Notch-Hes1 signaling activation in Caroli disease and polycystic liver disease

The Notch signaling pathway plays a key role in the morphogenesis of the biliary tree, but its involvement in cystic biliary diseases, such as Caroli disease (CD) and polycystic liver disease (PLD), has yet to be determined. Immunostaining was performed using liver sections of CD and PLD, and the results were compared with those of congenital hepatic fibrosis (CHF) and von Meyenburg complex (VMC). The expression of Notch receptor 1 (Notch1) was increased in the nuclei of biliary epithelial cells in all cases of CD and PLD, whereas it remained at a low level in CHF and VMC. In addition, Notch2 and Notch3 were preferably expressed in the nuclei of biliary epithelial cells of PLD. Accordingly, the Notch effector Hes1 was highly expressed in biliary epithelial cells of CD and PLD, and the cell proliferative activity was significantly higher in CD and PLD. The expression of the Notch ligand Delta-like 1 was significantly increased in biliary epithelial cells of CD and PLD, which may be causally associated with the nuclear overexpression of Notch1 and Hes1. These results indicate that aberrant activation of the Notch-Hes1 signaling pathway may be responsible for the progression of biliary cystogenesis in CD and PLD.     

Nontuberculous mycobacteria‐associated spindle cell pseudotumor of the nasal cavity: A case report

Mycobacterial spindle cell pseudotumor (MSP) is a rare mass‐forming lesion caused by mycobacterial infection, mostly in immunocompromised patients. Since it is composed of a proliferation of spindle‐shaped fibrohistiocytic cells without forming epithelioid cell granulomas, histological distinction from other spindle cell lesions is often difficult and its pathophysiology is poorly understood. MSP arising in the nasal cavity is extremely rare, and only two cases have been reported previously. Here we report a case of MSP of the nasal cavity in an 83‐year‐old man with no evidence of immunodeficient state. The resected tumor consisted of spindle cells, which contained numerous acid‐fast bacilli in the cytoplasm. By polymerase chain reaction and sequencing using DNA extracted from the paraffin sections, the bacilli were identified as Mycobacterium intracellulare. Immunohistochemistry revealed that the spindle cells were positive for CD68, CD11c and S100 protein, confirming the histiocytic nature of these cells. They were also positive for CD163 and CD204, suggesting that they showed a phenotype similar to alternatively activated (M2) macrophages and the phenotype might contribute to the maintenance of mycobacterial infection despite apparent immunocompetence of the host.     

Pentraxin 3 as a new biomarker of peritoneal injury in peritoneal dialysis patients

It is well known that bioincompatible peritoneal dialysate plays a central role in the development of peritoneal fibrosis. Peritoneal inflammation continues even after the cessation of peritoneal dialysate stimulation. It is important to establish the definition of persistent inflammation in the peritoneal cavity at the cessation of peritoneal dialysis (PD). The objective of the present study was to determine whether pentraxin 3 (PTX3) in peritoneal effluent (PE) may be a new biomarker in PD patients. Serum, PE, and peritoneal specimens were obtained from 50 patients with end-stage kidney disease at Juntendo University Hospital. Samples of 19 patients were obtained at the initiation of PD and those of 31 patients at the cessation of PD. PTX3, high-sensitivity CRP, and MMP-2 and IL-6 were analyzed. An immunohistological examination using an anti-PTX3 antibody was performed. Expressions of PTX3 were observed in endothelial cells, fibroblasts, and mesothelial cells in the peritoneum. The PTX3 level in PE at the cessation of PD was significantly higher than that at the initiation of PD. Effluent PTX3 levels in patients with a history of peritonitis or a PD duration of more than 8 years were significantly higher than those in patients without peritonitis or patients with a PD duration of <8 years. The PTX3 level was significantly correlated with MMP-2 and IL-6 levels in PE, as well as the thickness of the submesothelial compact zone and the vasculopathy. It appears that PTX3 may be a new biomarker of peritoneal inflammation and progressive fibrosis.     

Low contrast dose protocol involving a 100 kVp tube voltage for hypervascular hepatocellular carcinoma in patients with renal dysfunction

Purpose

To evaluate the feasibility of a 20 % reduced contrast dose hepatic arterial phase (HAP) CT for hypervascular hepatocellular carcinoma (HCC) with 100 kVp.

