Search

The sable Martes zibellina is distributed in northeastern Asia including Siberia, Sakhalin, northern Mongolia, northern China, and northernmost Japan (Hokkaido) (Bakeyev and Sinitsyn 1994). The Japanese sable M. zibellina brachyura, a subspecies indigenous to Hokkaido, was previously distributed throughout this region, but extensive hunting led to a reduction in population size, resulting in prohibition of hunting since 1920 (Inukai 1938). Only a few ecological and genetic studies have been conducted on the Japanese sable (e.g., Hosoda et al. 1999; Kurose et al. 1999; Miyoshi and Higashi 2005), and it is currently designated as data deficient (DD) on the IUCN Red List. The Japanese marten Martes melampus was originally distributed in Honshu, the largest island of Japan, and was reportedly introduced to southern Hokkaido from Honshu in the 1940s for the fur industry (Kadosaki 1996). Some of the individuals escaped from farms and spread naturally. Martes melampus is more similar to M. zibellina in terms of body size, habitat preference (Anderson 1970), and phylogenetic relationships (Sato et al. 2003), than other non-indigenous species in Hokkaido, such as the American mink Neovison vison, the Japanese weasel Mustela itatsi, and the raccoon Procyon lotor, and therefore, habitat expansion of M. melampus in Hokkaido could cause a significant impact on M. zibellina, and possible hybridization between the two is an issue of concern. The distribution of M. zibellina and M. melampus in Hokkaido was investigated by Murakami and Ohtaishi (2000) using photographs, videotapes, carcasses, and live observations. They showed that M. melampus occupied southern Hokkaido and M. zibellina occupied other areas but not the southern areas. This clear parapatric distribution occurred along the Ishikari lowland, located in central Hokkaido (Fig. 1). Their results, however, were based on only 43 samples, and thus, further observations are needed to confirm whether M. zibellina is still distributed in southern Hokkaido and whether M. melampus is distributed in the area across the Ishikari lowland. To explore the distribution of such elusive species, feces are useful materials, since they can be collected in larger quantities from diverse locations compared to carcasses or live samples. DNA extracted from feces can provide accurate species identification. Fecal DNAbased species identification has been conducted for mustelid species (see Gomez-Moliner et al. 2004; Kurose et al. 2005; Namba et al. 2007; Shimatani et al. 2008) and is recognized as an effective approach for identifying the presence of such elusive species. Currently, four other mustelid species, the ermine Mustela erminea, the least weasel Mustela nivalis, the Japanese weasel Mustela itatsi, and the American mink Neovison vison, are distributed in Hokkaido, and they deposit feces similar to those of M. zibellina and M. melampus. Murakami (2002) attempted species identification for mustelid feces collected in Hokkaido by sequencing a part of mitochondrial DNA extracted from feces, but the success rate was extremely low (2.6%; 5/189), indicating that this method is impractical for studying M. zibellina and M. melampus. A novel fecal genetic study by Shimatani et al. (2008) developed species specific primers for ten species of carnivores in Hokkaido including Martes species. Since they did not apply the primers for discriminating between the fecal samples of M. zibellina and M. melampus, its use for this purpose is still uncertain. Therefore, the present study aimed to develop a fecal DNA-based discrimination method with high practicality for feces of M. zibellina and M. melampus, to contribute to the understanding of their distribution in Hokkaido.

The Amur tiger (Panthera tigris altaica) is a critically endangered felid that suffered a severe demographic contraction in the 1940s. In this study, we sampled 95 individuals collected throughout their native range to investigate questions relative to population genetic structure and demographic history. Additionally, we sampled targeted individuals from the North American ex situ population to assess the genetic representation found in captivity. Population genetic and Bayesian structure analyses clearly identified two populations separated by a development corridor in Russia. Despite their well-documented 20th century decline, we failed to find evidence of a recent population bottleneck, although genetic signatures of a historical contraction were detected. This disparity in signal may be due to several reasons, including historical paucity in population genetic variation associated with postglacial colonization and potential gene flow from a now extirpated Chinese population. Despite conflicting signatures of a bottleneck, our estimates of effective population size (N(e) = 27-35) and N(e)/N ratio (0.07-0.054) were substantially lower than the only other values reported for a wild tiger population. Lastly, the extent and distribution of genetic variation in captive and wild populations were similar, yet gene variants persisted ex situ that were lost in situ. Overall, our results indicate the need to secure ecological connectivity between the two Russian populations to minimize loss of genetic diversity and overall susceptibility to stochastic events, and support a previous study suggesting that the captive population may be a reservoir of gene variants lost in situ.

