Satiety effect and sympathetic activation of leptin are mediated by hypothalamic melanocortin system

Leptin is an adipocyte-derived blood-borne satiety factor that decreases food intake and increases energy expenditure, thereby leading to a substantial decrease in body weight. To explore the possible roles of the hypothalamic melanocortin system in leptin action, we examined the effects of intracerebroventricular (i.c.v.) injection of leptin with or without SHU9119, a potent antagonist of alpha-melanocyte stimulating hormone, on food intake, body weight, and mitochondrial uncoupling protein-1 (UCP-1) mRNA expression in the brown adipose tissue (BAT) in rats. A single i.c.v. injection of leptin decreased cumulative food intake and body weight gain, and increased UCP-1 mRNA expression during 3 h at the onset of the dark phase. Inhibition of food intake and body weight change with leptin was reversed by co-injection of SHU9119 in a dose-dependent manner. Co-injection of SHU9119 also inhibited completely the leptin-induced increase in UCP-1 mRNA expression in the BAT. Treatment with SHU9119 alone did not affect food intake, body weight, and UCP-1 mRNA expression in rats. The present study provides evidence that the hypothalamic melanocortin system plays a central role in both satiety effect and sympathetic activation of leptin.

Involvement of apoptosis and cyclin D1 gene repression in growth inhibition of T-47D human breast cancer cells by methylglyoxal bis(cyclopentylamidinohydrazone)

Polyamines are considered to be important intracellular molecules for the proliferation of the cancer cells. In this study, effects of methylglyoxal bis(cyclopentylamidinohydrazone) (MGBCP), a potent inhibitor of the polyamine biosynthetic pathway, on the growth and cell cycle of T-47D human breast cancer cells were investigated. MGBCP dose-dependently inhibited the growth of T-47D cells, in which the contents of spermine, spermidine and putrescine decreased concomitantly. The gene expression of cyclin D1 was also repressed by the MGBCP treatment. The MGBCP-treated cells clearly exhibited morphological changes indicating the blebbing and chromatin condensation which are characteristic of apoptosis. Flow cytometric analysis showed hypo-diploid subpopulations due to apoptotic cells, and characteristic oligonucleosomal-sized DNA fragments were clearly observed for MGBCP-treated cells as the concentration of the drug was increased. These findings suggest that the inhibition of polyamine synthesis results in the repressions of cyclin D1 expression and cell cycle progression, eventually inducing apoptosis in these human breast cancer cells.

Quantity of prelocalized maternal factor is associated with the timing of initiation of an epidermis-specific gene expression of the ascidian embryo

We produced half-egg-volume ascidian embryos by dividing the unfertilized egg of Halocynthia roretzi at the equatorial plane, and investigated the timing of the initiation of the expression of three tissue-specific genes, a muscle-specific actin gene HrMA4, a notochord-specific gene As-T and an epidermis-specific gene HrEpiC in the half-egg-volume embryos of the animal side and those of the vegetal side. The timing of the onset of HrMA4 and As-T expression in both the animal- and vegetal-half embryos and that of HrEpiC expression in the animal-half embryos were essentially the same as that of normal embryos. In contrast, the timing of HrEpiC expression in the vegetal-half embryos was delayed by one division cycle compared with the normal embryos. This delay was partially recovered by increasing the amount of unfertilized egg cytoplasm of the animal hemisphere, suggesting that the timing of HrEpiC expression is regulated by the amount of a maternal factor which is distributed abundantly in the animal hemisphere of the unfertilized egg.

Expression of an ascidian gene in the tip of the tail of tail-bud-stage embryos

The occurrence of tadpole-type larvae is one of the key events used to understand the origin and evolution of chordates, and the tail bud of chordate embryos is thought to be associated with formation of the tip of the tail. Although some transcriptional factor genes including Brachyury are expressed in the tail bud, no structural genes have been reported to be expressed there. We report here that an ascidian gene HrTT-1 is expressed exclusively in the tip of elongating tail of the tail-bud embryo. This gene encodes a possible secreted protein of 415 amino acids with the SCP/TPX family consensus sequences.

