Prevalent founder mutation c.736T>A of LIPH in autosomal recessive woolly hair of Japanese leads to variable severity of hypotrichosis in adulthood

BACKGROUND

Mutations in LIPH are a cause of autosomal recessive woolly hair (ARWH). Homozygous c.736T>A (p.Cys246Ser), and compound heterozygous c.736T>A and c.742C>A (p.His248Asn) have been reported in 5 and 7 Japanese children with ARWH respectively. The severity of hypotrichosis is known to be able to change in the clinical course, and the mutation patterns of LIPH do not always correlate with the severity of hypotrichosis in ARWH caused by other mutation sites of LIPH. However, all 12 Japanese children previously reported to have ARWH have shown similar severity of hypotrichosis.

OBJECTIVE

In this study, we investigated the clinical features and molecular basis of ARWH in patients including three adults (three adults and two children) from five non-related Japanese families.

METHODS

Five families of Japanese origin that presented with woolly hair were studied. The phenotype was confirmed by clinical examination. Direct automated DNA sequencing of the LIPH gene was performed to identify the mutations in our probands.

RESULTS

All patients had had woolly hair since birth. Homozygous c.736T>A mutations were found in four patients, including three adult cases, and compound heterozygous c.736T>A and c.742C>A mutations were found in one child patient. The two adults and two children had only sparse scalp hair, although one adult woman had mild hypotrichosis with long hairs.

CONCLUSION

Some patients with homozygous c.736T>A can have a mild hypotrichosis phenotype with long hairs in adulthood.

Growth factor signalling in the regulation of α-cell fate

Glucagon plays critical roles in regulating glucose homeostasis, mainly by counteracting the effects of insulin. Consequently, the dysregulated glucagon secretion that is evident in type 2 diabetes has significant implications in the pathophysiology of the disease. Glucagon secretion from pancreatic α-cells has been suggested to be modulated by blood glucose, signals from the nervous system and endocrine components. In addition to these regulators, intraislet factors acting in a paracrine manner from neighbouring β-cells are emerging as central modulator(s) of α-cell biology. One of the most important of these paracrine factors, insulin, modulates glucagon secretion. Indeed, the α-cell-specific insulin receptor knockout (αIRKO) mouse manifests hypersecretion of glucagon in the postprandial stage and exhibits defective secretion in fasting-induced hypoglycaemia, together mimicking the α-cell defects observed in type 2 diabetes. Interestingly, αIRKO mice display a progressive increase in β-cell mass and a concomitant decrease in α-cells. Lineage trace analyses reveal that the new β-cells originate, in part, from the insulin receptor-deficient α-cells indicating a critical role for α-cell insulin signalling in determining β-cell origin. Our studies also reveal that glucagon-like peptide-1 (GLP-1) treatment of αIRKO mice suppresses glucagon secretion despite absence of functional insulin receptors precluding a role for insulin in GLP-1 action on α-cells in this model. These findings highlight the significance of insulin signalling in the regulation of α-cell biology.

Pyoderma gangrenosum of the eyelid: report of two cases and review of the literature

Pyoderma gangrenosum (PG) of the eyelid is extremely rare, and its proper management is essential for the preservation of visual function. Here, we report 2 cases of PG of the eyelid with intraorbital involvement. In both cases, the skin and intraorbital lesions improved after systemic immunosuppressive therapies; however, corneal perforation occurred in 1 case. In order to assess the clinical features of PG of the eyelid and to obtain clues for optimal treatment, we reviewed 15 well-documented cases in the literature, including the present cases. Corneal perforation occurred in 4 cases and defective ocular motility in 1 case. Three patients eventually underwent enucleation of the affected eye. Our cases and the literature review clearly indicate that MRI is a powerful tool for evaluating the extent of extracutaneous PG lesions around the eye and that early diagnosis and immediate immunosuppressive therapy are crucial for the preservation of visual acuity.

Mocvd Growth of GaAs on Si

The initial stage of the growth of GaAs on Si by, MOCVD, the reduction of the residual dislocations by annealing at high temperatures and the dependence of the growth temperature on the stress in the GaAs layer were studied. The density and the size of deposited GaAs islands at the initial stage of the growth in the two-step growth sequence strongly affected the domain property of the subsequently grown layer. For reducing the residual dislocations by annealing at high temperatures, to repeat the growth and the annealing was more effective method compared with the other annealing methods we tried. The stress in the GaAs layers showed a constant value independently of the growth temperature and the value was related to the thermal expansion between room temperature and about 350°C.

