Seasonal ultrastructural changes in apocrine gland cells in back skin of male brown bears (Ursus arctos).

Oily secretions from the back skin are involved in the marking behavior of male brown bears (Ursus arctos), and apocrine glands in back skin are activated during the breeding season. Here, we investigated seasonal changes in the intracellular organelles of apocrine gland cells in the back skin of male brown bears using transmission electron microscopy (TEM) and osmium-maceration scanning electron microscopy (OM-SEM). The morphological features of mitochondria and intracellular granules, and secretory mechanisms obviously differed between breeding and non-breeding seasons. The TEM findings showed that contents of low-density granules were released into the glandular lumen by frequent exocytosis, and sausage-shaped mitochondria were located in the perinuclear region during the non-breeding season. In contrast, high-density granules appeared in the apical region and in projections during the breeding season, and swollen mitochondria and lysosome-like organelles separating into high-density granules were located in the perinuclear region. The OM-SEM findings revealed swollen mitochondria with only a few partially developed cristae, and small mitochondria with cristae shaped like those in swollen mitochondria in the apical regions during the breeding season. These findings indicated that the small mitochondria corresponded to the high-density granules identified by TEM. These findings suggested that mitochondria in apocrine gland cells swell, degenerate, fracture into small pieces, and are finally released by apocrine secretions during the breeding season. Small mitochondria released in this secretory manner might function as the source of chemical signals in the oily secretions of brown bears during the breeding season.

Reliability and validity of the Children's Depression Inventory-Japanese version.

BACKGROUND: Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression. METHODS: The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression. RESULTS: The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24. CONCLUSION: The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

Testicular regulation of seasonal change in apocrine glands in the back skin of the brown bear (Ursus arctos).

Brown bears communicate with other individuals using marking behavior. Bipedal back rubbing has been identified as a common marking posture. Oily substances are secreted via enlarged sebaceous glands in the back skin of male bears during the breeding season. However, whether apocrine gland secretions are associated with seasonal changes remains unknown. The present study aimed to identify histological and histochemical changes in the secretory status and the glycocomposition of the apocrine glands in the back skin of male bears in response to changes in seasons and/or reproductive status. The apocrine glands of intact males during the breeding season were significantly larger and more active than those of castrated males during the breeding season and those of intact males during the non-breeding season. Lectin histochemical analyses revealed a more intense reaction to Vicia villosa agglutinin (VVA) in the cytoplasm, mainly Golgi zones of apocrine cells during the breeding season among castrated, compared with intact males. Positive staining for VVA was quite intense and weak in intact males during the non-breeding and breeding seasons, respectively. Ultrastructural analysis revealed VVA positivity in the Golgi zone, especially around secretory granules in apocrine cells. Changes in lectin binding might reflect a change in the secretory system in the apocrine cells. The present histological and histochemical findings of changes in the secretory status and glycocomposition of the apocrine glands according to the season and reproductive status suggest that these glands are important for chemical communication.

Effect of leaflet-based intervention on family members of terminally ill patients with cancer having delirium: historical control study.

OBJECTIVE: We aimed to assess leaflet-based intervention effects on family-perceived distress, the need for improvements in professional care for delirium, and family knowledge of delirium causes. METHODS: Leaflet-based intervention effects were assessed by comparing responses of family members given in the leaflet with those of a historical control group not receiving it. RESULTS: Knowledge of delirium causes was significantly more likely to be correct in the intervention group, while there were no significant differences in family-perceived distress or need for improvements in professional care for delirium between the 2 groups. CONCLUSIONS: The leaflet providing information about delirium improved family knowledge of cancer delirium. To relieve family distress, a comprehensive program focused mainly on psychological aspects, in addition to educational intervention with this leaflet, is a promising strategy.

Usefulness of the leaflet-based intervention for family members of terminally ill cancer patients with delirium.