A negative component on event related potential recorded in the drowsy state

Behavior of event related potential (ERP) components in the drowsy state was examined in nine subjects using oddball paradigm. A component with peak latency of 300 msec, N300, was superimposed on ERP in the drowsy state. N300 appeared also in stage 1 of NREM sleep and closely resembled vertex sharp wave evoked by sound stimulation in both scalp distribution and peak latency. It was suggested that N300 recorded in the drowsy state and vertex sharp wave recorded in stage 1 of NREM sleep are generated by the identical synchronizing mechanism in the brain.

The significance of the Trp 64 Arg mutation of the beta3-adrenergic receptor gene in impaired glucose tolerance, non-insulin-dependent diabetes mellitus, and insulin resistance in Japanese subjects

It has been reported that the Trp 64 Arg mutation of the human beta3-adrenergic receptor (beta3-AR) gene is related to an earlier age of onset of non-insulin-dependent diabetes mellitus (NIDDM) and features of insulin resistance and weight gain in morbidly obese patients. However, such findings have not been consistent in varying ethnic populations. In the present study, we investigated the frequency of the Trp 64 Arg mutation of the human beta3-AR gene in Japanese control subjects (n = 253) and in NIDDM (n = 314) and impaired glucose tolerance (IGT) patients (n = 100). We compared the frequency of the mutation with the body-mass index (BMI) in these groups and with the metabolic clearance rate (MCR) of glucose in the NIDDM patients. A Trp 64 Arg mutation was observed in 36.7%, 31.6%, and 37.0% of the control, NIDDM, and IGT subjects, respectively. The frequency of the homozygotes for the mutation was 4.3%, 4.8%, and 3.0%, respectively. Neither the genotype frequency (Trp/Arg, Arg/Arg) nor the frequency of the mutated allele was significantly different among the three groups. The BMI of the subjects with the mutation was not significantly higher than that of the subjects without the mutation in each group. Furthermore, the allele frequency (A) was not different among the subjects with different BMIs (BMI < 22.0, 22.0 < or = BMI < or = 26.4, BMI > 26.4) in each group. In a separate group of NIDDM patients, the MCR of the subjects with intermediate BMIs (22.0 < or = BMI < or = 26.4) with the mutation tended to be lower than that of those without the mutation. In addition, the MCR of the subjects with the mutation in this group was significantly lower compared with that of those with a BMI less than 22. These results indicate that the Trp 64 Arg mutation of the beta3-AR gene may not contribute to the development of NIDDM or be a determinant of obesity in the Japanese population. However, the mutation may contribute to insulin resistance in NIDDM patients with an intermediate BMI.

Some sensory stimuli generate spontaneous K-complexes

The present study was performed in order to determine whether spontaneous K-complex are induced by sensory stimuli. Electroencephalogram (EEG) segments in stage 2 sleep containing an evoked K-complex or spontaneous K-complex were separately averaged with respect to the peak of N300, one of the main components constituting the K-complex. Small negative and positive components were found immediately before the main components of spontaneous K-complex in averaged EEG. These two components were judged to correspond to N100 and P200 induced by the sound stimulus. The present findings suggest that the spontaneous K-complex is not a spontaneous phenomenon but that it is induced by sensory stimuli.

