Recurrent disease following endoscopic ablation of Barrett's high-grade dysplasia with spray cryotherapy

BACKGROUND AND AIMS

Recurrent disease after endoscopic ablation of Barrett's esophagus should be detected early to prevent malignant progression. We assessed the incidence and patterns of disease recurrence in patients after liquid nitrogen spray cryotherapy ablation of Barrett's esophagus with high grade dysplasia (HGD), including the area below the neosquamocolumnar junction (NSCJ).

PATIENTS AND METHODS

This is a single-center, retrospective study of prospectively collected data on consecutive cases of endoscopic ablation with liquid nitrogen spray cryotherapy for Barrett's HGD. Post-treatment surveillance biopsies were obtained of suspicious lesions and in 4 quadrants every 1 cm in the treated esophagus and just below the NSCJ. Primary outcome measures were location and histology of recurrent disease.

RESULTS

36 patients (median age 62 years, 92% men) were enrolled, and 11 (30%) developed recurrent disease in a median of 6.5 months; three developed a second recurrence. Ten recurrences (71%) were identified below the NSCJ in 9 patients, including HGD (4), low grade dysplasia (LGD) (2), and intestinal metaplasia (4). Six recurrences were identified in the treated esophagus in five patients, including intramucosal cancer (1), HGD (1), and intestinal metaplasia (4). Two patients had recurrent disease involving both locations. Ultimately 33 patients (92%) achieved a complete response. Diagnosis in the remaining three was LGD (1) and intestinal metaplasia (2).

CONCLUSION

Most patients with recurrent intestinal metaplasia with or without dysplasia after ablation achieve a complete response. Recurrent disease commonly involves the area just below the NSCJ. Surveillance endoscopies should include this area to accurately identify patients with disease recurrence.

Enhanced GABAergic network and receptor function in pediatric cortical dysplasia Type IIB compared with Tuberous Sclerosis Complex

Tuberous Sclerosis Complex (TSC) and cortical dysplasia Type IIB (CDIIB) share histopathologic features that suggest similar epileptogenic mechanisms. This study compared the morphological and electrophysiological properties of cortical cells in tissue from pediatric TSC (n=20) and CDIIB (n=20) patients using whole-cell patch clamp recordings and biocytin staining. Cell types were normal-appearing and dysmorphic-cytomegalic pyramidal neurons, interneurons, and giant/balloon cells, including intermediate neuronal-glial cells. In the cortical mantle, giant/balloon cells occurred more frequently in TSC than in CDIIB cases, whereas cytomegalic pyramidal neurons were found more frequently in CDIIB. Cell morphology and membrane properties were similar in TSC and CDIIB cases. Except for giant/balloon and intermediate cells, all neuronal cell types fired action potentials and displayed spontaneous postsynaptic currents. However, the frequency of spontaneous glutamatergic postsynaptic currents in normal pyramidal neurons and interneurons was significantly lower in CDIIB compared with TSC cases and the GABAergic activity was higher in all neuronal cell types in CDIIB. Further, acutely dissociated pyramidal neurons displayed higher sensitivity to exogenous application of GABA in CDIIB compared with TSC cases. These results indicate that, in spite of similar histopathologic features and basic cell membrane properties, TSC and CDIIB display differences in the topography of abnormal cells, excitatory and inhibitory synaptic network properties, and GABA(A) receptor sensitivity. These differences support the notion that the mechanisms of epileptogenesis could differ in patients with TSC and CDIIB. Consequently, pharmacologic therapies should take these findings into consideration.

Variations in the course of the cervical vagus nerve on thyroid ultrasonography

BACKGROUND AND PURPOSE

Only 1 ultrasonography study that described the variation of the VN had been published at the time our research was begun. The purpose of this study was to evaluate the incidence and type of variation in the course of the cervical VN on thyroid ultrasonography.

MATERIALS AND METHODS

From August 2009 to September 2010, 163 consecutive patients were evaluated by sonography for the screening and characterization of thyroid nodules (mean age, 49.0 ± 14.4 years, male:female, 20:143). Two types of variation were defined as follows: 1) anterior variation, when the course of the VNs changed from the typical location to an anterior location in front of the CCA; and 2) medial variation, when the course of the VNs changed from the typical location to a location medial to the CCA (between CCA and thyroid gland). The incidence of the each variation was studied.

