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Chronic subdural hematoma (CSDH) is considered to be an inflammatory and angiogenic disease. The CSDH outer membrane, which contains inflammatory cells, plays an important role in CSDH development. Osteopontin (OPN) is an extracellular matrix protein that is cleaved by thrombin, generating the N-terminal half of OPN, which is prominently involved in integrin signal transduction. We explored the expression of the N-terminal half of OPN in CSDH fluid and the expression of integrins α9 and β1 and the downstream components of the angiogenic signaling pathways in the outer membrane of CSDHs. Twenty samples of CSDH fluid and 8 samples of CSDH outer membrane were included. The concentrations of the N-terminal half of OPN in CSDH fluid samples were measured using ELISA kits. The expression levels of integrins α9 and β1, vinculin, talin-1, focal adhesion kinase (FAK), paxillin, α-actin, Src and β-actin were examined by western blot analysis. The expression levels of integrins α9 and β1, FAK and paxillin were also examined by immunohistochemistry. We investigated whether CSDH fluid could activate FAK in cultured endothelial cells in vitro. The concentration of the N-terminal half of OPN in CSDH fluid was significantly higher than that in the serum. Western blot analysis confirmed the presence of these molecules. In addition, integrins α9 and β1, FAK and paxillin were localized in the endothelial cells of vessels within the CSDH outer membrane. FAK was significantly phosphorylated immediately after treatment with CSDH fluid. Our data suggest that the N-terminal half of OPN in CSDH fluid promotes neovascularization in endothelial cells through integrins α9 and β1. The N-terminal half of OPN, which is part of the extracellular matrix, plays a critical role in the promotion of CSDH.

Hepatic biliary injury is one of the most common complications in cholecystectomy and is frequently accompanied by arterial injuries. Because there are several anatomical variations of the hepatic ducts, including the accessory hepatic ducts (AHDs), it is important to consider not only the anatomical position of the hepatic ducts but also those of the AHDs in cholecystectomy. However, the topographical relationships between the AHDs and the hepatic arteries are still poorly understood. In the present study we show that AHDs were observed in 7 out of 59 (11.9%) of the cadavers. There was a single AHD in the 6 out of the 7 cadavers and double AHDs in one. In these cases, the right AHDs emerged from the anterior medial segment of the liver piercing the parenchyma, while the left AHDs emerged directly from the anterior part of the caudate lobe. The right AHDs ran anterior to the right hepatic artery, while the left AHDs ran posterior to the hepatic arteries. The topographical relationship between the AHD and the hepatic artery system was thus reversed in the cases of the right and the left AHDs.

In the human hippocampus, the pyramidal layer consists of the inferior aspect of the hippocampus which is organized segmentally. Each segment, together with granule layer of the dentate gyrus, exhibits structural unity. In humans, ellipsoidal protrusions called pyramidal hillocks (PHs), which consist of a thick pyramidal cell layer (PL), are present in the inferior aspect of the hippocampus, and are segmentally organized along a longitudinal axis. It is also known that the granule cell layer (GL) of the dentate gyrus (DG) is not a smooth but undulated structure. However, the cytoarchitectural relationships between the protrusions and undulation have yet to be studied well. Here, we aimed to clarify the three-dimensional cytoarchitecture of the PL and GL of human hippocampus. For that purpose, the GL and PL were three-dimensionally reconstructed from serial sections of human hippocampus stained with hematoxylin and eosin. The GL was shaped as tubing with an opening in the dorsal part, and undulated especially in the medial part, forming digit-like processes. In the base of a digit-like process, protrusions of the GL extended laterally, with longer ones reaching the lateral edge, whereas shorter ones disappeared around the medial 1/3 of the GL. Consequently, the lateral part of the GL was undulated loosely. In the ventral view of the PL, the ellipsoidal PHs were sagittally aligned, whereas in the top view, each PH formed an ellipsoidal trough. Each structural unit was formed by a trough of the PH along the bottom, and had a longer GL protrusion in the upper-center, and shorter GL protrusions located between the longer protrusions and the lateral edge of the GL. A digit-like process extended into a dens. It is concluded that a unit of the PH and the GL comprises the longitudinal segmental formation of the hippocampus.