Tripartite organization of the ancestral chordate brain and the antiquity of placodes: insights from ascidian Pax-2/5/8, Hox and Otx genes

Ascidians and vertebrates belong to the Phylum Chordata and both have dorsal tubular central nervous systems. The structure of the ascidian neural tube is extremely simple, containing less than 400 cells, among which less than 100 cells are neurons. Recent studies suggest that, despite its simple organization, the mechanisms patterning the ascidian neural tube are similar to those of the more complex vertebrate brain. Identification of homologous regions between vertebrate and ascidian nervous systems, however, remains to be resolved. Here we report the expression of HrPax-258 gene: an ascidian homologue of vertebrate Pax-2, Pax-5 and Pax-8 genes. Molecular phylogenetic analyses indicate that HrPax-258 is descendant from a single precursor gene that gave rise to the three vertebrate genes. The expression pattern of HrPax-258 suggests that this subfamily of Pax genes has conserved roles in regional specification of the brain. Comparison with expression of ascidian Otx (Hroth) and a Hox gene (HrHox1) by double-staining in situ hybridizations indicate that the ascidian brain region can be subdivided into three regions; the anterior region marked by Hroth probably homologous to the vertebrate forebrain and midbrain, the middle region marked by HrPax-258 probably homologous to the vertebrate anterior hindbrain (and maybe also midbrain) and the posterior region marked by Hox genes which is homologous to the vertebrate hindbrain and spinal cord. Later expression of HrPax-258 in atrial primordia implies that basal chordates such as ascidians have already acquired a sensory organ that develops from epidermal thickenings (placodes) and expresses HrPax-258; we suggest it is homologous to the vertebrate ear. Therefore, placodes are not likely to be a newly acquired feature in vertebrates, but may have already been possessed by the earliest chordates.

Early changes in excitation-contraction coupling: transition from compensated hypertrophy to failure in Dahl salt-sensitive rat myocytes

OBJECTIVE

The aims were to (1) define the early changes in excitation-contraction coupling during the transition from cardiac hypertrophy to heart failure, and (2) to clarify the causal relationship between mechanical dysfunction and abnormal Ca2+ handling in the Dahl salt-sensitive rat model.

METHODS

Myocardial contractile function was assessed in whole heart perfusion studies. In separate experiments, isolated left ventricular myocytes from Dahl salt-sensitive (DS) and Dahl salt-resistant (DR) rats were paced at a physiological rate of 5Hz and cell shortening (CS) and [Ca2+]i measured simulataneously by video-edge detection and fura-2 fluorescence.

RESULTS

DS hearts developed hypertrophy after 4 weeks of a high-salt diet (4WHSD), as indicated by a 26% increase (p < 0.01) in the heart to body weight ratio and a 21% increase (p < 0.01) in cell width. Heart failure developed after 12 weeks of a high-salt diet (12WHSD), as indicated by an 11% increase (p < 0.01) in the lung wet to dry weight ratio. Furthermore, in DS-12WHSD hearts, the diastolic pressure-volume relationship had shifted rightward. DR rats did not develop hypertension and seved as age-matched controls. A 31% (p < 0.05) increase in the %CS in DS-4WHSD myocytes compared to DR-4WHSD myocytes with a trend of a parallel increase in Ca2+ transient amplitude was found. There was no difference in the Ca2+ transient parameters between DR and DS at 12WHSD, but an 18% (p < 0.01) decrease occurred in peak [Ca2+]i in DS myocytes between 4WHSD and 12WHSD. In DS-12WHSD, the time to peak shortening and the time from peak shortening to 50% and 90% relaxation was significantly prolonged by 27%, 44%, and 38%, respectively, as compared to the age-matched DR myocytes.

CONCLUSION

Our results indicated that: (I) normal Ca2+ homeostasis is preserved at the stage of compensated hypertrophy; (2) the early signs of isolated myocyte dysfunction were a prolongation of the shortening and relaxation time course without an abnormal time course of the Ca2+ transient. Thus, in the hypertensive Dahl salt rat model, abnormal Ca2+ handling appears neither to precede nor initiate the transition to failure.