RESULTS

Variation in the course of the VN occurred in 5.5% (18/326) of cases. The anterior variation was observed in 4.3% (14/326, right:left = 4:10), and the medial variation was observed in 1.2% (4/326, right:left = 3:1). For both variations, the VN was close to or nearly abutted the thyroid gland after it changed course.

CONCLUSIONS

Variation in the course of the cervical VN could be assessed by ultrasonography. Two variations were observed in 5.5% of cases. The anterior variation was more common than the medial variation.

EZH2 silencing by RNA interference inhibits proliferation in bladder cancer cell lines

The Enhancer of Zeste homologue2 gene (EZH2) is frequently expressed at high levels in malignant tumours, including bladder cancer. It functions as a transcriptional regulator to the maintenance of cell identity, cell cycle regulation and oncogenesis. In the study, we detected EZH2 expression in bladder cancer tissues. These results showed EZH2 high expression in bladder cancer tissue at level of transcript and protein compared with normal bladder tissue and EZH2 expression correlated positively with tumour stage and grade. Then, we used RNA interference to inhibit EZH2 expression in bladder cancer EJ cell line. Efficient downregulation of EZH2 resulted in significantly decreased cell proliferation in EJ cells and retarded transition of G(1) phase to S phase. Our data suggest that EZH2 is involved in the tumourigenesis of bladder cancer and EZH2 downregulation contributes to inhibiting malignant growth by retarding cell entrance to S phase.

Comparison of the molecular adsorbent recirculating system and plasmapheresis for patients with graft dysfunction after liver transplantation

BACKGROUND

Graft dysfunction after liver transplantation (OLT) is a life- threatening condition. Molecular adsorbent recirculating system (MARS) or plasmapheresis (PLP) may be effective supportive therapy of graft dysfunction for patients who cannot undergo retransplantation. The aim of this study was to compare the effects of MARS and PLP in patients with graft dysfunction after OLT.

METHODS

Between January 2002 and July 2007, 31 OLT recipients who experienced graft dysfunction, defined as hyperbilirubinemia (>10 mg/dL) without bile duct obstruction and/or presence of hepatic encephalopathy, were treated with MARS or PLP. Biochemical and hemodynamic data and survival were compared in MARS and PLP groups.

RESULTS

Fifteen patients were treated with 41 MARS sessions and 16 with 105 PLP sessions. After a single MARS session, patients showed significant reductions in creatinine, urea nitrogen, bilirubin, and ammonia. After a single PLP session, patients showed significant improvements in prothrombin time, bilirubin, alanine aminotransferase, alkaline phosphatase, and albumin. After the completion of treatment, Both MARS and PLP significantly improved bilirubin values. at 90 days there were no differences in overall survival rates; 53% in MARS versus 56% in PLP.

CONCLUSION

Both MARS and PLP are alternative supportive treatments for graft dysfunction after OLT.

Electro-optic guided-to-radiation mode conversion in annealed proton-exchanged PPLN waveguides

We report the design and experimental demonstration of electro-optically active TM-guided to TE-radiation mode converters in annealed proton-exchanged (APE) periodically poled lithium niobate (PPLN) channel waveguides in telecom S-C-L bands (1495-1640 nm). A maximum mode conversion efficiency of >95%/cm was obtained at 1520 nm from a 24-μm-period APE PPLN waveguide under an electro-optic (EO) field of ~6.3 V/μm at 35°C. This efficiency has been enhanced by a factor of >4.6 over a waveguide built in the single-domain (unpoled) LiNbO3; it is also to the best of our knowledge the most efficient guided-to-radiation (GTR) mode converter ever reported based on LiNbO3 on-axis waveguides. A conversion bandwidth of ~250 nm was also observed from this EO GTR mode converter.

Interrelationship between exposure to PCDD/Fs and hypertension in metabolic syndrome in Taiwanese living near a highly contaminated area