Background. Brain injury often causes severe motor dysfunction, leading to difficulties with living a self-reliant social life. Injured neural circuits must be reconstructed to restore functions, but the adult brain is limited in its ability to restore neuronal connections. The combination of molecular targeting, which enhances neural plasticity, and rehabilitative motor exercise is an important therapeutic approach to promote neuronal rewiring in the spared circuits and motor recovery. Objective. We tested whether genetic reduction of Src homology 2-containing phosphatase-1 (SHP-1), an inhibitor of brain-derived neurotrophic factor (BDNF)/tropomyosin receptor kinase B (TrkB) signaling, has synergistic effects with rehabilitative training to promote reorganization of motor circuits and functional recovery in a mouse model of brain injury. Methods. Rewiring of the corticospinal circuit was examined using neuronal tracers following unilateral cortical injury in control mice and in Shp-1 mutant mice subjected to voluntary exercise. Recovery of motor functions was assessed using motor behavior tests. Results. We found that rehabilitative exercise decreased SHP-1 and increased BDNF and TrkB expression in the contralesional motor cortex after the injury. Genetic reduction of SHP-1 and voluntary exercise significantly increased sprouting of corticospinal tract axons and enhanced motor recovery in the impaired forelimb. Conclusions. Our data demonstrate that combining voluntary exercise and SHP-1 suppression promotes motor recovery and neural circuit reorganization after brain injury.

It is commonly known that brain metastases usually have clear boundaries in magnetic resonance imaging. However, little is known regarding the trajectory of white matter fibers around the tumors, especially using the fiber dissection technique. Here, we focused on the anatomical interaction between white matter fibers and the tumor, using the fiber dissection in a postmortem brain with metastatic tumor and compared the findings with those of diffusion tensor imaging (DTI) tractography. One postmortem human brain hemisphere with metastatic adenocarcinoma in the Broca’s area was dissected using fiber dissection following the Klingler’s method. In order to compare the in vitro and in vivo results, additional brains from 15 patients with metastatic adenocarcinomas, the volumes of which were comparable to that of the adenocarcinoma in the brain used for fiber dissection, were analyzed using DTI tractographic reconstruction. Morphological findings of white matter bundles running around the tumor were compared between the two techniques. In the fiber dissection technique, the superior longitudinal fascicle, arcuate fascicle, and frontal aslant tract could be dissected, and the white matter bundles were curved and retracted to avoid the tumor. In all the cases analyzed, white matter fibers or streamlines surrounding the tumor avoided the lesion. Using the fiber dissection technique, this is the first direct evidence to elucidate the anatomy of white matter fibers affected by a metastatic brain. This suggests that brain metastatic adenocarcinoma is an intra-axial neoplasm with extra-axial white matter structures.

The prognostic nutritional index (PNI) is calculated using the serum albumin and peripheral lymphocyte counts. We sought to assess the correlation between the preoperative PNI and postoperative outcomes in patients with colon cancer treated with laparoscopic surgery. We included 896 colon cancer patients who underwent curative laparoscopic colectomy between January 2013 and March 2016. To identify any predictors of the postoperative outcomes, we compared the clinical characteristics and immunonutritional parameters, including the PNI, between patients classified as the Clavien–Dindo grade 2 or higher (n = 99) with those classified as grade 0 or 1 (n = 797). A longer surgical time and a preoperative low PNI (

The anatomical variations of the confluence of sinuses were examined, focusing on the continuity of the superior sagittal sinus (SSS) and the transverse sinuses (TSs). In the 142 specimens studied, there were 72 symmetric cases (50.7%) and 70 asymmetric cases (49.3%). The symmetric group (no dominant type) was categorized into 34 cases of bifurcation (23.9%) and 38 cases of confluence (26.8%). The asymmetric group was categorized into 54 cases of the right-dominant type (38.0%) and 16 cases of the left-dominant type (11.3%). The right-dominant type was further categorized into 38 partially-communicating (26.8%) and 16 non-communicating types (11.3%). The left-dominant type was categorized into 11 partially-communicating (7.7%) and 5 non-communicating types (3.5%). In summary, the SSS asymmetrically drained into one TS in about half of the cases studied. The right-dominant type was about three to four times as common as the left-dominant type. The draining pattern shown by the asymmetric group could provoke intracranial hypertension due to unilateral jugular vein obstruction. In order to avoid this risk in cases of neck dissection, jugular vein catheterization, or hypercoagulopathy, preoperative evaluations of the dural sinus variations via MR venography, three-dimensional CT, or plain X-ray of the skull are recommended.