BACKGROUND AND OBJECTIVE: Delirium in terminally ill cancer patients causes considerable distress to family members. The aim was to determine the family-perceived usefulness of a leaflet about delirium in terminally ill cancer patients. METHODS: Family members received a leaflet about delirium designed for this study as a part of routine practice. Questionnaires were mailed to bereaved family members of cancer patients recruited from three palliative care units, one hospital palliative care team, and three specialized home care teams in Japan. RESULTS: Among 235 family members, 16 questionnaires were returned as undeliverable, and responses were obtained from 169 bereaved family members (response rate 77%, 169/219). Of these, 22 were excluded because of missing data and 34 families reported they did not recognize that the patient had delirium, and thus 113 responses were finally analyzed. As a whole, 81% of the family members reported that the leaflet was "very useful" or "useful." Many respondents noted that the leaflet "helped them understand the dying process" (84%), "helped them identify what they could do for the patient" (80%), "helped them understand the patient's physical condition" (76%), and "was useful in preparing for the patient's death" (72%). CONCLUSIONS: The leaflet about delirium was evaluated as useful for family members. This leaflet could help family members cope with a difficult situation by facilitating accurate understanding of the situation and by helping family members understand what they could do for the patient. More comprehensive intervention programs should be developed and tested in the future.

Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report.

Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US), which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2 x 1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

Hepatocellular carcinoma in a Hokkaido brown bear (Ursus arctos yesoensis).

Hepatocellular carcinoma with metastases to lymph nodes and adrenal glands was found in a 26-year-old male Hokkaido brown bear (Ursus arctos yesoensis). Left hepatic lobe was largely replaced by well-differentiated neoplastic cells, whereas poorly differentiated tumor cells had proliferated in part of the left hepatic lobe, in scattered nodules in the remaining liver tissue, and at the metastatic sites. Immunoreactivity for hepatocyte antigen (hepatocyte paraffin 1 antibody) and alpha-fetoprotein was observed in both well- and poorly differentiated neoplastic cells in the liver and metastatic foci. To our knowledge, this case is the first report of hepatocellular carcinoma in brown bears.

Feasibility study of adjuvant chemotherapy with gemcitabine and split-dose cisplatin for completely resected non-small-cell lung cancer.

INTRODUCTION: Recent clinical trials have shown significant survival benefits from postoperative adjuvant chemotherapy for resected non-small-cell lung cancer (NSCLC). However, due to the comparatively low compliance in recent clinical trials, this study investigated the feasibility of adjuvant chemotherapy with gemcitabine plus split-dose cisplatin for completely resected NSCLC. METHODS: Gemcitabine at a dose of 1000 mg m(-2) and cisplatin at 40 mg m(-2) were given intravenously on days 1 and 8 every 4 weeks for a maximum of four cycles. According to Simon's minimax two-stage design, if the regimen was judged to be safe and tolerable in five or more of the seven patients in the first stage, then enrollment would increase to a total of 20 patients. The feasibility of this regimen was proven if four cycles of chemotherapy were completed in more than 14 patients. The primary endpoint was the compliance to this regimen in the adjuvant setting, while the secondary endpoints were safety and toxicity. RESULTS: The regimen was judged to be safe and tolerable in the first stage, and therefore 21 patients were accrued as planned. Twenty patients (95%) received four cycles of chemotherapy; therefore chemotherapy compliance in the four cycles was 95%. The relative dose intensity was 97% for both gemcitabine and cisplatin. Grade 3/4 toxicities of neutropenia occurred in 33% and thrombocytopenia in 20%. Nonhematological adverse effects were extremely rare. CONCLUSION: Adjuvant chemotherapy with gemcitabine and split-dose cisplatin showed a favorable feasibility and acceptable toxicity in Japanese NSCLC patients.

Diffuse malignant pleural mesothelioma: a multi-institutional clinicopathological study.

PURPOSE: The relative rarity of malignant pleural mesothelioma (MPM) in Japan makes it difficult to perform a large-scale clinicopathological study of this tumor at a single institute. Thus, we performed a multiinstitutional study to evaluate the current status of diagnosis and treatment in Japan. METHODS: We analyzed the records of 65 patients with MPM, obtained from the 13 institutions comprising the Japanese Chiba Multicenter Study Group. RESULTS: In 56 patients, the tumor was detected after a visit to a medical facility for subjective symptoms such as chest pain, shortness of breath, and cough. It took a median period of 2 months from the initial visit to establish the diagnosis. The overall survival rates of 33 patients with unresectable MPM 1, 2, and 3 years after the diagnosis were 40.5%, 10.8%, and 0%, respectively, whereas those of 32 patients who underwent surgery were 67.9%, 35.0% and 10.9%, respectively (P=0.0035). According to multivariate analysis, histological type, International Mesothelioma Interest Group clinical stage, sex, and the presenting symptom of shortness of breath were significant prognostic factors. CONCLUSIONS: The definitive diagnosis of early MPM is difficult, but establishing the best diagnostic modality would improve survival rates, since radical surgery is likely to be effective for resectable disease.

