Preheating Thermoplastic Membrane Reduce Setup Error in Patients with Thoracic Cancer Undergoing Radiation Therapy: A Prospective Randomized Controlled Study

PURPOSE/OBJECTIVE(S)

Thermoplasticfilm routinely placed in the treatment room always led to uncomfortable feeling in patients receiving thorax radiation therapy because of significant temperature difference between thermoplastic film and body surface. Therefore, it may result in setup error and further affect accuracy of radiation therapy. Here, we designed a randomized controlled study to investigate the efficacy of preheat thermoplastic film to reduce setup error in patients receiving thorax radiotherapy.

MATERIALS/METHODS

Patients with thoracic cancer receiving radiotherapy once daily with five fraction per week were enrolled in this study from October 2022 to January 2023. All participants were randomly assigned into room-temperature group and preheating group in a 1:1 ratio. For the preheating group, the thermoplastic film was preheated for 10 minutes in a 37°C thermostat before it was used for patients' setup. For controlled group, the thermoplastic film with room-temperature was used for patients' setup. The cone beam computed tomography (CBCT) was used to evaluate setup errors once a week. The setup errors in translational directions X, Y and Z were recorded based on CBCT image. to measure the left-right as well as anterior-posterior diameter of the thorax in cross-section to observe whether there was any difference in thorax size from that at positioning. A modified Likert questionnaire was conducted to investigate the setup comfort level between two groups before radiotherapy and Day 5 of radiotherapy.

RESULTS

A total of 34 patients were enrolled in this study. Patient characteristics were well balanced in both arms. The setup errors in the X, Y, and Z axes in group A were 1(-1,1) mm, 0(-1,2.75) mm and 0(-1,1) mm, respectively, while those in group B were 0(-2,2) mm, 1(-1.25,3) mm, and -1(-2,1) mm in the X, Y, and Z axes, respectively. Setup error in preheating group was smaller than room-temperature group in the X-axis direction (Z = 2.04, P = 0.042), but no significant differences were detected in Y and Z axes. Comparison of changes in anteroposterior thoracic diameter between the two groups. The preheated group was smaller than the normothermic group (-0.19 ± 0.48 vs -0.38 ± 0.36, P < 0.01). The total comfort scale scores of the two groups were 30.88 ± 3.39 vs 30.59 ± 3.34 (p = 0.42) before treatment and 32.125 ± 4.31 vs 31.06 ± 3.15 (p = 0.80) after treatment. Among the eight sub-items, only the fourth dimension of temperature was statistically different (pre 3.12 ± 0.48 vs 2.88 ± 0.60, P = 0.218; post 4.12 ± 0.78 vs 2.94 ± 0.43, P < 0.01).

CONCLUSION

Ourcenter proposed the first method of heating the mold for postural fixation during patient radiotherapy. Compared with room-temperature thermoplastic film, our study found preheating thermoplastic film with 37°C could significantly reduce setup error in the X direction with less effect on the anterior-posterior diameter change of the thorax and higher patient temperature comfort satisfaction.

Ce-Substituted Spinel CuCo2O4 Quantum Dots with High Oxygen Vacancies and Greatly Improved Electrocatalytic Activity for Oxygen Evolution Reaction

Exploring effective electrocatalysts for oxygen evolution reaction (OER) is a crucial requirement of many energy storage and transformation systems, involving fuel cells, water electrolysis, and metal-air batteries. Transition-metal oxides (TMOs) have attracted much attention to OER catalysts because of their earth abundance, tunable electronic properties, and so forth. Defect engineering is a general and the most important strategy to tune the electronic structure and control size, and thus improve their intrinsic activities. Herein, OER performance on spinel CuCo₂O₄ was greatly enhanced through cation substitution and size reduction. Ce-substituted spinel CuCe_δCo_2-δO_x (δ = 0.45, 0.5 and 0.55) nanoparticles in the quantum dot scale (2-8 nm) were synthesized using a simple and facile phase-transfer coprecipitation strategy. The as-prepared samples were highly dispersed and have displayed a low overpotential of 294 mV at 10 mA·cm^-2 and a Tafel slope of 57.5 mV·dec^-1, which outperform commercial RuO₂ and the most high-performance analogous catalysts reported. The experimental and calculated results all confirm that Ce substitution with an appropriate content can produce rich oxygen vacancies, tune intermediate absorption, consequently lower the energy barrier of the determining step, and greatly enhance the OER activity of the catalysts. This work not only provides advanced OER catalysts but also opens a general avenue to understand the structure-activity relationship of pristine TMO catalysts deeply in the quantum dot scale and the rational design of more efficient OER catalysts.

