Classification of Patients with Painful Tumors to Predict the Response to Palliative Radiotherapy

PURPOSE/OBJECTIVE(S)

Palliative radiotherapy is an effective and commonly used treatment for pain relief in metastatic cancer patients. This study aimed to classify the patients to predict their response to palliative radiotherapy.

MATERIALS/METHODS

This study used the data from our single-center, prospective observational study (UMIN000044984), which included all patients undergoing palliative radiotherapy for the painful tumor, except for postoperative setting or brain metastases. The eligibility criteria were as follows: (1) numerical rating scale (NRS) was two or more before treatment, and (2) underwent palliative radiotherapy between August 2021 and September 2022. Questionnaires for pain site, NRS, and presence/dose of opioids were obtained before, on the last day of treatment, two weeks later, one month later, three months later, and every three months after that. Patients with severe performance status (PS) were contacted by telephone. Pain response was defined to reduce NRS 2 or more at the treated site without an analgesic increase. The primary outcome was the response rate within three months of the treatment. We used multivariable logistic regression to find the independent prognostic factors for the response based on the following covariates: age, sex, PS, body mass index, NRS, history of radiotherapy, treated site, radiographic features (lytic/sclerotic/mixed), metastatic complication, presence/dose of opioids, bone-modifying agents, radiation dose, type of primary tumor, radiosensitivity, number of metastases, and days from diagnosis to treatment. A classification model was created using significant factors, and response rates were calculated for each class. Statistical significance was defined as P<0.05.

RESULTS

Among 488 targets of 300 patients registered, 366 targets of 261 patients met the criteria. The median age was 65 years, 44% were female, and PS (0/1/2/3/4) was 6/63/18/9/4%. The major type of tumor was gastrointestinal (32%), lung (19%), and breast (12%). Bone metastases were 75% at treated sites. Opioids were used by 72%, BMA was 27%, and chemotherapy was 50%. Re-irradiation rate was 22%. With a median follow-up of 5.8 months, 113 patients were alive, 129 had died, and 20 were lost follow-up. The average NRS was reduced from 6.1 to 3.1 from pretreatment to 3 months later per evaluable 232 targets, resulting in a pain relief rate of 60%. Opioids use (P<0.001) and re-irradiation (P<0.001) were significant factors of poor response in multivariate analysis. In our classification model, 89 targets were classified as class 1 (no opioids & no irradiation history), 211 were class 2 (other than class 1 and 3), and 66 were class 3 (opioids & re-irradiation), were 75/61/36% (P<0.001) of response rate. The 6-month cumulative pain progression rate was 12/22/32% (P<0.001), respectively.

CONCLUSION

Palliative radiotherapy is highly effective for patients with painful tumors especially for those without previous irradiation history or use of opioids.

Serum Fatty Acid Binding Protein 4 Concentrations Are Positively and Independently Associated with Blood Pressure and Abdominal Fat among Parameters in Health Check-Ups in Ordinary Middle-Aged Japanese Males

We wished to examine potential associations among blood concentrations of fatty acid-binding protein (FABP) 4 and parameters in health check-ups such as abdominal fat area (AFA) and blood pressure (BP) in middle-aged Japanese males. We conducted a cross-sectional study of males who participated in health check-ups in Japan. We excluded participants diagnosed with metabolic diseases by the time of their check-up. A total of 305 subjects (30-64 [mean±standard deviation, 47.3±8.5] y) were recruited. Areas of total-abdominal, visceral and subcutaneous fat were measured using computed tomography. We compared the association of serum concentrations of FABP4 with various clinical parameters by Pearson product-moment correlation coefficient (PPMCC) analyses, and by step-wise multivariate linear regression analyses (MLRA). PPMCC analyses showed that blood concentrations of FABP4 were positively associated with: body mass index; areas of fat (total abdominal, visceral, subcutaneous); systolic BP; diastolic BP; total cholesterol; low-density lipoprotein-cholesterol; triacylglycerol; activities of γ-glutamyl transpeptidase, aspartate aminotransferase and alanine aminotransferase; white blood cell count; and levels of creatinine. Step-wise MLRA showed that AFAs (visceral and subcutaneous) and diastolic BP were positively and independently associated with serum concentrations of FABP4 among the parameters tested. These data suggest that serum concentrations of FABP4 are independently and positively associated with BP and AFA among parameters measured in health check-ups in middle-aged Japanese males.

