Film-based resources for grief management in medical education

Introduction

Grief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education.

Objectives

To explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue.

Methods

We reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1].

Results

We recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person’s loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system.

Conclusions

This film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves. [1] Sondheimer, A. The life stories of children and adolescents. Acad Psychiatry. 2000:24(4):214–24.

Disclosure

No significant relationships.

The dark side of social ties: coronavirus 2019-induced fear and intergroup conflicts

Introduction

The relationship between fear and social ties has been frequently discussed in the context of the coronavirus 2019 (COVID-19) pandemic, but investigation of the nature of these experiences is still insufficient. Research suggests that people who respect social ties often experience better mental health outcomes. However, when socially isolated, excluded, or subjected to rumors, they may become more vulnerable to criticism, shame, and fear. Another potential problem of the COVID-19 pandemic is intergroup prejudice and distrust.

Objectives

To examine the development and mitigation of social ties, fears, and biases during the COVID-19 pandemic.

Methods

We applied discourse analysis to relevant literature and their associated references that incorporated textual, social, and cognitive dimensions. The main databases used were PubMed and Web of Science.

Results

Although the importance of social ties was loudly vocalized as lessening loneliness, people also globally described stigma-related fear or intergroup conflicts. The sense of social ties appeared disproportionately amplified in the form of an in-group identity, group pressures, and empathic distress. Some people overstated worries about their COVID-19-positive status being revealed to others and causing distress for them. Furthermore, discrimination and vigilantism were manifested with fear-related stereotyping and hostility.

Conclusions

Our findings support the view that social ties can indeed function as both risk and protective factors. Context-adjusted perspectives and reciprocal dialogs seem crucial to alleviate these negative impacts. The subsequent mitigation of misunderstandings, fear-induced bias, and maladaptive distress appraisal may lead to a more reasonable and flexible recognition of social ties.

Disclosure

No significant relationships.

Gray matter volume and burnout severity among medical professionals

Introduction

Occupational burnout has become a pervasive problem in human services. Medical professionals are particularly vulnerable to burnout, which may lead to reduced motivation, medical errors, and voluntary absenteeism. To ensure effect functioning of medical systems, better understanding of burnout among medical professionals is warranted.

Objectives

We aimed to investigate the structural brain correlates of burnout severity among medical professionals.

Methods

Nurses in active service underwent structural magnetic resonance imaging. We assessed their burnout severity using self-reported psychological questionnaires. This study was approved by the Committee on Medical Ethics of Kyoto University and was conducted in accordance with the Code of Ethics of the World Medical Association.

Results

The results reflected considerable individual differences in burnout severity in our sample. Our findngs revealed that the levels of burnout severity were associated with the regional gray matter volumes in brain areas such as ventromedial prefrontal cortex and insula.

Conclusions

Since the outbreak of the COVID-19 pandemic, medical professionals have faced even greater stress. We hope that our findings will contribute to a better understanding of the mechanisms of burnout and offer useful insights for developing effective interventions to manage stress and burnout.

Disclosure

No significant relationships.

Sense of coherence, spontaneous brain activity, and burnout severity

Introduction

Burnout has become a critical issue in health care systems during the COVID-19 pandemic. Several studies report on the importance of peoples’ sense of coherence (SOC) or control over work for dealing with burnout. SOC implicates a stress-coping capacity involving comprehensibility, manageability, and meaningfulness. However, little is known on how SOC cognitively modulates burnout experiences.

Objectives

To investigate neurocognitive mechanisms of SOC and burnout in medical professionals.

Methods

Forty-one registered nurses were enrolled. We used functional magnetic resonance imaging and measured resting-state brain activity. We identified brain regions associated with SOC and burnout levels by correlating these trait scores to regional fractional amplitude of low frequency fluctuations (fALFF). Subsequently, we investigated whether participants’ levels of SOC impacted their fALFF-burnout association by mediation analysis.