Functional analysis of an ascidian homologue of vertebrate Bmp-2/Bmp-4 suggests its role in the inhibition of neural fate specification

The ascidian tadpole larva is thought to be close to a prototype of the ancestral chordate. The vertebrate body plan is established by a series of inductive cellular interactions, whereas ascidians show a highly determinate mode of development. Recent studies however, suggest some roles of cell-cell interaction during ascidian embryogenesis. To elucidate the signaling molecules responsible for the cellular interaction, we isolated HrBMPb, an ascidian homologue of the vertebrate bone morphogenetic protein (BMP) gene, from Halocynthia roretzi. The amino acid sequence of HrBMPb closely resembled those of vertebrate BMP-2 and BMP-4 and of Drosophila Decapentaplegic (DPP). In addition to the sequence similarity, HrBMPb overexpression induced the ventralization of Xenopus embryos, suggesting functional conservation. The zygotic expression of HrBMPb was first detected around gastrulation. HrBMPb expression was maintained in some cells at the lateral edges of the neural plate through gastrulation to neurulation, although that in the presumptive muscle cells was downregulated. HrBMPb was not expressed in the presumptive epidermis during gastrulation. When HrBMPb mRNA was injected into fertilized Halocynthia eggs, cells that normally give rise to the neural tissue differentiated into epidermis, causing a loss of anterior neural tissue in the larva. In addition, HrBMPb might function synergistically with HrBMPa, an ascidian homologue of BMPs-5 to 8. However, HrBMPb overexpression did not affect differentiation of the notochord and muscle cells. These results suggest that HrBMPb functions as a neural inhibitor and as an epidermal inducer but not as a ventralizing agent in ascidian development.

Posterior end mark 2 (pem-2), pem-4, pem-5, and pem-6: maternal genes with localized mRNA in the ascidian embryo

The posterior-vegetal cytoplasm of an ascidian egg contains maternal factors required for pattern formation and cell specification of the embryo. We report here the isolation and characterization of cDNA clones for novel maternal genes, posterior end mark 2 (pem-2), pem-4, pem-5, and pem-6. We obtained these clones from a cDNA library of Ciona savignyi fertilized egg mRNAs subtracted with gastrula mRNAs by examining the localization of the corresponding mRNAs of randomly selected clones by whole-mount in situ hybridization. As in the case of pem, all of these mRNAs were localized in the posterior-vegetal cytoplasm of the egg, and they later marked the posterior end of early embryos. The predicted amino acid sequence suggested that PEM-2 contains a signal for nuclear localization, an src homology 3 (SH3) domain, and a consensus sequence of the CDC24 family guanine nucleotide dissociation stimulators (GDSs). PEM-4 has a signal for nuclear localization and three C2H2-type zinc finger motifs, while PEM-5 and PEM-6 show no similarity to known proteins. These results provide further evidence that the ascidian egg contains maternal messages that are localized in the posterior-vegetal cytoplasm.

Autonomy of ascidian fork head/HNF-3 gene expression

We have characterized the expression pattern of a class I fork head/HNF-3 gene (HrHNF3-1) of the ascidian Halocynthia roretzi. Zygotic HrHNF3-1 expression was detectable as early as the 16-cell stage, and the transcript was evident in blastomeres of the endoderm, notochord and mesenchyme lineages of the early embryos. After the late gastrula stage, HrHNF3-1 was also expressed in the presumptive spinal cord cells and some brain cells. The spinal cord of the ascidian tadpole consists of four layers of cells; the dorsal layer, two lateral layers and the ventral layer, the latter of which simply lies on the notochord. Cross-sections of in situ hybridized specimens showed that HrHNF3-1 was expressed in cells of the ventral layer, reminiscent of the floor plate of vertebrate embryos. In addition, we found autonomy in the initiation of early HrHNF3-1 expression, because the gene was expressed in blastomeres continuously dissociated from the first cleavage until the 16-cell stage.