The causal role of gut microbiota in development of osteoarthritis

OBJECTIVE

There is considerable evidence for relationship between gut microbiota and osteoarthritis (OA), but no studies have investigated their causal relationship.

METHOD

This study utilized large-scale genome-wide association studies (GWAS) summary statistics to evaluate the causal association between gut microbiota and OA risk. Specifically, two-sample Mendelian randomization (MR) approach was used to identify the causal microbial taxa for OA. Comprehensively sensitive analyses were performed to validate the robustness of results and novel multivariable MR analyses were further conducted to ensure the independence of causal association. Reverse-direction MR analyses were performed to rule out the possibility of reverse associations. Finally, enrichment analyses were used to investigate the biofunction.

RESULTS

After correction, three microbial taxa were identified to be causally associated with diverse joint OA (P_FDR < 0.100), namely Methanobacteriaceae family for knee OA (P_FDR = 0.043) and any OA (P_FDR = 0.028), Desulfovibrionales order for knee OA (P_FDR = 0.045) and Ruminiclostridium5 genus for knee OA (P_FDR = 0.063). In addition, we also identified five suggestive microbial taxa that were significant with three different methods under the nominal significance (P < 0.05). Sensitive analysis excluded the influence of heterogeneity and horizontal pleiotropy and multivariable MR analysis ruled out the possibility of horizontal pleiotropy of BMI. GO enrichment analysis illustrates the protective mechanism of the identified taxa against OA.

CONCLUSIONS

This study found that several microbial taxa were causally associated with diverse joint OA. The results enhanced our understanding of gut microbiota in the pathology of OA.

Metabonomic analysis of toxic action of long-term low-level exposure to acrylamide in rat serum

This study assessed the effects of long-term, low-dose acrylamide (AA) administration in rats using ultra-performance liquid chromatography–mass spectrometry. Forty male Wistar rats were randomly divided into the following four groups: control, low-dose AA (0.2 mg/kg BW), middle-dose AA (1 mg/kg BW), and high-dose AA (5 mg/kg BW). AA was administered to rats via drinking water ad libitum. After 16-week treatment, rat serum was collected for metabonomic analysis. Biochemical tests were further conducted to verify metabolic alterations. Eleven metabolites were identified with significant changes in intensities (increased or reduced) as a result of treatment. These metabolites included citric acid, pantothenic acid, isobutyryl-l-carnitine, eicosapentaenoic acid, docosahexaenoic acid, sphingosine 1-phosphate, LysoPC(20:4), LysoPC(22:6), LysoPE(20:3), undecanedioic acid, and dodecanedioic acid. Results indicate that chronic exposure to AA at no observed adverse effect level does not exert a toxic effect on rats at the body metabolism level. AA disturbed the metabolism of lipids and energy, affected the nervous system of rats, and induced oxidative stress and liver dysfunction.

Research on the function and mechanism of survivin in heart failure mice model

OBJECTIVE

To observe the role of survivin in the heart failure mice model and to study its mechanism.

MATERIALS AND METHODS

20 male C57BL/ 6J mice were selected and randomly divided into two groups: normal group (n=10) and heart failure group (n=10). After continuous modeling, the cardiac functions of mice in the two groups were detected via ultrasonic cardiogram equipment. The pathological conditions of hearts in the two groups were detected via hematoxylin and eosin (HE) staining. The expressions of survivin in heart tissues in both groups were detected via immunofluorescence method. The mRNA expressions of tumor necrosis factor-α (TNF-α), factor associated suicide (Fas) and factor associated suicide ligand (FasL) were detected via reverse transcription polymerase chain reaction (RT-PCR). The expressions of survivin in heart tissues of two groups were detected via Western blotting.

RESULTS

Ultrasonic cardiogram showed that the myocardial motion amplitude of mice in heart failure group was significantly decreased compared with that in normal group. HE staining further revealed the pathological conditions in heart failure group. RT-PCR showed that the mRNA expressions of TNF-α, Fas and FasL in heart failure group were significantly higher than those in normal group. Immunofluorescence and Western blotting showed that the expression of survivin in heart failure group was significantly higher than that in normal group.

