内側大腿回旋動脈下行枝と貫通動脈の分布域に関する研究 : 第1貫通動脈が大腿方形筋の直下を通る1変異例を中心に

The authors encountered an anatomical variant in which the first perforating artery (FPA) emerged posteriorly immediately below the quadratus femoris muscle. Although the usual medial circumflexus/circumflex femoral artery (MCFA) was coexistent, the variant suggested an intermediate morphology between the FPA and the usual descending branch of the MCFA. Using the observations from 51 lower extremities, we examined configurations of these arteries with special reference to the territorial correlation, i. e., whether the descending branch of the MCFA shows complementary territorial relations with the FPA and, if so, whether there is an intermediate morphology between these two arteries. The MCFA consistently supplied a limited area of the posterior thigh, whereas the FPA varied independently in its territory but consistently was the most dominant of all arteries supplying the region. Consequently, the variant might occur as a result of a muscular variation, and the suggested intermediate morphology was not evident

経頚静脈肝内門脈静脈短絡術(transjugular intrahepatic portosystemic shunt:TIPS)の手技のためのヒト肝を用いた形態計測学的研究

The most difficult step during transjugular intrahepatic portosystemic shunt (TIPS) procedure is deciding the puncture direction from the hepatic to portal vein. The aim of this study was to obtain a rule based on the puncture distance and the required angle of bend of the needle. Forty-one livers of donated Japanese cadavers were used for analysis. We made a shunt from the right hepatic vein to the portal bifurcation and measured the puncture distance and angle bend of the needle. In accordance with these measurements, we punctured another eleven pre-dissected livers to try to establish a reliable rule regarding distance and angle in shunt procedure. We found that in about 81 percent of the cases, puncture distance ranged between 20 mm and 40 mm no matter how large the angle bend was. We also found a correlation between the angle bend and the size of the liver, which will provide information to facilitate a successful puncture

Effects of Valsartan on Inflammatory and Oxidative Stress Markers in Hypertensive, Hyperglycemic Patients: An Open-Label, Prospective Study

AbstractBackground: Diabetes mellitus and hypertension are aggravated by activation of the renin-angiotensin system caused by increased oxygen stress and local inflammatory responses. Several studies have suggested that angiotensin II type 1 receptors can reduce inflammatory markers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, IL-18, soluble vascular cell adhesion molecule [VCAM]-I, and l-selectin) and oxidative stress markers (urinary 8-hydroxy-7,8-dihydro-2'-deoxyguanosine [8-OHdG] and 8-epi-prostaglandin F2α [8-isoprostane]) in hypertensive patients.Objective: The aim of this study was to assess the effects of valsartan, an angiotensin II receptor blocker, on inflammatory and oxidative stress markers in hypertensive patients with mild diabetes or impaired glucose tolerance.Methods: In this open-label, prospective study, hypertensive patients aged >20 years with mild diabetes (requiring treatment by diet alone or an oral hypoglycemic), seen on an outpatient basis at the Division of Diabetes, Metabolism, and Endocrinology, Omori Hospital, Toyko, Japan, who were receiving a therapeutic dietary regimen for ≥1 month in the treatment of diabetes or hypertension, were eligible for enrollment. Blood pressure, inflammatory markers (hs-CRP, IL-6, IL-18, VCAM-1, and L-selectin), and oxidative stress markers (urinary 8-OHdG and 8-isoprostane) were monitored before treatment commencement with valsartan (40-80 mg/d) and after 3 months of treatment.Results: A total of 26 patients (18 men, 8 women; mean [SD] age, 57.7 [11.3] years; mean [SD] weight, 65.3 [13.1] kg) were enrolled in the study. After 3 months of treatment, patients' mean (SD) blood pressure had significantly decreased from 153.1 (11.2)/88.3 (11.4) to 143.7 (13.7)/85.2 (9.0) mm Hg (P < 0.05). Among the inflammatory and oxidative stress markers, hs-CRP, VCAM-1, and urinary 8-OHdG concentrations decreased significantly from 0.231 (0.199) to 0.134 (0.111) mg/dL (P = 0.043), 471.1 (193.9) to 403.2 (135.2) ng/mL (P = 0.012), and 12.12 (5.99) to 8.07 (3.36) ng/mg · creatinine (P = 0.001), respectively. The reductions in these markers were observed in patients regardless of whether or not their glycosylated hemoglobin (HbA1c) concentration improved (defined as a decrease of ≥1% in HbA1c).Conclusion: This small, open-label, prospective study found that a 3-month treatment with valsartan was associated with a significant reduction of hs-CRP, VCAM-1, and urinary 8-OHdG concentrations independent of improvement in HbA1c concentration in these hypertensive patients with hyperglycemia