Expression of actin genes in the arrow worm Paraspadella gotoi (Chaetognatha)

Arrow worms (the phylum Chaetognatha), one of the major marine planktonic animals, exhibit features characteristic to both deuterostomes and protostomes, and their ancestry therefore remains unknown. As the first step to elucidate the molecular bases of arrow worm phylogeny, physiology and embryology, we isolated cDNA clones for three different actin genes (PgAct1, PgAct2 and PgAct3) from the benthic species Paraspadella gotoi, and examined their expression patterns in adults and juveniles. The amino acid sequences of the three actins resembled each other, with identities ranging from 86% to 92%. However, the patterns of the spatial expression of the genes were independent. The PgAct1 gene might encode a cytoplasmic actin and was expressed in oogenic cells, spermatogenic cells, and cells in the ventral ganglion. The PgAct2 and PgAct3 genes encoded actins of divergent types. The former was expressed in well-developed muscle of the head (gnathic) region and trunk muscle cells, whereas the latter was expressed in muscle of the trunk and tail regions and oogenic cells. These results suggest that, similarly to other metazoans, the chaetognath contains multiple forms of actins, which are expressed in various manners in the adult and juvenile arrow worm.

Relation of urinary sodium excretion to blood pressure, glucose metabolism, and lipid metabolism in residents of an area of Japan with high sodium intake

To evaluate the effects of prolonged intake of a high-sodium diet on glucose and lipid metabolism, we examined the relation of daily urinary sodium excretion to blood pressure, glucose metabolism, and lipid metabolism in 140 Japanese adults who lived in a region where the average daily consumption of sodium was high and stable during the past 15 yr; no subject had received any treatment for hypertension or metabolic disorders. Each subject was admitted to our health examination center for 2 d for measurement of blood pressure, sampling of blood, and glucose tolerance testing. A 24-h urine specimen was collected by each subject after discharge. Multiple regression analysis revealed that urinary sodium excretion was significantly independent of the mean blood pressure and was unrelated to the area under the serum glucose curve after glucose administration. The urinary sodium level was also unrelated to low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The prevalence of hypertension in the group with a daily sodium excretion below 140 mEq (low sodium group) was 0%, while that in the group with a daily sodium excretion above 280 mEq (high sodium group) was 44%; this difference was significant (p < 0.01). No significant difference was observed in the prevalence of metabolic disorders between the two groups. Our results suggest that sodium intake has little influence on glucose and lipid metabolism but has a significant influence on blood pressure in normotensive and untreated hypertensive subjects who reside in an area with a relatively high sodium intake.

Fundamentals of transarterial embolization technique by drug-delivery embolic emulsion

SUMMARY

We developed new embolic drug delivery emulsions to be utilized for malignant neoplasms. We combined additional water-soluble contrast materials (Ioxaglic acid, Iopamidol) with Glyceol, Poloxamer-188, or D-Mannitol to antitumor agent Lipiodol ultrafluid in order to generate stable emulsions. Some of these emulsions have been shown to cause pulmonary embolism in rabbits and to allow gradual diffusion of the antitumor agent in vitro. Good therapeutic utility is indicated. In particular, one emulsion containing D-Mannitol (Mizonokuchi emulsion), is expected to prolong drug delivery in malignant brain tumors.