Plasma TNF-α Is Associated with Inflammation and Nutrition Status in Community-Dwelling Japanese Elderly

Inflammation has been suggested to play an important role in age-related chronic diseases and disability, and it is associated with nutritional status including obesity and malnutrition. While numerous studies have examined the validity of inflammatory markers in the population studies in Caucasian elderly people, very little information is available for the factors affecting inflammatory markers in Asian elderly people. Among inflammatory markers frequently used for the studies of aging, tumor necrosis factor α (TNF-α) is produced mainly by macrophages, and contributes to production of interleukin-6 (IL-6) and C-reactive protein (CRP), thus directing a chronic inflammatory process in the body. In the present study, we examined the associations between plasma TNF-α level and several factors related to nutrition status, including BMI, albumin, and energy intake in community-dwelling Japanese elderly. We conducted a cross-sectional study of 390 men and women aged 70-86 y (average 73.5 y), who participated in health check-ups. Associations between plasma TNF-α levels, other clinical parameters, and lifestyle factors were analyzed using Spearman's rank correlation coefficient analysis and multiple linear regression analysis. In elderly men, plasma TNF-α level was positively associated with age, white blood cell count, monocyte count, plasma CRP level, serum creatinine, ureic acid, and triacylglycerol levels, and negatively associated with albumin/globulin ratio, eGFR, and serum HDL-cholesterol level. In elderly women, plasma TNF-α level was positively associated with age, plasma CRP level, and serum triacylglycerol level, and negatively associated with serum albumin and HDL-cholesterol levels. The results of this study suggest that plasma TNF-α is associated with inflammation and insulin resistance in both Japanese elderly men and women, and a prominent association of TNF-α with malnutrition status was observed in elderly women.

Positive linear dose-response relationships, but no J-shaped relationship, between drinking habits and estimated glomerular filtration rate in middle-aged Japanese men

The relationship between drinking frequency and amount of alcohol consumption (i.e., drinking habits) and the risk of chronic kidney disease (CKD) remains unclear. We aimed to clarify either a linear or J-shaped dose-response relationship between drinking habits and estimated glomerular filtration rate (eGFR) as a biomarker for identifying individuals at high risk of CKD. In a large-scale cross-sectional study, 403 men and 121 women with an eGFR of 30-60 mL/min per 1.73 m(2) were defined as cases, and 1209 men and 363 women with ≥60 mL/min/1.73 m(2) were randomly extracted as controls (one case subject was matched with three control subjects, matched according to age and season of data collection). We calculated multivariate-adjusted CKD risk and the corresponding mean eGFR according to drinking habits. In men, negative and positive linear relationships with drinking habits were found for CKD risk and mean eGFR (p < 0.001 for all linear terms), respectively, but there were no corresponding J-shaped relationships (not significant for all quadratic terms). In regard to the mean eGFR, however, positive linear relationships were only shown in men in the highest eGFR quartile (p < 0.05 and p < 0.01 for drinking frequency and amount of alcohol consumption, respectively). In women, no association was found. Regarding each drinking habit, we found a positive linear dose-response relationship to eGFR in middle-aged men with an eGFR ≥30 mL/min/1.73 m(2).

Circulating interleukin-1β concentrations are independently-positively associated with γ-glutamyltransferase activity within the normal range in middle-aged apparently healthy Japanese women