Results

SOC and depersonalization dimension of burnout were negatively correlated (p < 0.01). The fALFF in the mid-dorsolateral prefrontal cortex (DLPFC) correlated positively with SOC scores, and negatively with depersonalization dimension of burnout (p < 0.05). Furthermore, SOC mediated the negative relationship between DLPFC activity and burnout severity (p < 0.05).

Conclusions

Our data suggested that SOC alleviates burnout experience and supports prefrontal activity to prompt cognitive control; they may facilitate flexible shifting of perspective and optimistic reappraisal of work-stress. In effect, workplace-stressors may be acknowledged as being more meaningful than distressing. Without sufficient SOC, frequent exposures to stressors can lead to maladaptive coping to exhibit emotional numbing or depersonalization.

Disclosure

No significant relationships.

Roles of trait resilience, flexibility, and volitional self-control in social adaptation: An fMRI study

Introduction

Resilience and cognitive flexibility are considered as pre-adaptive traits that help individuals to deal with environmental and social distress. Although they may alleviate emotional impulses and/or support volitional self-control (VSC), these cognitive mechanisms remain insufficiently explored.

Objectives

To better understand resilience and flexibility, we built a mechanistic framework to explain variations in socially adaptive responses under distressing situations (cooperation dilemma) using economic and social decision-making paradigms.

Methods

Twenty-four university students (7 females) were enrolled. We used ego-resiliency (ER) and Machiavellian (Mach) questionnaires to measure resilience and flexibility, and applied third-party punishment (TPP) and ultimatum game (UG), as well as moral dilemma (MD) tasks to derive VSC-associated brain activity using 3T-functional magnetic resonance imaging. Mediation analysis was used to investigate whether these pre-adaptive trait levels explain cooperative decision-making (invested sum in TPP and acceptance rate of unfair offers in UG), together with VSC-associated brain activity during MD. The regions of interest included the orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DLPFC), and temporoparietal junction (TPJ).

Results

Pre-adaptive traits were a statistically significant mediator for two different models. There was an indirect effect of 1) ER on the relationship between OFC activity strength and TPP scores, and 2) Mach on the relationship between DLPFC/TPJ and UG (p < 0.05).

Conclusions

Although recruitment is still ongoing, our results suggested that trait resilience and flexibility may help other-regarding and goal-directed motivation shifts. They may align self-interests with collective interests and support VSC, thereby adjusting peoples’ behaviors within social contexts and cultivating social intelligence.

Disclosure

No significant relationships.

The right temporoparietal junction and cooperation dilemma

Introduction

Cooperation is a key component of our lives. When we identify people in need, we are frequently motivated to cooperate by overcoming selfishness. However, we may also become selfish to pursue greater gains by putting ourselves at risk and exploiting others. Such cooperation dilemmas are ubiquitous in real life. Although functional magnetic resonance imaging studies have repeatedly reported the involvement of right temporoparietal junction (rTPJ) in cooperation dilemmas, a causal link between the two has been rarely explored.

Objectives

To investigate a causal role of rTPJ in resolving cooperation dilemmas in ecologically valid settings.

Methods

Twenty-two healthy volunteers were examined. We combined repetitive transcranial magnetic stimulation (rTMS) with a snowdrift cooperation dilemma game task (cross-the-traffic intersection version) wherein either cooperation or defection should be chosen. Participants and opponents jointly faced a problem at the intersection where their cooperation could diffuse the situation (stopping/avoiding a car-crash). This conflicted with a choice in the participant’s self-interest which was more rewarding, but risky (not stopping/defection). We also included explicit-cue condition that showed elderly/pregnant passengers in the opponent’s car. Furthermore, we measured participants’ empathic-traits (e.g., perspective-taking) to study personality-cooperation associations.

Results

The cooperation-ratio did not statistically differ between the sham stimulation and inhibitory continuous theta burst stimulation (cTBS) in both the no-cue and with-cue conditions. However, after cTBS, only in the no-cue condition, the strength of the relationship between cooperation-ratios and empathic-traits decreased significantly (p<0.05).