Growth of GaAs on Si and its Application to FETs and LEDs

In recent years, the heteroepitaxial growth of GaAs layers on Si substrates has been gained an increasing interest [1 - 14]. GaAs is one of the most important III-V materials and has been well studied and used for optical and electrical devices. On the other hand, with Si we have large size wafers of superior quality and sophisticated technologies and Si is a main material for semiconductor industries. Therefore, GaAs/Si system has possibilities for realizing new types of functional devices or ICs with GaAs and Si devices. This system, however, has two serious problems. One is the large lattice mismatch of about 4 % between these materials and the other is the polar on nonpolar problem i.e., the formation of an antiphase domain disorder. It was reported that when (211)-oriented Si substrates were used, there was no problem of the formation of an antiphase domain structure 5. For growing materials on lattice mismatched substrates, it was reported that the thin layers deposited at low temperatures were effective to relax the lattice mismatches for the systems such as SiC on Si[15] and Si on saphire [16]. In GaAs/Si system, the Ge buffer layer has been used to relax the lattice mismatch[17 - 22] It was also reported that the composite strained layer superlattice with GaP/GaAsP and GaAsP/GaAs was very effective as a buffer layer[23 - 25].

Optical & Electronic Properties of Carbon Nitride Thin Films

We have deposited carbon nitride (CNx) films by magnetron sputtering at varying nitrogen pressures and substrate temperatures. The films were deposited on silicon and quartz substrates simultaneously. The incoming ion energy was controlled by a radio frequency power supply. A magnet in front of the substrate holder was used to enhance the plasma density. The films deposited at room temperature (RT) were found to have nitrogen content of ≥ 40%. These films were semiconducting with an optical bandgap of greater than 2 eV and a RT resistivity of 1012 Ω-cm. Films deposited at low nitrogen pressure (< 7 mtorr), at RT and in the presence of a 15 mtesla magnetic field were found to be hard and also exhibited extremely high elastic recovery. The most interesting result we found was that the hard and elastic CN films were also semiconducting with an optical band gap of 1.7 eV, RT resistivity of 107 Ω-cm and an activation energy of 0.8 eV. In all cases the CN films were almost entirely sp2 bonded.

Abstract P2-02-01: Characterization of the Breast Lesions by Biexponential Signal Attenuation Analysis of Diffusion-Weighted Magnetic Resonance Images

Purpose: Signal attenuation of diffusion-weighted magnetic resonance images (DWI) in vivo with high b-values is sometimes non-linear when plotted with a semilogarithmic function, but it fits well with the biexponential equation, Sb/S0=f1exp(bD1) + (1-f1)(bD2). Others have indicated that the fast and slow component fractions (f1, 1-f1) of the apparent diffusion coefficients (D1, D2) can be derived by biexponential fitting, and that these fractions correspond to actual diffusion components in the extra-and intracellular space. Here, we investigated the clinical value of DWI for breast screening by performing multi b-factor DWI on healthy volunteers and patients. We then analyzed signals by fitting them with the biexponential equation and compared the fitting parameters of breast lesions.

Patients and methods: This study was approved by our center's institutional review board and all patients and volunteers gave their informed consent. We analyzed data from eight healthy females (controls) and 80 female patients with a total of 100 breast tumors (42 benign and 58 malignant). We performed DWI using 12 and 6 b-values for the controls and patients up to a maximum b-value of 3500 sec/mm2.

Results: We identified the DWI signal attenuation features of the normal mammary gland, and of benign and malignant tumors [Figure1]. The DWI signal attenuation was similar between some proliferative benign tumors and malignancies. A comparison of the parameters derived from biexponential fitting revealed a significant difference in f1 between noninvasive and invasive ductal carcinoma [Figure 2]. Conclusion: The biexponential fitting parameters might reflect the features of tumor cellularity. Thus, to distinguish malignant from benign breast tumors only by DWI is difficult due to the pathological diagnosis that rather emphasizes cell configuration or shape rather than cellularity. Nevertheless, our findings will help to understand why malignant tumors present as high signal intensity in DWI.