We previously demonstrated that the circulating concentrations of interleukin (IL)-1β, which is known to induce the development and progression of type 2 diabetes and its complications, were positively associated with γ-glutamyltransferase (γ-GTP) activity in middle-aged apparently healthy Japanese men. It was still unknown if the association between IL-1β concentrations and γ-GTP activity is within the normal range in apparently healthy Japanese women. In this study, we conducted a cross-sectional study of 824 apparently healthy women aged 40-64 y [mean±standard deviation age, 53.1±7.1 y; body mass index (BMI), 22.0±3.1 kg/m(2)] who participated in health checkups in Japan, and whose γ-GTP activity was within the normal range (<38 U/L). Associations of γ-GTP with IL-1β and other clinical or lifestyle factors were determined using analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA) followed by Tukey's multiple-range test. Multivariate logistic regression analyses (MLRA) were performed with γ-GTP activity as the dependent variable; independent variables included IL-1β plus clinical and lifestyle factors. ANOVA and ANCOVA indicated that IL-1β concentrations were positively associated with γ-GTP activity. MLRA showed that γ-GTP activity showed trends for higher IL-1β concentrations after adjusting for age, BMI, energy intake, alcohol intake, and smoking status. Together, IL-1β concentrations are positively associated with γ-GTP activity within the normal range in middle-aged apparently healthy Japanese women. Our results suggest that γ-GTP activity would be useful for assessing inflammation from the healthy state in Japanese women.

Serum γ-GTP activity is closely associated with serum CRP levels in non-overweight and overweight middle-aged Japanese men

The relationship between γ-glutamyltransferase (γ-GTP) and C-reactive protein (CRP) has not been established, particularly in the lean or non-overweight population. In the present study, we examined the associations between γ-GTP and CRP in non-overweight and overweight middle-aged Japanese men. We conducted a cross-sectional study of 4,271 apparently healthy men aged 40 to 64 y (mean±SD, 50.5±6.6 y) who participated in health checkups. Associations between serum CRP levels, other clinical parameters, and lifestyle factors were analyzed using Spearman's rank correlation coefficient analysis and multiple linear regression analysis in the non-overweight (body mass index [BMI]<25 kg/m(2)) and overweight (BMI≥25 kg/m(2)) men. Associations between serum γ-GTP activity and serum CRP levels were analyzed using analysis of covariance by comparisons of serum CRP levels of four subgroups according to γ-GTP status. In non-overweight men, BMI, high-density lipoprotein cholesterol, triacylglycerols, fasting blood glucose, aspartate aminotransferase, γ-GTP, and smoking habit were positively associated with serum CRP levels. In overweight men, BMI, diastolic blood pressure, triacylglycerols, and γ-GTP were positively associated with serum CRP levels. After adjustment for age, BMI, smoking status, and alcohol intake, dose-response relationships were observed between γ-GTP and CRP levels in both overweight and non-overweight men. The results of this study indicate that an increase in serum γ-GTP activity is closely associated with elevated CRP levels in both non-overweight and overweight middle-aged Japanese men.

Plasma sE-selectin level is positively correlated with neutrophil count and diastolic blood pressure in Japanese men

Increased levels of circulating soluble type of E-selectin (sE-selectin), neutrophil counts and blood pressure are associated with the development of cardiovascular diseases (CVD). In this study, we conducted a cross-sectional study of men who participated in health check-ups, and selected those who were not diagnosed with or being treated for metabolic diseases such as diabetes, hypertension and lipid abnormality according to the health check-ups. We measured their basic clinical parameters including blood pressure and neutrophil count, plasma sE-selectin concentration and lifestyle factors, and assessed their interrelations by multivariate linear regression (MLR) analysis. A total of 351 subjects aged 47.5±8.41 (range, 30-64) y were recruited. Significantly correlated with sE-selectin concentration were neutrophil count, diastolic blood pressure (DBP), and systolic blood pressure (SBP) (Pearson's correlation coefficient, 0.194, 0.220 and 0.175, respectively). MLR analysis showed that sE-selectin concentration was independently positively related with DBP and neutrophil count, whereas neutrophil count was positively associated with sE-selectin concentration but not DBP. DBP, but not SBP, was independently positively correlated with sE-selectin concentration but not neutrophil count. These results indicate that circulating sE-selectin concentration may be a biomarker for indicating subsequent development of metabolic diseases, in particular CVD, from a healthy state.

Principal component 1 score calculated from metabolic syndrome diagnostic parameters is a possible marker for the development of metabolic syndrome in middle-aged Japanese men without treatment for metabolic diseases

PURPOSE

The risk of metabolic syndrome (MetS) is assessed based on the presence of risk factors that include dyslipidemia, hyperglycemia, hypertension and obesity. In this study, we assessed the risk of MetS using principle component (PC) analysis of MetS diagnostic parameters and examined whether the resulting eigenvalues are associated with the circulating concentrations of inflammatory cytokines [interleukin (IL)-1β and IL-6] and a marker for insulin sensitivity (adiponectin) in middle-aged Japanese men without treatment for metabolic diseases.