Materials and methods

The study included 97 patients with hypervascular HCC who underwent dynamic CT, including HAP scanning. The 54 patients had an estimated glomerular filtration rate (eGFR) of ≥60 were scanned with our conventional 120 kVp protocol. The other 43 patients (eGFR < 60) underwent scans using a tube voltage of 100 kVp and a 20 % reduced contrast dose. We compared the estimated effective dose, image noise, tumor-liver contrast (TLC), and contrast-to-noise ratio (CNR) in the hepatic arterial phase between the two groups using the Student’s t test.

Results

Estimated effective dose and image noise were not significantly different between these groups (p = 0.67 and p = 0.20, respectively). The TLC and CNR were significantly higher for the 100 kVp protocol than for the 120 kVp protocol (52.2 HU ± 17.4 vs 40.8 HU ± 18.6, p < 0.01 and 6.8 ± 2.6 vs 5.5 ± 2.4, p = 0.01, respectively).

Conclusion

For hepatic arterial phase CT of hypervascular HCC, 100 kVp scan allows a 20 % reduction in the contrast dose without reduction in image quality compared with a standard 120 kVp CT protocol.

     

Superior Turbinectomy: Role for a Two-surgeon Technique in Endoscopic Endonasal Transsphenoidal Surgery—Technical Note

We describe a practical technique of superior turbinectomy followed by posterior ethmoidectomy as a less invasive procedure for two-surgeon technique on endoscopic endonasal transsphenoidal surgery. After identification of the superior turbinate and the sphenoid ostium, the inferior third portion of the superior turbinate was coagulated and resected. This partial superior turbinectomy procedure exposed the posterior ethmoidal sinus. Resection of the bony walls between the sphenoid and posterior ethmoid sinuses provided more lateral and superior exposure of the sphenoid sinus. This technique was performed in 56 patients with midline skull base lesions, including 49 pituitary adenomas and 7 other lesions. Meticulous manipulation of instruments was performed in all cases without surgical complications such as permanent hyposmia/anosmia or nasal bleeding. Our findings suggested that the partial superior turbinectomy followed by retrograde posterior ethmoidectomy is a simple and safe technique providing a sufficient surgical corridor for two-surgeon technique to approaching midline skull base regions, mainly involving pituitary adenomas.     

Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities

It has been reported that nearly 90% of patients with rheumatoid arthritis (RA) have problems with their feet. Several methods of treating hallux valgus deformity in RA have previously been reported, including arthrodesis and joint resection, and good results have been observed with surgical procedures. In this report, we compare the clinical and radiological outcomes of resection arthroplasty alone (the first method) and resection arthroplasty with arthrodesis of the first MTP joint (the second method) for the treatment of forefoot deformities of RA patients. On clinical assessment, the American Orthopaedic Foot and Ankle Society (AOFAS) scale score significantly improved in both methods; however, the second method gave better results than the first method in relation to the footwear and alignment components. On radiographic assessment, in the first method there were no significant changes in the valgus angle (H–V angle) and the fifth metatarsal bone (M1/5) angle between preoperation and last follow-up. In contrast, these angles were decreased in the second method. One of the most important issues in the treatment of forefoot deformities in RA patients is to correct splaying foot deformity. We believe that the second method, which can correct splaying foot deformity, is currently the most reliable treatment method.     

Studies on the mechanism of xylitol-induced insulin secretion in dogs

Summary The effect of infusion of small doses of xylitol into the pancreatic artery upon insulin release was studied in anaesthetized dogs, in order to decide whether the strong insulin-releasing effect of xylitol in dogs is mediated by a direct action of xylitol upon the islets or indirectly by some of its metabolites. Xylitol or glucose was infused at 0.5–1.0 mg/kg · min either into the femoral vein or into the superior pancreaticoduodenal artery, and the changes in plasma insulin were measured in the superior pancreaticoduodenal vein. Infusion into the pancreatic artery always resulted in a sharp increase in insulin release, whereas intravenous infusion caused no or little increase. Infusion of xylitol into the superior pancreaticoduodenal artery produced a prompt increase in plasma insulin in the superior pancreaticoduodenal vein but not in the splenic vein. These data suggest that xylitol has a direct stimulatory effect upon islet cells. — During intravenous infusion of epinephrine (1.0 g/kg. min), plasma insulin did not increase despite intravenous administration of glucose or xylitol (0.4 g/kg). There was a rebound rise of plasma insulin after cessation of epinephrine infusion. Plasma insulin responses to intravenous injection of glucose or xylitol (0.4 g/kg) were inhibited also by the intravenous infusion of diazoxide (0.2 mg/kg · min), but this was somewhat variable among individual dogs. The suppression by epinephrine or diazoxide of both glucose and xylitol-induced hyperinsulinaemia may suggest that there is some common mechanism between the insulin-releasing effects of glucose and xylitol.

