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Introduction/Aims: Amyotrophic lateral sclerosis (ALS) exhibits selective muscle weakness. The weak shoulder and arm sparing signs, assessed by a single experienced neurologist, have been reported to be superior to previous signs in sensitivity and specificity. However, it is unknown whether the same results are observed when assessed by multiple neurologists. Methods: Subjects were retrospectively identified from our department's inpatient database from 2014 to 2023. Medical Research Council (MRC) scores of the deltoid (Del), biceps brachii (BB), triceps brachii (TB), and first dorsal interosseous (FDI) muscles were evaluated. The weak shoulder sign was defined as positive when Del was weaker than BB and TB. The arm sparing sign was defined as positive when both Del and FDI were weaker than BB and TB. Sensitivity was analyzed in all ALS patients and in subgroups based on the region of symptom onset, presence or absence of upper motor neuron (UMN) signs, and the Japanese ALS Severity Classification. Results: Seventy‐one patients with ALS were identified. Eight neurologists and three neurology residents evaluated each patient's MRC scores. The weak shoulder and arm sparing signs were observed in 72% and 48% of patients, respectively, with no significant difference in sensitivity across patient subgroups. Discussion: The weak shoulder and arm sparing signs showed high and moderate sensitivity, respectively, consistent with a previous report, even when evaluated by multiple examiners. This expands the clinical utility and increases the reliability of these signs, potentially contributing to accurate ALS diagnosis when combined with other clinical features and objective assessments. [ABSTRACT FROM AUTHOR]

Background: The optimal timing for therapeutic drug monitoring (TDM) of voriconazole in Asians, who have higher rates of poor metabolisers than non‐Asians, is unclear. This can cause unexpectedly high concentrations and delays in reaching steady‐state levels. Objectives: To determine the appropriate timing of TDM in Japanese patients receiving voriconazole. Patients/Methods: Trough levels (Cmin) were measured on days 3–5 (recommended timing, RT) and days 6–14 (delayed timing, DT) after starting voriconazole in patients receiving an appropriate dosage. Considering bioavailability, Cmin was only compared in patients receiving oral voriconazole. Results: A total of 289 and 186 patients were included in the safety and pharmacokinetic analyses, respectively. There was a significant difference in Cmin measured no later than and after day 5 (3.59 ± 2.12 [RT] vs. 4.77 ± 3.88 μg/mL [DT], p =.023), whereas no significant difference was observed on cutoff day 6 (3.91 ± 2.60 vs. 4.40 ± 3.94 μg/mL, p =.465), suggesting that Cmin close to the steady‐state was achieved after day 5. DT causes a delay in achieving the therapeutic range. The hepatotoxicity rates were 21.5% and 36.8% in the RT and DT groups, respectively (p =.004); DT was an independent risk factor for hepatotoxicity. Conclusion: Although steady‐state concentrations may not be achieved by day 5, early dose optimisation using RT can prevent hepatotoxicity in Japanese patients. TDM should be performed on days 3–5 to ensure safety. However, subsequent TDM may be necessary due to a possible further increase in Cmin. [ABSTRACT FROM AUTHOR]

The gut peristaltic movement, a wave‐like propagation of a local contraction, is important for the transportation and digestion of ingested materials. Among three types of cells, the enteric nervous system (ENS), smooth muscle cells, and interstitial cells of Cajal (ICCs), the ICCs have been thought to act as a pacemaker, and therefore it is important to decipher the cellular functions of ICCs to further our understanding of gut peristalsis. c‐Kit, a tyrosine kinase receptor, has widely been used as a marker for ICCs. Most studies with ICCs have been conducted in mammals using commercially available anti‐c‐Kit antibody. Recently, the chicken embryonic gut has emerged as a powerful model to study gut peristalsis. However, since the anti‐c‐Kit antibody for mammals does not work for chickens, cellular mechanisms by which ICCs are regulated have largely been unexplored. Here, we report a newly raised polyclonal antibody against the chicken c‐Kit protein. The specificity of the antibody was validated by both western blotting analyses and immunocytochemistry. Co‐immunostaining with the new antibody and anti‐α smooth muscle actin (αSMA) antibody successfully visualized ICCs in the chicken developing hindgut in the circular muscle and longitudinal muscle layers. As previously shown in mice, common progenitors of ICCs and smooth muscle cells at early stages were double positive for αSMA and c‐Kit, and at later stages, differentiated ICCs and smooth muscle cells exhibited only c‐Kit and αSMA, respectively. A novel ICC population was also found that radially extended from the submucosal layer to the circular muscle layer. Furthermore, the new antibody delineated individual ICCs in a cleared hindgut. The antibody newly developed in this study will facilitate the study of peristaltic movement in chicken embryos. [ABSTRACT FROM AUTHOR]