MATERIALS

We conducted a cross-sectional study of 308 Japanese men without treatment for metabolic diseases aged 40-69 years who participated in health checkups in Japan. We calculated the PC1 score from the following MetS diagnostic parameters: body mass index (BMI), fasting blood glucose, diastolic blood pressure, triacylglycerol and high-density lipoprotein cholesterol. We compared the relationship between PC1 scores and other clinical parameters, including IL-1β, IL-6 and adiponectin, by Spearman's rank correlation coefficient analyses and Jonckheere-Terpstra test.

RESULTS

The associations for most clinical parameters were higher with the PC1 score than with other MetS diagnostic parameters. Homeostasis model assessment-insulin resistance, an index of insulin resistance, showed stronger associations with PC1 score than with MetS diagnostic parameters. Significant associations for IL-1β, IL-6 and adiponectin were observed with the PC1 score, BMI and triacylglycerol; these associations were higher with the PC1 score than with BMI and triacylglycerol.

CONCLUSIONS

The present results show that the PC1 score is closely associated with parameters of MetS, inflammation and insulin resistance.

Accumulation of visceral fat is positively associated with serum ALT and γ-GTP activities in healthy and preclinical middle-aged Japanese men

Elevated circulating alanine aminotransferase (ALT) and γ-glutamyltransferase (γ-GTP) activities, and the accumulation of fat, particularly visceral fat, in healthy and preclinical subjects reportedly increase the risk for metabolic diseases such as diabetes. In the present study, we examined the associations between these hepatic enzymes and the total visceral and subcutaneous fat area, and for both regions of fat independently, in healthy and preclinical middle-aged Japanese men. We conducted a cross-sectional study of men who participated in health check-ups in Japan. We removed participants, who were diagnosed with metabolic diseases at the time of the health check-up. Three hundred fifteen subjects aged 40-64 y (mean±SD, 50.5±6.9 y) were selected. We compared associations between the total visceral and subcutaneous fat area, and for both regions independently, with various clinical parameters, including hepatic enzyme markers, using Spearman's rank correlation coefficient analysis and multiple linear regression analysis. The total visceral and subcutaneous fat area and both regions independently were positively associated with body mass index, systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, aspartate aminotransferase, ALT and γ-GTP. ALT and γ-GTP activities were the strongest explanatory variables for increased visceral fat area, independent of the subcutaneous fat area. In contrast, these hepatic enzymes were not explanatory variables for increased subcutaneous fat area. The results of the present study show that the accumulation of visceral fat is positively associated with ALT and γ-GTP activities independently of subcutaneous fat area in healthy and preclinical Japanese men.

Circulating interleukin-1β and interleukin-6 concentrations are closely associated with γ-glutamyltranspeptidase activity in middle-aged Japanese men without obvious cardiovascular diseases

Interleukin (IL)-1β and IL-6 expressions are known to be induced by oxidant stress. In the present study, we examined the relationships between these interleukins and the activity of γ-glutamyltranspeptidase (γ-GTP), which was recently reported as a source of oxidant stress production, in the circulating blood of middle-aged Japanese men without obvious cardiovascular diseases. We conducted a cross-sectional study of 317 Japanese men without obvious cardiovascular diseases aged 40 to 69 years (mean ± SD, 58.6 ± 7.6 years) who participated in health checkups in Japan. We analyzed their clinical parameters in serum, lifestyle factors, and plasma IL-1β and IL-6 concentrations. We compared the relationships between these interleukin concentrations and the clinical parameters and lifestyle factors by Spearman correlation coefficients. Stepwise multiple linear regression analyses for interleukins based on the other parameters and γ-GTP, which were classified into 3 groups according to the concentrations, were performed. Interleukin-1β and IL-6 concentrations were closely associated with γ-GTP activity but less associated with alanine aminotransferase and aspartate aminotransferase activities by Spearman correlation coefficients. Stepwise multiple linear regression analyses showed that γ-GTP activity was the explanatory variable for elevated IL-1β and IL-6 concentrations. As natural logarithms, the IL-1β and IL-6 concentrations were estimated to be 1.734- and 1.157-fold higher, respectively, in subjects with high γ-GTP activity ranges than in subjects with a low γ-GTP activity range. The present results show that circulating IL-1β and IL-6 concentrations are strongly and independently associated with γ-GTP activity in middle-aged Japanese men without obvious cardiovascular diseases.