Functional deficiency of MHC class i enhances LTP and abolishes LTD in the nucleus accumbens of mice

Major histocompatibility complex class I (MHCI) molecules were recently identified as novel regulators of synaptic plasticity. These molecules are expressed in various brain areas, especially in regions undergoing activity-dependent synaptic plasticity, but their role in the nucleus accumbens (NAc) is unknown. In this study, we investigated the effects of genetic disruption of MHCI function, through deletion of β2-microblobulin, which causes lack of cell surface expression of MHCI. First, we confirmed that MHCI molecules are expressed in the NAc core in wild-type mice. Second, we performed electrophysiological recordings with NAc core slices from wild-type and β2-microglobulin knock-out mice lacking cell surface expression of MHCI. We found that low frequency stimulation induced long-term depression in wild-type but not knock-out mice, whereas high frequency stimulation induced long-term potentiation in both genotypes, with a larger magnitude in knock-out mice. Furthermore, we demonstrated that knock-out mice showed more persistent behavioral sensitization to cocaine, which is a NAc-related behavior. Using this model, we analyzed the density of total AMPA receptors and their subunits GluR1 and GluR2 in the NAc core, by SDS-digested freeze-fracture replica labeling. After repeated cocaine exposure, the density of GluR1 was increased, but there was no change in total AMPA receptors and GluR2 levels in wildtype mice. In contrast, following repeated cocaine exposure, increased densities of total AMPA receptors, GluR1 and GluR2 were observed in knock-out mice. These results indicate that functional deficiency of MHCI enhances synaptic potentiation, induced by electrical and pharmacological stimulation

Corticosterone Induces Rapid Spinogenesis via Synaptic Glucocorticoid Receptors and Kinase Networks in Hippocampus

BACKGROUND: Modulation of dendritic spines under acute stress is attracting much attention. Exposure to acute stress induces corticosterone (CORT) secretion from the adrenal cortex, resulting in rapid increase of CORT levels in plasma and the hippocampus. METHODOLOGY/PRINCIPAL FINDINGS: Here we demonstrated the mechanisms of rapid effect (∼1 h) of CORT on the density and morphology of spines by imaging neurons in adult male rat hippocampal slices. The application of CORT at 100-1000 nM induced a rapid increase in the density of spines of CA1 pyramidal neurons. The density of small-head spines (0.2-0.4 µm) was increased even at low CORT levels (100-200 nM). The density of middle-head spines (0.4-0.5 µm) was increased at high CORT levels between 400-1000 nM. The density of large-head spines (0.5-1.0 µm) was increased only at 1000 nM CORT. Co-administration of RU486, an antagonist of glucocorticoid receptor (GR), abolished the effect of CORT. Blocking a single kinase, such as MAPK, PKA, PKC or PI3K, suppressed CORT-induced enhancement of spinogenesis. Blocking NMDA receptors suppressed the CORT effect. CONCLUSIONS/SIGNIFICANCE: These results imply that stress levels of CORT (100-1000 nM) drive the spinogenesis via synaptic GR and multiple kinase pathways

解剖体において両側性の星状神経節ブロックは頻繁に硬膜外腔への薬液浸潤を起こす

It is well known that epidural infusion of injectate in association with a C6 paratracheal stellate ganglion block (SGB) leads to negative and/or positive side effects for the patient. However, this associated infusion has not been demonstrated experimentally using cadavers. We found that, in postmortem-fixed cadavers, epidural infusion occurred much more frequently in cases of bilateral SGB than in unilateral SGB. The frequency in the bilateral case (36.1%) was far beyond the two times of the unilateral one (7.7%). The injectate (latex resin, 10 ml for one side) was delivered from the prevertebral deposit into the epidural space by way of the spaces around the C8 and/or T1 spinal nerve roots. Thus, the latex spread around and/or in the brachial plexus usually combined with the epidural infusion. We speculate that the amount of injectate spreading into the prevertebral space in the bilateral injection (total 20 ml) was beyond the hypothetical tentative capacity and that the excess amount made the addional, perineural spread. The present results suggests that, in clinical cases, the frequency of epidural infusion depends on the amount of injectate even in the routine unilateral SGB. However, the cadaveric study did not indicate how much amount is the excess for the living patient