The accessory parotid gland is a solitary salivary gland separate from the main parotid gland. Although it is recognized in 21-56% of individuals, the incidence of accessory parotid tumor is relatively rare. We report a 57-year-old male with pleomorphic adenoma arising from an accessory parotid gland. The patient had suffered from a gradually growing mass with no pain in his right cheek for six years. CT scans showed a well-circumscribed, 24×19-mm solid tumor lying on the masseter muscle. Fine needle aspiration revealed a cytological finding of pleomorphic adenoma. Considering the clinical course, radiological and cytological findings, pleomorphic adenoma of the accessory parotid gland was highly suspected. At surgery, a standard incision for parotid tumor was made and extended superiorly. Buccal branches of the facial nerve were detected at the anterior edge of the parotid gland. Total removal of the tumor with excision of the accessory parotid gland was performed. The pathological diagnosis was pleomorphic adenoma. Slight paresis of buccal branches resolved two months after surgery. No recurrence has occurred during 20-month follow-up. We recommend a standard parotidectomy approach that is safe and has cosmetic benefits for the surgical management of neoplasms arising from accessory parotid gland tissue.

Background. We examined the psychological dis- tress in patients with head and neck cancer and investigated how preoperative self-esteem influenced psychological distress during treatment. Methods. Fifty-eight patients who were scheduled for sur- gery for head and neck cancer participated. The Japanese ver- sion of hospital anxiety and depression scale (HADS) was administered preoperatively, after surgery, and 6 months post- operatively, and Rosenberg self-esteem scale was administered preoperatively and 6 months postoperatively. Results. There were significant differences among the 3 examination periods for psychological distress; the course of anxiety and depression differed between the high self-esteem group (HSEG) and the low self-esteem group (LSEG). In all ex- amination periods, anxiety and depression scores for HSEG were significantly better than for LSEG. As for depression, scores did not change significantly over time in HSEG, whereas the scores went from bad to worse in LSEG. Conclusions. Patients with cancer undergoing surgery, especially patients with low self-esteem, need preoperative and ongoing intervention. V C 2008 Wiley Periodicals, Inc. Head Neck 30: 1303-1309, 2008

Objective:The aim of this study is to clarify the etiology of first-bite syndrome. Methods:A total of 29 consecutive patients treated with a surgical resection for parapharyngeal space tumor between April 1999 and April 2005 were retrospectively reviewed. Results:Ninecases offirst-bitesyndromeweredeveloped.Eightofthosepatientshad undergonesurgicalablationofthecervicalsympathetic chain and/or external carotid artery. In two patients who underwent ablation of the sympathetic chain but in whom first-bite syndrome did not develop, the superior cervical ganglion was probably preserved. Conclusion:The present findings strongly indicate that loss of sympathetic innervation to the parotid gland from the superior cervical ganglion causes first-bite syndrome. They also suggest that some residual or autonomous activity of the superior cervical ganglion could prevent development of first-bite syndrome even if the lower sympathetic trunk was ablated. #2007 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVE Carcinoma of the ethmoid sinus is very rare, and treatment for locally advanced tumors remains as a formidable challenge to the clinician. We reviewed cases of ethmoid carcinoma in which anterior craniofacial resection had been undertaken and evaluated the safety and validity of the operative methods. METHODS We retrospectively reviewed 13 patients with ethmoid carcinoma who underwent combined anterior craniofacial resection. We evaluated the surgical procedures, complications, outcomes, local recurrence, and the survival rate. RESULTS Coronal incision and anterior craniotomy were performed in all cases. Four out of 13 cases underwent ipsilateral orbital exenteration due to involvement of the orbital contents. There were no potentially fatal complications, except for two cases of epidural abscesses which were successfully cured. Positive surgical margins were observed in 6 patients, and they received postoperative radiotherapy and/or chemotherapy. Local recurrences occurred in 4 cases, and 3 died at 9, 11, and 49 months after the surgery. Distant metastasis was not observed during the observation period. The overall 5-year survival rate was 75.2% (Kaplan-Meier method). CONCLUSION These tumors were safely removed without severe complications and postoperative mortality. Combined anterior craniofacial resection is an effective and safe option for treatment of locally advanced ethmoid carcinomas after various preoperative treatments.

Background In 2014, the new transnasal endoscopy with Blue laser Imaging (BLI) has been developed. Aim We present the usefulness of the observation of from the pharynx to the cervical esophagus using transnasal endoscopy with BLI. Patients and Methods This study was conducted between June 2014 and October 2014. During this period, 70 consecutive patients (60 men, 10 women; mean age 67.9 years old) with esophageal or head and neck cancer underwent endoscopic screening at the orophar‐ ynx and hypopharynx by transnasal endoscopy with BLI system We performed this endoscopic observation from oral cavity to pharynx before inserting into the cervical esophagus.The visibility of subsites of the hypopharynx and the orifice of the esophagus was evaluated. The extent of the view of hypopharyngeal opening was classified into 3 categories (excellent, good, poor). Then, the diagnostic accuracy of transnasal endoscopy with BLI system was estimated. Our screening is as follows. First, the patient is asked to bow their head deeply in the left lateral position. We put a hand on the back of the patient’s head and push it forward. The patient is then asked to lift the chin as far as possible. In order to inspect the oral cavity, we insert an endoscope without a mouthpiece. After observation of the oral cavity, the endoscope was inserted through the nose. When the tip of the endoscope reached caudal to the uvula, the patient opened his mouth wide, stuck his tongue forward as much as possible and made a vocal sound like “ayyy”. The endoscopist caused the endoscope to U-turn and observed the oropharynx, in particular the radix linguae (Intra© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. oropharyngeal U-turn method). For examination of the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed (Trumpet maneuver). Results 8 elderly cases were excluded because they could not perform the adequate ballooning. Finally, 62 cases were investigated. The ballooning the pyriform sinus and posterior wall not only allows accurate assessment of the stretched pharyngeal mucosa but also gives a view of postcricoid subsite and the orifice of the esophagus. The wide endoscopic view of the pharynx was obtained in a series of the procedures (excellent=53/62, 85.4%; good=7/52, 4.5%; and poor=2/62, 7.6%). Among 70 patients, 6 superficial lesions (8.6%) at the oropharynx(n=1) and hypopharynx (n=5) were discovered with BLI system. Mucosal redness, a pale thickened mucosa, white deposits or loss of a normal vascular pattern, well demarcated areas covered with scattered dots are important characteristics to diagnose superficial carcinoma. Conclusion The more progress achieved in transnasal endoscopy rapidly in the last few years, it can improve for observing the blind area using trans-oral endoscopy, therefore the trans-nasal endoscope will be a standard tool for the screening of the upper gastrointestinal tract in the near future.