Background: Intensive glycemic control is recommended to prevent surgical site infections (SSI). Our aim was to evaluate retrospectively the effect of improvement in hyperglycemia irrespective of insulin use on the incidence of SSI in non-diabetic patients. Methods: The highest blood glucose (BG) concentration within 12 h (early peak BG) and the final BG from 12 to 24 h after surgery were evaluated in patients who underwent gastrointestinal surgery. Patients with an early peak BG of ≥150 mg/dL were divided into those with persistent (final BG of ≥150 mg/dL) and improved hyperglycemia (final BG of <150 mg/dL). Patients without hyperglycemia and those with late-onset hyperglycemia were also assessed for SSI risk. Results: Overall, 1612 patients were studied (diabetes, n = 293). Although hyperglycemia increased the SSI rates in non-diabetic patients, no correlation was demonstrated in patients with diabetes at any cutoff final BG defining htperglycemia except for 180 mg/dL. Hyperglycemia improved without insulin therapy in 283 of 512 non-diabetic patients who had early hyperglycemia. The adjusted standardized residual for those with SSI and persistent hyperglycemia was 5.2 (P < 0.05). In contrast, the absence of hyperglycemia was a significant preventive factor for SSI. In the multivariate analyses, persistent hyperglycemia was an independent risk factor for SSI (odds ratio 1.54; 95% confidence interval 1.03–2.31). Conclusions: Remission of hyperglycemia within 24 h after surgery prevented SSI in non-diabetic patients. Considering that hyperglycemia improved in approximately half of patients without insulin therapy, commencement of insulin dosing after two consecutive BGs of ≥150 mg/dL might be reasonable, especially in general wards. [ABSTRACT FROM AUTHOR]

The autonomic nervous system consists of sympathetic and parasympathetic nerves, which functionally antagonize each other to control physiology and homeostasis of organs. However, it is largely unexplored how the autonomic nervous system is established during development. In particular, early formation of parasympathetic network remains elusive because of its complex anatomical structure. To distinguish between parasympathetic (cholinergic) and sympathetic (adrenergic) ganglia, vesicular acetylcholine transporter ( VAChT) and choline O-acetyltransferase (Ch AT), proteins associated with acetylcholine synthesis, are known to be useful markers. Whereas commercially available antibodies against these proteins are widely used for mammalian specimens including mice and rats, these antibodies do not work satisfactorily in chickens, although chicken is an excellent model for the study of autonomic nervous system. Here, we newly raised antibodies against chicken VAChT and Ch AT proteins. One monoclonal and three polyclonal antibodies for VAChT, and one polyclonal antibody for Ch AT were obtained, which were available for Western blotting analyses and immunohistochemistry. Using these verified antibodies, we detected cholinergic cells in Remak ganglia of autonomic nervous system, which form in the dorsal aspect of the digestive tract of chicken E13 embryos. The antibodies obtained in this study are useful for visualization of cholinergic neurons including parasympathetic ganglia. [ABSTRACT FROM AUTHOR]

The adrenal gland is an endocrine organ that plays essential roles in stress responses. This organ consists of two types of tissues, adrenomedulla and adrenocortex, deriving from different embryonic origins. Whereas it is well accepted that the adrenomedulla derives from neural crest cells, the origin of the adrenocortex remains elusive. In addition, the adrenocortex and gonads, two major steroid hormone-producing tissues, have been thought to share the same origin, although the experimental evidence is lacking. In this study, to identify the origin of adrenocortex and to compare it to that of gonads, we scrutinized the medial portion of the coelomic epithelium ( CE) after the lateral plate mesoderm has split into two CE components with a concomitant opening of the coelomic cavity in between them. We found that early medial CE consists of a two-cell layer-thick band of epithelial-like cells, the outer and inner CEs. The outer CE faces the coelomic cavity, whereas the inner CE is juxtaposed to nascent blood vessels. Combining direct cell labeling with early molecular markers, we found that outer CE was the origin of the gonad but not the adrenocortex. The adrenocortex, instead, appears to derive from inner CE. Thus, the adrenocortical and gonadal progenitors are already segregated from each other when the coelomic cavity has opened. This study provides a new basis for understanding how the adrenal gland forms and how steroid hormone-producing tissues arise during development. [ABSTRACT FROM AUTHOR]

Sudden‐onset immobilisation generates unexpected external forces over bony prominences and is a potential cause of pressure ulcers. Here, we report two cases of deep pressure ulcers in patients with acute monoarthritis as a result of calcium pyrophosphate (CPP) crystal deposition (pseudogout). The patients were women in their 80 who could perform activities of daily living by themselves. They developed pressure ulcers while living in their own home. Because acute CPP crystal arthritis is known to develop in relatively healthy elderly patients, patients and caregivers do not expect sudden‐onset immobilisation. In addition, larger joints are preferentially involved in acute CPP crystal arthritis, leading to the inability of patients to change positions themselves. Therefore, acute CPP crystal arthritis should be recognised as a potential causal disease for pressure ulcers. This case report further highlights a new concept of "disease‐specific unexpected external force", which is beneficial for the prevention of pressure ulcers. [ABSTRACT FROM AUTHOR]

Placement of a self-expandable metallic stent ( SEMS) is recognized as a safe and effective procedure for patients with malignant severe colonic stenosis. However, reports of this stent for right-sided colonic stenosis are limited, possibly as a result of technical difficulties. We report a new method for delivering SEMS to the site of right-sided colonic stenosis in four patients with malignant right-sided colonic stenosis. Technical success was obtained with sequential use of a double-balloon endoscope and ultrathin endoscope, while we also injected non-ionic contrast agent into the submucosal layer as a marker for stenting under fluoroscopy. There were no adverse events noted during the procedure and clinical improvement was seen in all four cases. In conclusion, SEMS placement for right-sided malignant colonic stenosis with our newly developed method appears to be safe and effective, and can be used for decompression of the right colon. [ABSTRACT FROM AUTHOR]