Identification and expression analysis of connexin-45 and connexin-60 as major connexins in porcine oocytes

During mammalian oogenesis, intercellular communication between oocytes and the surrounding follicle cells through gap junction channels is crucial for oocyte development and maturation. The channel properties of gap junctions may be affected by the composition or combination of connexins, the expression of which is regulated by gonadotropins and other factors. Thus, identification and expression analysis of connexin genes in oocytes and follicle cells will help us to better understand how oogenesis and folliculogenesis are regulated in a species-specific manner in mammals. We previously reported the spatiotemporal expression of multiple connexin genes in porcine follicle cells. Here, we searched for connexin genes specifically expressed in porcine oocytes that may be involved in the formation of gap junctions between oocytes and follicle cells. To achieve this, we constructed an oocyte-specific cDNA library to identify which connexin genes are expressed in these cells and found that gap junction protein, alpha 10, which encodes connexin-60, and a porcine ortholog of mouse gap junction protein, gamma 1 encoding connexin-45, are the major connexins expressed in porcine oocytes during folliculogenesis. Immunostaining and in situ hybridization of sectioned porcine ovaries confirmed oocyte expression of these genes at 3 different stages of ovary development. Furthermore, their gap junction channel activity was assessed using a heterologous cell system. However, gap junction protein, alpha 4, which encodes connexin-37 and is expressed in the oocytes of several other mammals, was undetectable. We demonstrate that there is diversity in the connexin genes expressed in mammalian oocytes, and hence in the gap junctions connecting oocytes and cumulus cells.

[Effect of a comprehensive image processing on radiologists' performance in differential diagnosis of liver lesions using CT and MRI]

PURPOSE

To evaluate whether a comprehensive image processing method as CAD using CT and MRI can improve the radiologists' diagnosis performance in the differentiation of focal liver lesions.

METHOD AND MATERIALS

A clinical image database used in this study consists of 14 cases of each lesion including hepatic cysts, hepatocellular carcinoma (HCC), metastatic liver cancer, and hemangioma. This technique by using MR images obtained with various imaging sequences and a series of dynamic MR and dynamic CT images is designed for the enhancement of liver lesions pixel by pixel. In this method, we make the pixel sizes of MR images the same size of CT image by using tri-linear interpolation technique. Then the 3D image registration technique based on mutual information is applied for the matching of images. The image intensity pattern with and without contrast enhancement is determined as the template for the differential detection of each lesion. Pixel-by-pixel cross-correlation coefficient is calculated for the enhancement of each lesion. The radiologists' performance in distinguishing between the liver lesion was evaluated by receiver operating characteristic analysis (ROC) with a continuous rating scale.

RESULTS

In free-response ROC analysis, true positive fractions were 75%, 87%, 85%, and 86% for hepatic cysts, HCC, metastatic liver cancer and hemangioma, respectively. Furthermore, average number of false positive and false negatives per image was 3.4 and 0.3, respectively. When radiologists made differential diagnosis of the liver lesions with the images of this technique, diagnostic accuracy was statistically significantly improved compared to the diagnostic accuracy without the images of this technique. The average area under the ROC curve (Az value) improved from 0.881 to 0.964 (p=0.069) for the differential diagnosis of hepatic cysts. Furthermore, the Az value of HCC, metastatic liver cancer, and hemangioma improved from 0.951 to 0.979 (p=0.040), from 0.946 to 0.976 (p=0.226), and from 0.966 to 0.987(p=0.045), respectively.

CONCLUSION

A comprehensive image processing method as CAD using CT and MRI can improve the radiologists' diagnostic performance in the differentiation of focal liver lesions. CLINICAL RELEVANCE/APPLICATION: This method improved the performance of differential detection of liver lesions from a large number of images and it would save radiologists' reading time, and thus could assist their diagnosis.

Left-sided ICD implantation via right-sided venous access in a patient with left hemodialysis fistula

A sufficient patency of the central vein ipsilateral to atriovenous fistula is the lifeline for hemodialysis patients. We describe a case with left dialysis fistula who underwent left-sided pectoral implantation of an implantable cardioverter defibrillator via right subclavicular venous access in order to avoid the possibility of development of left subclavian stenosis or occlusion and to achieve lower defibrillation thresholds. This approach may serve as an alternative choice in patients unsuitable for left-sided venous access and with higher defibrillation thresholds on right-positioned implantable cardioverter defibrillator.

