Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct

We report a case of double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. A 73-year-old woman was admitted to the hospital complaining of upper abdominal pain. Endoscopic retrograde cholangiography showed a stenotic lesion in the lower common bile duct and no visualization of the cystic duct or gallbladder. Enhanced computed tomography revealed a heterogeneously enhanced tumorous lesion around the lower bile duct in the pancreatic head. A diagnosis of cancer arising from the cystic duct that entered the lower part of the common hepatic duct was made by intraductal ultrasonography, which showed an intraluminal protruding lesion in the cystic duct. Isolated gallbladder cancer was also diagnosed, by abdominal computed tomography. She underwent pancreaticoduodenectomy with dissection of regional lymph nodes. Histological examination revealed moderately differentiated adenocarcinoma of the cystic duct and well-differentiated adenocarcinoma of the gallbladder. Double cancer of the cystic duct and gallbladder is extremely rare, and this case also suggests a relationship between a low junction of the cystic duct and neoplasm in the biliary tract.     

Conversion ratio between intravenous oxycodone/hydrocotarnine and sustained-release oral oxycodone in patients with cancer pain

The demand for oxycodone increases in the treatment of patients with cancer pain, but there is no injection formulation containing oxycodone as a single ingredient in Japan. Instead, we have an oxycodone/hydrocotarnine compound product. Long ago, hydrocotarnine was added to enhance the analgesic effect of oxycodone. However, the mechanism of hydrocotarnine is unclear, and few studies have mentioned the conversion ratio between intravenous and oral oxycodone. In the present study, in order to define the conversion ratio between them, we investigated 18 patients treated by intravenous or oral oxycodone and changed to another administration route during their treatment. We surveyed the change in pain level and adverse effects before and after changing the administration route. The conversion ratio from oral oxycodone to intravenous oxycodone/hydrocotarnine was 0.71+/-0.12 (mean+/-S. D.), and no obvious change in adverse effect was observed.     

Pharmacokinetics of controlled-release oxycodone in patients with cancer pain

Oxycodone is a useful analgesic for cancer patients in pain. However, its pharmacokinetics have not been sufficiently examined and there is a lack of information, with very few reports on pharmacokinetics concerning the absorption process in particular. With this in mind, we studied the pharmacokinetics of controlled-release oxycodone (Oxy contin). We measured its serum concentration in patients with cancer pain, and calculated parameters derived using the nonlinear least-squared method program (MULTI). In the result, pharmacokinetic parameters calculated at CL/F were: 45.6+/-22.0 L/hr (Mean+/-SD), Vd/F: 473.0+/-19 6.7 L, t(1/2): 7.2+/- 6.2 hr, kel: 0.103+/-0.034, kal: 1.082+/-0.604, Lag time: 0.9 9+/-0.40 hr. In addition, the serum oxycodone concentration hardly rose until 1 hour after and just before medication, whereupon a rapid increase was evident after 1 hour. The pharmacokinetics of controlled-release oxycodone in patients with cancer pain were clarified in this study. Especially during the absorption process, the lag time was calculated specifically at about 1 hour, making it approximately equal to MS contin.     

Properties of receptive field on binocular fusion stimulation in the central visual field

BACKGROUND: Visual information projected onto corresponding points on the right and left retinas converges on the binocular cells in the visual cortex. The aim of this study is to investigative the characteristics of the receptive field for binocular stimulation in the central visual field of normal-sighted human subjects. METHODS: We investigated the receptive field for binocular stimulation under fusion conditions by combining the Octopus 201 with the space synoptophore. We measured binocular and monocular sensitivities while the fusion patterns were projected onto the Octopus 201 cupola, using the space synoptophore. We designed a new program to test 37 points in the central 6 degrees visual field. Six target sizes were tested: the white-spot targets of 0.054 degrees, 0.108 degrees, 0.216 degrees, 0.431 degrees, 0.862 degrees and 1.724 degrees projected diameters. RESULTS: The threshold energy necessary for binocular stimulation was lower than that for the monocular stimulation in all subjects. This difference was more obvious on the test points that were more distant from the fovea when target sizes of 0.054 degrees and 0.108 degrees were used. The amount of binocular summation ratio was highest for target size 0.054 degrees in each stimulus area in the central 6 degrees of the visual field. When we measured binocular summation using target sizes larger than 0.108 degrees, the result was the constant summation. CONCLUSIONS: The size of the receptive field for binocular stimulation is smaller than monocular stimulation under the same fusion condition. The amount of binocular summation varies as a function of target size.     