During skin pigmentation in avians and mammalians, melanin is synthesized in the melanocytes, and subsequently transferred to adjacently located keratinocytes, leading to a wide coverage of the body surface by melanin-containing cells. The behavior of melanocytes is influenced by keratinocytes shown mostly by in vitro studies. However, it has poorly been investigated how such intercellular cross-talk is regulated in vivo because of a lack of suitable experimental models. Using chicken embryos, we developed a method that enables in vivo gene manipulations of melanocytes and keratinocytes, where these cells are separately labeled by different genes. Two types of gene transfer techniques were combined: one was a retrovirus-mediated gene infection into the skin/keratinocytes, and the other was the in ovo DNA electroporation into neural crest cells, the origin of melanocytes. Since the Replication-Competent Avian sarcoma-leukosis virus long terminal repeat with Splice acceptor (RCAS) infection was available only for the White leghorn strain showing little pigmentation, melanocytes prepared from the Hypeco nera (pigmented) were back-transplanted into embryos of White leghorn. Prior to the transplantation, enhanced green fluorescent protein ( EGFP)+Neor+-electroporated melanocytes from Hypeco nera were selectively grown in G418-supplemented medium. In the skin of recipient White leghorn embryos infected with RCAS- mOrange, mOrange+ keratinocytes and transplanted EGFP+ melanocytes were frequently juxtaposed each other. High-resolution confocal microscopy also revealed that transplanted melanocytes exhibited normal behaviors regarding distribution patterns of melanocytes, dendrite morphology, and melanosome transfer. The method described in this study will serve as a useful tool to understand the mechanisms underlying intercellular regulations during skin pigmentation in vivo. [ABSTRACT FROM AUTHOR]

Pluripotency is an important feature of early embryonic cells of multicellular organisms. Recent advances in stem cell research have shown that Nanog and Pou5f1 (Oct3/4) play important roles in mammalian pluripotency. However, whether these molecules exert conserved functions in other species remains unknown. Although the epiblast of the early chicken embryo would provide a useful experimental model, a lack of antibodies against chicken Nanog ( cNanog) and chicken PouV/Pou5f3 ( cPouV) proteins has hampered intensive investigation. Here we report newly raised polyclonal antibodies that specifically recognize cNanog and cPouV proteins. The specificity and sensitivity of the antibodies were validated by both western blotting and immunostaining with transfected 293T cells and chicken embryonic tissues. Immunohistochemistry using these antibodies revealed that cNanog protein was specifically localized in epiblastic cells and germ cells. In contrast, cPouV expression was seen almost ubiquitously. We also found that chicken epiblast-derived colony-forming cells that morphologically resemble mouse embryonic stem cells were cNanog-positive, implying that these colony-forming cells possess pluripotency. The anti- cPouV antibody further enabled us to identify a previously unknown region at the N-terminus of the cPouV protein containing a characteristic motif that is absent in mammalian Pou5f1. Thus, the antibodies raised in this study are useful tools for studying the functions of cNanog and cPouV at the protein level and the molecular mechanisms of chicken pluripotency. [ABSTRACT FROM AUTHOR]

To understand how blood vessels form to establish the intricate network during vertebrate development, it is helpful if one can visualize the vasculature in embryos. We here describe a novel labeling method using highlighter ink, easily obtained in stationery stores with a low cost, to visualize embryo-wide vasculatures in avian and mice. We tested 50 different highlighters for fluorescent microscopy with filter sets equipped in a standard fluorescent microscope. The yellow and violet inks yielded fluorescent signals specifically detected by the filters used for green fluorescent protein ( GFP) and red fluorescent protein ( RFP) detections, respectively. When the ink solution was infused into chicken/quail and mouse embryos, vasculatures including large vessels and capillaries were labeled both in living and fixed embryos. Ink-infused embryos were further subjected to histological sections, and double stained with antibodies including QH-1 (quail), α smooth muscle actin (α SMA), and PECAM-1 (mouse), revealing that the endothelial cells were specifically labeled by the infused highlighter ink. Highlighter-labeled signals were detected with a resolution comparable to or higher than signals of fluorescein isothiocyanate ( FITC)-lectin and Rhodamine-dextran, conventionally used for angiography. Furthermore, macroconfocal microscopic analyses with ink-infused embryos visualized fine vascular structures of both embryo proper and extra-embryonic plexus in a Z-stack image of 2400 μm thick with a markedly high resolution. Together, the low cost highlighter ink serves as an alternative reagent useful for visualization of blood vessels in developing avian and mouse embryos and possibly in other animals. [ABSTRACT FROM AUTHOR]