Characterization of a potent uveitopathogenic site derived from rat phosducin

Phosducin is a retinal and pineal phosphoprotein assumed to play an important role in visual phototransduction. Phosducin is also a uveitopathogenic retinal antigen, but its potency has been reported to be mild. During the course of studies aimed at identifying uveitopathogenic sites in phosducin, we found that rat phosducin possessed a potent uveitopathogenic site. In this study, we characterize the potent uveitopathogenic site by using synthetic peptides. Several synthetic peptides from this region plus adjuvants were injected into Lewis rats, and the uveitopathogenic core sequence was defined. We also determined the pivotal amino acid residues by using synthetic peptides with single residue substitution. Immunization with PDC(R)65-96 (amino acid residues 65 through 96 derived from rat phosducin) at doses of 0.83 nmol or more induced severe experimental autoimmune uveitis (EAU) in all rats within 12 days. Experimental autoimmune pinealitis (EAP) was also observed in all rats after immunization with 0.83 nmol or higher doses of the peptide. The lowest dose of the peptide to induce EAU and EAP was 0.24 nmol. The smallest peptide that induced EAU as severe as PDC(R)65-96 was PDC(R)77-87, which consisted of 11 amino acid residues (YELIHQDKEDE). The core sequence within the uveitopathogenic site was a pentapeptide (LIHQD), amino acid residues from 79 to 83. To determine the role of individual residues within PDC(R)77-87, we tested the uveitopathogenicity of analogues of PDC(R)75-85 and PDC(R)77-89, respectively, in which each of the residues from 77 to 87 was replaced by alanine (A). Analogous peptides bearing a single residue substitution at 80 (I-->A) and 82 (Q-->A), respectively, were not uveitopathogenic. Our findings demonstrated the presence of a potent uveitopathogenic site in PDC(R)65-96 whose potency in Lewis rats was comparable to that of S-antigen. The pivotal amino acid residues for uveitopathogenicity were the residues at 80 (I) and 82 (Q). The clinical and histological features of this EAU closely resembled those of the EAU induced by S-antigen and recoverin.

Isolation of cDNA clones for genes that are expressed in the tail region of the ascidian tailbud embryo

An ascidian tailbud embryo is comprised of the anterior trunk and posterior tail. We constructed cDNA libraries of the tail region and trunk region of the ascidian Halocynthia roretzi. The screening of the tail library by tail single-stranded cDNA minus the trunk library RNA as a probe, yielded cDNA clones for genes that are expressed in the tail epidermis, visceral ganglion, trunk lateral cells, muscle cells, and certain regions of the tail. Among them, a cDNA clone for a gene designated HrPost-1 is described in detail. HrPost-1 encodes a novel, possible secreted protein of 238 amino acids. The expression of the gene is zygotic. HrPost-1 transcript was first evident in the posterior B-line blastomeres including muscle cells and endodermal strand cells of the gastrula-stage embryo, and the expression in these regions disappeared by the early tailbud stage. Around neurulation, the HrPost-1 transcript appeared in epidermal cells of the posterior-most region of the embryo. As development proceeded, the gene expression spread anteriorly in the epidermal cells of the neurula and tailbud embryo, and thus at the early-to-mid tailbud stage, HrPost-1 expression appeared to define the boundary between the trunk and tail epidermis. These results suggest that, in addition to tissue-specific genes, the activities of a set of region-specific genes are associated with tail formation in the ascidian embryo.

[Head and neck cancer]

Phase II study of nedaplatin (NDP), a new derivative of cisplatin, was completed in 1990, so this agent is now commercially available. NDP is very effective for head and neck cancer. Out of the 90 evaluable patients, CR was achieved in 11 patients and PR in 27 with a response rate of 42%. A new combination chemotherapy containing NDP, especially NDP + 5-FU, was clinically tried. Furthermore concurrent NDP and radiotherapy will be tried in the near future. Phase II study of S-1 (tegafur + CDHP + Oxo) and taxotere (TXT), however, is ongoing. The results obtained so far are almost satisfactory. The aouthor also adopted several new agents which were presented at the ASCO meeting (1993-1997): taxol (TXL), taxotere (TXT), topotecan, amonafide, vinorelbine and thymitaq. Response rates of these agents were as follows: TXL: 26-37%, TXT: 27-41%, topotecan: 0-27%, vinorelbine: 6.7-12.5%, thymitaq: 18.2% and amonafide: 3.6%. So TXL and TXT are very effective for head and neck cancer. In terms of combination chemotherapy, response rates are 33-71% in TXL + CDDP, 23-62% in TXL + CBDCA, 78% in TXT + CDDP and 75% in TXT + CDDP + 5-FU. Concurrent radiotherapy and chemotherapy including new agents are interesting and important issues. Two kinds of protocol were adopted, 5-FU + HU + TXL + RT and TXL + CBDCA + RT. Both protocols are responsive to squamous cell carcinoma of the head and neck. But severe local toxicity (stomatitis) and bone marrow suppression pose problems.