A middle rectal artery arising from the lateral sacral artery (MRAls) in the right pelvis of a 99-year-old male was observed. Although variations of the origin of the middle rectal artery have been reported on many occasions, there are few descriptions of the trajectory in the literature. In our case, the MRAls branched from the lateral sacral artery on the sacral surface close to the third sacral sympathetic ganglion and immediately penetrated the third sacral splanchnic nerve and the parasympathetic pelvic splanchnic nerve from the ventral ramus of the forth sacral nerve. The MRAls entered in the lateral wall of the rectal ampulla without giving off a prostatic branch. Preservation of the pelvic autonomic nerves are crucial in rectal cancer excision to preserve the autonomic functions. The close topography of the MRAls to the origin of the fine autonomic nerves should be noted.

Echolocating bats emit various types of vocalizations for navigation and communication, and need to pay attention to vocal sounds. Projections from forebrain centers to auditory centers are involved in the attention to vocalizations, with the inferior colliculus (IC) being the main target of the projections. Here, using a retrograde tracer, we demonstrate that three forebrain structures, namely, the medial prefrontal cortex (mPFC), amygdala, and auditory cortex (AC), send direct descending projections to the central nucleus of IC. We found that all three structures projected to the bilateral IC. A comparison of the patterns of retrogradely labeled cells across animals suggests that the ipsilateral AC-IC projection is topographically organized, whereas mPFC-IC or amygdala-IC projections did not show clear topographic organization. Together with evidence from previous studies, these results suggest that three descending projections to the IC form loops between the forebrain and IC to make attention to various vocal sounds.

This is the first report of laparoscopic-endoscopic cooperative surgery (LECS) for an ileal tumor. A 50-year-old man was admitted to our hospital with a positive fecal occult blood test. Colonoscopy detected a submucosal tumor with intussusception located in the ileum, 10 cm oral from the Bauhin valve. On further examination, he was diagnosed with an ileal lipoma. There were no signs of malignancy. LECS was performed for the ileal tumor. After submucosal elevation by injecting saline solution, a mucosal incision was made circumferentially along the tumor. A full-thickness incision was created endoscopically and laparoscopically on the circumferential mucosal incisional line. The tumor was withdrawn intraluminally by endoscopy. The defect of the ileal wall was closed laparoscopically in an axial direction with linear staplers. Histologically, the tumor was a 25-mm ileal lipoma with negative resection margins and no malignancy.

Biometric ratios of the relative length of the rays in the hand have been analyzed between primate species in the light of their hand function or phylogeny. However, how relative lengths among phalanges are mechanically linked to the grasping function of primates with different locomotor behaviors remains unclear. To clarify this, we calculated cross and triple-ratios, which are related to the torque distribution, and the torque generation mode at different joint angles using the lengths of the phalanges and metacarpal bones in 52 primates belonging to 25 species. The torque exerted on the finger joint and traction force of the flexor tendons necessary for a cylindrical grip and a suspensory hand posture were calculated using the moment arm of flexor tendons measured on magnetic resonance images, and were compared among Hylobates spp., Ateles sp., and Papio hamadryas. Finally, the torques calculated from the model were validated by a mechanical study detecting the force exerted on the phalanx by pulling the digital flexor muscles during suspension in these three species. Canonical discriminant analysis of cross and triple-ratios classified primates almost in accordance with their current classification based on locomotor behavior. The traction force was markedly reduced with flexion of the MCP joint parallel to the torque in brachiating primates; this was notably lower in the terrestrial quadrupedal primates than in the arboreal primates at mild flexion. Our mechanical study supported these features in the torque and traction force generation efficiencies. Our results suggest that suspensory or terrestrial quadrupedal primates have hand structures that can exert more torque at a suspensory posture, or palmigrade and digitigrade locomotion, respectively. Furthermore, our study suggests availability of the cross and triple-ratios as one of the indicators to estimate the hand function from the skeletal structure.