Delayed contrast enhancement of MRI in hypertrophic cardiomyopathy.

Fibrotic lesions in the myocardium exhibit delayed contrast enhancement (DCE) on MR images. On the other hand, plexiform fibrosis is observed in hypertrophic cardiomyopathy (HCM), indicating an association of this condition with the pathogenesis of heart failure and arrhythmia. To examine the occurrence and extent of DCE and its relation to cardiac function and arrhythmia in HCM, we studied 59 patients with HCM who had undergone MRI. The relationship of DCE to cardiac function and arrhythmia was further investigated. DCE occurred in 45 (76.3%) of the 59 patients with HCM, with a high frequency of localization in regions, where the right ventricle is attached. As for the relationship of DCE to cardiac function, a significant decrease (P=0.007) in cardiac function was observed in the group in which 4 or more segments exhibited DCE, compared with the group in which DCE was observed in 3 or less segments. Regarding the relationship of DCE to arrhythmia, both the occurrence of DCE and the extent of DCE were significantly larger (p<0.05, p=0.026, respectively) in the group with VT. These results indicate that DCE may save to identify severe cases of HCM on the basis of cardiac function, arrhythmia, and pathophysiological aspects.

[Hypertrophic cardiomyopathy with mid-ventricular obstruction complicated by apical aneurysm appearing as delayed contrast hyperenhancement on magnetic resonance imaging: two case reports].

Case 1: A 52-year-old man presented with a chief complaint of palpitation. Diabetes mellitus was pointed out in 1992. Electrocardiography (ECG) revealed left ventricular hypertrophy in 1997. He visited our department in October 1997. Echocardiography showed increased wall thickness at the interventricular septum. The diagnosis was hypertrophic cardiomyopathy. Holter ECG revealed nonsustained ventricular tachycardia in December 1997. After this, he visited our outpatient clinic. Echocardiography indicated ventricular aneurysm in January 2002, so he was hospitalized in March 2002. Case 2: A 64-year-old woman was transferred to our hospital because of chest discomfort and tachycardial attack. She had been treated for hypertension and diabetes mellitus. She was taken to a hospital by ambulance. On admission, ECG showed wide QRS tachycardia. Cardiac magnetic resonance imaging in both patients disclosed almost complete obstruction of the mid-ventricle in the systolic phase on long- and short-axis cine images, and gadolinium delayed imaging revealed contrast hyperenhancement corresponding to an apical ventricular aneurysm on both long- and short-axis images. The final diagnosis was mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm characterized by delayed hyperenhancement on magnetic resonance imaging with gadolinium.

Detection of sentinel lymph nodes in patients with papillary thyroid cancer.

OBJECTIVES: To determine the feasibility of sentinel lymph node biopsy as a means of evaluating the cervical lymph nodes of patients with papillary thyroid cancer. METHODS: Isosulfan blue dye was injected around the tumour of 68 patients with papillary thyroid cancer; sentinel lymph node biopsy was performed in addition to subtotal thyroidectomy and central and modified lateral neck lymph node dissections. Surgical specimens were examined by routine processing to determine whether metastasis was present. RESULTS: Sentinel lymph nodes were identified in 63 (92.6%) of the 68 patients. There was concordance between the sentinel lymph node status and the final regional lymph node status in 58 (92.1%) of the 63 patients. There were five false-negative cases. Sentinel lymph node biopsy had a sensitivity of 87.5% (35/40), specificity of 100% (23/23), positive predictive value of 100% (35/35), negative predictive value of 82.1% (23/28), and accuracy of 92.1% (58/63). CONCLUSIONS: Sentinel lymph node biopsy may allow discrimination between patients with true lymph-node-negative papillary thyroid carcinoma and those with non-palpable metastatic lymph nodes. It may also be helpful in diagnosing metastases and avoiding unnecessary lymph node dissection in thyroid cancer.