Long-term results of Tokyo Children's Cancer Study Group trials for childhood acute lymphoblastic leukemia, 1984-1999

We report the long-term results of Tokyo Children's Cancer Study Group's studies L84-11, L89-12, L92-13, and L95-14 for 1846 children with acute lymphoblastic leukemia, which were conducted between 1984 and 1999. The value of event-free survival (EFS)+/-s.e. was 67.2+/-2.2% at 10 years in L84-11, which was not improved in the following two studies, and eventually improved to 75.0+/-1.8% at 10 years in L95-14 study. The lower EFS of the L89-12 reflected a high rate of induction failure because of infection and delayed remission in very high-risk patients. The L92-13 study was characterized by short maintenance therapy; it resulted in poor EFS, particularly in the standard-risk (SR) group and boys. Females did significantly better than males in EFS in the early three studies. The gender difference was not significant in overall survival, partly because >60% of the males survived after the testicular relapse. Randomized studies in the former three protocols revealed that intermediate- or high-dose methotrexate therapy significantly reduced the testicular relapse rate. In the L95-14 study, gender difference disappeared in EFS. Contrary to the results of larger-scale studies, the randomized control study in the L95-14 reconfirmed with updated data that dexamethasone 8 mg/m(2) had no advantage over prednisolone 60 mg/m(2) in the SR and intermediate-risk groups. Prophylactic cranial irradiation was assigned to 100, 80, 44, and 44% of the patients in the studies, respectively. Isolated central nervous system relapse rates decreased to <2% in the last two trials. Secondary brain tumors developed in 12 patients at 8-22 years after cranial irradiation. Improvement of the remission induction rates and the complete omission of irradiation are currently main objectives in our studies.

Near-full-length REV3L appears to be a scarce maternal factor in Xenopus laevis eggs that changes qualitatively in early embryonic development

REV3 is the catalytic subunit of DNA polymerase zeta (pol zeta), which is responsible for the damage-induced mutagenesis that arises during error-prone translesion synthesis in eukaryotes. The related REV3L genes in human and mouse encode proteins of approximately 350kDa, twice as large as yeast REV3, but full-length REV3L has not been identified in any vertebrate cell. We report that Xenopus laevisREV3L encodes a 352-kDa protein that has high overall amino acid sequence similarity to its mammalian counterparts, and, for the first time in a vertebrate species, we have detected putative REV3L polypeptides of 300 and 340kDa in X. laevis oocytes. Only the 300-kDa form is stored in eggs, where its concentration of about 65pM is much lower than those of other replication and repair proteins including the accessory pol zeta subunit REV7. In fertilized eggs, the levels of this polypeptide did not change until neurula; the larger 340-kDa form first appeared at stages after gastrula, suggesting a pattern of regulation during development. These observations indicate the existence of REV3L as a scarce protein, of approximately the full predicted size, whose level may impose severe constraints on the assembly of pol zeta in X. laevis.

Awareness of early warning signs and help-seeking behaviours among patients with schizophrenia who utilize social rehabilitation facilities in Japan

The purpose of this study was to examine the relationship between early warning signs (EWS) and early help-seeking behaviours (HSB) and to identify the characteristics of patients with schizophrenia who sought early help. A cross-sectional study was carried out in 2004 using a self-reported questionnaire. Participants were recruited from social rehabilitation facilities for the mentally ill; 224 subjects participated, 170 of whom had schizophrenia. The survey included questions about demographic characteristics, self-care behaviours (HSB, recognition of EWS and others) and current service utilization and satisfaction. Fisher's exact test and Student's t-test were used to compare the characteristics of study participants. Logistic regression analyses were used to examine the association between recognition of EWS and early HSB.We found that 96 (56.5%) of 170 patients with schizophrenia reported at least one occasion of early HSB during their deterioration. Early HSB were related to the following factors: recognition of EWS, consultation with non-professional and professional support persons during deterioration, consulting with public mental health workers and living with family. Care and support should be offered to patients with schizophrenia to enable them to recognize their own mental deterioration.

FLG mutation p.Lys4021X in the C-terminal imperfect filaggrin repeat in Japanese patients with atopic eczema

BACKGROUND

Mutations in the gene encoding filaggrin (FLG) have been shown to predispose to atopic eczema (AE).

OBJECTIVES

Further to establish population genetics of FLG mutations in the Japanese population and to elucidate effects of FLG mutations to filaggrin biosynthesis in skin of patients with AE.

METHODS

We searched for FLG mutations in 19 newly recruited Japanese patients with AE. We then screened 137 Japanese patients with AE and 134 Japanese control individuals for a novel mutation identified in the present study. In addition, we evaluated FLG mRNA expression by real-time reverse transcription-polymerase chain reaction and profilaggrin/filaggrin protein expression by immunohistochemical staining in the epidermis of the patients carrying the novel mutation.