Key points We recently showed that orexin neurons in the hypothalamus are indispensable for stress-induced thermogenesis., In this study we examined whether the orexin neurons are also important for other forms of thermogenic processes, including brain prostaglandin E2 (PGE2) injection that mimics inflammatory fever and environmental cold exposure., As was the case with stress-induced thermogenesis, orexin neuron-ablated (ORX-AB) mice exhibited a blunted PGE2-induced fever and intolerance to cold (5°C) exposure., Injection of retrograde tracer into the medullary raphe nucleus, where sympathetic premotor neurons regulating thermogenesis by the brown adipose tissue are located, revealed direct and indirect projection from the orexin neurons, of which the latter seemed to be preserved in the ORX-AB mice., These results suggest that orexin neurons are important in general thermogenic processes, and their importance is not restricted to stress-induced thermogenesis., Abstract We recently showed using prepro-orexin knockout (ORX-KO) mice and orexin neuron-ablated (ORX-AB) mice that orexin neurons in the hypothalamus, but not orexin peptides per se, are indispensable for stress-induced thermogenesis. To examine whether orexin neurons are more generally involved in central thermoregulatory mechanisms, we applied other forms of thermogenic perturbations, including brain prostaglandin E2 (PGE2) injections which mimic inflammatory fever and environmental cold exposure, to ORX-KO mice, ORX-AB mice and their wild-type (WT) litter mates. ORX-AB mice, but not ORX-KO mice, exhibited a blunted PGE2-induced fever and intolerance to cold (5°C) exposure, and these findings were similar to the results previously obtained with stress-induced thermogenesis. PGE2-induced shivering was also attenuated in ORX-AB mice. Both mutants responded similarly to environmental heating (39°C). In WT and ORX-KO mice, the administration of PGE2 and cold exposure activated orexin neurons, as revealed by increased levels of expression of c-fos. Injection of retrograde tracer into the medullary raphe nucleus revealed direct and indirect projection from the orexin neurons, of which the latter seemed to be preserved in the ORX-AB mice. In addition, we found that glutamate receptor antagonists ( d-(-)-2-amino-5-phosphonopentanoic acid and 6-cyano-7-nitroquinoxaline-2,3-dione) but not orexin receptor antagonists (SB334867 and OX2 29) successfully inhibited PGE2-induced fever in WT mice. These results suggest that orexin neurons are important in general thermogenic processes, and their importance is not restricted to stress-induced thermogenesis. In addition, these results indicate the possible involvement of glutamate in orexin neurons implicated in PGE2-induced fever. [ABSTRACT FROM AUTHOR]

Deciphering how the tubulogenesis is regulated is an essential but unsolved issue in developmental biology. Here, using Wolffian duct ( WD) formation in chicken embryos, we have developed a novel method that enables gene manipulation during tubulogenesis in vivo. Exploiting that WD arises from a defined site located anteriorly in the embryo (pronephric region), we targeted this region with the enhanced green fluorescent protein ( EGFP) gene by the in ovo electroporation technique. EGFP-positive signals were detected in a wide area of elongating WD, where transgenic cells formed an epithelial component in a mosaic manner. Time-lapse live imaging analyses further revealed dynamic behavior of cells during WD elongation: some cells possessed numerous filopodia, and others exhibited cellular tails that repeated elongation and retraction. The retraction of the tail was precisely regulated by Rho activity via actin dynamics. When electroporated with the C3 gene, encoding Rho inhibitor, WD cells failed to contract their tails, resulting in an aberrantly elongated process. We further combined with the Tol2 transposon-mediated gene transfer technique, and could trace EGFP-positive cells at later stages in the ureteric bud sprouting from WD. This is the first demonstration that exogenous gene(s) can directly be introduced into elongating tubular structures in living amniote embryos. This method has opened a way to investigate how a complex tubulogenesis proceeds in higher vertebrates. [ABSTRACT FROM AUTHOR]

We report on a 2-year-old Japanese boy with early-onset pulmonary emphysema, exhibiting dysmorphic face, loose skin, and inguinal and Morgagni hernias. He was admitted to our hospital owing to refractory respiratory infection. On the basis of his clinical features, we investigated the SLC2A10 gene and identified novel compound heterozygous mutations of c.417T > A and c.692G > A, leading to the diagnosis of artery tortuosity syndrome (ATS). This syndrome is an extremely rare autosomal recessive disorder characterized by tortuosity and elongation of the large and medium-sized arteries, hyperextensible skin, and diverse hernias, mostly reported from Europe and Middle Eastern countries, but not from Asia. Although chronic obstructive pulmonary disease, namely, emphysema, has not been well documented in ATS, it may be likely because TGF-beta up-regulation is known to be evoked by SLC2A10 mutations, resulting in reconstruction of pulmonary endothelial cells and emphysema. This is the first report of ATS associated with early-onset pulmonary emphysema, suggesting that patients with ATS may also require close attention for chronic obstructive pulmonary disease. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: A few studies have explored the prevalence of dyslexia among children who speak Japanese as their native language by evaluating them individually by means of reading-based tasks. The present study was designed to clarify the frequency of suspected dyslexia among second-graders attending ordinary classes. Methods: The subjects were 40 children (22 males, 18 females; 7 years 4 months-8 years 4 months; mean age, 7 years 11 months) out of 182 second-graders at a public elementary school situated in a local city. Each subject underwent a monomoraic syllable reading task, a word reading task, a non-word reading task, and a short sentence reading task. Results: The scores on the four tests were not normally distributed; rather, they were strongly skewed to shorter reading time or fewer reading errors. In addition, they were significantly extended toward either longer reading time or more reading errors. Except in the non-word reading task, most subjects only made a few reading errors. Seven subjects (17.5%) showed at least one score that was more than 1.5 IQR (interquartile range) higher than the third quartile of that subject's eight scores on the four tasks. Assuming that those seven children are potentially dyslexic, at least 3.8% of second-graders (seven out of 182) are suspected to be suffering from dyslexia. Conclusion: It is likely that the prevalence of dyslexia in Japan is comparable to that in Europe and the US. To confirm this, a more comprehensive study on a larger scale should be implemented in the future. [ABSTRACT FROM AUTHOR]