[Prognosis and preoperative imaging of patients with small hepatocellular carcinoma]

We conducted a retrospective study on the relation of the preoperative imaging patterns to the prognosis of patients with small HCC after hepatectomy. Forty patients with small HCC less than 2 cm in diameter without vascular invasion were enrolled in this study. There were no significant differences in the signal intensity of T1WI on MRI, and angiographic findings such as neo-vascularity or tumor stain. Ultrasonographical images of the internal of tumor were classified into two groups. Six cases with homogeneous pattern were significantly worse in cumulative survival rate than 28 cases with heterogeneous pattern (p = 0.0012). The same results were obtained with respect to limitation of cases treated by relative curative operation (p = 0.0041). It was concluded that histopathological grading and malignant potential of small HCC could be evaluated by classification of the pattern of internal ultrasonographical images, and complete locoregional therapy, and that intense course observation for cases with ultrasonographical homogeneous pattern would be important.

Isolation and characterization of cDNA clones for beta-tubulin genes as a molecular marker for neural cell differentiation in the ascidian embryo

The central nervous system (CNS) of an ascidian tadpole larva is composed of about 340 cells, the lineages of which are well documented. To elucidate the mechanisms underlying the neural induction of ascidians, appropriate molecular markers are required. In this study, to obtain an early differentiation marker of the neural cells, we isolated and characterized cDNA clones for two beta-tubulin genes (HrTBB1 and HrTBB2) of the ascidian Halocynthia roretzi. We found that the HrTBB1 and HrTBB2 amino acid sequences are highly conserved, with 91-98% identities to other invertebrate and vertebrate beta-tubulins. The expression of HrTBB1 was found to be maternal, while HrTBB2 is expressed both maternally and zygotically. We observed that the zygotic expression of HrTBB2 commences at the neural plate stage and is specific to cells of the differentiating CNS. In the larvae, HrTBB2 expression was restricted to cells of the CNS, some cells of the papilla and cells of the peripheral nervous system. These results indicate that HrTBB2 will be a useful early molecular marker for neural cell differentiation in the ascidian embryo.

The rectus abdominis myocutaneous flap combined with vascularized costal cartilages in reconstructive craniofacial surgery

The efficacy of osteocutaneous or vascularized bone flaps for reconstruction of massive skeletal and soft-tissue defects has been supported by recent descriptions in the literature. In this article we presented an alternative technique, which is the rectus abdominis myocutaneous flap combined with vascularized eighth and ninth costal cartilages, for reconstruction of midfacial composite defects. The vascular pedicle of the composite flap is the deep inferior epigastric artery and vein. The costal cartilages are supplied by the perichondrial vascular network through the anterior intercostal vessels connecting with the deep epigastric vascular system. Vascularized costal cartilages are considered to reduce the incidence of postoperative complications and resorption of this material. This technique is a useful tool for restoration of craniofacial contour in reconstructive head and neck surgery.

[Automated anesthesia record keeping system in in the United States]

We have implemented an automated anesthesia record keeping system (AARK) since 1992. The system stands in need of re-designing to function as a perioperative patient's information system. We discussed the issues with anesthesiologists who's institutes are implemented with AARK in the United States. We visited the following three institutes: St. Luke's Hospital (Kansas City, MO), University of Florida (Gainesville, FL), and Burbank Hospital (Fitchburg, MA). All of them are implemented with ARKIVE system. Dr. Edsall in Burbank Hospital stressed quality assurance (QA), and using ARKIVE's database for QA. University of Florida has a big anesthesia and engineering team to develop a new ergonomically sound AARK. Some of the members regarded ARKIVE as an "out of date" system. Dr. Tuohy in St. Luke's Hospital stressed cost/benefit of AARK. Taking their experience into account, we are designing a new perioperative patient's information system including AARK.