The distribution of type IV collagen alpha chains in the mouse ovary and its correlation with follicular development

The present study aims to identify alpha chains of type IV collagen in the basement membrane of the mouse ovarian follicle and examine their changes during follicular development using immunofluorescence microscopy with specific monoclonal antibodies. The basement membrane of the serous mesothelium enveloping the ovary contained all alpha chains of type IV collagen, alpha1(IV) through alpha6(IV) chains. Primordial follicles showed a distinct immunoreactivity against all six alpha chains in their basement membranes. Immunolabeling for alpha3(IV) and alpha4(IV) chains was almost eliminated in the primary follicles. In basement membranes of secondary and Graafian follicles, the immunofluorescent reaction of alpha3(IV) and alpha4(IV) chains disappeared in Graafian follicles, a partial reduction in fluorescent immunostaining intensity to alpha5(IV) and alpha6(IV) chains was observed; only alpha1(IV) and alpha2(IV) chains were not degraded throughout follicular development. On atretic follicles, in addition to alpha1(IV) and alpha2(IV) chains, alpha3(IV), alpha4(IV), alpha5(IV) and alpha6(IV) chains frequently persisted. A basement membrane-like matrix within the follicular granulosa cell layer, such as the focimatrix (focal intraepithelial matrix) and/or Call-Exner body, was also recognized in mouse secondary and Graafian follicles and contained alpha1(IV), alpha2(IV), alpha5(IV) and alpha6(IV) chains but not alpha3(IV) and alpha4(IV) chains. We expect that the decrease in alpha(IV) chains prompts follicular development and is a prerequisite condition for follicular maturation.     

Elevated levels of anti-CD9 antibodies in the cerebrospinal fluid of patients with subacute sclerosing panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a slowly progressive and highly lethal disease of the central nervous system. Although the primary cause of SSPE is believed to be persistent infection of neuron and glial cells by a measles virus, the precise mechanism of the progression of this disease has not yet been elucidated. CD9, a member of the tetraspanin family, is expressed in myelin and other nervous tissues. This study detected significant amounts of anti-CD9 antibodies in the cerebrospinal fluid (CSF) of all patients with SSPE included in the study. Anti-CD9 antibodies were also detected in the CSF of some patients with other neurologic disorders, but those patients had lower levels of anti-CD9 antibodies than did the patients with SSPE. The level of anti-CD9 antibodies was elevated and reached a peak that coincided with the appearance of brain atrophy. These findings shed light on a new aspect of the causes and progression of SSPE.     

Effects of glucose and meal ingestion on incretin secretion in Japanese subjects with normal glucose tolerance