CONCLUSIONS

Survivin expression is closely related to the occurrence and development of heart failure, indicating that survivin has an important value in the research on heart failure and the mechanism is related to inflammation and apoptosis.

Highly selective oxidation of cyclohexene to 2-cyclohexene-1-one over polyoxometalate/metal–organic framework hybrids with greatly improved performances

H_3+xPMo_12−xV_xO₄₀@MIL-100 (Fe) (x = 0, 1, 2) hybrids were prepared by encapsulation of polyoxometalates (POMs) within the metal–organic framework using a direct hydrothermal method.

Dung and farm dairy effluent affect urine patch nitrous oxide emissions from a pasture

Urine patches in grazed pastures have been identified as important sources of nitrous oxide (N2O) emissions. An increase in N2O emissions is possible where urine patches coincide with dung patches and farm dairy effluent (FDE) applications. The aim of the present study was to quantify the effects of dung additions and fresh FDE applications on N2O emissions from urine patches. A field experiment was conducted on a pasture site at the AgResearch’s Ruakura dairy farm in Hamilton, New Zealand. A closed soil chamber technique was used to measure the N2O emissions from a free-draining volcanic soil that received urine (492 kg N/ha, simulated urine patches), with or without dung (1146 kg N/ha) and fresh FDE (100 kg N/ha) and to compare these with controls receiving no urine. The addition of dung delayed the peak N2O fluxes from the urine patches by ~30 days. This could be due to temporary nitrogen (N) immobilisation during decomposition of carbon from the dung. However, over the whole measurement period (271 days), dung addition increased the N2O emission factor (EF, % of applied N emitted as N2O) for the urine from 1.02% to 2.09%. The application of fresh FDE increased the EF to 1.40%. The effluent- or dung-induced increases in N2O emissions from the urine patches were possibly caused both by the direct input of N from effluent or dung and through the indirect priming effect of addition of dung or effluent on the availability of N from urine patches for N2O production. We conclude that when EFs are used in calculations of N2O emissions from urine, consideration should be given to the likelihood of coincidence with dung or FDE applications.

Muscarinic-mediated vasoconstriction in human, rat and sheep umbilical cords and related vasoconstriction mechanisms

OBJECTIVE

The umbilical cord provides nutrition and oxygen to the fetus. The aim of this study was to determine the effects of acetylcholine (ACh) on umbilical cords from humans and other mammals, and the mechanisms of ACh-mediated vasoconstriction in the human umbilical cord.

DESIGN

Human and animal umbilical cords used in vascular and cellular experiments.

SETTING

Institute for Fetology, First Hospital of Soochow University, Suzhou, China.

POPULATION

A total of 85 pregnant women, 16 Sprague Dawley rats and seven pregnant sheep.

METHODS

Umbilical cord veins and arteries from humans, rats and sheep, aortas and mesenteric arteries from rats, and mesenteric, carotid and femoral arteries from ovine fetuses were used to compare vascular functions in response to ACh and to determine the mechanisms of ACh-mediated umbilical vasoconstriction. Vascular tension and ion channel currents were measured on isolated vessels and smooth muscle cells from human umbilical cords.

MAIN OUTCOME MEASURES

Provision of new evidence to conclude that ACh-stimulated vasoconstriction is common to all umbilical cords, and cellular mechanisms are linked to potassium channels.

RESULTS

ACh caused reliable vasoconstriction in umbilical veins/arteries in humans, rats and sheep, but not in any other vessels, including fetal vessels. Atropine inhibited the effects of ACh. The mRNA of ACh-muscarinic receptor subtypes M1 -M5 was expressed in human umbilical vessels. The protein kinase C antagonist GF109203X and the calcium inhibitor nifedipine decreased ACh-induced vasoconstriction in human umbilical vessels. ACh also caused a reduction in whole-cell potassium channel currents and the single-channel current of large-conductance calcium-activated potassium (BKca) channels.

CONCLUSION

Umbilical vessels are significantly different from other vessels in their response to ACh. BKca channels in smooth muscle cells may play important roles in ACh-mediated vasoconstriction in human umbilical cords. This information may be important for fetal medicine and practice with regard to the effect on fetal development of umbilical vascular functions.

Therapeutic efficacies of different hemoperfusion frequencies in patients with organophosphate poisoning

OBJECTIVE

We tested therapeutic efficacies of different hemoperfusion frequencies in patients with acute severe organophosphate poisoning (ASOP).

