The nasal mucosa and submucosa likely contain both vascular beds against cold and dry air and resident immunoreactive cells against various antigens. Therefore, a specific fibrous structure seems to be necessary. Using histological specimens from 20 elderly cadavers, we examined the nasal mucosal and submucosal architecture. The ciliated columnar epithelium of the nasal mucosa was characterized by 1) a thick basal lamina, 2) few elastin-positive fibers beneath the epithelium, that was quite different from the nearby mucocutaneous junction area with a thick layer (0.3–0.8 mm) of elastic and oxytalan fibers corresponding to the skin dermis, 3) CD34-positive cells distributing diffusely in the submucosal tissue, and 4) few smooth muscle actin (SMA)-positive fibers beneath the epithelium. Some of submucosal fibrous structure appeared to express both elastin and CD34. CD34-positive arterioles were abundant beneath the ciliated epithelium, but they appeared negative for SMA antibody that cross-reacts with endothelium. Notably, the ciliated columnar epithelium was thin in the lateral wall of the nasal cavity, while the inferior concha carried the thick pseudostratified columnar epithelium.Strangely, the inferior or palatal wall of the nasal cavity was covered by the thick stratified epithelium. We found SMApositive mucosal venous plexus in the lateral wall of nasal cavity, but the submucosa was filled with glands in the inferior concha. Vascular beds might be replaced by glands in the nasal submucosa. The site-dependent difference in the mucosal morphology as well as the absence of vascular beds might be a result of secondary change with aging.

Although human lymph node architecture varies by site, the intranodal distribution of interdigitating dendritic cells (DCs) remains poorly understood. To address this, we compared the morphology of submandibular, paratracheal, mesenteric, and inguinal nodes obtained from 24 donated cadavers. Immunoreactivity was evaluated by comparing these cadaveric nodes with surgically resected lymph nodes obtained from five old-aged patients with nonmetastatic cancer.Despite the limited number of dendritic cell-specific ICAM-3–grabbing nonintegrin (DC-SIGN)–positive cells (candidate DCs) in cadaveric specimens, these tissues were deemed suitable for analysis. The submandibular and paratracheal nodes exhibited a belt-like cortex, with paracortical lymph sinus extending from the subcapsular sinus and surrounding the follicle.In contrast, the mesenteric and inguinal nodes contained multiple island-like cortices separated by thick paracortical lymph sinuses. Endothelial cells lining all lymph sinuses showed reactivity for smooth muscle actin and DC-SIGN. Macrophages and candidate DCs were abundant in the paratracheal and mesenteric node sinuses but scarce in the submandibular and inguinal nodes. Notably, the medullary sinus in the submandibular and inguinal nodes was filled with fibrous tissue, and the surrounding paracortical sinuses formed a “sea” around the island-like cortices, often resulting in loss of nodal polarization.Although the proportional area occupied by candidate DCs per nodal section was almost the same at the four sites, the overlap between DCs and macrophage clusters was small in paratracheal and inguinal nodes. The amount of afferent lymph and the retention of efferent lymph might determine the site-dependent architecture. Therefore, in aged nodes, DCs were preferentially localized in the paracortical sinus.

The occipital bone squamosa (OCS) is unique because of its double origin from both endochondral and membranous bones. The present study attempted to demonstrate the process of connection between these two bone types. We examined sagittal and frontal histological sections from 29 human fetuses with a crown-rump length ranging from 38 to 328 mm (approximately 7–39 weeks of gestational age [GA]). An initial cartilage plate appeared in the posterior side of the fourth ventricle at GA 7–8 weeks and extended inferiorly to connect with the cartilaginous basioccipital and condyle. At GA 9–10 weeks, on the superior side of the cartilage plate, membranous bone fragments appeared and adopted an arrangement resembling a chain of irregularly-shaped beads.They did not form a complete plate-like bone until late-term. At GA 11–12 weeks, endochondral ossification centers appeared at the upper and lower ends of the cartilage plate. At GA 12–15 weeks, a bar-like periosteal bone developed near and superior to the upper ossification center. Notably, sinusoidal structures, which were surrounded by growing periosteal bones, contained islandlike clusters of calcified cartilage fragments. Therefore, the upper ossification center appeared likely to “migrate” downward and become distant from membranous bones. The extending periosteal bone reached and joined the membranous bone fragments.Consequently, the periosteal bones connected between the endochondral and membranous bones in the OCS. This connection was quite different from the other components of the calvaria, where membranous bones overlap the skull base cartilages at the margin.

A 65-year-old male was diagnosed with severe aortic stenosis with an indication for surgery and referred to our department. The patient opted for aortic valve replacement using a bioprosthesis. Due to the patient's relatively small native aortic valve area, a concurrent root dilatation maneuver (Bo Yang method) was performed to prevent patient-prosthetic mismatch and to allow for the implantation of a sufficiently larger bioprosthesis, facilitating the valve-in-valve procedure. The successful implantation of an Inspiris 25-mm bioprosthesis was achieved. Post-operative 3D-computed tomography revealed no tilting or misalignment of the bioprosthesis, and a properly sized, undistorted Valsalva sinus was observed. Aortic valve replacement using the Bo Yang root enlargement technique is considered a promising alternative for relatively younger patients requiring aortic valve intervention.

Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

In an attempt to clarify the function of the suboccipital muscles, we performed morphological observation of the suboccipital muscles for variations in the muscle belly and compared the morphology of their muscle fibers in terms of cross-sectional area by immunostaining with anti-myosin heavy chain antibodies. The cadavers of 25 Japanese individuals were used: 22 for morphological examinations and three for histological examinations. Among samples of the rectus capitis posterior major muscle (RCPma) and rectus capitis posterior minor muscle (RCPmi), 86.4% had a typical muscle appearance with a single belly, and 13.6% had an anomalous morphology. None of the samples of the obliquus capitis superior (OCS) or obliquus capitis inferior (OCI) muscles had an anomalous appearance. Measurement of cross-sectional area revealed that fast-twitch muscle fibers in the RCPma and OCI had a significantly greater cross-sectional area than those of the RCPmi and OCS. The cross-sectional area of intermediate muscle fibers was also significantly greater in the OCS than in the RCPma, RCPmi, and OCI. The cross-sectional area of slow-twitch muscle fibers was significantly greater in the OCS than in the RCPma, RCPmi, and OCI, and the RCPmi showed a significantly greater cross-sectional area for slow-twitch muscle fibers than did the RCPma, and OCI. Our findings indicate that the RCPmi and OCS exert a greater force than the RCPma and OCI, and act as anti-gravity agonist muscles of the head. Prolonged head extension in individuals with anomalous suboccipital muscle groups could result in dysfunction due to undue stress.
Antibodies ; Asian Continental Ancestry Group ; Cadaver ; Classification* ; Head ; Headache ; Humans ; Muscle Fibers, Fast-Twitch ; Muscle Fibers, Slow-Twitch ; Muscles

Objectives: This study aimed to describe the experiences of bereaved family members of cancer patients in terms of regret in relation to ending terminal treatment for the patient. Methods: We conducted a semi-structured qualitative interview of 37 bereaved family members regarding their decision-making and their psychological adjustment from the time they made the decision to terminate treatment. Interviews were analyzed using qualitative content analysis. Results: Approximately 40% of bereaved family members reported that they had some regrets about their decision. Regret contents were classified into 8 categories and diversified from 4 categories at the time of decision-making to 7 categories after the death. The reasons for regret were classified into 43 categories. Common factors that minimized regret included situations at the time when they made the decision, such as patient- and family-specific factors and relationship with the medical staff. In comparison, the common reasons for regret centered on factors related to the approach for decision-making, such as the process, options, as well as psychological coping and relationships with medical staff. Conclusion: The results suggest that regret in the bereaved could be modified by understanding the relationship between regret characteristics and psychological coping.

Background:Capecitabine and irinotecan combination therapy (XELIRI) has been examined at various dose levels to treat metastatic colorectal cancer (mCRC). Recently, in the Association of Medical Oncology of the German Cancer Society (AIO) 0604 trial, tri?weekly XELIRI plus bevacizumab, with reduced doses of irinotecan (200mg/m2 on day 1) and capecitabine (1600mg/m2 on days 1–14), repeated every 3weeks, has shown favorable tolerability and effcacy which were comparable to those of capecitabine and oxaliplatin (XELOX) plus bevacizumab. The doses of capecit?abine and irinotecan in the AIO trial are considered optimal. In a phase I/II study, XELIRI plus bevacizumab (BIX) as second?line chemotherapy was well tolerated and had promising effcacy in Japanese patients. Methods:The Asian XELIRI ProjecT (AXEPT) is an East Asian collaborative, open?labelled, randomized, phase III clinical trial which was designed to demonstrate the non?inferiority of XELIRI with or without bevacizumab versus standard FOLFIRI (5?lfuorouracil, leucovorin, and irinotecan combination) with or without bevacizumab as second?line chemo?therapy for patients with mCRC. Patients with 20years of age or older, histologically conifrmed mCRC, Eastern Coop?erative Oncology Group performance status 0–2, adequate organ function, and disease progression or intolerance of the ifrst?line regimen will be eligible. Patients will be randomized (1:1) to receive standard FOLFIRI with or with?out bevacizumab (5mg/kg on day 1), repeated every 2weeks (FOLIRI arm) or XELIRI with or without bevacizumab (7.5mg/kg on day 1), repeated every 3weeks (XELIRI arm). A total of 464 events were estimated as necessary to show non?inferiority with a power of 80% at a one?sided α of 0.025, requiring a target sample size of 600 patients. The 95% conifdence interval (CI) upper limit of the hazard ratio was pre?speciifed as less than 1.3. Conclusion:The Asian XELIRI ProjecT is a multinational phase III trial being conducted to provide evidence for XELIRI with or without bevacizumab as a second?line treatment option of mCRC.

Purpose: The aim of this study was to clarify the experience of the bereaved families at the time of death of a patient. Methods: A cross-sectional nationwide survey of the bereaved families of cancer patients was performed at 95 palliative care units in Japan in 2007. Results: Of the 670 questionnaires sent to bereaved families, 492 were returned (73%). There were no significant differences between the level of the families' emotional distress and which doctor pronounced the death and whether the doctor was present at the moment of patients' death. Regarding the perceived need for improvement in the care of a dying patient, there were significant differences with respect to which doctor pronounced a patient's death and whether the doctor was present at the moment of a patient's death. There ware no significant differences between the attendance by doctor at the moment of patient's death and no attendance with frequent visit on that day. Conclusion: The bereaved families desire the patient's primary doctor to be present at the time of death and to then pronounce the death. However, the bereaved families consider an appropriate manner as the frequent visit by doctor on patient's last day even if the doctor do not attend at the moment of patient's death. Palliat Care Res 2010; 5(2): 162-170