Olfactory neuroblastoma is a rare malignant tumor arising from epithelium derived from the olfac-tory mucosa. Anterior cranial base surgery is the first choice of treatment for patients with early-stage disease. We report one case of olfactory neuroblastoma in which anterior cranial base surgery was supported by a navigation system.

Junco Nagata*, Vladimir V. Aramilev, Alexander Belozor, Taro Sugimoto & Dale R. McCullough Department of Environmental Science, Policy and Management, University of California, Berkeley, CA, 94720, USA; Institute of Sustainable Use of Natural Resources, Vladivostok, Russia; Graduate School of Environmental Earth Science, Hokkaido University, Sapporo, Hokkaido, 060-0810, Japan; Forestry and Forest Products Research Institute, Tsukuba, 305-8687, Japan; (*Corresponding Author: Phone: +81-29873-3211, ext. 417; Fax: +81-29-873-1543; E-mail: junbe@ffpri.affrc.go.jp)

The current guideline-recommended blood pressure values are difficult to maintain in general practice, partly due to the lack of ideal anti-hypertensive agents. Since morning hypertension has a high correlation with cardiovascular events, expectations that telmisartan, a long-acting angiotensin-II type-1 receptor blocker (ARB), can improve cardiovascular mortality are high. In this study, the efficiency of telmisartan in reducing morning hypertension and pulse wave velocity (PWV) as a practical surrogate endpoint was investigated. Seventeen unsupervised and 7 untreated hypertensive patients were prescribed telmisartan 40 mg/day for 3 months. Medication already prescribed upon enrollment in this study was continued, with the exception of ARBs (all of which turned out to be losartan 50 mg/day), which were discontinued and replaced with telmisartan. Morning home blood pressure (MHBP), office blood pressure (OBP), and brachial-ankle PWV (baPWV) were investigated in a prospective fashion. A stratified analysis was performed regarding previous use (group L) or non-use (group N) of losartan. Over a 3-month period, telmisartan was found to significantly reduce both OBP (from 153±13/85±9 to 141±17/80±7 mmHg (p

Objective:This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument.Method:Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test–retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy–Head and Neck (FACT–H&N) scales.Results:Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT–H&N demonstrated significant correlations (Spearman's ρ = 0.47–0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test–retest reliability showed an intraclass correlation coefficient (ICC) of 0.62–0.79.Significance of Results:The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.

Insulinlike growth factor (IGF) I and IGF-II are synthesized in osteoblasts and stimulate proliferation, differentiation, and matrix synthesis in these cells. There is some evidence that IGFs act on bone cells not only by paracrine but also by endocrine pathways, suggesting that circulating IGFs may be of importance for the regulation of bone metabolism. On the other hand, the serum IGF-I level is also thought to be a good indicator of the nutritional conditions in hemodialysis patients. The present study was performed to analyze the correlations of circulating levels of IGF-I, IGF-II, IGF-binding protein (IGFBP) 1 and IGFBP-3 with biochemical markers of bone metabolism and parameters of the urea kinetic model which reflect nutritional conditions in hemodialysis patients. We also examined the differences between these relationships in male and female patients on hemodialysis. Sixty-two hemodialysis patients, 36 men (male group) and 26 women (female group), were included in this study. We measured the serum levels of IGF-I, IGF-II, IGFBP-1, and IGFBP-3. The bone mineral content (BMC) of the radius was measured by dual-energy X-ray absorptiometry. We calculated Kt/V, protein catabolic rate, and percent creatinine generation rate (%CGR). We also examined the relationships between serum levels of IGFs and BMC and the parameters of the urea kinetic model. It was found that the serum levels of IGF-I in the hemodialysis patients were almost the same as those in the control group. However, the serum levels of IGF-II, IGFBP-1, and IGFBP-3 in the hemodialysis patients were significantly higher than those in the control group. In the male group, the serum IGF-I levels showed a significant correlation with both serum intact parathyroid hormone levels and BMC, but no significant correlations between these indices were found in the female group. The serum levels of both IGF-I and IGF-II showed significant correlations with %CGR in the male group, but not in the female group. Stepwise multiple regression analysis was performed to clarify the relationship between serum levels of IGFs and BMC or %CGR. It was found that age, hemodialysis duration, serum intact parathyroid hormone levels, and sex were independent factors associated with BMC. The %CGR was associated independently with serum levels of IGF-I, and IGF-II and with the presence of diabetes mellitus. In conclusion, it is thought that serum levels of IGF-I and IGF-II can be used as indices of nutritional conditions in hemodialysis patients. However, the serum IGF-I level cannot be used as a marker of bone metabolism in hemodialysis patients.