Conclusions

These results contribute to our understandings of rTPJ’s role in spontaneous social cognition, which may be considerably complex and require further examination.

Disclosure

No significant relationships.

An fMRI study of decision-making under conflict in individuals with autism spectrum condition

Introduction

Individuals with autism spectrum condition (ASC) frequently report difficulties in social communications, combined with restricted inflexible behaviors. However, it is unclear whether this rigidity is pervasive across cognitive flexibility (CF) and affective flexibility (AF) in situations which resolve different social conflicts.

Objectives

To study CF and AF levels and associated brain activity in individuals with ASC.

Methods

Individuals with ASC and with typical development (TD) performed a moral dilemma task during functional magnetic resonance imaging. For CF, participants made decisions on (1) whether to enforce result-oriented actions to prioritize social/public benefits; and (2) judged whether these actions are right or wrong. For AF, participants made decisions on (1) whether to permit social norm/rule violations in sympathy-evoking situations; and (2) permit these identical violations in no sympathy-evoking situations. We calculated participants’ CF/AF levels by computing the switching-rate of decisions in CF/AF sessions (switching was defined as: CF, judging the actions as wrong but choosing to enforce the action in the same vignette; AF, judging the violations as not permissible in a no sympathy-evoking circumstance, but permissible in a sympathy-evoking circumstance).

Results

For CF, ASC participants showed a marked decrease in CF switching-rates compared to TD participants (p < 0.05), and in corresponding brain activity for executive functioning. For AF, although the AF switching rate difference was non-significant, we observed unique brain activities in each group (e.g., TD activation of the greater dorsomedial-prefrontal cortex and ASC activation of the cingulate cortex).

Conclusions

Our results suggest ASC inflexibility may be further characterized by both CF and AF.

Disclosure

No significant relationships.

Reduced sensitivity to situational change in individuals with autism spectrum condition

Introduction

Individuals with autism spectrum condition (ASC) frequently report difficulties in detecting changes in social situations, which considerably hinder interpersonal communications.

Objectives

To better understand the features of detecting changes in social situations among individuals with ASC.

Methods

Individuals with ASC (N=24) and typical development (TD) (N=24) were included. To examine participants’ sensitivity to situational contexts, we conducted an economic-game task: a modified computer version of the ultimatum game (mod-UG). In UG, two players were offered a chance to win 10 coins after dividing it amongst themselves. The proposer suggests how to split the sum and the responder can accept or reject the deal. After practice, all participants played the role of responders with an imaginary proposer. Participants had to decide whether to accept or reject proposers’ fair/unfair offers. In our mod-UG, additional condition was included that involved intentionality considerations: Unfair offers were displayed with another identical unfair offer. This emphasized the proposers’ inevitable situation of unfair offers. Subsequently, we conducted a 2×2 repeated-measures ANOVA (unfair offers with/without additional cues)×(ASC/TD).

Results

Participants indeed accepted unfair offers significantly more frequently when the other player’s unfair proposal was unavoidable in cue-added conditions, when compared to unfair offers in no-cue conditions. This suggested that participants considered their opponent’s perspective more attentively in cue-added conditions. However, this effect was significantly decreased in the ASC-group (p<0.05; group-condition interaction).

Conclusions

Decreased sensitivity to situational changes among ASC-individuals may be partly due to diminished or inflexible shifting of perspective. Whether this systematized decision-making associates with attentional-bias and stereotyped-behaviors requires further investigation.

Disclosure

No significant relationships.

[Two Cases of Advanced Gastric Cancer Diagnosed as Pathological Complete Response after Preoperative Chemotherapy with S-1 and Oxaliplatin]

We herein report 2 cases of gastric cancer treated by S-1 and oxaliplatin combination therapy before later undergoing gastrectomy. The pathological results of both cases demonstrated complete response. Case 1 had a giant tumor which was suspected to have invaded the pancreas. Case 2 was associated with extensive lymph node metastasis. Based on the findings of these 2 cases, preoperative chemotherapy with S-1 and oxaliplatin for advanced gastric cancer shows sufficient efficacy.