Metabolic syndrome (MetS) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease. There is a positive correlation between exposure to persistent organic pollutants and MetS. We examine the association between PCDD/Fs and MetS components in 1490 non-diabetic persons living near a highly dioxin-contaminated area. We used factor analysis, with a set of core variables considered central features of MetS and PCDD/Fs, to group similar risk factors. Serum PCDD/Fs were positively and significantly correlated with the number of MetS components. Four risk factors-lipidemia, blood pressure, body size, and glycemia-accounted for 72.6% of the variance in the 10 core factors, and PCDD/Fs were linked to MetS through shared correlations with high blood pressure. After adjusting for confounding factors, we found that diastolic blood pressure (β=0.018; p=0.006), glucose (β=0.013; p=0.046), and waist circumference (β=0.721; p=0.042) significantly increased with increasing serum PCDD/F levels. We found significant trends for associations between metabolic syndrome and serum low-chlorinated PCDD/Fs. The highest quintiles of 2,3,4,7,8-PeCDF, 1,2,3,6,7,8-HxCDF and 2,3,7,8-TCDD had the top three adjusted ORs (95% CI) of 3.5 (1.9-6.3), 2.9 (1.7-4.9) and 2.8 (1.6-4.9), respectively. We also found a slight monotonic relationship between serum PCDD/Fs and the prevalence of MetS, especially when the serum dioxin level was higher than 25.4pg WHO(98)-TEQ(DF)g(-1) lipid (the fourth Quintile). We hypothesize that high-dose exposure to PCDD/Fs is a blood pressure-related factor that raises MetS risk.

Pulsed orange generation optimized in a diode-pumped Nd:YVO4 laser using monolithic dual PPLN electro-optic Q switches

We report a pulsed intracavity sum-frequency generator in a diode-pumped, dual-wavelength Nd:YVO(4) laser whose operation was optimized with two electro-optic Q switches built in a monolithic periodically poled lithium niobate (PPLN) crystal. The dual PPLN Q switches, though integrated, are able to work separately at their respective working wavelengths of 1064 and 1342 nm. At 4.8 W diode pump power and 5 kHz Q-switching rate, a maximum orange (593 nm) output peak power of >480 W was achieved in this laser system using the Q-switch opening-time offset technique. This power is approximately 1.7 times higher than that obtained with the system operated in a conventional single-Q-switch mode.

Effect of citral, eugenol, nerolidol and alpha-terpineol on the ultrastructural changes of Trichophyton mentagrophytes

The antifungal effects of citral, eugenol, nerolidol and alpha-terpineol on Trichophyton mentagrophytes were investigated. Citral over 0.1 mg/ml strongly inhibited the hyphal growth of T. mentagrophytes, and the antifungal activity of alpha-terpineol was less effective. The morphological changes of the fungus exposed to the terpenes were observed by electron microscopy. The hyphae were distorted and collapsed at 0.2, 0.4 and 1 mg/ml of eugenol, nerolidol and alpha-terpineol respectively, and cell membrane and organelles were irreversibly damaged at 0.2 mg/ml citral. These suggested that four terpenes possess antifungal activity against T. mentagrophytes, and the activity might lead to irreversible cellular disruption.

Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia

Gamma knife radiosurgery (GKS) has been generally considered as a viable therapeutic option for the management of medically refractory idiopathic trigeminal neuralgia (TN). We reviewed our experience with GKS in patients with TN. Between Feb 1996 and May 2006, 77 patients with medical refractory idiopathic TN were treated using GKS. Thirty-six patients who had undergone other previous procedures, previous GKS, or had brain stem lesion, atypical symptoms, were excluded from this study. Pain improvement was achieved in 38 of the patients with TN (pain response rate 92.7%). Twenty-three patients were pain free and 15 had reduced pain. There were no serious complications. We think that GKS is an effective treatment option for patients with medical refractory idiopathic TN.

Current status and issues in cancer stem cell study

Cancer stem cells (CSCs) have been positively identified and successfully isolated from some but not all cancers. The studies on CSCs to date suggest that these cells are rare among the tumor cell population, and they are capable of self-renewing and maintaining tumor growth and heterogeneity. Therapies aimed at CSCs have shown some promise, but their further development will require a more thorough understanding of the biology of CSCs and methods for identifying and isolating this cell subpopulation. This review examines what is known to date regarding the similarities and differences between cancer and somatic stem cells: CSC surface marker development and cell isolation (including a model isolation from our lab), the frequency, potential origin, and signal transduction of CSCs, and the current state of CSC-targeting therapeutic strategies.