Acoustic neuromas are benign neoplasms that most often arise from the vestibular nerve. Many patients with this tumor experience some degree of vestibular symptoms. However, patients rarely complain of rotatory vertigo. Acoustic neuromas are known to exhibit a cystic appearance in some patients. It was hypothesized that cystic change might be a causative factor for rotatory vertigo. A retrospective study of 178 patients with unilateral acoustic neuroma who underwent surgery in the Department of Otolaryngology at Tokyo Medical and Dental University was carried out. The cystic appearance of the tumors was detected preoperatively by magnetic resonance imaging and confirmed at surgery. The relationship between cystic change of the tumor and presentation with rotatory vertigo was examined. Of the 178 patients studied, only 10 had both cystic change of the tumor and rotatory vertigo, and 120 had neither cystic tumor nor rotatory vertigo. Of the remaining 48 patients, 24 experienced rotatory vertigo with negative findings for cystic tumor and the other 24 had evidence of cystic tumor but no rotatory vertigo. Tumor with cystic change was observed in 34 patients, accounting for 19.1% of all patients studied. Rotatory vertigo was also experienced in 34 patients (19.1%). Of the 34 patients with cystic lesions, 29.4% (10) had rotatory vertigo. The difference in percentage of the two groups did not reach statistical significance. It is suggested that there may be other factors causing rotatory vertigo in patients with acoustic neuromas than cystic change of the tumor.

There have been many reports of a high rate of hearing impairment in divers. A prospective study was performed to determine whether sensorineural hearing acuity in the same divers deteriorated faster than in a normal population as they continued diving. After an observation period of approximately 5 years, audiometric examination was performed on a group of professional fishery divers who had normal hearing or sensorineural hearing loss at the time of initial study. Thirty-three ears of 18 divers were included in statistical analyses. The average hearing deterioration in the divers in 5 years, after elimination of the aging effect, was 6.6 dB (SD 4.5) and was statistically significant. We concluded that the hearing acuity of our subjects deteriorated faster than that of normal Japanese.

The present study examined whether or not hepatocyte growth factor (HGF), an endothelium-specific growth factor that stimulates regeneration of the endothelium, is increased or has a prognostic significance in patients with acute coronary syndromes. HGF was measured in 106 patients with coronary artery disease (20 stable effort angina, 12 unstable angina without adverse events, 24 unstable angina with adverse events and 50 acute myocardial infarction) on admission and 21 normal volunteers. The measurements in all patients were recorded before administration of heparin, and in acute myocardial infarction patients they were recorded from days 2 to 6 after heparin discontinuation on day 1. HGF levels (ng/ml) were 0.30±0.06 for the controls, 0.31±0.08 for stable effort angina patients, 0.31±0.08 for unstable angina patients without adverse events, 0.40±0.20 for unstable angina patients with adverse events and in acute myocardial infarction patients they were 0.45±0.18 on day 0, 0.57±0.45 on day 2, 0.50±0.35 on day 3, 0.48±0.32 on day 4, 0.44±0.20 on day 5, and 0.38±0.14 on day 6. HGF plays a crucial role in the restoration of injured endothelial cells and is a predictor of adverse events in patients with acute coronary syndromes. (Jpn Circ J 1999; 63: 583 -588)

Carcinoma arising in a thyroglossal duct remnant is relatively rare. We experienced a case of a papillary adenocarcinoma in a remnant of the thyroglossal duct. In Japan, only 45 such cases have been reported to date.A 17-year-old male visited our hospital complaining of a mass in the anterior region of the neck. A well circumscribed and soft elastic mass was palpated in the midline of the neck at the level of the hyoid bone. Ultrasonography, computed tomography and magnetic resonance imaging revealed a mass of 4×3cm, in contact with the hyoid bone. The mass was cystic in structure and contained a calcific protrusion. This protuberance was intermediately enhanced in the CT image. Aspiration biopsy of the tumor, however, did not reveal atypical cells and the tumor was diagnosed as class I.The mass was resected by Sistrunk's procedure. The tumor had adhered to the hyoid bone and the connective tissue around it, but no metastatic neighboring lymph nodes were found.The histopathologic diagnosis of the tumor was papillary adenocarcinoma arising in a thyroglossal duct remnant. Neither invasion of the hyoid bone nor invasion of the surrounding connective tissue was evident, and the surgical margin of the resected specimen was negative.The patient has been free from the disease for 18 months after surgery. In diagnosing this condition, preoperative assessment using CT, MRI, US and an aspiration biopsy smear was necessary. In most cases, however, malignancies are not suspected before surgery.