The combination of genetic variations in the PRDX3 gene and dietary fat intake contribute to obesity risk

Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) and the antioxidant capacity of the cell. This imbalance and an excess of ROS induce tissue/cellular damage, which are implicated in chronic inflammation disorders such as obesity, insulin resistance, and metabolic syndromes. Peroxiredoxins (Prxs) are the most abundant and ancient cellular antioxidant proteins that help to control intracellular peroxide levels and ROS-dependent signaling. Of the six mammalian isoforms, Prx III is specifically localized in mitochondria. In this study, we detected novel associations between genetic variations of the PRDX3 gene and BMI and obesity risk in the general Japanese population. In addition, these associations were observed only in the subjects with high dietary fat intake, but not in the subjects with low dietary fat intake. These findings indicate that the interaction between genetic variations in the PRDX3 gene and dietary fat intake is important for modulation of BMI and obesity risk.

Plasma interleukin-1β concentrations are closely associated with fasting blood glucose levels in healthy and preclinical middle-aged nonoverweight and overweight Japanese men

Plasma interleukin (IL)-1β and IL-6 are markers that predict the risk of inflammation in diabetes. In the current study, we examined the relationship between fasting glucose and plasma inflammatory cytokines (IL-1β and IL-6) concentrations in healthy and preclinical middle-aged Japanese men (mean ± SD, 58.7 ± 7.8 years old) divided according to body mass index (<25 kg/m(2), nonoverweight group; ≥25 kg/m(2), overweight group). We conducted a cross-sectional study of 413 healthy and preclinical men aged 40 to 69 years who participated in health checkups in Japan. We measured their clinical parameters, lifestyle factors, and plasma IL-1β and IL-6 concentrations. Participants were classified according to their fasting blood glucose levels, and we compared their plasma cytokine levels. Plasma IL-1β and IL-6 levels in nonoverweight subjects were positively and strongly associated with fasting blood glucose and hemoglobin A(1c); in contrast, these cytokines were strongly associated with homeostasis model assessment of insulin resistance and fasting glucose in overweight subjects. Significant positive associations between plasma IL-1β and glucose concentrations were observed within the groups classified according to glucose concentrations, after adjustment for age and body mass index. The results of our current study show that plasma IL-1β levels are strongly associated with fasting blood glucose concentrations in healthy and preclinical nonoverweight and overweight Japanese men.

Double-layer fluorescent zymography for processing protease detection

We have developed a novel double-layer zymographic method for the detection of specific processing proteases of a target proprotease using a specific fluorescent substrate. The target processing proteases were separated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the gel was subsequently incubated with the target proenzyme used as the substrate. A cellulose acetate membrane was immersed in 10% glycerol and then soaked in the fluorescent substrate solution. The slab gel of the processing protease was covered with the fluorescent substrate membrane, making a double layer. The double layer was incubated at 37 degrees C, and the released fluorescent band, in which the processing protease was located, was detected using UV light. The advantages of the double-layer fluorescent zymographic method are as follows: (i) the specific detection of target proprotease using a specific substrate, (ii) a relatively rapid and sensitive method, (iii) effective detection using small amounts of crude material, and (iv) wide applications that include the detection of processing proteases and activators for target proteases. Typical examples used for the detection of the processing proteases, such as plasminogen activator, chymotrypsinogen activator, procaspase-3 processing protease and caspase-3 activators, using this new method are described in this article.

