culture.