PATIENTS AND METHODS

36 patients with ASOP were enrolled in this study and divided into two groups. Patients in the repeated hemoperfusion group (n=20) received 3-4 hemoperfusions within 48 hours after poisoning, while other patients (n=16) received 1 hemoperfusion. The therapeutic efficacies were compared using the following outcomes: dosage of atropine, time to awake from coma, time for normalization of cholinesterase levels, appearance of intermediate myasthenia syndrome, and survival rates.

RESULTS

Compared with patients who receive one hemoperfusion, patients with repeated hemoperfusion had a significantly less atropine use, shorter time of awakening from coma, higher cure rates, shorter time until normalization of cholinesterase levels, lower appearance of intermediate myasthenia syndrome, and higher survival rates.

CONCLUSIONS

Early repeated hemoperfusion is more efficient than single hemoperfusion in treating organophosphate poisoning.

Autophagic program is regulated by miR-325

Autophagy is required for the maintenance of cardiomyocytes homeostasis. However, the abnormal autophagy could lead to the development of heart failure. Autophagy is enhanced during myocardial ischemia/reperfusion; it remains to elucidate the molecular regulation of autophagy. We report here that miR-325, ARC and E2F1 constitute an axis that regulates autophagy. Our results showed that miR-325 expression is upregulated upon anoxia/reoxygenation and ischemia/reperfusion. Cardiomyocyte-specific overexpression of the miR-325 potentiates autophagic responses and myocardial infarct sizes, whereas knockdown of miR-325 inhibited autophagy and cell death. We searched for the downstream mediator of miR-325 and identified that ARC is a target of miR-325. ARC transgenic mice could attenuate autophagy and myocardial infarction sizes upon pressure-overload-induced heart failure, whereas ARC null mice exhibited an increased autophagic accumulation in the heart. The suppression of ARC by miR-325 led to its inability to repress autophagic program. In exploring the molecular mechanism by which miR-325 expression is regulated, our results revealed that the transcription factor E2F1 contributed to promote miR-325 expression. E2F1 null mice demonstrated reduced autophagy and myocardial infarction sizes upon ischemia/reperfusion. Our present study reveals a novel autophagic regulating model that is composed of E2F1, miR-325 and ARC. Modulation of their levels may provide a new approach for tackling cardiac failure.

Melatonin and hypothalamic-pituitary-gonadal axis

Melatonin (N-acetyl-5-methoxy-tryptamine), a principal product of the pineal gland, is produced mainly during the dark phase of the circadian cycle. This hormone plays a crucial role in the regulation of circadian and seasonal changes in various aspects of physiology and neuroendocrine functions. In mammals, melatonin can influence sexual maturation and reproductive functions via activation of its receptors and binding sites in the hypothalamic-pituitary-gonadal (HPG) axis. This review summarizes current knowledge of melatonin on the hypothalamus, pituitary gland, and gonads. We also review recent progress in clinical applications of melatonin or potentials of using melatonin, as a reducer of oxidative stress, to improve reproductive functions for the diseases such as women infertility.

Differentiation of bone marrow-derived mesenchymal stem cells into hepatocyte-like cells in an alginate scaffold

OBJECTIVES

Alginate scaffolds are the most frequently investigated biomaterials in tissue engineering. Tissue engineering techniques that generate liver tissue have become important for treatment of a number of liver diseases and recent studies indicate that bone marrow-derived stem cells (BMSCs) can differentiate into hepatocyte-like cells. The goal of the study described here, was to examine in vitro hepatic differentiation potential of BMSCs cultured in an alginate scaffold.

MATERIALS AND METHODS

To investigate the potential of BMSCs to differentiate into hepatocyte-like cells, we cultured BMSCs in alginate scaffolds in the presence of specific growth factors including hepatocyte growth factor, epidermal growth factor and fibroblast growth factor-4.

RESULTS

We can demonstrate that alginate scaffolds are compatible for growth of BMSCs and when cultured in alginate scaffolds for several days they display several liver-specific markers and functions. Specifically, they expressed genes encoding alpha-foetoprotein, albumin (ALB), connexin 32 and CYP7A1. In addition, these BMSCs produced both ALB and urea, expressed cytokeratin-18 (CK-18) and were capable of glycogen storage. Percentage of CK-18 positive cells, a marker of hepatocytes, was 56.7%.