Here, we describe laparoscopic colectomy with spleen-preserving distal pancreatectomy for descending colon cancer with pancreatic tail invasion. A 69-year-old man with descending colon cancer staged as clinical state IIIC (cT4b [pancreas] N1M0) underwent definitive laparoscopic surgery that was performed in collaboration with surgeons who specialize in laparoscopic colorectal and hepatobiliary-pancreatic laparoscopy. After the left colon was mobilized, tumor infiltration of the pancreas, but not the splenic vessels, was confirmed, and the spleen was preserved. The procedures were safely completed laparoscopically, without intraoperative and postoperative complications. Laparoscopic multivisceral resection could be a treatment option for similar patients but only when performed by multidisciplinary specialists.

The superficial morphology of the acinus of the mandibular gland in rats, which corresponds to the submandibular gland in humans, is very difficult to observe under scanning electron microscope due to a closely adherent capsule. Therefore, we evaluated the most effective protocol for removing this capsule from the acinus using various solutions, at different temperatures and for different durations of soaking. Based on the data for 50 male Wistar rats, the most effective method was soaking in an 8 N hydrochloric acid solution at 60°C for 70 min, in a water bath, followed by soaking in a 0.1-0.2% collagenase solution at 37°C for 330-350 min.

The clinical anatomy of the recurrent artery of Heubner (RAH) was examined, focusing on its number, origin, and course, in a large number of brain specimens. We studied 724 RAH in total from 357 brain specimens (714 hemispheres). In 98.74 % of 714 cases there were one or more RAHs, while it was absent in 1.26 % of cases. There was a single RAH in 96.22 % of cases, double in 2.38 % of cases, and triple in 0.14 % of cases. In this study, three origin types of the RAH were defined. We defined A1 and A2 segment of the anterior cerebral artery (ACA) as the artery from the origin of the ACA to the junction of the anterior communicating artery (AComA) and the artery from the junction of the AComA to the anterior border of the corpus callosum, respectively. In 76.2 % of 724 arteries, the RAH originated from the junction of the A1 and A2 segment of the ACA. In 16.3 %, the RAH originated from the A2 segment of the ACA. In 7.5 %, the RAH originated from the A1 segment of the ACA. The course of the RAH was superior to the A1 segment of the ACA in 30.1 % of 724 arteries, anterior in 62.2 %, and posterior in 7.7 %. It is of great importance for neurosurgeons to understand the detailed anatomical variations of the RAH before operating to prevent operative complications resulting in neurological deficits.

SUMMARY Brain hypothermia requires control of its temperature within an appropriate range, considering the change of body temperature over a long period. Various mathematical models have been used for the study of control and cooling capability of brain temperature in hypothermia. In previous models, a lumped-parameter hemisphere of uniform temperature has been assumed as a simplified brain model without considering the temperature distribution. In the present study, however, a new model is proposed to visualize the temperature distribution in the brain. The model has the approximate shape of the organs in the head based on MRI data, and may well reflect properties such as heat transfer coefficients, metabolic heat production, and heat capacity of human organs. The model has a pseudo-blood-flow component in which any temperature can be set as the initial value at the starting place of blood flow. Simulations using this model were performed with the temperature controlled by the introduction of Ringer's solution into any of the four arteries leading to the brain. The simulation results suggest that the various cooling effects are manifested in every region of brain, and that the temperature distribution can be known for applications to controlling brain temperature in a part of interest.