High-resolution scanning electron microscopic evaluation of cell-membrane porosity by ultrasound

The effect of low-intensity ultrasound on HL-60 cells (human promyelocytic leukemia cells) in the presence of the photo sensitizing drug merocyanine 540 (MC 540) was evaluated morphologically, using a high-resolution scanning electron microscope and a transmission electron microscope. Exposure of HL-60 cells to ultrasound without MC 540 resulted in a decrease of finger-like processes in the cells. The cells showed many undulating ruffles on the surface. Distinct pits or holes in the membrane were not observed in these cells. The surface of HL-60 cells treated only with MC 540 was relatively smooth compared with that of control cells. HL-60 cells exposed to ultrasound in the presence of MC 540 showed apparent surface deformation. Numerous crater-like depressions of heterogeneous dimensions were observed in many cells. In addition, various-sized pores were noted in the cell membranes of more damaged cells. These results indicate that cell degeneration was induced by a rapid change in cell membrane porosity during sonication in the presence of MC540.

Studies on 8-methoxyquinolones: synthesis and antibacterial activity of 7-(3-amino-4-substituted)pyrrolidinyl derivatives

A series of 8-methoxyquinolones bearing 3-amino-4-methylpyrrolidines or 3-amino-4-fluoromethylpyrrolidines at the C-7 position was synthesized and their physicochemical and biological properties were evaluated. All of the compounds synthesized showed more potent activity than LVFX (3) against both gram-positive and negative bacteria. Increases in lipophilicity of these compounds had desirable effects on their potency of single intravenous toxicity and pharmacokinetic profiles in animals. Among the compounds synthesized, 1-fluorocyclopropyl derivatives 17 and 20, and 7-(cis-3-amino-4-fluoromethylpyrrolidinyl) derivative 19 (DC-756h) showed negative responses in the micronucleus test in mice while 1-cyclopropyl-7-(3-aminopyrrolidinyl) derivative 16 showed a positive response. These results suggested that the introduction of a fluorine atom into the 3-aminopyrrolidinyl substituent resulted in favorable influence on genetic toxicity as well as into the N-1 cyclopropyl substituent.

Human persistent left superior vena cava with doubled coronary sinus

A heart with a persistent left superior vena cava was found in a 72 year old man during routine dissection. The right superior vena cava was absent. The right brachiocephalic vein crossed over the aortic arch and its branches to the left side of the heart. This variation reportedly occurs in about 0.16% of humans. The azygos vein was, as a result, also left sided with a hemiazygos vein on the right side. The left superior vena cava drained into a channel contained with the posterior wall of the left atrium of the heart above, and parallel with the coronary sinus. The channel of the left superior vena cava opened into the right atrium above the opening of the coronary sinus. The coronary sinus may have been doubled during embryonic development. The two vessels were joined by a small connecting vessel.

The true nature of the adductor brevis dually innervated by the anterior and posterior branches of the obturator nerve in humans

To clarify the true nature and the mechanism of the human adductor brevis (specific adductor brevis, SAB) innervated dually by the anterior and posterior branches of the obturator nerve, we have carried out gross anatomical examination of 100 body halves of 50 adult Japanese cadavers. The SAB was found in 23 of the 100 thighs (23.0%), and its anterior and posterior surfaces received respectively the twigs from the anterior branch of the obturator nerve and the filament(s) from the posterior branch. The filament(s) was either indirectly derived from the medial stratum of the posterior branch through the formation of a common trunk with the twigs distributed in the obturator externus (14/23 thighs, 60.9%) or directly originating in the medial stratum of the posterior branch of the obturator nerve (9/23 thighs, 39.1%). In the close examination of the intramuscular distribution of the nerve to the SAB, the region innervated by the anterior branch of the obturator nerve could clearly be distinguished from that innervated by the posterior branch. The obturator nerve received fibers from L1234 (2/23 thighs) or from L234 (21/23 thighs), and the posterior branch of the obturator nerve ran through the obturator externus (18/23 thighs, 78.3%) or ran over the obturator externus (5/23 thighs, 21.7%), and finally emerged into the thigh. In view of the mode of origin of the filament(s), the structural element of the filament(s), and the pattern of entry of the filament(s) into the SAB, the fasciculus of the SAB, which is innervated by the posterior branch of the obturator nerve, was considered to originate in the obturator externus. Thus, the true nature of the SAB was concluded to be a complex product which was formed by a mechanism in which the fasciculus, which had separated from the obturator externus during the process of ontogeny, fused secondarily to the posterior surface of the regular adductor brevis. From findings in our series of studies, it was estimated that the maximum frequency of occurrence of the SAB could be 56%. Furthermore, from a statistical point of view, the segmental composition or course of the obturator nerve is not considered to be related to either the formation or the incidence of this muscle.