Background: The incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) have risen steadily in the USA and in northern Europe. These increases are thought to be a consequence of persistent infection with high-risk human papillomavirus (HPV) in OPSCC patients. HPV is an emerging etiologic factor in OPSCC. In Japan, the incidence of OPSCC has significantly increased over the last three decades. However, the population of HPV-positive OPSCC patients is currently unknown. We examined the nationwide trends with regard to HPV incidence in OPSCC patients at 21 specific sites, and examined the relationship between the presence of HPV and survival in OPSCC patients in Japan. Methods: Tumor samples were obtained from patients with OPSCC prior to treatment, and HPV infection was investigated by polymerase chain reaction (PCR). Hybrid Capture 2 (HC2) was also adopted for swab examination on the surface of fresh tumors. Results: HPV was detected by PCR in 79 (50.3%) out of 157 OPSCC patients. The clinical features of HPV-positive OPSCC were low differentiation, a tendency to involve the lateral wall, and high nodal staging. The sensitivity and specificity of HC2 were 93.7 and 96.2%, respectively, indicating its utility as a screening test. HPV-positive patients had significantly better overall survival and disease-free survival than HPV-negative patients.

Vocal cord paralysis (VCP) is one of the postoperative complications after radical esophagectomy. VCP may also lead to serious morbidities such as respiratory distress and aspiration pneumonia. Therefore, an early diagnosis of VCP is meaningful in the postoperative management of patients undergoing esophagectomy. We evaluated a new practical method for diagnosing postoperative VCP.The laryngeal assessment of 30 patients was performed, and the presence of VCP was inferred while the following 15 patients by endoscopy before extubation after performing consecutive radical esophagectomy in 45 esophageal cancer patients. The vocal cord mobility, including adduction and abduction, were assessed by inserting the tip of a transnasal endoscope near the vocal cord in the awake patients with orotracheal intubation on the first postoperative day. The presence of VCP was reevaluated after extubation.Eleven of the 30 patients assessed after radical esophagectomy had unilateral VCP and one patient had bilateral VCP. The abduction findings were useful for assessing VCP and the sensitivity, specificity, positive and negative predictive values and accuracy were 97.9%, 100%, 100%, 92.9% and 98.3%, respectively. The results of the following 15 patients were closely similar.The VCP during orotracheal intubation is assessable by transnasal endoscopy.

Two cases of intraparotid facial nerve schwannoma are presented. Case 1 was a 38-year-old female who complained of a slowly growing tumor under her left ear. She had had an open biopsy at another hospital about two years earlier ; the tumor was diagnosed histologically as schwannoma. Surgical excision was performed, and the tumor was diagnosed as a schwannoma originating from the buccal branch of the facial nerve. Case 2 was a 74-year-old female who complained of a slowly growing tumor under her left ear. The tumor was accompanied by slight pain, and left facial palsy was noted. Surgical excision was performed under a preoperative diagnosis of malignant parotid gland tumor. However, the tumor was found to be a schwannoma originating from the main trunk of the facial nerve, the upper part of the tumor was growing into the stylomastoid foramen.Intraparotid facial nerve schwannoma is rare, and in Japan, only 26 cases have been reported to date.

We proposed SMALL (Seamless Mobile-Assisted Language Learning Support System) seeking for seamless language learning in our previous study. In this paper, we describe how far we have developed the system for the realization of seamless learning. As our first step, we aim to support English vocabulary learning, since vocabulary learning is one of the fundamental aspects of language learning. The initial evaluation of this system showed that the experimental group showed a larger improvement for the two kinds of tests than the control group. The experimental group uploaded less words, but learned more words than the control group. The system added some fun factor in vocabulary learning. The entwining function showed statistically significant effectiveness only when excluding two exceptional cases.

A 64-year-old man presented with proteinuria during postoperative interferon (IFN)-β therapy against malignant melanoma. Renal pathologic findings were consistent with minimal change nephrotic syndrome (MCNS) showing extensive foot process effacement of visceral glomerular epithelial cells (podocyte). Nephrotic range proteinuria gradually regressed after stoppage of local injection of IFN-β without glucocorticoid treatment. To our knowledge this is the first report that demonstrates histological abnormalities of the glomerulus associated with postoperative IFN-β therapy for the malignant melanoma.