SUMMARY Accurate temperature control of brain tissue during hypothermia treatment is necessary in order to prevent secondary brain damage and to avoid various side effects. Thus, the visualization of the intracerebral temperature distribution in hypothermia treatment was studied at the fundamental level. For this purpose a virtual reality technology was used to create a mathematical model that reflects metabolic heat production and Fourier heat conduction in a brain with the necessary parameters based on various clinical models. In the present study, an experimental system was developed to examine a mathematical simulation of the blood flow in a human head by using a solid brain model constructed using silicon rubber in the shape of a brain based on MRI data, taking into account the metabolic heat given off by three film heaters and including six sensors for the measurement of regional brain temperature. The mathematical simulation describes the internal temperature distribution in a brain with a similar structure to the brain solid model. The results of mathematical simulations and experiments using the brain solid model were quite consistent in the steady state, including control of regional temperature. This allows for the performance of heat conduction experiments under conditions similar to those of a living body, in which the internal temperature is clinically difficult to observe. Thus, the mathematical simulation is confirmed to be useful together with experiments using the solid model for the study of future brain hypothermia treatment. C⃝ 2015 Wiley Periodicals, Inc. Electr Eng Jpn, 193(2): 58–68, 2015; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/eej.22642

We report a case of human epidermal growth factor receptor(HER)2 positive stage IV advanced gastric cancer successfully treated with chemotherapy combined with trastuzumab. A 50-year-old man was diagnosed with type 3 gastric cancer complicated by liver and lymph node metastases. Owing to a HER2 immunohistochemistry tumor score of 3+, we initiated capecitabine plus CDDP plus trastuzumab chemotherapy. After 6 chemotherapy courses, computed tomography showed the liver metastasis had disappeared and the paraaortic lymph nodes had shrunk. We continued the capecitabine plus trastuzumab chemotherapy, which resulted in a progression free survival of 31 months. After 38 chemotherapy courses, the primary tumor progressed; therefore, the patient underwent surgery. Chemotherapy combined with trastuzumab can allow for resec- tion of the primary tumor.

A rare case of multiple renal arteries was found in a 78-year-old female cadaver undergoing routine dissection. The characteristic findings in the cadaver included the presence of four right and four left renal arteries with one common trunk (a total of nine renal arteries). This variation may represent an immature form of complicated development of the renal arteries.

The topographic relationship between arteries and hepatobiliary ducts can be crucial during cholecystectomy. We observed the right hepatic artery traveling a rare route in a 91-year-old male. The common hepatic artery gave off the left hepatic, the right gastric, the gastroduodenal, and the right hepatic arteries consecutively without forming the proper hepatic artery. The right hepatic artery crossed the common bile duct anteriorly, ascended on the right side of the duct, passed the cystic duct posteriorly, and entered the right lobe of the liver. The so-called 9 o'clock artery running on the right side of the common hepatic and common biliary is reasonably speculated to be the aberrant right hepatic artery as presently shown. Developmental and clinical issues are discussed.

The human superficial brachial artery passes superficially to the median nerve and can be classified into three subtypes according to its topographical relationship to the pectoral ansa. When the superficial brachial artery passes superficially to the pectoral ansa, it is defined as the highest superficial artery. We found the highest superficial brachial arteries in both arms of a single cadaver. The right one coexisted with a normal axillary artery, and its identification was not difficult. The left one ran medially to the brachial plexus proximally and became superficial to the brachial plexus after branching off the artery, which gave the subscapular artery, then passed between the radial nerve and its accessory root from deep to superficial and ended as an inferior collateral ulnar artery. We also found a muscular axillary arch in each of the arms, both of which were innervated by the medialmost branch from the pectoral ansa. The right highest superficial brachial artery passed deep to the nerve to the muscular axillary arch. We conjectured that the left axillary artery is where the highest superficial brachial artery, as found on the right, coexists with the axillary artery in the case of Adachi's C-type brachial plexus (AxC). Then, the highest superficial brachial artery develops as a main stem, and the latter remains as a rudimentary AxC. Because the left axillary artery is caught on neither the pectoral ansa nor its branches, the left axillary artery can shift medially to the brachial plexus, and its true form is not obvious.

A Web-Learning system was developed for medical engineering which is one of the required subjects of the medical technologist's examination for specialist. The system helps students' self-learning to acquire the essential knowledge by the explanation of questions chosen from the past examination. We discussed its learning effect on the basis of experimental results presented at the lecture and practice. The students evaluated that the learning system was practical method for more knowledge of important points in the concerning subjects. Thus, the present method is regarded effective for learning medical engineering, while most students are reluctant to make an effort for its study.