Aims/Introduction: Gastric inhibitory polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1) are the major incretins; their secretion after various nutrient loads are well‐evaluated in Caucasians. However, little is known of the relationship between incretin secretion and differing nutritional loading in Japanese subjects. In the present study, we evaluated GIP and GLP‐1 secretion in Japanese subjects with normal glucose tolerance (NGT) after glucose loading (75 g glucose and 17 g glucose) and meal ingestion. Materials and Methods: A total of 10 Japanese NGT subjects participated in 75 g oral glucose tolerance test (OGTT), 17 g OGTT and meal tolerance test (MTT). Plasma glucose (PG), serum insulin (IRI), serum C‐peptide (CPR), plasma total GIP, and plasma total GLP‐1 levels during OGTT and MTT were determined. Results: Area under the curve (AUC)‐GIP was increased in proportion to the amount of glucose, and was highest in MTT, showing that GIP secretion is also stimulated by nutrients other than glucose, such as lipid. In contrast, although the larger glucose load tended to induce a larger GLP‐1 release, AUC‐GLP‐1 was not significantly different among the three loading tests (75 g OGTT, 17 g OGTT, MTT) irrespective of the kind or amount of nutrition load. Conclusions: Our results suggest that nutritional composition might have a greater effect on GIP secretion than that on GLP‐1 secretion in Japanese NGT subjects . (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00143.x, 2012)     

CAMSAP3 orients the apical-to-basal polarity of microtubule arrays in epithelial cells

Polarized epithelial cells exhibit a characteristic array of microtubules that are oriented along the apicobasal axis of the cells. The minus-ends of these microtubules face apically, and the plus-ends face toward the basal side. The mechanisms underlying this epithelial-specific microtubule assembly remain unresolved, however. Here, using mouse intestinal cells and human Caco-2 cells, we show that the microtubule minus-end binding protein CAMSAP3 (calmodulin-regulated–spectrin-associated protein 3) plays a pivotal role in orienting the apical-to-basal polarity of microtubules in epithelial cells. In these cells, CAMSAP3 accumulated at the apical cortices, and tethered the longitudinal microtubules to these sites. Camsap3 mutation or depletion resulted in a random orientation of these microtubules; concomitantly, the stereotypic positioning of the nucleus and Golgi apparatus was perturbed. In contrast, the integrity of the plasma membrane was hardly affected, although its structural stability was decreased. Further analysis revealed that the CC1 domain of CAMSAP3 is crucial for its apical localization, and that forced mislocalization of CAMSAP3 disturbs the epithelial architecture. These findings demonstrate that apically localized CAMSAP3 determines the proper orientation of microtubules, and in turn that of organelles, in mature mammalian epithelial cells.Microtubules play pivotal roles in fundamental cellular functions, including cell division, intracellular transport, and cell morphogenesis. They are dynamic structures with an intrinsic polarity of rapidly growing plus-ends and slowly growing minus-ends (1). In living cells, the microtubule minus-ends are stabilized by binding to specific molecules or structures, such as the γ-tubulin ring complex located at the centrosome (2). In epithelial cells, however, most microtubules do not emanate from the centrosome; instead, they are aligned along the apicobasal axis with their minus ends facing toward the apical domain (3–5). These observations suggest the presence of unidentified mechanisms that stabilize the minus ends of microtubules at apical regions. Such mechanisms have not yet been identified, although the potential involvement of microtubule-binding proteins, such as ninein, has been suggested (6).Although many proteins that modulate plus-end dynamics have been identified (7), how the minus-ends are controlled at noncentrosomal sites remains less well understood (2, 8–10). CAMSAP3 (also known as Nezha) is a member of the calmodulin-regulated–spectrin-associated proteins (CAMSAP)/Nezha/Patronin family proteins, which bind and stabilize the minus-ends of microtubules (11–18). In cultured mammalian cells, CAMSAP proteins have been shown to stabilize noncentrosomal microtubules in the cytoplasm or cell junctions (11, 14, 19, 20), suggesting their possible involvement in the spatial regulation of microtubule assembly in polarized cells, such as epithelial-specific longitudinal microtubule alignment.To date, no study has analyzed CAMSAP function in fully polarized epithelial cells, however. In the present study, we examined whether CAMSAP3 contributes to the epithelial-specific microtubule organization using intestinal epithelial cells. Our results demonstrate that CAMSAP3 plays a key role in tethering microtubules to the apical cortex in epithelial cells, and in turn regulates the positioning of organelles at their cytoplasm.