CONCLUSIONS

Our three-dimensional alginate scaffolds were highly biocompatible with BMSCs. Furthermore, culturing induced their differentiation into hepatocyte-like cells. Therefore, BMSCs cultured in alginate scaffolds may be applicable for hepatic tissue engineering.

Estimation of standard liver volume in Chinese adult living donors

AIM

To determine a formula predicting the standard liver volume based on body surface area (BSA) or body weight in Chinese adults.

MATERIALS AND METHODS

A total of 115 consecutive right-lobe living donors not including the middle hepatic vein underwent right hemi-hepatectomy. No organs were used from prisoners, and no subjects were prisoners. Donor anthropometric data including age, gender, body weight, and body height were recorded prospectively. The weights and volumes of the right lobe liver grafts were measured at the back table. Liver weights and volumes were calculated from the right lobe graft weight and volume obtained at the back table, divided by the proportion of the right lobe on computed tomography. By simple linear regression analysis and stepwise multiple linear regression analysis, we correlated calculated liver volume and body height, body weight, or body surface area.

RESULTS

The subjects had a mean age of 35.97 +/- 9.6 years, and a female-to-male ratio of 60:55. The mean volume of the right lobe was 727.47 +/- 136.17 mL, occupying 55.59% +/- 6.70% of the whole liver by computed tomography. The volume of the right lobe was 581.73 +/- 96.137 mL, and the estimated liver volume was 1053.08 +/- 167.56 mL. Females of the same body weight showed a slightly lower liver weight. By simple linear regression analysis and stepwise multiple linear regression analysis, a formula was derived based on body weight. All formulae except the Hong Kong formula overestimated liver volume compared to this formula.

CONCLUSIONS

The formula of standard liver volume, SLV (mL) = 11.508 x body weight (kg) + 334.024, may be applied to estimate liver volumes in Chinese adults.

Genetic imbalance and human papillomavirus states in vulvar squamous cell carcinomas

PURPOSE OF INVESTIGATION

Vulvar squamous cell carcinoma (VSCC) is a disease of significant clinical importance, which arises in the presence or absence of human papillomavirus (HPV).

METHODS

We used comparative genomic hybridization (CGH) to document non-random chromosomal gains and losses with HPV positive and negative VSCCs.

RESULTS

Gains of 3q and 12q were significantly more common in HPV-positive cancers compared to HPV-negative cancers where chromosome 8q was more commonly gained in HPV-negative compared to HPV-positive cancer chromosomes and, 4p and 3p were lost in both categories of VSCCs.

CONCLUSIONS

The data indicate that one or more oncogenes important in the development and progression of HPV-induced carcinomas are located on 3q and 12q.

Decoloration of aqueous Brilliant Green by using glow discharge electrolysis

This paper described a plasma degradation of Brilliant Green (BG) by glow discharge electrolysis. Various influencing factors such as the voltage, the distance between cathode and anode were examined. Ultraviolet (UV) absorption spectra, gas chromatogram-mass spectrum (GC-MS), and chemical oxygen demand (COD) were used to monitor the degradation process and to identify the major oxidation intermediates. It was confirmed that benzoic acid, 1,2,3,4,5,6-cyclohexanehexaol, and carboxylic acids (e.g., oxalic acid, succinic acid and hydroxyacetic acid) were produced in the degradation process. The results showed that BG rapidly underwent degradation and eventually mineralized into CO(2) and H(2)O.

Incoherently coupled steady-state soliton pairs in biased photorefractive-photovoltaic materials

A theory on incoherently coupled soliton pairs for photorefractive screening solitons is developed that gives rise to incoherently coupled steady-state soliton pairs and multicomponent spatial solitons in biased photorefractive-photovoltaic materials, which result from both the bulk photovoltaic effect and the spatially nonuniform screening of the external bias field. When the bulk photovoltaic effect is neglectable, these soliton pairs are the previously studied soliton pairs for screening solitons, these multicomponent spatial solitons predict incoherently coupled multicomponent spatial solitons for screening solitons, and their space-charge field is the space-charge field of screening solitons. When the external field is absent, these soliton pairs and multicomponent spatial solitons predict incoherently coupled soliton pairs and multicomponent spatial solitons for photovoltaic solitons, and their space-charge field is the space-charge field of photovoltaic solitons. The stability of these soliton pairs and multicomponent spatial solitons is also discussed using the modulation instability theory.