Bladder cancer initiating cells (BCICs) are among EMA-CD44v6+ subset: novel methods for isolating undetermined cancer stem (initiating) cells

Bladder cancer stem (initiating) cell has not been isolated now, and no one verified its persistence experimentally. The aim of this study was to conclude the persistence of bladder cancer stem (initiating) cell in human primary bladder cancer and investigate the possibility of EMA(-) CD44v6(+) as markers of bladder cancer stem (initiating) cell. Genes differentially expressed between normal urothelium and low malignant bladder cancer were identified by DNA array assay. Overpressed stem cell related genes, Bmi-1 and EZH2, were verified by immunohistochemistry. Side population cells in bladder cancer were found under fluorescence microscope. The value of 28 potential surface markers of bladder cancer stem (initiating) cell for isolating them were judged by immunohistochemistry. Both EMA(-) and CD44v6(+) cells located in basal layer (potential location of stem cells). After gathering the CD44v6(+) cells and EMA(-) cells by magnetic cell sorting, their ability for colony-forming, self-renewal and extensive proliferation were assayed by cells culture. Both EMA(-) cells and CD44v6(+) cells posses the ability for colony-forming, self-renewal and proliferation. We conclude the persistence of bladder cancer stem (initiating) cell. Bladder cancer stem (initiating) cell might be among EMA(-) CD44v6(+) subset. Our strategies for isolating bladder cancer stem (initiating) cell might be useful for isolating other undetermined epithelial cancer stem cell, especially those in well-differentiated cancers.

AAV-GAD gene for rat models of neuropathic pain and Parkinson's disease

The introduction of therapeutic genes to neurons by genetic modification has potential as an effective treatment for CNS disorders for all that a successful clinical application has not yet been fully implemented. In this paper, we will discussed the role of AAV vectors with the GAD65 gene for animal models of PD and neuropathic pain. AAV vector is one of the most attractive gene delivery vehicles for direct introduction of therapeutic genes into the CNS in the treatment of neurological diseases. GAD65 is present as a membrane-associated form in synapses and is primarily involved in producing synaptic gamma-aminobutyric acid (GABA) for vesicular release. We constructed rAAV-GAD65 expressing rat GAD65 and demonstrated that rat Parkinsonian symptoms can be significantly improved concomitantly with the production of GAD65. We also demonstrated rAAV-GAD65 as a successful gene delivery vehicle in a chronic pain model by administrating rAAV-GAD65 to DRGs because GABA driven by GAD is a major inhibitory neurotransmitter in the dorsal horn of the spinal cord and also plays an important role in the ventral horn. We believe that AAV vectors can be excellent candidates for gene therapy of neurological diseases.

Dopamine transporter density in the basal ganglia in obsessive-compulsive disorder, measured with [123I]IPT SPECT before and after treatment with serotonin reuptake inhibitors

It has been suggested that dopamine as well as serotonin are associated with the pathophysiology of obsessive-compulsive disorder (OCD). 5-Hydroxytryptophan inhibits dopamine release in healthy persons as well as in patients with OCD, and serotonin tonic inhibition affects dopamine function in basal ganglia, indicating a close relationship between serotonin and the dopamine system. Using iodine-123-labeled N-(3-iodopropen-2-yl)-2 beta-carbomethoxy-3beta-(4-chlorophenyl) tropane ([(123)I]IPT) single photon emission computed tomography (SPECT), we investigated the dopamine transporter (DAT) density in the basal ganglia of patients with OCD. The test consists of two measurements before and after treatment with serotonin reuptake inhibitors (SRIs). Ten patients with OCD before and after treatment with SRIs were included. We performed brain SPECT 2 h after intravenous administration of [(123)I]IPT using a dual-head SPECT camera (Vertex, ADAC, Calif., USA) and analyzed the SPECT data, reconstructed for the assessment of the specific/nonspecific DAT binding ratio in the basal ganglia. We then examined the correlation between the scores of OCD symptom changes, assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and DAT binding ratio. Patients with OCD after treatment with SRIs showed a significantly decreased DAT binding ratio in the right basal ganglia compared with baseline. A significant correlation was found between the total scores and compulsion score changes of the Y-BOCS and the changes of the DAT binding ratio of the right basal ganglia. These findings suggest that the dopaminergic neurotransmitter system of the basal ganglia could play an important role in the symptom improvement of OCD patients.

Infantile spasm-associated microencephaly in tuberous sclerosis complex and cortical dysplasia

OBJECTIVE

In children with and without infantile spasms, this study determined brain volumes and cell densities in epilepsy surgery patients with tuberous sclerosis complex (TSC) and cortical dysplasia with balloon cells (CD).

METHODS

We compared TSC (n = 18) and CD (n = 17) patients with normal/autopsy controls (n = 20) for MRI gray and white matter volumes and neuronal nuclei (NeuN) cell densities.