Limb muscle formation is spread out over time and, consequently, muscle cells are not easy to target at any particular stages. We aimed to design a technique to study gene function in the different steps of limb muscle formation. We have associated transposon-mediated gene transfer and a tetracycline-dependent activation method with forelimb somite electroporation. In addition, we have established a new vector combining a differentiated-muscle-cell-specific promoter and the transposon system, which allows stable gene expression in limb differentiated muscle cells and not in muscle progenitors. Using these methods, we observed that conditional Fgf4 expression in muscle cells at the onset of fetal muscle differentiation and specific Fgf4 expression in differentiated muscle cells alter muscle fiber formation in chick limbs. Limb somite electroporation with these set of vectors allowing stable, conditional, and differentiated-muscle-specific expression of transgenes opens new perspectives for investigating gene function at various steps of limb muscle formation. Developmental Dynamics, 2011. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The body tail is a characteristic trait of vertebrates, which endows the animals with a variety of locomotive functions. During embryogenesis, the tail develops from the tail bud, where neural and mesodermal tissues make a major contribution. The neural tube in the tail bud develops by the process known as secondary neurulation (SN), where mesenchymal cells undergo epithelialization and tubulogenesis. These processes contrast with the well known primary neurulation, which is achieved by invagination of an epithelial cell sheet. In this study we have identified the origin of SN-undergoing cells, which is located caudo-medially to Hensen's node of early chicken embryo. This region is distinctly fate-mapped from tail-forming mesoderm. The identification of the presumptive SN region has allowed us to target this region with exogenous genes using in ovo electroporation techniques. The SN-transgenesis has further enabled an exploration of molecular mechanisms underlying mesenchymal-to-epithelial transition during SN, where activity levels of Cdc42 and Rac1 are critical. This is the first demonstration of molecular and cellular analyses of SN, which can be performed at a high resolution separately from tail-forming mesoderm. [ABSTRACT FROM AUTHOR]

Embryonic cells are classified into two types of cells by their morphology, epithelial and mesenchymal cells. During dynamic morphogenesis in development, epithelial cells often switch to mesenchymal by the process known as epithelial-to-mesenchymal transition (EMT). EMT is a central issue in cancer metastasis where epithelial-derived tumor cells are converted to mesenchymal with high mobility. Although many molecules have been identified to be involved in the EMT mostly by in vitro studies, in vivo model systems have been limited. We here established a novel model with which EMT can be analyzed directly in the living body. By an electroporation technique, we targeted a portion of the lateral plate mesoderm that forms epithelial cell sheets delineating the kidney region, called nephric coelomic epithelium (Neph-CE). Enhanced green fluorescent protein-electroporated Neph-CE retained the epithelial integrity without invading into the underling stroma (mesonephros). The Neph-CE transgenesis further allowed us to explore EMT inducers in vivo, and to find that Ras-Raf and RhoA signals were potent inducers. Live-imaging confocal microscopy revealed that during EMT processes cells started extending cellular protrusions toward the stroma, followed by translocation of their cell bodies. Furthermore, we established a long-term tracing of EMT-induced cells, which were dynamically relocated within the kidney stroma. The Neph-CE-transgenesis will open a way to study cellular and molecular mechanisms underlying EMT directly in actual body. [ABSTRACT FROM AUTHOR]

In vivo electroporation has served as an effective tool for the study of developmental biology. Here we report tetracycline inducible gene knockdown by electroporation. Our system consists of genome integration of a cassette encoding long double strand RNA (dsRNA) of a gene of interest by electroporation, transcription of which is assured by RNA polymerase II, and induction of transcription of dsRNA by tetracyclin. Long dsRNA decapped by ribozyme in the cassette and without poly A tail is processed into siRNA within nuclei. We could successfully induce knockdown of En2 and Coactosin by Dox administration. [ABSTRACT FROM AUTHOR]