RESULTS

We identified a novel FLG nonsense mutation c.12069A>T (p.Lys4021X) in one patient with AE. Upon further screening, p.Lys4021X was identified in four patients with AE (2.9% of all the patients with AE). In total, there are at least eight FLG variants in the Japanese population. Here we show that about 27% of patients in our Japanese AE case series carry one or more of these eight FLG mutations and these variants are also carried by 3.7% of Japanese general control individuals. There is a significant statistical association between the eight FLG mutations and AE (chi(2) P = 6.50 x 10(-8)). Interestingly, the present nonsense mutation is in the C-terminal incomplete filaggrin repeat and is the mutation nearest the C-terminal among previously reported FLG mutations. Immunohistochemical staining for filaggrin revealed that this nonsense mutation leads to remarkable reduction of filaggrin protein expression in the patients' epidermis.

CONCLUSIONS

We clearly demonstrated that FLG mutations are significantly associated with AE in the Japanese population. The present results further support the hypothesis that the C-terminal region is essential for proper processing of profilaggrin to filaggrin.

Presence of platelet-associated anti-glycoprotein (GP)VI autoantibodies and restoration of GPVI expression in patients with GPVI deficiency

BACKGROUND

Glycoprotein (GP)VI deficiency is a rare platelet disorder with a mild bleeding tendency. However, its pathophysiology remains unclear.

OBJECTIVES

We characterized a novel GPVI-deficient patient with immune thrombocytopenic purpura and searched for the presence of anti-GPVI autoantibodies in this and another patient with GPVI deficiency.

METHODS AND RESULTS

A 12-year-old Japanese girl (case 1) with moderate thrombocytopenia and mild bleeding showed selectively impaired collagen-induced platelet aggregation. Flow cytometric analysis indicated that the patient had a defect in the expression of GPVI-FcRgamma. An eluate of her platelet-associated IgG contained anti-alpha(IIb)beta3 autoantibodies. Moreover, using GPVI-FcRgamma-transfected cells, we unexpectedly identified anti-GPVI antibodies against the soluble ectodomain of GPVI in the eluate, despite the patient's GPVI deficiency. In contrast, anti-GPVI antibodies were not detectable in her plasma. In another case of GPVI deficiency (case 2) without detectable plasma anti-GPVI antibodies, we again detected platelet-associated anti-GPVI antibodies. In a 2-year follow-up of case 1, the platelet count increased to within the normal range and the bleeding tendency improved. Interestingly, GPVI was again expressed on her platelets, in association with a decrease in the relative amount of anti-GPVI antibodies.

CONCLUSIONS

This is the first demonstration of platelet-associated anti-GPVI antibodies in GPVI-deficient subjects, in one case with spontaneous restoration of GPVI expression. These results strongly suggest an autoimmune mechanism in GPVI deficiency.

Increased insulin demand promotes while pioglitazone prevents pancreatic beta cell apoptosis in Wfs1 knockout mice

AIMS/HYPOTHESIS

The WFS1 gene encodes an endoplasmic reticulum (ER) membrane-embedded protein called Wolfram syndrome 1 protein, homozygous mutations of which cause selective beta cell loss in humans. The function(s) of this protein and the mechanism by which the mutations of this gene cause beta cell death are still not fully understood. We hypothesised that increased insulin demand as a result of obesity/insulin resistance causes ER stress in pancreatic beta cells, thereby promoting beta cell death.

METHODS

We studied the effect of breeding Wfs1 ( -/- ) mice on a C57BL/6J background with mild obesity and insulin resistance, by introducing the agouti lethal yellow mutation (A ( y ) /a). We also treated the mice with pioglitazone.

RESULTS

Wfs1 ( -/- ) mice bred on a C57BL/6J background rarely develop overt diabetes by 24 weeks of age, showing only mild beta cell loss. However, Wfs1 ( -/- ) A ( y ) /a mice developed selective beta cell loss and severe insulin-deficient diabetes as early as 8 weeks. This beta cell loss was due to apoptosis. In Wfs1 ( +/+ ) A ( y ) /a islets, levels of ER chaperone immunoglobulin-binding protein (BiP)/78 kDa glucose-regulated protein (GRP78) and phosphorylation of eukaryotic translation initiation factor 2, subunit alpha (eIF2alpha) apparently increased. Levels of both were further increased in Wfs1 ( -/- ) A ( y ) /a murine islets. Electron micrography revealed markedly dilated ERs in Wfs1 (-/-) A ( y ) /a murine beta cells. Interestingly, pioglitazone treatment protected beta cells from apoptosis and almost completely prevented diabetes development.