Stereophonic noise reduction using a combined sliding subspace projection and adaptive signal enhancement

A novel stereophonic noise reduction method is proposed. This method is based upon a combination of a subspace approach realized in a sliding window operation and two-channel adaptive signal enhancing. The signal obtained from the signal subspace is used as the input signal to the adaptive signal enhancer for each channel, instead of noise, as in the ordinary adaptive noise canceling scheme. Simulation results based upon real stereophonic speech contaminated by noise components show that the proposed method gives improved enhancement quality in terms of both segmental gain and cepstral distance performance indices in comparison with conventional nonlinear spectral subtraction approaches

Urinary Myoinositol Index: A New and Better Marker for Postmeal Hyperglycemia

We investigated the usefulness of the urinary myoinositol index (UMI) for identifying postmeal hyperglycemia in type 2 diabetics undergoing a meal tolerance test. Fifty-eight patients (18 males, 40 females) were enrolled, fasted overnight and blood collected prior to and 1 and 2 hours following the test meal. Urine was collected 2 hours after the test meal. Plasma 1,5-anhydroglucitol (1,5-AG) was measured enzymatically, and UMI with an improved enzymatic cycling method. Simple and multiple regression analyses were employed to determine correlations between plasma glucose (PG) and three PG markers; HbA1C (Japan Diabetes Society), 1,5-AG and UMI. Study population characteristics were age 67.6±7.9 years, body mass index 24.9±3.8kg/m2 and waist circumference 90.2±10.4cm. Mean concentrations for PG were 130±23mg/dL (fasting), 179±46mg/dL (1h postmeal) and 150±49mg/dL (2h postmeal), HbA1C (6.3±0.6%), 1,5-AG (11.9±5.7μg/mL) and 2h UMI (52.0±35.9mg/gCr). Correlation coefficients were calculated between 1h postmeal PG and HbA1C (r=0.558), 1,5-AG (r=0.256), and 2h UMI (r=0.496), and 2h postmeal PG HbA1C (r=0.605), 1,5-AG (r=0.306), and 2h UMI (r=0.606). Two hour UMI and HbA1C (Japan Diabetes Society) were significant determinants of 2h postmeal PG. As HbA1C reflects PG excursion during the previous 1-3 months, UMI may be a useful marker for monitoring and management of postmeal hyperglycemia in type 2 diabetics

Endogenous Synthesis of Corticosteroids in the Hippocampus

BACKGROUND: Brain synthesis of steroids including sex-steroids is attracting much attention. The endogenous synthesis of corticosteroids in the hippocampus, however, has been doubted because of the inability to detect deoxycorticosterone (DOC) synthase, cytochrome P450(c21). METHODOLOGY/PRINCIPAL FINDINGS: The expression of P450(c21) was demonstrated using mRNA analysis and immmunogold electron microscopic analysis in the adult male rat hippocampus. DOC production from progesterone (PROG) was demonstrated by metabolism analysis of (3)H-steroids. All the enzymes required for corticosteroid synthesis including P450(c21), P450(2D4), P450(11β1) and 3β-hydroxysteroid dehydrogenase (3β-HSD) were localized in the hippocampal principal neurons as shown via in situ hybridization and immunoelectron microscopic analysis. Accurate corticosteroid concentrations in rat hippocampus were determined by liquid chromatography-tandem mass spectrometry. In adrenalectomized rats, net hippocampus-synthesized corticosterone (CORT) and DOC were determined to 6.9 and 5.8 nM, respectively. Enhanced spinogenesis was observed in the hippocampus following application of low nanomolar (10 nM) doses of CORT for 1 h. CONCLUSIONS/SIGNIFICANCE: These results imply the complete pathway of corticosteroid synthesis of 'pregnenolone →PROG→DOC→CORT' in the hippocampal neurons. Both P450(c21) and P450(2D4) can catalyze conversion of PROG to DOC. The low nanomolar level of CORT synthesized in hippocampal neurons may play a role in modulation of synaptic plasticity, in contrast to the stress effects by micromolar CORT from adrenal glands