Orexin neurons contribute to cardiovascular, respiratory and analgesic components of the fight-or-flight response against stressors. Here, we examined whether the same is true for stress-induced hyperthermia. We used prepro-orexin knockout mice (ORX-KO) and orexin neuron-ablated mice (ORX-AB) in which the latter lack not only orexin, but also other putative neurotransmitter/modulators contained in the orexin neurons. In response to repetitive insertion of a temperature probe into their rectum (handling stress), ORX-KO mice showed a normal temperature change as compared to that of wild-type littermates (WT) while ORX-AB showed an attenuated response. Stress-induced expression of uncoupling protein-1, a key molecule in non-shivering thermogenesis in the brown adipose tissue (BAT), was also blunted in ORX-AB but not in ORX-KO. When the BAT was directly activated by a β3 adrenergic agonist, there was no difference in the resultant BAT temperature among the groups, indicating that BAT per se was normal in ORX-AB. In WT and ORX-KO, handling stress activated orexin neurons (as revealed by increased expression of c-Fos) and the resultant hyperthermia was largely blunted by pre-treatment with a β3 antagonist. This observation further supports the notion that attenuated stress-induced hyperthermia in ORX-AB mice was caused by a loss of orexin neurons and abnormal BAT regulation. This study pointed out, for the first time, the possible importance of co-existent neurotransmitter/modulators in the orexin neurons for stress-induced hyperthermia and the importance of integrity of the orexin neurons for full expression of multiple facets of the fight-or-flight response. Stress increases cardiac function, ventilation and body temperature. These changes prepare the body for fight-or-flight behaviour by increasing the metabolic rate, oxygen supply and by conduction velocity of nerve impulses. We previously demonstrated that cardiorespiratory excitation during stress depends on the level of the hypothalamic neuropeptide orexin. We examined whether the same is true for stress-induced hyperthermia. Orexin neuron-ablated mice (ORX-AB) showed attenuated stress-induced hyperthermia, but their basal body temperature was normal. The brown adipose tissue, which is a major thermogenic organ in rodents, did not respond to stress; however, it did respond to a direct pharmacological stimulation. These abnormalities in ORX-AB were not observed in orexin knockout mice, in which the orexin peptide is deficient but neurons are preserved. Therefore, the integrity (orexin and other co-existing neurotransmitters/modulators) of the orexin neurons is indispensable for full expression of the multiple factors involved in the fight-or-flight response. [ABSTRACT FROM AUTHOR]

In utero electroporation is widely used to study neuronal development and function by introducing plasmid DNA into neural progenitors during embryogenesis. This is an effective and convenient method of introducing plasmid DNA into neural precursors and is suitable for manipulating gene expression in cells of the CNS. However, the applicability of this technique is comparatively limited to neuronal research, as the plasmid DNA introduced into neural progenitors during embryogenesis is diluted by cell proliferation and is not stably maintained in glial cells generated around and after birth. To overcome this limitation, we applied the Tol2 transposon system, which integrates a transgene into the genome of the host cell, to in utero electroporation. With this system, we confirmed that the transgene was effectively maintained in the progeny of embryonic neural precursors, astrocytes and oligodendrocytes. Using the glial promoters GFAP and S100β, targeted and stable expressions of transgenes in glia were obtained, which enabled the expression of different transgenes simultaneously in neurons and glia. Glia-targeted expression of the transgene that causes neuronal migration defect was achieved without the defect. Thus, use of the Tol2 transposon system in combination with in utero electroporation is a powerful method for studying glia-neuron interactions in vivo. [ABSTRACT FROM AUTHOR]

Drug-induced akinesia is a potential cause of pressure ulcers. However, pressure ulcers that are caused by drug-induced akinesia are not considered an adverse drug reaction (ADR). We propose that drug-induced pressure ulcers (DIPU) are pressure ulcers that are caused by an external force that is experienced after drug administration, and we considered resolution of these ulcers after drug discontinuation to be a supportive finding. In this report, we reviewed the medical records of pressure ulcer cases from a 300-bed hospital. Among 148 patients, four patients with pressure ulcers met the criterion for DIPU. In these cases, the suspected DIPU were related to treatment with olanzapine, fluvoxamine, valproic acid, clotiazepam, triazolam and rilmazafone. These drugs were administrated to manage the patients' behavioral and psychological symptoms that accompanied dementia. The DIPU in these patients were categorized as stage IV according to the National Pressure Ulcer Advisory Panel criteria. Discontinuation of the causal drugs led to significant improvements or complete healing of the pressure ulcers, and the patients subsequently recovered their mobility. Therefore, we propose that DIPU are potential ADR that have been overlooked in clinical practice. Thus, recognition of DIPU as an ADR may be important in preventing and appropriately managing pressure ulcers among elderly patients. [ABSTRACT FROM AUTHOR]

Aim: To determine the prophylactic effect of antibiotics administration in the prevention of infection following an ultrasound-guided percutaneous liver biopsy or treatment of liver tumors, we performed an open-labeled randomized prospective study of patients who received prophylactic antibiotics after undergoing those procedures. Methods: We studied 101 patients, with ultrasound-guided percutaneous aspiration biopsies of the liver performed in 48 to diagnose diffuse liver diseases or liver tumors, while percutaneous ethanol-injection therapy was performed in two patients with malignant liver tumors and percutaneous radiofrequency ablation was performed in 51 patients. An oral administration of levofloxacin at 400 mg/day was given to 50 of the enrolled patients from the morning of the treatment day for three days. Preventive antibiotics were not administered to the remaining 51 patients. Body temperature, peripheral blood leukocyte number, c-reactive protein, alanine aminotransferase, and lactic dehydrogenase were measured daily for three days after treatment. Results: Most parameters changed following percutaneous treatments of liver tumors, though no significant differences were seen between the patients treated with antibiotics and those untreated. Most significantly, there was no difference in the frequency of post-procedure infection between the groups. Conclusion: Our results suggest that prophylactic administration of antibiotics following a percutaneous liver biopsy and treatment of liver tumors does not have a significant impact on the post-procedure results or incidence of infection. [ABSTRACT FROM AUTHOR]