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Untersuchungen zum Mechanismus der verstärkten Insulinsekretion unter Xylit

Zusammenfassung An anaesthesierten Hunden wurde die Wirkung der Infusion kleiner Xylit-Mengen in die Pankreasarterie auf die Insulinfreisetzung untersucht, um zu klären, ob das Xylit direkt oder über einen seiner Metabolite auf die Insulinausschüttung wirkt. Xylit oder Glucose wurde in Mengen von 0.5–1.0 mg/kg/min entweder in die Femoralvene oder in die A.pankreaticoduodenalis sup. infundiert und die Änderung des PlasmaInsulins in der V.pankreatico-duodenalis sup. gemessen. Zufuhr über die Pankreasarterie löste immer eine abrupte Steigerung der Insulinfreisetzung aus, während intravenöse Gaben zu keinem oder nur einem geringen Anstieg führten. Die Xylit-Infusion in die A.pankreaticoduodenalis sup.bewirkte zwar eine prompte Steigerung der Plasma-Insulinspiegel in der V.pankreatico duodenalis sup., nicht aber in der Milzvene. — Diese Befunde sprechen dafür, daß Xylit die Inselzellen direkt stimuliert. Während einer i.v.Infusion von 1.0 g/kg/min Adrenalin stieg das Plasma-Insulin trotz intravenöser Zufuhr von 0.4 g/kg Glucose oder Xylit nicht an. Nach Beendigung der Adrenalin-Infusion wurde ein verstärkter Wiederanstieg des Plasma-Insulins beobachtet. Auch durch i.v.Gaben von 0.2 mg/kg/min Diazoxid ließ sich die Wirkung der Infusion von 0.4 g/kg Glucose oder Xylit unterdrükken, wobei sich jedoch Unterschiede zwischen den einzelnen Tieren ergaben. Die Aufhebung des Xylit- u. Glucose-Effektes auf die Insulinsekretion durch Adrenalin und Diazoxid könnte darauf hinweisen, daß die Steigerung der Insulinfreisetzung durch Glucose und Xylit auf einem gemeinsamen Mechanismus beruht.

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Etudes sur le mécanisme de la sécrétion d'insuline provoquée par le xylitol chez des chiens

Résumé L'effet sur la sécrétion d'insuline de l'infusion de petites doses de xylitol dans l'artère pancréatique a été étudié chez des chiens anesthésiés, afin de savoir si l'effet fortement insulino-sécréteur du xylitol chez les chiens est dû à une action directe du xylitol sur les îlots ou à une action indirecte par l'intermédiaire de certains de ses métabolites. Le xylitol ou le glucose était infusé la dose de 0.5–1.0 mg/kg. min, soit dans la veine fémorale, soit dans l'artère pancréatico-duodénale supérieure, et les variations de l'insuline plasmatique étaient mesurées dans la veine pancréatico-duodénale supérieure. L'infusion dans l'artère pancréatique provoquait toujours une rapide augmentation de la sécrétion d'insuline, tandis que l'infusion intraveineuse ne causait pas ou peu d'augmentation. L'infusion de xylitol dans l'artère pancréaticoduodénale supérieure provoquait une augmentation prompte de l'insuline plasmatique dans la veine pancréatico-duodénale supérieure, mais pas dans la veine splénique. Ces données suggèrent que le xylitol a un effet stimulateur direct sur les cellules des îlots. — Pendant l'infusion intraveineuse d'adrénaline (1.0 g/kg. min), l'insuline plasmatique n'augmentait pas malgré l'administration intraveineuse de glucose ou de xylitol (0.4 g/kg). Après l'arrêt de l'infusion d'adrénaline, l'insuline plasmatique présentait un phénomène de rebound. Les réponses de l'insuline plasmatique l'injection intraveineuse de glucose ou de xylitol (0.4 g/kg) étaient également inhibées par l'infusion intraveineuse de diazoxide (0.2 mg/ kg. min), mais ceci était un peu variable selon les chiens. La suppression par l'adrénaline ou le diazoxide de l'hyperinsulinémie provoquée par le glucose et le xylitol peut suggérer qu'il existe un mécanisme commun entre les effets insulino-sécréteurs du glucose et du xylitol.