The origins of the inferior epigastric and obturator arteries and the relationship between these arteries have been determined macroscopically in examinations of 706 body-halves of Japanese subjects. Three very rare inferior epigastric arteries were found to arise from the obturator artery leaving the internal iliac artery. The intimate relationship between these arteries has been documented by the obturator artery arising from the inferior epigastric artery and the anastomosis between them. It is generally interpreted that such anomalies occur as remnant or partial disappearance of the connection between the pubic branches of the inferior epigastric and obturator arteries. The inferior epigastric artery arising from the obturator artery is also thought to be a similar anomaly. Since the obturator artery from the inferior epigastric artery represents one form of extreme anomaly, and the inferior epigastric artery from the obturator artery represents another form, it would seem that these two forms of extreme anomaly should occur at similar frequencies. However, in our research, the incidence of the former was 10.5% while that of the latter was a very low 0.4%. During normal development, the inferior epigastric artery is established at an earlier stage than the obturator artery as a channel for blood supply. We suppose that the difference of blood flow resulting from this time lag is one of the reasons why the inferior epigastric artery from the obturator artery is very rare in comparison to the obturator artery from the inferior epigastric artery.

A left inferior vena cava was found in the cadaver of an 88-year-old Japanese man during a student dissection course at Kumamoto University School of Medicine. The right common iliac vein ascended obliquely toward the left behind the right common iliac artery and united with the left common iliac vein to form the inferior vena cava in front of the fifth lumbar vertebral body behind the left common iliac artery. The inferior vena cava ascended on the left side to the aorta, and after the left renal vein joined to it at the level of the third lumbar vertebral body, it turned obliquely to the right and crossed superficially to the aorta. At the right side of the aorta, the common stem of the third lumbar vein and the posterior renal vein was joined to the oblique part. The inferior vena cava then ascended, receiving the right renal vein as it would normally. The inferior vena cava is thought to develop symmetrically but this left inferior vena cava shows a persistence of the left channel of the infrarenal part, which normally disappears. Although the common stem of the veins that joined to the oblique part on the right side did not continue to the right common iliac vein, gross anatomical findings suggested it to be the remnant of the right inferior vena cava.

Ligamentum teres joining to the right branch of the portal vein in a 79-year-old Japanese male cadaver was noted during student dissection at Kumamoto University in 2004. The ligamentum teres entered the liver along the left side of the gallbladder fossa. The quadrate lobe was not distinguished from the left lobe in the visceral surface. When the liver parenchyma was removed by tearing off to expose the branches of the portal and hepatic veins, it was clarified that the ligamentum teres unusually joined to the bifurcation of the upper anterior and lower anterior branches of the right branch of the portal vein. The ligamentum teres is the remnant of the umbilical vein working throughout fetal life. Initially a pair of the umbilical veins entered the sinus venosus. During the fourth and fifth weeks they connect to the hepatic sinusoids, which become the portal and hepatic veins, and the parts entering the sinus venosus of both umbilical veins disappear. By the eighth week, as all remainder of the right umbilical vein disappears, the left umbilical vein is the only one to carry blood from the placenta to the liver. It results in the ligamentum teres joining to the left branch of the portal vein. However, in the present case it is thought that the right umbilical vein remained instead of the left one for some reason, and it then became the right ligamentum teres joining to the right branch of the portal vein.