Background: Enriched blood vessels occur in the stroma of Barrett's esophagus and are related to the ease of tumor invasion in the early stage of the cancer. Hypoxia-inducible factor (HIF) is closely related with angiogenesis through expression of vascular endothelial growth factor. The aim of the present study was to determine the predictors for angiogenesis in Barrett's esophagus and evaluate their clinical significance. Methods: Between December 2003 and May 2004, 209 patients with endoscopically and histologically proven Barrett's esophagus were enrolled. Before endoscopic examination, all participants answered structured questionnaires for gastroesophageal reflux symptoms and drug usage. HIF-1α and COX-2 protein expressions, cellular proliferation, and apoptosis were investigated immunohistochemically in biopsy samples taken from the esophagus of each patient. The degree of angiogenesis was determined by CD34 immunostaining analysis. Predictors for angiogenesis were evaluated with multivariate logistic regression analysis. Results: Sixty (28.7%) of the 209 enrolled patients with Barrett's esophagus had a high CD34 score. Factors proven as positive predictors for a high CD34 score were presence of gastroesophageal reflux symptoms, reflux esophagitis, COX-2 protein expression, and the proliferating cell nuclear antigen (PCNA) index. Administration of proton-pump inhibitors and HIF-1α protein expression were not predictors. Conclusions: Reflux esophagitis and gastroesophageal reflux symptoms were positive predictors for enriched angiogenesis in the stromal portion of Barrett's esophagus, which has malignant potential because the epithelial cells express COX-2 and have accelerated cellular proliferation. [ABSTRACT FROM AUTHOR]

We report convenient retinal fiber tracing by transfecting the tracer cDNA by in ovo electroporation. Long-term and stable expression of tracer proteins such as green fluorescent protein is achieved by transposon-mediated genome integration of the tracer protein expression cassette. We carried out coelectroporation of a plasmid containing CAGGS-tracer cDNA flanked by the Tol2 transposable element along with a transposase expression vector to the optic vesicle of chick embryos at stage 11. By selecting electrodes, we can label a large group of retinal ganglion cells, or a small group of retinal ganglion cells; parallel electrodes assure transfection of large areas of the retina, and needle type electrodes label small areas of the retina. The retinal fiber trajectory and terminal zone (TZ) could be detected in the precise retinotopic manner on the contra-lateral side of the optic tectum. The method has advantage in that we can show the retinal fiber trajectory in relation to the molecules that are responsible for pathfinding for the retinal fibers in the same specimen. [ABSTRACT FROM AUTHOR]

The formation of morphological boundaries between developing tissues is an integral mechanism for generating body forms and functions. For the molecular and cellular studies of how such morphological boundaries form, somitogenesis serves as a particularly good model. When an intersomitic boundary forms in the anterior end of the presomitic mesoderm, cells undergo dynamic behaviors including a separation of tissues and changes in cell shape from mesenchymal to epithelial. Moreover, these events occur repeatedly and periodically. We here overview the inductive events that have recently been shown to play important roles in the formation of the intersomitic fissures. We then discuss molecular mechanisms underlying these inductive actions, and also discuss how the fissure formation is interpreted by the subsequent morphogenesis, including cell epithelialization and the acquisition of anterior–posterior identities in the newly formed somite. Thus, somitogenesis provides a unique model to understand how sequentially occurring processes of morphogenesis are coordinated in a 3-D environment. [ABSTRACT FROM AUTHOR]

Background and Aim: Acid suppressive therapy has been reported to regress Barrett’s esophagus. However, it is still controversial as to whether all Barrett’s esophagus patients respond to this therapy. The factors that might facilitate newly developed squamous re-epithelialization after biopsy excision of Barrett’s mucosa were evaluated to identity individuals who may favorably respond to the regression therapy. Methods: Two hundred and forty-seven biopsy sites from 185 patients with Barrett’s esophagus were examined by endoscopy to investigate possible squamous re-epithelialization of Barrett’s mucosa after endoscopic biopsy. Before endoscopic examination, all participants were requested to answer questionnaires concerning sociodemographic characteristics, lifestyle habits and drugs usage. The mucin phenotype, Cdx2 expression, cyclooxygenase-2 expression, cellular proliferation and apoptosis of Barrett’s mucosa were immunohistochemically investigated in the biopsy samples taken from Barrett’s esophagus. The influence of these factors on the newly developed squamous re-epithelialization of Barrett’s mucosa after endoscopic biopsy excision was evaluated. Results: By multivariate analysis, the independent factors that favored squamous re-epithelialization were the gastric mucin predominant phenotype of Barrett’s mucosa and the absence of Cdx2 protein expression. In Barrett’s mucosa with the gastric predominant mucin phenotype, proton pump inhibitor administration, the absence of reflux esophagitis and a low proliferating cell nuclear antigen index were found to be independent predictors for squamous re-epithelialization. Conclusions: The absence of the intestinal predominant mucin phenotype was a positive predictor for newly developed squamous re-epithelialization at the site of biopsy of Barrett’s mucosa. Only Barrett’s esophagus with the gastric predominant mucin phenotype may predict a favorable response to acid suppressive therapy. [ABSTRACT FROM AUTHOR]