[Long-Term Survival of Gastric Cancer with Multiple Liver and Lymph Node Metastases-A Case Report]

Currently, chemotherapy against unresectable advanced gastric cancer is progressing with the development new drugs and due to results of several clinical trials. Here, we reported a case of long-term survival of gastric cancer with multiple liver and lymph node metastases. A 68-year-old man was diagnosed with gastric cancer and Virchow lymph node, para-aortic lymph node, and multiple liver metastases at another hospital. He was referred to our hospital from Yamashita Naika Syokakika. We administrated 4 courses of S-1 plus CDDP. The main tumor and all metastatic lesions were significantly reduced. Subsequently, total gastrectomy, partial liver resection, and left neck and para-aortic lymph node resection(conversion surgery)were performed. The cancer cell was remnant at the main tumor and para-gastric lymph node. No cancer cells were detected in another lesion(R0 resection). Postoperatively, only S-1 was administered. However, 28 months after undergoing gastrectomy, liver metastasis occurred. Therefore, S-1 plus oxaliplatin, paclitaxel plus ramucirumab, and CPT-11 plus CDDP were administered. Liver metastases again increased and decreased, respectively. However, 46 months after gastrectomy, liver metastasis recurred and nivolumab was administered. Subsequently, liver metastases disappeared. At 55 months after gastrectomy, rectal resection was performed against rectal cancer and partial liver resection against liver metastases. Cancer cells were not detected in the resected specimens.

[A Study of Therapy for Locally Advanced Breast Cancer with Metastasis]

We reviewed 21 patients with locally advanced breast cancer with distant metastasis.The median age was 61 years.The median time to presentation at hospital was 13 months, and the median neoplasm diameter on the first visit was 10 cm.The main histological type was scirrhous carcinoma.Sixteen cases tested positive for hormone receptor(76%), 4 tested positive for HER2(19%), and 3 were triple negative(14%).Four patients underwent surgery.The techniques performed included mastectomy and axillary lymph node dissection.Three patients experienced local recurrence.The first-line treatment was surgery for 1 patient, chemotherapy for 12 patients, hormonal therapy for 7 patients, and trastuzumab for the HER2 positive patients.The median follow-up period was 49 months.The patients for where an operation was performed were 49 months and the operation not- enforcement patients were 54 months.If treatment is possible for patients with locally advanced breast cancer with distant metastasis, multidisciplinary treatment according to individual patient characteristics is recommended. In the case of surgical treatment, careful consideration must also be given to these characteristics.

[Resection of Paraaortic Lymph Node Recurrence Wherein Complete Response to Bevacizumab Was Observed after Surgery for Sigmoid Colon Cancer]

We report a case of resection of a paraaortic lymph node recurrence, wherein complete response to bevacizumab was observed. Our patient was a 50-year-old woman who had a paraaortic lymph node recurrence during adjuvant chemotherapy with FOLFOX 6 months after surgery for sigmoid colon cancer. She was treated with chemotherapy consisting of FOLFOX plus bevacizumab/FOLFIRI plus bevacizumab, which suppressed progression of the periaortic lymph node recurrence. She underwent surgery for the paraaortic lymph node recurrence, and the pathologic result was complete response. We report that bevacizumab was effective for her paraaortic lymph node recurrence.

[A case of primary peritoneal carcinoma successfully treated using Paclitaxel and Carboplatin chemotherapy]

BACKGROUND

A standard treatment for primary peritoneal carcinoma has not been established to date. We describe a case in which this cancer was successfully treated by use of paclitaxel and carboplatin chemotherapy.