Seminiferous tubules develop from sex cords, which are embryonic structures with simple C-shaped arches. Histologically, the epithelium of adult mouse seminiferous tubules has been divided into 12 stages based on the associations of spermatogenic cells in four cycles of spermatogenesis. However, the gross characteristics of the seminiferous tubules themselves, including their number, length, run, and mutual relationships remain largely unknown. In the present study, we analyzed all seminiferous tubules in a single adult mouse testis with high resolution using serial paraffin sections and high-perfomance three-dimensional reconstruction software. There were 11 seminiferous tubules with an average length of 140 mm. Each tubule ran along circular paths within the testis while making convolutions with cranial and caudal hairpin turns. The cranial turns of all tubules were in contact with the tunica albuginea, whereas the caudal turns were not, resulting in funnel-shaped networks of these tubules with tapered caudal portions. The caudally located networks surrounded the preceding cranially located networks from the bottom and outside, similar to stacked paper cups. Five out of the 11 seminiferous tubules were continuous from one end to the other both connected with the rete testis (10 connection points). Nine branching points, one blind end, and 18 more connection points with the rete testis were detected in the remaining six seminiferous tubules, making the paths of these tubules complicated to various degrees. The present study revealed that the 3D structures of seminiferous tubules were highly regular as a whole in the adult mouse testis.

An aberrant axillary artery running deep to the brachial plexus during its course was observed. The brachial plexus in this case was formed by the fourth cervical nerve to the first thoracic nerve and the radial nerve received a small nerve bundle (accessory radial nerve root) from the posterior aspect of the lower trunk. The axillary artery passed between the lateral and the medial cords of the brachial plexus, the same as for an ordinary axillary artery. In addition, it passed between their posterior divisions, forming the posterior cord, and further ran between the radial nerve root and the accessory radial nerve root from deep to superficial. This axillary artery was recognized as the deep axillary artery, the same as the axillary artery we have reported previously. It was thought that the branches to the subscapularis and serratus anterior muscles, nutrient branch to the radial nerve root and the subscapular artery played important roles in its formation.

Summary In 2002, we came across a very rare case of nonrotation of the midgut with a middle mesenteric artery (MM) (tentative name). It was found in a 73-year-old Japanese female cadaver donated for student dissection at Kumamoto University. In this case, the small intestine occupied the right half of the abdominal cavity and the large intestine occupied the left half. The caecum was situated on the anterior inferior part of the abdominal cavity near the midline. The duodenum (Du) was fused to the posterior abdominal wall. The small intestine except the Du and the ascending colon were suspended from the posterior abdominal wall by the mesentery, but the remainder of the colon was fused to the left posterior abdominal wall. In addition, an anomalous branch arose from the abdominal aorta between the superior and inferior mesenteric arteries (SM and IM) in this case. It chiefly supplied the ascending and the transverse colons and anastomosed with the SM and IM, respectively, through the marginal arteries. It is very rare that these anomalies appear simultaneously in one body. In this case, it is difficult to declare that the existence of the MM directly caused the nonrotation of the midgut, but it is reasonable to suppose some kind of relation between them.

An aberrant axillary artery that descended deep beneath the brachial plexus during its course was observed. The artery passed between the lateral and medial cords, as would an ordinary axillary artery, but further passed between the posterior divisions forming the posterior cord. The axillary artery turned medially to emerge from the lower border of the medial cord and finally ran as an ordinary artery. The aberrant axillary artery is judged to reach deeper to the brachial plexus, because it penetrated the posterior division of the brachial plexus from superficial to deep. It is possible to account for the formation of this artery as one of the combinations of the ordinary axillary artery and its branches, with the positional relationships between the brachial plexus.

During anatomy practice in 1999 at Kumamoto University School of Medicine, the anomalous lumbrical muscles originating in the forearm were observed in both arms of a cadaver. These muscles, originating from the intermediate tendon of the deep layer of the flexor digitorum superficialis for the index finger (FDS-II), passed through the carpal tunnel to join the insertion of the first lumbrical muscle, and formed a muscle belly near the origin in the left and at the insertion in the right. The left anomalous muscle was innervated by a branch of the median nerve just proximal to the carpal tunnel. The right one received a twig from the nerve to the first lumbrical muscle. Tracing the nerve fibers by peeling off the epi- and perineurium clarified that the nerve fibers supplying the left anomalous muscle formed a common bundle with the fibers to the first lumbrical muscle. Therefore, these anomalous muscles are considered to be the accessory lumbrical muscles arising from the forearm. The three accessory lumbricalis, including one case reported by Yamada (1986), received branches which had slightly different origins from proximally (nerve to the distal belly of FDS-II) to distally (nerve to the first lumbricalis). Accordingly the position of the muscle belly shifted distally. The occurrence of these unusual accessory lumbrical muscles indicates that the distal belly of FDS-III and the first lumbricalis are derived from a common muscle origin and presents an important clue to the phylogenetic origin of the flexor digitorum superficialis.