RESULTS

In patients without a history of infantile spasms, TSC cases showed decreased gray and white matter volumes (-16%). In cases with a history of infantile spasms, both CD (-25%) and TSC (-35%) patients showed microencephaly. This was confirmed in monozygotic twins with TSC, where the twin with a history of spasms had cerebral volumes less (-16%) than the twin without a history of seizures. Regardless of seizure history, TSC patients showed decreased NeuN cell densities in lower gray matter (-36%), whereas CD patients had increased densities in upper cortical (+52%) and white matter regions (+65%). For TSC patients, decreased lower gray matter NeuN densities correlated with reduced MRI volumes.

CONCLUSIONS

Patients with tuberous sclerosis without spasms showed microencephaly associated with decreased cortical neuronal densities. In contrast, cortical dysplasia patients without spasms were normocephalic with increased cell densities. This supports the concept that tuberous sclerosis and cortical dysplasia have different pathogenetic mechanisms despite similarities in refractory epilepsy and postnatal histopathology. Furthermore, a history of infantile spasms was associated with reduced cerebral volumes in both cortical dysplasia and tuberous sclerosis patients, suggesting that spasms or their treatment may contribute to microencephaly independent of etiology.

Enhanced expression of glutamate decarboxylase 65 improves symptoms of rat parkinsonian models

In this study, we report the amelioration of parkinsonian symptoms in rat Parkinson's disease (PD) models, as a result of the expression of glutamate decarboxylase (GAD) 65 with a modified cytomegalovirus (CMV) promoter. The transfer of the gene for gamma-amino butryic acid (GAD), the rate-limiting enzyme in gama-amino butrylic acid (GABA) production, has been investigated as a means to increase inhibitory synaptic activity. Electrophysiological evidence suggests that the transfer of the GAD65 gene to the subthalamic nucleus (STN) can change the excitatory output of this nucleus to inhibitory output. Our in vitro results also demonstrated higher GAD65 expression in cells transfected with the JDK promoter, as compared to cells transfected with the CMV promoter. Also, a rat PD model in which recombinant adeno-associated virus-2 (rAAV2)-JDK-GAD65 was delivered into the STN exhibited significant behavioral improvements, as compared to the saline-injected group. Interestingly, we observed that these behavioral improvements were more obvious in rat PD models in which rAAV2-JDK-GAD65 was injected into the STN than in rat PD models in which rAAV2-CMV-GAD65 was injected into the STN. Moreover, according to electrophysiological data, the rAAV2-JDK-GAD65-injected group exhibited more constant improvements in firing rates than did the rAAV2-CMV-GAD65-injected group. These data indicate that the JDK promoter, when coupled with GAD65 expression, is more effective with regard to parkinsonian symptoms than is the CMV promoter.

Differential gene expression profiling in aggressive bladder transitional cell carcinoma compared to the adjacent microscopically normal urothelium by microdissection-SMART cDNA PCR-SSH

Identifying novel and known genes that are differentially expressed in aggressive bladder transitional cell carcinoma (BTCC) has important implications in understanding the biology of bladder tumorigenesis and developing new diagnostic and therapeutic agents. In this study we identified the differential gene expression profiles comparing tumor to the adjacent microscopically normal mucosa by manual microdissection on frozen sections. The RNAs extracted from microdissected tissues were amplified by SMART cDNA PCR technology to generate forward subtractive cDNA library by suppressive subtractive hybridization (SSH). We obtained 376 positive clones, one hundred clones of aggressive BTCC subtracted cDNA library were selected at random and inserts were reamplified by PCR. After differential screening by reverse dot blotting, 73 positive clones, that contend inserts putatively upregulated in aggressive BTCC, were further analysed by DNA sequencing, GenBank and EST database searching. Sequencing results showed that 66 clones stand for 23 known genes and 7 clones for three new EST (Genbank number: DN236875, DN236874 and DN236873). In conclusion, microdissection-SMART cDNA PCR-SSH allowed for an efficient way to identify aggressive BTCC-specific differential expressed genes that may potentially be involved in the carcinogenesis and/or progression of aggressive BTCC. These differentially expressed genes may be of potential utility as therapeutic and diagnostic targets for aggressive BTCC.

Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique: A prospective, randomized clinical trial

As a result of the high rate of infection, the NKF-K/DOQI guidelines recommended that an uncuffed catheter (UC) should not be used for longer than three weeks. However, the findings of the Dialysis Outcomes and Practice Patterns Study recognized that 48% of new hemodialysis patients in the US and 75% in Europe used UC for temporary access during arteriovenous fistula or graft maturation. The antibiotic lock technique (ALT) has been recommended to prevent catheter-related bacteremia (CRB). Here, we prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 120 new hemodialysis patients requiring a temporary catheter while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a UC were randomly assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1000 U/ml) as a catheter lock solution during the interdialytic period. The end point of the trial was CRB. CRB developed in seven (11.7%) patients in the no-antibiotic group (Staphylococcus aureus, two; Staphylococcus epidermidis, five) whereas only one patient in the antibiotic group had S. aureus bacteremia. CRB rates per 1000 catheter-days were 0.44 in the antibiotic group versus 3.12 in the no-antibiotic group (P=0.031). Kaplan-Meier analysis also showed that mean CRB-free catheter survival of 59 days (95% CI, 58-61 days) in the antibiotic group was greater than that in the no-antibiotic group (55 days; 95% CI, 50-59 days). The results suggest that ALT may be a beneficial means of reducing the CRB rate in hemodialysis patients with UC.

The behavioral effect of human mesenchymal stem cell transplantation in cold brain injured rats

We investigated the effect of stereotaxically transplanted human mesenchymal stem cells (hMSCs) on behavioral change after traumatic cold brain injury in adult rats. Cortical lesions (n= 20) were induced by touching a metal stamp, cooled with liquid nitrogen, to the dura over the forelimb motor cortex of adult rats. The procedure produced a localized lesion, and the animals showed significant motor deficits. hMSCs were freshly isolated from human iliac bone and cultured in tissue culture flasks with 10 ml Dulbecco's modified Eagle's medium. The animals received hMSC grafts (3 x 10(5) hMSCs) 6 days after cold lesion (n = 10). All rats were sacrificed 3 or 7 weeks after cold injury, and immunohistochemical staining was performed on brain sections to identify donor hMSCs. Neurological evaluations were performed with the forepaw adjusting step test and modified neurological scoring. Treatment with 3 x 10(5) hMSCs improved the rat's neurological functions. We also found that the transplanted cells successfully migrated into the injured brain, preferentially localized around the injury site, and expressed the neuronal and astrocyte marker. These data suggest that hMSCs may be a potential therapeutic tool for brain injuries.

Electrical stimulation of the anterior cingulate cortex in a rat neuropathic pain model

BACKGROUND

Electrical stimulation is currently employed to treat several neurological conditions, including pain and Parkinson's disease. It is one of several minimally invasive alternatives to drug treatments for painful conditions. A number of studies have shown that the anterior cingulate cortex (ACC) plays an important role in the processing of pain and pain modulation. The purpose of this study is to investigate these neuropathic pain-relieving effects by delivering electrical stimulation into the ACC of rat models.

METHODS

Following the approval of the AAALAC and the Guidelines and Regulations for Use and Care of Animals in Yonsei University, rats were subjected to surgery under pentobarbital anesthesia (50 mg/kg, i.p.) to produce neuropathic pain. Electrodes were bilaterally implanted into the ACC with a metal holder for the electrical stimulation. The effect of the electrical stimulation of the ACC on the rat neuropathic pain model was measured by the von Frey test.

FINDINGS

The effect of electrical stimulation of the ACC on neuropathic pain was shown during stimulation at 30, 40, 50, and 60 min, and at 10 min after stimulation. In the pain ACC stimulation group, the response of mechanical allodynia was significantly reduced during the time of ACC electrical stimulation.

CONCLUSION

The mechanical allodynia of the neuropathic pain could be modulated by ACC electrical stimulation.

Contralateral hemimicrencephaly and clinical-pathological correlations in children with hemimegalencephaly