Objective The parapharyngeal space (PS) is defined as the deepest space in the neck and it consists of the pre- and post-styloid regions. PS tumors originating in these regions are thought to dislocate the carotid artery (CA) in either the posterior or anterior direction. To determine the precise anatomy of the PS and its relationship with the CA in diagnostic images, we conducted cadaveric and imagining analysis. Materials and methods We examined the posterior and lateral aspects of the PS in three cadavers. We also examined 17 patients who suffered from PS tumors, in which the carotid artery was dislocated (CA), then compared the results with surgical and pathological findings. Results The anterior part of the PS was mainly composed of fatty tissue and is generally referred to as the pre-styloid region of the PS. In the posterior of this fatty region, blood vessels and nerves were tightly covered with muscles and adjacent fascias to form a compact musculo-fascial structure containing the CA, jugular vein, vagal, glossopharyngeal, accessory and sympathetic nerves, and a portion of the hypoglossal nerves. The hypoglossal nerves emerged from the hypoglossal canal posterior to this structure and coursed behind it, entering it at the upper third of the PS. These anatomical findings indicated that the PS was actually comprises of three regions. Image analysis showed that the CA was dislocated in the postero-lateral direction by a pleomorphic adenoma originating from the parotid gland and by a trigeminal schwannoma, both of which were pre-styloid tumors. On the other hand, the post-styloid tumors did not always dislocate the CA in the anterior direction. Tumors that developed within the musculo-fascial structure such as those of the carotid body tumor or sympathetic nerve schwannoma dislocated the CA from both the antero- to the postero-lateral directions. A hypoglossal nerve schwannoma originating from the most posterior part of the PS, which was behind the musculo-fascial structure dislocated the CA in the anterior direction. Conclusion The present findings indicated that the post-styloid region of the PS is considered to consist of two regions. As the CA is a component of this musculo-fascial structure, tumors originating from it that are defined as post-styloid did not always displace the CA in the anterior direction. Such anatomical recognition is helpful for diagnostic imaging of PS tumors.

We investigated the impact of olmesartan and temocapril on pancreatic islet beta-cells during the development of diabetes mellitus using Otsuka-Long-Evans-Tokushima Fatty (OLETF) rats. Four-week-old male OLETF rats were fed standard chow (untreated:n5), or chow containing either 0.005% olmesartan(n5) or 0.01% temocapril (n5) until being sacrificed at 35 weeks of age. Pancreas sections were double-stained with anti-insulin and anti-glucagon antibodies. The percent areas of beta-cells, alpha-cells and non-alpha-non-beta-cells were compared among groups. In untreated OLETF rats, the fasting plasma glucose (FPG) level was elevated at the 18th week and remained elevated until the 35th week. On the other hand, no significant elevation in FPG levels was observed in olmesartan- or temocapril-treated rats. Pancreatic islets from olmesartan-treated rats were significantly smaller in size as compared with those from untreated OLETF rats. Furthermore, the average area occupied by beta-cells as a fraction of the total area of an individual islet was significantly higher in olmesartan- or temocapril-treated rats than that in untreated OLETF rats. Olmesartan and temocapril both prevented the development of hyperglycemia, possibly through the prevention of islet beta-cell loss in spontaneously diabetic OLETF rats.

The molecular mechanism of anemia that is hyporesponsive to recombinant human erythropoietin (rHuEPO) in hemodialysis patients without underlying causative factors has not been investigated fully in hematopoietic stem cell system. Circulating CD34+ cells (1 x 10(4)) were isolated from rHuEPO hyporesponsive hemodialysis patients (EPO-H; n = 9), patients who were responsive to rHuEPO (EPO-R; n = 9), and healthy control subjects (n = 9). The patients with known causes of EPO hyporesponsiveness were eliminated from the current study. The cells were cultured in STEM PRO 34 liquid medium, supplemented with rHuEPO, IL-3, stem cell factor, and granulocyte-macrophage colony stimulating factor for 7 d and then transferred to a semisolid methylcellulose culture medium for performing burst forming unit-erythroid (BFU-E) colony assay. Expression of src homology domain 2 (SH2)-containing tyrosine phosphatase-1 (SHP-1), phosphorylated Janus kinase 2 (p-JAK2), and phosphorylated signal transducer and activator of transcription 5 (p-STAT5) was assessed with Western blot analysis. In EPO-H patients, SHP-1 antisense or scrambled S-oligos were included in the culture medium, and its effects were evaluated. The number of circulating CD34+ cells was not statistically different among the three groups, and their proliferation rates were similar for 7 d in culture. However, BFU-E colonies were significantly decreased in EPO-H patients compared with EPO-R and control groups. The mRNA and protein expression of SHP-1 and p-SHP-1 was significantly increased, whereas that of p-STAT5 was reduced in EPO-H patients. The inclusion of SHP-1 antisense S-oligo in culture suppressed SHP-1 protein expression associated with p-STAT5 upregulation, increase in p-STAT5-regulated genes, and partial recovery of BFU-E colonies. In EPO-H hemodialysis patients, the EPO signaling pathway is attenuated as a result of dephosphorylation of STAT5 via upregulation of SHP-1 phosphatase activity, and SHP-1 may be a novel target molecule to sensitize EPO action in these patients.

Diabetic nephropathy is the most important cause of end-stage renal failure. Recent clinical trials have postulated the possibility for prevention and remission of the disease once reckoned as irreversible. In DCCT, UKPDS and Kumamoto study, progression to overt proteinuria was prevented by intensive blood glucose control. Lewis study has demonstrated renoprotective effect of ACE inhibitor in type-1 diabetic nephropathy, and RENAAL and IDNT has documented that of angiotensin II type-1 receptor blocker in type-2 diabetes. Moreover, potential efficacy of lipid lowering in prevention of diabetic nephropathy has been postulated in recent Steno-2, multifactorial intervention trial. Thus, simultaneous adjustment on hyperglycemia, hypertension, and dyslipidemia may lead to prevention and remission of diabetic nephropathy.