Ten years have passed since a serial block-face scanning electron microscopy (SBF-SEM) method was developed [1]. In this innovative method, samples were automatically sectioned with an ultramicrotome placed inside a scanning electron microscope column, and the block surfaces were imaged one after another by SEM to capture back-scattered electrons. The contrast-inverted images obtained by the SBF-SEM were very similar to those acquired using conventional TEM. SFB-SEM has made easy to acquire image stacks of the transmission electron microscopy (TEM) in the mesoscale, which is taken with the confocal laser-scanning microcopy(CF-LSM).Furthermore, serial-section SEM has been combined with the focused ion beam (FIB) milling method [2]. FIB-incorporated SEM (FIB-SEM) has enabled the acquisition of three-dimensional images with a higher z-axis resolution com- pared to ultramicrotome-equipped SEM.We tried immunocytochemistry for FIB-SEM and correlated this immunoreactivity with that in CF-LSM. Dendrites of neurons in the rat neostriatum were visualized using a recombinant viral vector. Moreover, the thalamostriatal afferent terminals were immunolabeled with Cy5 fluorescence for vesicular glutamate transporter 2 (VGluT2). After detection of the sites of terminals apposed to the dendrites by using CF-LSM, GFP and VGluT2 immunoreactivities were further developed for EM by using immunogold/silver enhancement and immunoperoxidase/diaminobenzidine (DAB) methods, respectively.We showed that conventional immuno-cytochemical staining for TEM was applicable to FIB-SEM. Furthermore, several synaptic contacts, which were thought to exist on the basis of CF-LSM findings, were confirmed with FIB-SEM, revealing the usefulness of the combined method of CF-LSM and FIB-SEM.

A left single coronary artery of heart was observed during anatomy practice at Kumamoto University School of Medicine in a 73-year-old female cadaver who died from a thalamic hemorrhage. The left single coronary artery, having a single orifice in the left aortic sinus, bifurcated into the anterior interventricular (IVa) and circumflex (CIR) arteries. No orifice of the right coronary artery was found on the aortic wall. Giving off a branch which traversed the upper part of the infundibulum to supply the anterior upper region of the right ventricle, the IVa descended in the anterior interventricular sulcus to supply the apex of the heart. The CIR curved leftwards in the atrioventricular sulcus to reach the posterior surface, after which it continued to emerge again into the anterior surface. The atrial arteries showed no anomalous distribution pattern and histological observation revealed no pathological abnormality other than a slightly thickened tunica intima. Furthermore, we observed the distribution patterns of bilateral coronary arteries in 377 hearts dissected during anatomical practice over 13 years at Kanazawa University (1980-1986) and Kumamoto University (1993-1998). Although the reason why only the right coronary artery was absent is left unexplained, it was concluded that the left single coronary artery in this study, having the developed left conal and circumflex branches, was an extreme case of the left dominant series of coronary arteries. The formation of single coronary arteries can be explained embryologically by the change of flow in the capillary plexus established on the ventricle wall.

Web-Learning system was developed to support the self-learning for national qualification examination and medical engineering practice by students. The results from small tests in various situations suggest that the unit-learning systems are more effective, especially for the early stage of their self learning. In addition, the answers of some questionnaire suggest that the students' motivation has a certain relation with the number of the questions in the system. That is, the less number of the questions, the easier they are worked out with a higher learning motivation by students. Thus, the system was extended to enable students to study various subjects and/or units by themselves. The system enables them to have learning effects more easily by the exercise during lectures. The effectiveness of the system was investigated on medical associated subjects installed in the system. The concerning questions of Medical engineering and Pathological histology are adequately divided into several groups, of which sixteen Web-Learning subsystems were well composed for their practical application. Our concerning various unit-learning systems were confirmed much useful for most students comparing with the case of the overall Web-Learning system.