CONCLUSIONS/INTERPRETATION

Wfs1-deficient beta cells are susceptible to ER stress. Increased insulin demand prompts apoptosis in such cells in vivo. Pioglitazone, remarkably, suppresses this process and prevents diabetes. As common WFS1 gene variants have recently been shown to confer a risk of type 2 diabetes, our findings may be relevant to the gradual but progressive loss of beta cells in type 2 diabetes.

Discrimination between His-bundle and the right bundle branch during electrophysiologic studies

BACKGROUND

The purpose of this study was to identify the His-bundle (HB) versus right bundle branch (RBB) during electrophysiologic studies, using the V3 phenomenon, and to compare the timing of HB versus RBB potentials of sinus cycles (His-ventricular [H-V] interval).

METHODS

The study enrolled 16 patients without structural heart disease, who underwent electrophysiologic studies during which the H-V interval was within normal limits and the V3 phenomenon was induced during recordings of the HB and the RBB potentials by a multi-electrode catheter. The recording site of the earliest HB potential just before the V3 phenomenon was defined as the branching portion of His bundle (HBBP), the site immediately proximal to the HBBP as the HB, and the site immediately distal to the HBBP as the RBB.

RESULTS

The HBBP was identified in all patients. In all cases but one patient, the H-V interval measured at the HB adjacent to the HBBP was > or =35 ms. However, in 12 patients, the H-V interval measured at the RBB adjacent to the HBBP was also > or =35 ms.

CONCLUSIONS

The electrophysiologic identification of HB versus RBB by simultaneous recordings of HB and RBB potentials during induction of the V3 phenomenon was feasible. When the discrimination between HB and RBB was based on the measurement of the H-V interval, the proximal portion of the RBB was frequently misidentified as the HB.

A severe and refractory case of anti-p200 pemphigoid resulting in multiple skin ulcers and scar formation

Anti-p200 pemphigoid is a recently described autoimmune blistering skin disease that is characterized by the presence of autoantibodies against an unidentified 200-kDa dermal autoantigen. Most of the previous cases have been successfully treated using mild-to-moderate immunosuppressive therapies, which resulted in a good prognosis. We report here a severe and refractory case of anti-p200 pemphigoid that developed in a 53-year-old woman, in which blisters led to multiple skin ulcers, followed by severe scar formation. In the present case, methylprednisolone pulse therapy was effective enough to reduce the disease activity.

ABF1-binding sites promote efficient global genome nucleotide excision repair

Global genome nucleotide excision repair (GG-NER) removes DNA damage from nontranscribing DNA. In Saccharomyces cerevisiae, the RAD7 and RAD16 genes are specifically required for GG-NER. We have reported that autonomously replicating sequence-binding factor 1 (ABF1) protein forms a stable complex with Rad7 and Rad16 proteins. ABF1 functions in transcription, replication, gene silencing, and NER in yeast. Here we show that binding of ABF1 to its DNA recognition sequence found at multiple genomic locations promotes efficient GG-NER in yeast. Mutation of the I silencer ABF1-binding site at the HMLalpha locus caused loss of ABF1 binding, which resulted in a domain of reduced GG-NER efficiency on one side of the ABF1-binding site. During GG-NER, nucleosome positioning at this site was not altered, and this correlated with an inability of the GG-NER complex to reposition nucleosomes in vitro.We discuss how the GG-NER complex might facilitate GG-NER while preventing unregulated gene transcription during this process.

A review of the distribution of the arterial and venous vasculature of the diaphragm and its clinical relevance

The diaphragm is the major respiratory muscle of the body. As it plays such a vital role, a continuous arterial and venous blood supply is of the utmost importance. It is therefore not surprising to find described in the literature a complex system of anastomoses that contributes to the maintenance of this muscle's life-preserving contraction. Understanding the anatomy of the diaphragm and any divergence in its vasculature is literally vital to humanity. In the light of this, we review the literature on the blood supply to the diaphragm, with specific emphasis on the recent description of the inferior phrenic vessels and the superior phrenic artery, summarize the clinical significance of the diaphragmatic vasculature and suggest future avenues of study to further expand on this current body of knowledge.