Postoperative cervical lymphorrhea is a complication uncommonly encountered following neck dissection for which several treatment modalities have been described in the literature. We managed 8 cases of lymphorrhea after neck dissection by injecting Minocycline through a drainage tube. We attempted this procedure for lymph discharge that had continued despite pressure dressing and systemic management with nutritional modification for about 1 week. This treatment rapidly resolved lymph discharge in 6 of the 8 cases. No patient required surgical intervention. Minocycline sclerotherapy has typically been used to treat pleural effusion, ascites, pneumothorax, and other cystic diseases of the liver, pancreas, and kidney. In many cases, this therapy brings rapid resolution. This inefficiency is due to the acidity and toxicity of Minocycline. No major adverse effects have been reported. We believe that Minocycline sclerotherapy is effective for rapidly resolving lymphorrhea following neck dissection and use of this therapy should be attempted before surgical intervention.

A 51-year-old woman with systematic lupus erythematosus(SLE) associated with minimal change nephrotic syndrome(MCNS) is described. The patient was diagnosed as SLE at 33 years of age. After steroid therapy for two years, the patient's course was uneventful without therapy until June 2000, when facial erythema and facial, pretibial edema developed. On admission, proteinuria and renal dysfunction were detected. Subsequently, oliguric acute renal failure developed and hemodialysis was started. Laboratory examination showed no significant change in complements and anti ds-DNA antibody levels. Renal biopsy revealed minor glomerular abnormalities without the deposition of immune complexes. Electron microscopic examination showed foot process fusion and a vacuolar change in glomerular epithelial cells. The diagnosis of MCNS was made and administration of steroid(40 mg/day) was started. Urine volume and renal function improved after 2 weeks, and nephrotic syndrome remitted completely after 5 weeks. Although the association of SLE and MCNS is rare, the findings suggest that in the course of SLE manifesting acute ranal failure, not only lupus nephritis, but also the complication of MCNS should be considered.

Background: Neuropeptide Y (NPY) is a 36-amino-acid peptide that was originally isolated from the porcine brain. NPY, in contrast to leptin, is one of the most potent appetite stimulants. In some previous studies, NPY was found to be correlated with mean blood pressure (MBP) and fluid volume in patients on hemodialysis (HD), contributing to volume-induced hypertension. However, it is still unclear which NPY-sensitive neuronal pathways are responsible for the various changes seen in response to central NPY administration. In this study we analyzed the correlation of circulating levels of NPY with parameters of nutritional conditions, and we investigated the relationships between NPY concentrations and clinical markers of fluid volume in patients on HD. We also evaluated the effects of high-flux dialysis membranes on plasma NPY levels as compared with those of low-flux membrane. Methods: Plasma NPY concentrations in patients on regular HD were measured using commercially available radioimmunoassay (RIA) kits. We examined the relationship between plasma NPY concentration and other clinical indices in patients on HD. Results: Plasma NPY concentrations were inversely correlated with the serum urea nitrogen levels (r = –0.32) as well as protein catabolic rate (PCR) (r = –0.28). Plasma NPY was also correlated with the increase in body weight between HD sessions (r = 0.29). On the other hand, plasma NPY concentrations were not correlated with MBP, atrial natriuretic peptide (ANP), or adrenomedullin (AM). The reduction rate of plasma NPY with a high-flux dialysis membrane was significantly higher than that with a low-flux dialysis membrane. Conclusions: The secretion of NPY may be enhanced in a poor state of nourishment and stress induced by fluid volume overload in patients on HD, and plasma NPY is removed by a high-flux dialyzer.

Background: Orexins A and B are neuropeptides that regulate feeding behavior and are localized exclusively in neurons within and around the lateral hypothalamic area. Intracerebroventricular injection of orexin A stimulates food consumption in rats. Plasma concentrations of orexins may reflect nutritional states and may have clinical significance in patients on hemodialysis. In this study, we investigated the relationship between plasma orexin concentrations and nutritional states in patients on hemodialysis. Method: We measured plasma orexin concentrations in patients on hemodialysis (HD group, n = 67), patients with IgA nephropathy (n = 10), patients with diabetes mellitus (n = 11) and healthy controls (n = 10). We examined the relationships between plasma orexin concentrations and nutritional indices. Results: Plasma orexin A concentrations were significantly higher in the HD group than in the control group and showed a significant correlation with serum creatinine. In all subjects, there was a positive correlation between the plasma orexin A concentration and the serum creatinine concentration, but there were no correlations between these concentrations in each group. In the HD group, plasma orexin A concentrations had a significant positive correlation with the serum albumin concentration and percent creatinine generation rate (%CGR). Multiple regression analysis demonstrated that %CGR was the only independent factor associated with plasma orexin A concentrations. Conclusion: Plasma orexin A concentrations are increased in patients on hemodialysis. It is possible that the kidney plays a major role in the clearance of orexins. The plasma orexin A concentration is significantly correlated with %CGR, and it may be able to be used as a clinical marker of the nutritional state in patients on hemodialysis.