A new complex variant t(4;15;17) in acute promyelocytic leukemia: fluorescence in situ hybridization confirmation and literature review

We report a 37-year-old male with acute promyelocytic leukemia (APL) harboring a complex translocation (4;15;17). Karyotypic analysis with R-banding of bone marrow cells revealed 46,XY,t(4;15;17)(q21;q22;q21). Fluorescence in situ hybridization analysis using painting probes for chromosomes 4, 15 and 17 and reverse transcriptase polymerase chain reaction analysis revealed three derivative chromosomes: der(4)t(4;15)(q21;q22), der(15)t(4;15;17)(q21;q22;q21), and del(17)(q21q22). This is the third report of such a translocation and the first confirmed by molecular methods. Considering reported similar cases, it is possible that 4q21 is a nonrandom breakpoint in APL with complex translocations and the gene involved in 4q21 should be investigated.

[Dynamic monitoring of Ph positive cells during early post-transplant period in chronic granulocytic leukemia by interphase FISH]

OBJECTIVE

To assess the effectiveness of transplantation and observe the kinetics of residual leukemic cells during early post-transplantation period in chronic granulocytic leukemia (CGL).

METHODS

Ten normal controls, seven untreated CGL patients and eleven CGL patients after allogeneic bone marrow transplantation (allo-BMT) or peripheral blood stem cell transplantation (PBSCT) were studied by interphase fluorescence in situ hybridization (I-FISH) with the FITC fluorescein labeled BCR probe. Conventional cytogenetic analysis (CCA) and reverse transcriptase-polymerase chain reaction (RT-PCR) were also employed.

RESULTS

The normal cutoff was defined as less than 6.68% (x +/- 3s) from the analysis of normal controls. The reproduciblity of FISH method was confirmed by serial dilutions by mixing Ph positive cells and normal cells. Forty specimens from 11 CGL patients at 1 week to 6 years post-BMT were investigated after PBSCT and the results showed that (1) FISH and RT-PCR could accurately evaluate Ph (+) cells during early transplantation period (within one month), but RT-PCR was more sensitive in six months after BMT. (2) Residual Ph (+) cells tended to be linear decreasing with the time after transplantation and fell in normal range in most samples three months later. The mean time of normaligation was 57 days (20 to 170 days). (3) One case relapsed and received a second transplantation. FISH presented more precise data for predicting relapse as compared to CCA and RT-PCR.

CONCLUSIONS

I-FISH as a useful tool can not only offer more precise assessment of residual leukemic cells compared with CCA and RT-PCR, but also provide dynamic monitoring during early post-BMT period to evaluate the transplantation outcome and predict relapse.

[The development of a hemorrhologity observating and measuring instrument]

A new instrument for observing blood cell state and the process of variation on hemorrheology has been developed. There are three ways of shear rate: setting by hand, automatically setting and simulating pulsative state. It can provide different variable flow fields. The shear rate can be set in the range from 0.1 to 1000 s-1. It needs only a little blood. It can be easyly and rapidely operated. it has clear images. The hemorrheology state of blood cells can be directly perceived through thd instrument by eyes. The display and measurement and record of blood cell's hemorrheology state can be finished in real time dynamically and simultaneously.

Ascaris peritonitis and peritoneal granuloma in China

This article is a survey of the Chinese literature of perforation of gastrointestinal tract by ascaris. We wish to draw attention to the acute abdominal disease of ascaris infection, and acute ascaris peritonitis as a result of perforation, most cases being found in children. The disease has very high morbidity (24/112; 21.4%) and high mortality (17/112; 15.2%). Early detection and operation are of critical importance. Perforation of gastrointestinal tract by ascaris may develop into peritoneal granuloma, which has a different clinical presentation and outcome.

Intercalated duct cells in the chicken pancreatic islet

Intercalated duct cells are present in the alpha and beta islets of the chicken pancreas. The intercalated duct cells adhere to each other via intercellular junctional complexes at the apical side, projecting many microvilli and a few of cilia into the lumen. Abluminally, these cells extend slender cytoplasmic processes between islet endocrine cells. These intercalated duct cells appear to have a stellate form, and to wrap around endocrine cells with their cytoplasm. These observations suggest that intercalated ducts not only pass through the islet, but also play a role in supplying islet cells.