Musculus comitans nervi mediani (M. palmaris profundus)

Palmaris profundus muscles were found in two cadavers during routine dissection of the upper limb. This rare muscle was found in two forms. In the first case, the muscle resembled a diminutive palmaris longus with the belly arising from the common flexor tendon. In the second case however, a reversed muscle with the belly emerging from beneath the transverse carpal ligament and its long thin tendon extended to and inserted in the common flexor tendon. The similarity therefore of these muscles to variable forms of palmaris longus is remarkable but they differed in one very important aspect from palmaris longus. The muscles are of special interest because, in both cases, the muscles were found enclosed in a common fascial sheath with the median nerve. These unusual muscles, in spite of mimicking palmaris longus, may perhaps, be better named "musculus comitans nervi mediani" to denote their very important relationship to the median nerve, that of being the intimate traveling companion of the median nerve through the forearm and into the hand by way of the carpal canal beneath the transverse carpal ligament. In one case, a well developed median artery was also found which also entered the carpal canal along with the median nerve and its muscular companion.

Anatomic considerations of the peroneal nerve for division of the fibula during high tibial osteotomy

Twenty legs in 10 cadavers were dissected to determine the course of the deep peroneal nerve from its origin to its termination. Particular attention was paid to defining: (1) its relationship to palpable landmarks, (2) the angle of the course of its proximal portion against the long axis of the fibula, (3) distribution of the proximal branch to the extensor hallucis longus muscle, and (4) safe areas of osteotomy in the proximal fibula during high tibial osteotomy. The extensor hallucis longus was often supplied by only one branch from the deep peroneal nerve at 99.8 mm (31.7%) distally from the apex of the fibula; this seems to explain why osteotomy of the fibula at its proximal one third often causes paralysis of this muscle. The findings suggest that safe areas for osteotomy in the proximal fibula during high tibial osteotomy are located up to 20.5 mm (6.5%) distal to the tip of the fibular head and that the safe angle of a periosteal incision against the fibular neck area is 64.1 degrees.

Staining of pancreatic centroacinar cells, liver bile canaliculi and testicular Leydig cells with a monoclonal antibody against adrenocortical cells

The immunoreactivity of a monoclonal antibody against cell suspensions from guinea pig adrenal glands was examined at light- and electron-microscopic levels. In addition to the cell surface membrane of adrenocortical cells, the antibody labeled specific sites in the pancreas, liver and testis, but did not label any of the other tissues examined. In the pancreas, microvilli-like processes and the cell surface membrane of centroacinar cells were immunoreactive to the antibody. The microvilli of interlobular duct cells and pancreatic duct cells were also immunoreactive. In the liver, bile canalicular microvilli of hepatocytes were exclusively labeled. Membrane structures of cell organelles, mainly mitochondria, in testicular Leydig cells were also labeled. Immunoblot analysis showed that the monoclonal antibody bound to two common bands at molecular weights of approximately 62 kDa and 110 kDa in the pancreas, liver, testis, and adrenal gland. The two bands reacted with the digoxigenin-conjugated lectin, Sambucus nigra agglutinin (SNA), which recognizes sialic acid linked alpha (2-6) to galactose. Reaction patterns of SNA in the pancreas, liver and testis were similar to those of the monoclonal antibody; pancreatic centroacinar cells and interlobular duct cells, hepatocyte bile canaliculi and testicular Leydig cells were densely stained with SNA. Thus, the monoclonal antibody recognizes two common membrane glycoproteins containing sialic acids in the pancreas, liver, testis and adrenal cortex.