Background: Gastric emptying plays an important role in gastroesophageal reflux disease. Acid suppressants such as H2 receptor antagonists and/or proton pump inhibitors are often used in patients with gastroesophageal reflux disease. However, it remains controversial whether H2 receptor antagonists and proton pump inhibitors delay or accelerate gastric emptying. Here, the influence of acid suppressants on gastric emptying was evaluated via a cross-over study using the [13C]-labeled acetate breath test. Methods: Twenty normal male subjects without gastroesophageal reflux disease symptoms were enrolled. Gastric emptying was investigated five times in every subject by the [13C]-labeled acetate breath test with oral administration of the vehicle, domperidone, and three acid suppressants: ranitidine, famotidine and rabeprazole. Gastric emptying was estimated by the values of Tmax-calc, T1/2 and %dose/2 h calculated from the 13CO2 breath excretion curve. Results: Using the Tmax-calc values, rabeprazole, ranitidine and famotidine did not influence gastric emptying time in comparison with vehicle administration. Using the T1/2 and %dose/2 h values, rabeprazole tended to delay gastric emptying. Domperidone produced a statistically significant acceleration of gastric emptying for all three variables ( P < 0.05). Conclusion: Oral dosage of the H2 receptor antagonists, ranitidine and famotidine, has no significant effect on gastric emptying. However, rabeprazole may delay gastric emptying more strongly than H2 receptor antagonists. [ABSTRACT FROM AUTHOR]

Background and Aim: The size of radiofrequency ablation (RFA) in the liver can be negatively influenced by the surrounding blood flow. The indocyanine green (ICG) test can be used to evaluate the effective blood flow in the liver, and distance from the hilus can affect local blood flow. The aim of this study was to assess whether the ICG test or distance from the hilus could be used to predict the size of the ablated area in liver by RFA treatment of hepatocellular carcinoma (HCC) nodules. Methods: The RFA measurements of 44 HCC nodules in 39 patients were retrospectively studied. Cases were included if they met the following criteria: (i) no catheter treatment before RFA; (ii) no movement of the RFA device; (iii) strict ablation time; and (iv) only one ablation. In all patients, ICG-R15 testing was done immediately before RFA and the initial therapeutic efficacy was evaluated by dynamic computed tomography scanning 2–5 days after RFA. The correlation between the maximum size of the RFA area and the ICG test results or the distance of the target area from the hilus (site of first portal vein divergence) were analyzed statistically. Results: The ICG-R15 result was significantly correlated with the maximum diameter of the ablated area both in 2 cm-electrode tip length ( R2 = 0.35, P = 0.0012), and in 3 cm-tip length ( R2 = 0.26, P = 0.0377). Multiple-regression analysis showed that the electrode tip length ( P = 0.0010) and ICG-R15 ( P = 0.0046) were independent factors that could predict the maximum diameter of the RFA area. Conclusion: The results of ICG testing can be used to predict the size of the area that will be ablated at a target liver site before RFA treatment. [ABSTRACT FROM AUTHOR]

We investigated the ability of a genetically altered embryonic stem (ES) cell line to promote endodermal differentiation toward hepatocytes in vitro by transfecting the hepatocyte nuclear factor-3β (HNF-3β) gene. Parental and HNF-3β-transfected ES cells were initiated toward differentiation in embryoid bodies (EBs) for 5 days and the resulting EBs were transferred to an attached culture system. Albumin production was observed using an immuno-cytochemical method 7 days after induction of differentiation in almost all differentiating HNF-3β-transfected ES cells, whereas scant immuno-reactivity against albumin was found on the same day in the cultures of differentiating parental ES cells. An analysis using a reverse transcriptase polymerase chain reaction revealed the HNF-4α expression in the HNF-3β-transfected ES cells and also demonstrated that the expression of endodermal and hepatocyte-related markers, such as transthyretin, α-fetoprotein, albumin, α-1 antitrypsin, tryptophan-2,3-dioxygenase and phosphoenol-pyruvate carboxykinase, could be observed at an early stage in the outgrowths of HNF-3β-transfected ES cells compared to the parental ES cells. These results suggest that HNF-3β-transfected ES cells may be useful for the efficient induction of hepatocytes in vivo. [Copyright &y& Elsevier]

A technique by which genes can be introduced into the cells and tissues of developing embryos has great potential for studying the roles of genes during vertebrate embryogenesis. The ‘microelectroporation’ technique, in which DNA is introduced into cells within a restricted area of developing chick embryos with high reproducibility, was developed by the authors. In this review, the advantages and applications of this microelectroporation technique for developmental studies and functional analysis of genes in chick embryos is discussed. [ABSTRACT FROM AUTHOR]

The article describes a case study of ilium pressure ulcer with wound deformity known as cliff phenomenon seen in a 76-year-old woman with an 11-year history of Parkinson's disease. Topics discussed include the characteristic physical properties of a pressure ulcer, patient management and patient outcome. A detailed description of the cliff phenomenon is noted.

Streptococcus gallolyticus subsp. pasteurianus was formerly classified as S. bovis biotype II/2, which is recognized as a rare cause of neonatal sepsis and meningitis. Since the taxonomy classification change, there have not been many reports of meningitis due to S. gallolyticus subsp. pasteurianus. Moreover, the pathogenesis of late onset S. gallolyticus subsp. pasteurianus meningitis in infants is unclear. Here we report a case of meningitis in a 5-week-old infant with preceding diarrhea. S. bovis biotype II/2 was isolated from the blood, cerebrospinal fluid and stool, and then was identified as S. gallolyticus subsp. pasteurianus on 16 S rRNA gene sequencing. Isolates from all three sample types had identical profiles on pulsed-field gel electrophoresis. The intestinal tract was thought to be the source of the infection. [ABSTRACT FROM AUTHOR]