(MRI) Images of fibrous dysplasia (FD) on computed tomography (CT) or magnetic resonance imaging (MRI) vary depending on the relative proportions of the fibrous and osseous components. Based on analysis of the literature, Camilleri suggested that structural changes revealed by conventional radiography may be indicative of the progression of FD. Here we describe the case of a boy who presented at 12 years of age with monostotic FD located in the right maxilla. The lesion first appeared as a lamellar, 'onion peel'-like structure on CT; then over the course of the next five years, the structure became what has been termed an 'egg-shell lesion', before eventually assuming the form of a 'ground-glass lesion'.

Adrenomedullin (AM) is a hypotensive peptide that has recently been isolated from human pheochromocytoma. In this study, we measured plasma AM concentrations in 54 patients on hemodialysis (HD) and examined the clinical significance. We also evaluated the effects of high-flux and low-flux dialysis membranes on plasma AM levels. The average value of plasma AM at pre-HD (4.44 ± 0.16 fmol/ml) was significantly elevated compared with that in 44 healthy volunteers (1.31 ± 1.41 fmol/ml) (p < 0.0001). The plasma AM concentrations at pre-HD showed a negative correlation with age and mean blood pressure (MBP) at pre-HD. The plasma AM concentrations at post-HD showed a negative correlation with MBP at post-HD and a negative correlation with the reduction rate of AM. Multiple regression analysis showed that age and MBP were independent factors associated with plasma AM at pre-HD and that MBP and reduction rate of AM were independent factors associated with plasma AM at post-HD. We investigated the differences between high-flux dialyzers (PS-UW, PS-N and FB-F) and a low-flux dialyzer (AM-BC-F), and we found that high-flux dialyzers removed plasma AM more efficiently than a low-flux dialyzer did. In addition, in 3 patients on HD, plasma AM levels decreased significantly during isovolumic dialysis using a high-flux dialyzer, despite the fact that there were no significant changes in MBP and ANP. In conclusion, elevation in plasma AM level causes a fall in MBP in patients on HD, therefore, removal of AM by HD treatment using a high-flux dialyzer contributes to the stability of blood pressure during HD.

Three vestibular nerve specimens removed at transmeatal neurectomy were studied in order to understand better retrograde degeneration and regeneration after vestibular neurectomy in the posterior cranial fossa. In two cases this procedure followed retrolabyrinthine retrosigmoid posterior fossa vestibular neurectomy. The subjects, three patients with Menière's disease, were compared with one another and two autopsy controls with no known otological problem. The specimens were obtained at the distal end of the internal auditory canal and transversely sectioned. Many collapsed Schwann cell basement membranes were observed. The ratio of small-diameter nerve fibres increased significantly after neurectomy. Onion bulb formation around myelinated nerve fibres with small diameters and Schwann cell proliferation around the soma of vestibular ganglion cells reflected remyelination. We conclude that peripheral processes of vestibular nerve fibres can undergo retrograde degeneration and subsequent regeneration after transection of the central process.

Three cases of postoperative laryngopharyngeal edema following nonsimultaneous radical neck dissection are presented. Case 1 was a 65-year-old male with tongue cancer and left cervical lymph node metastases. Hemiglossectomy, reconstruction of the floor of the mouth with a free rectus abdominis flap, and left radical neck dissection had been performed. Postoperatively, the tongue and left upper neck were irradiated. Seven months later, right cervical lymph node metastases were observed. Right radical neck dissection was performed, and immediately after extubation, upper airway stenosis due to severe laryngopharyngeal edema occurred. Emergent tracheostomy saved his life. Case 2 was a 55-year-old female with tongue cancer and right cervical lymph node metastases. Radium needles had been implanted in the tongue, and right radical neck dissection was performed. Three months later, left cervical lymph node metastases were found. Left radical neck dissection was performed and, as in Case 1, upper airway stenosis revealed immediately after extubation. Since the situation was anticipated, an immediate tracheostomy was done. Case 3 was a 43-year-old male with laryngeal cancer and left cervical lymph node metastasis. Irradiation of the larynx and the bilateral upper neck followed by left radical neck dissection and partial laryngohypopharyngectomy had been performed. Five years later, right cervical lymph node metastasis was observed. Right radical neck dissection was performed, and laryngoscopic examination before extubation revealed severe laryngopharyngeal edema. In this case, tracheostomy was performed before extubation. To our knowledge, there have been only five cases of postoperative laryngopharyngeal edema, following nonsimultaneous radical neck dissection, reported in the literature.

This paper proposes Seamless Mobile-Assisted Language Learning Support System (SMALL system), which aims to entwine in-class learning with out-of-class learning. Learners upload what they have learned out-of-class to the SMALL system and then it supports linking out-of-class vocabulary learning with in-class one. It also links students' self-learning with that of others. This linking function is significant because we need to encounter as many different contexts as possible to build up vocabulary. It also supports retaining vocabulary in long-term memory by giving quizzes. The evaluation of this system showed that the experimental group uploaded less words, but learned more words than the control group and that the entwining function showed statistically significant effectiveness when excluding two exceptional cases. The subjects predominantly used mobile devices during out-of-class learning, which supports what is generally believed that mobile devices are more fitting tools for vocabulary learning than PCs.