Structural organization of the initial lymphatics in the monkey mesentery and intestinal wall as revealed by an enzyme-histochemical method

The structure and distribution of the initial lymphatics in whole mount preparations of the mesentery and intestinal walls of the Japanese monkey (Macaca fuscata) were studied using an enzyme-histochemical method (Kato et al., 1991, 1993). The lymphatic walls, colored dark brown by their positive 5'-nucleotidase (5'-Nase) activity, were clearly distinguished from the blood vessels (especially capillaries and arterioles) which were colored blue due to their positive alkaline phosphatase activity. The specificity and localization of both enzyme reactions were confirmed by comparative histochemical studies of the same specimen under a light microscope and scanning or transmission electron microscopes. Application of this staining method takes advantages of the overview preparation of flat membranous organs. The mesenterial area was generally lobulated in distribution with collecting lymphatics and blood vessels. At about the center of each lobule enclosed by the vessels, 5'-Nase-positive initial lymphatics assumed tubulo-saccular shapes, branching antler-like figure to form dense networks in the main lymph vascular pathway. Their apical parts revealed marked knob-like blind endings demarcated by a thin endothelial wall. No direct interconnection was recognizable between the lymphatic space and the tissue interstitium as a prelymphatic fluid pathway. In such preparations, 5'-Nase-positive lymphatic islands could be found isolated from the lymphatic network.

A supernumerary muscle between the adductors brevis and minimus in humans

In order to elucidate the nerve supply of a supernumerary muscle observed between the adductors brevis and minimus in humans and to investigate its true nature and mechanism of formation, 100 body halves from 50 adult Japanese cadavers were subjected to gross anatomical examination. A supernumerary muscle was noted in 33 (33.0%) out of the 100 thighs. In each of these thighs, it arose from the upper part of the inferior ramus of the pubis and ran obliquely downwards and laterally. It was inserted into the anterior surface of the insertion aponeurosis of the adductor minimus (17/33 thighs, 51.5%), the upper part of the pectineal line (9/33 thighs, 27.3%), or the posterior side of the base of the lesser trochanter (7/33 thighs, 21.2%). It was supplied, from its posterior aspect, by a filament from the twig originating from the posterior branch of the obturator nerve and being distributed to the superficial fasciculus of the obturator externus (18/33 thighs, 54.5%) or by a twig directly originating from the posterior branch (15/33 thighs, 45.5%). The obturator nerve received fibers from L1234 (4/33 thighs), L234 (25/33 thighs), L2345 (2/33 thighs) or L34 (2/33 thighs) and, moreover, its posterior branch ran through (25/33 thighs, 75.8%) or over (8/33 thighs, 24.3%) the obturator externus to emerge into the thigh. Based on the topographical-anatomical relationships of this muscle to its nerve supply, it seems probable that it is formed by separation from the superficial layer of the obturator externus and changes into an independent structure during the process of ontogeny. Furthermore, from a statistical standpoint, the segmental composition or course of the obturator nerve is not related to either the formation or incidence of this muscle.

Enzyme-histochemical study on the fine distribution of the intramural lymphatics at the ileocecal junction of the monkey intestine

The fine distribution of the intramural lymphatics at the ileocecal junction of the monkey intestine, especially in the lamina propria of the ileocecal valve, was examined by light and electron microscopy using enzyme-histochemical staining. The distinction between the lymphatics and the blood vessels was made by light microscopy on cold glycol methacrylate resin (JB-4) sections using 5'-nucleotidase (5'-Nase)-alkaline phosphatase (ALPase) double staining. The lymphatics were found to show strong 5'-Nase activity and to comprise irregularly shaped vessels or spaces. The central lymphatic vessels (central lacteals) in low villi were seen to lie deep within the ALPase-positive subepithelial capillary network. In the ileum side of the ileocecal junction, the 5'-Nase-positive lymphatics were seen both in the superficial layer and the deep layer of the lamina propria. On the contrary, in the cecum side the mucosal lymphatics were less numerous in the superficial layer and were distributed mainly in the deep layer near the lamina muscularis mucosae. These lymphatics ran through the lamina muscularis and merged into the lymphatic network in the submucosa. The submucosal lymphatics communicated with each other at the ileocecal junction and formed a well-developed network. Collecting lymphatics with valves were also seen near the tunica muscularis (sphincter muscle) in the deep submucosa. These lymphatics traversed the muscle layer and drained into the subserosal lymphatics.