CASE

An 80-year-old woman who presented with abdominal distension and right upper abdominal pain was diagnosed with massive ascites and an omentum tumor via abdominal computed tomography and magnetic resonance imaging (MRI); her ovaries were normal-sized. Serum levels of the tumor marker CA125 were above normal (170 U/mL), and aspiration cytology showed the presence of adenocarcinoma cells. Despite several examinations, the primary tumor was not detected. The patient underwent exploratory laparotomy and was diagnosed with primary peritoneal carcinoma. She received combination chemotherapy consisting of paclitaxel and carboplatin. Serum CA125 levels returned to normal, and an MRI showed no evidence ofa tumor.

CONCLUSION

Paclitaxel and carboplatin combination chemotherapy is effective for treatment of primary peritoneal adenocarcinomas.

[A case of liver metastasis from sigmoid colon cancer treated effectively by second-line chemotherapy]

A case of successful chemotherapy for a metachronous liver metastasis following resection for sigmoid colon cancer is presented. A 51-year-old man underwent sigmoidectomy, ileocecal resection, and descending colon colostomy for sigmoid colon cancer with ileum invasion. Six courses of FOLFOX4 were performed as adjuvant chemotherapy. One year after sigmoidectomy, a liver metastasis was detected on computed tomography (CT) examination. Chemotherapy with FOLFOX+bevacizumab was restarted. Three courses were administered, but hepatic dysfunction occurred after the second and third courses, and FOLFOX was discontinued. Subsequent chemotherapy was reinitiated with FOLFIRI+bevacizumab. After 9 courses, the carcinoembryonic antigen level was normalized and appeared to be decreased by imaging studies. Upon the patient's request, only oral S-1 was administered. After 2 courses, CT revealed that the diameter of the tumor had increased by 2 cm. Therefore, right lobectomy of the liver, colostomy closure, and anastomosis were performed. During these procedures, a nodule was found in the omentum and was removed. Rapid intra-operative diagnosis revealed peritoneal dissemination. The pathological diagnosis was liver metastasis of sigmoid colon cancer, with necrosis and fibrosis seen in approximately one-half of specimens. The surgical margins were negative. Neither metastatic cancer nor dissemination were found in the resected greater omentum.

[A case of Carboplatin and pemetrexed combination chemotherapy for synchronous double cancers of hepatocellular carcinoma and primary lung cancer]

A 78-year-old man presented to our hospital with lung abnormality on his chest radiograph. Computed tomography (CT) showed a mass and obstructive pneumonia in the right upper lobe of the lung. The mass was diagnosed as a pulmonary adenocarcinoma with a bronchoscopy (cT4N2M0, Stage IIIB). CT also revealed multiple hepatic tumors, which were diagnosed as hepatocellular carcinoma (HCC) by dynamic CT and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging(EOB-MRI). First, we treated the lung cancer with a combination of cisplatin and pemetrexed (PEM), but it caused renal dysfunction. Carboplatin (CBDCA) and PEM combination chemotherapy was administered, and not only the lung cancer but also the HCCs decreased in size. There are few reports of synchronous double cancers of HCC and primary lung cancer, and the treatment is not established. We report that platinum-containing anticancer drugs such as CBDCA may be effective against synchronous double cancers of HCC and lung cancer.

[Efficiency of pre-operative chemoradiotherapy in treating a case of advanced rectal cancer]

There is insufficient evidence for the pre-operative use of chemoradiotherapy (CRT) in treatment of advanced rectal cancers, and its efficiency and safety are unclear. However, it has recently been suggested that a new class of carcinostatic agents are more effective during preoperative CRT. Under the National Comprehensive Cancer Network (NCCN) guidelines, 5-FU and capecitabine have been recommended as the standard drugs for use during combination chemoradiotherapy. The Japanese Society for Cancer of Colon and Rectum (JSCCR) guidelines for 2014 also recommend the use of both drugs during preoperative CRT. We report a case of rectal cancer, which was successfully treated with radical resection and neoadjuvant chemoradiotherapy.