In paediatric epilepsy surgery patients with hemimegalencephaly (HME; n = 23), this study compared clinical, neuroimaging and pathologic features to discern potential mechanisms for suboptimal post-hemispherectomy developmental outcomes and structural pathogenesis. MRI measured affected and non-affected cerebral hemisphere volumes for HME and non-HME cases, including monozygotic twins where one sibling had HME. Staining against neuronal nuclei (NeuN) determined grey and white matter cell densities and sizes in HME and autopsy cases, including the non-affected side of a HME surgical/autopsy case. By MRI, the affected hemisphere was larger and the non-affected side smaller in HME compared with non-HME children. The affected HME side showed enlarged abnormal deep grey and white matter structures and/or T2-weighted hypointensity in the subcortical white matter in 75% of cases, suggestive of excessive pre-natal neurogenesis and heterotopias. Histopathological examination of the affected HME side revealed immature-appearing neurons in 70%, polymicrogyria (PMG) in 61% and balloon cells in 45% of cases. Compared with autopsy cases, in HME children NeuN cell densities on the affected side were increased in the molecular layer and upper cortex (+244 to +18%), decreased in lower cortical layers (-35%) and increased in the white matter (+139 to +149%). Deep grey matter MRI abnormalities and/or T2-weighted white matter hypointensity correlated with the presence of immature-appearing neurons and PMG on histopathology, decreased NeuN cell densities in lower cortical layers and a positive history of infantile spasms. Post-surgery seizure control was associated with decreased NeuN densities in the molecular layer. In young children with HME and epilepsy, these findings indicate that there are bilateral cerebral hemispheric abnormalities and contralateral hemimicrencephaly is a likely explanation for poorer post-surgery seizure control and cognitive outcomes. In addition, our findings support the hypothesis that HME pathogenesis probably involves somatic mutations that affect each developing cerebral hemisphere differently with more neurons than expected on the HME side.

Molecular pathology of low malignant bladder transitional cell carcinoma: a current perspective

Bladder transitional cell carcinoma (BTCC) actually has two phenotypes: low malignant and aggressive. Most previous molecular and cytogenetic analyses of bladder cancer were focused on aggressive BTCC. Little is known about the events that lead to the development of low malignant BTCC. This review mainly introduces the concept of two types of bladder tumors and then focuses on the molecular pathology of low malignant BTCC in particular. It is hoped that further understanding of the molecular pathology of low malignant BTCC may provide novel therapies and many other clinical benefits in patients with this disease.

Cysticercosis of cerebellopontine cistern: differential diagnosis using MRI

We report an example of subarachnoid neurocysticercosis located in the left cerebellopontine cistern of a 60 year-old man. The negative results of the serum and cerebrospinal fluid tests for parasites and the unusual MRI findings, such as the uncommon shape, location and extension pattern, made differential diagnosis difficult. Neurocysticercosis was confirmed by surgical and histopathological findings. The clinical and radiographic features of neurocysticercosis are highly variable. In an endemic area, neurocysticercosis should be considered in the differential diagnosis.

Effect of subthalamic lesion with kainic acid on the neuronal activities of the basal ganglia of rat parkinsonian models with 6-hydroxydopamine

The aim of the present study was to investigate the alteration of neuronal activities in the substantia nigra pars reticulata (SNpr) and globus pallidus (GP), after ipsilateral STN lesioning by kainic acid in the rat hemi-parkinsonian 6-hydroxydopamine (6-OHDA) model. In various rat Parkinson's disease (PD) models, an increase in the SNpr firing rate was observed, despite the occurrence of bursting patterns, and subthalamic lesion was found to reduce the mean firing rates and the percentage of bursting neurons in the SNpr. However, the relative proportion of bursting neurons, among all GP neurons, was slightly increased as a result of the subthalamic lesion. The significance of bursting activity in the SNpr and GP remains obscure. Further study is necessary to elucidate the pathophysiological mechanism behind Parkinson's disease.

Simple bone cyst occurring in calvarium

A 60 year-old female presented with a non-specific headache that she had experienced for 4 years. A simple skull X-ray indicated a well-defined, lobulated and radiolucent lesion with a thin sclerotic rim involving the parietal bone (Fig. 1A). Computed tomography revealed a hypodense lesion. Magnetic resonance imaging showed a 2 cm-sized cystic lesion in the diploic space with both tabular involvement. This lesion was not enhanced by contrast agent. It was well defined and the periosteum was intact. The cyst paralleled the CSF in signal intensity on all pulse sequences. No fluid levels were detected (Fig. 1B, C, D). After the scalp was incised, a semi-translucent and light yellow- to white-coloured bony lesion was easily identified. The outer bony cortex of this lesion was slightly elevated, and the consistency was same as that of the normal skull. A craniectomy was performed and the cystic skull lesion was removed. The inner surface of this cystic lesion was intact but appeared irregular. The cystic cavity was empty and the dura did not appear to be involved. Histologically, it was a simple cystic cavity without lining epithelium, and the surrounding bony structures were normal (Fig. 1E, F). It was diagnosed as a simple bone cyst (SBC). The postoperative course was uneventful.