First measurement of time evolution of electron temperature profiles with Nd:YAG Thomson scattering system on Heliotron J

A Nd:YAG Thomson scattering system has been developed for Heliotron J. The system consists of two 550 mJ 50 Hz lasers, large collection optics, and 25 radial channel (∼1 cm spatial resolution) interference polychromators. This measurement system achieves a S/N ratio of ∼50 for low-density plasma (ne ∼ 0.5 × 10(19) m(-3)). A time evolution of electron temperature profiles was measured with this system for a high-intensity gas-puff (HIGP) fueling neutral-beam-injection plasma. The peripheral temperature of the higher-density phase after HIGP recovers to the low-density pre-HIGP level, suggesting that improving particle transport in the HIGP plasma may be possible.

[A case of Stage IV gastric cancer was successfully treated with multi combination chemotherapy with S-1]

Stage IV gastric cancer has poor prognosis, and median survival time (MST) is reported to range from 6 to 13 months. We report a case of long-term survival in a Stage IV gastric cancer patient who was successfully treated with multi combination chemotherapy with S-1. A 73-year-old woman presenting with gastric cancer with pyloric stenosis and peritoneal dissemination at the sigmoid colon underwent distal gastrectomy with D2 lymphadenectomy and sigmoidectomy. She received adjuvant chemotherapy with S-1 and CDDP after surgery. During the twelfth administration of S-1 and CDDP, she developed an anaphylactic reaction against CDDP; therefore, only S-1 was administered for the next 6 courses. Thirty one months postgastrectomy, a left ovarian metastasis (about 4 cm) was detected by computed tomography. Two courses of S-1 and CPT-11 were administered; however, the ovarian metastasis grew to twice its initial size. She underwent hysterectomy and bilateral ovariectomy. The pathological diagnosis was metastatic tumors in the uterus and ovary(Krukenberg tumor). After the second surgery, S-1 and docetaxel therapy was initiated. A metastasis (S2, 5mm diameter) appeared in the right lung around 65 months after the gastrectomy. The patient received a total of 28 courses, up until 69 months post-gastrectomy. At present, she hopes to finish the chemotherapy and is consulting a palliative care facility. At 80 months post-gastrectomy, she has no symptoms because the lung metastasis exhibits slow growth (15 mm diameter), and is maintaining her quality of life (QOL).

[A case of rectal cancer with multiple liver metastases successfully treated by repeated hepatectomy]

A 61-year-old man was diagnosed with rectal cancer with multiple liver metastases in December 2009, and low anterior resection of the rectum was performed. Postoperative adjuvant chemotherapy with 6 courses of oxaliplatin, Leucovorin, and 5-FU (FOLFOX4) and bevacizumab was initiated, followed by 5 courses of fluorouracil, Leucovorin, and irinotecan (FOLFIRI) and bevacizumab. Right posterior segment (S6, S7) hepatectomy with enucleation of S2, S3 and S5 was performed, and chemotherapy with FOLFOX4 (11 courses) was administered. New metastases in the S5 segment were observed in August 2011 and right hepatic lobectomy was performed. The patient then underwent 8 courses of adjuvant chemotherapy with FOLFOX4. However, left hepatic lobe lateral segment and caudate lobe metastases then appeared. Subsequent repeated chemotherapy with FOLFIRI plus cetuximab (3 courses) and irinotecan plus cetuximab was interrupted in August 2013 owing to adverse events resulting in rapid growth of hepatic metastases. The patient underwent hepatic left lateral segmentectomy and left caudate lobectomy. The postoperative course was uneventful and the patient has currently survived 4 years and 7 months after the initial surgery.

[Long-term survival of a case with advanced sigmoid colon cancer and Virchow's lymph node metastasis]

A 63-year-old man presented with a tumor in his left supraclavicular fossa. Aspiration biopsy of the tumor revealed metastasis of an adenocarcinoma. Further examination indicated the presence of advanced sigmoid colon cancer with metastases to Virchow's lymph nodes and the para-aortic lymph nodes. Sigmoidectomy with D3 lymph node dissection was performed. Histological examination revealed moderately and well differentiated adenocarcinomas( double cancers) that had invaded the subserosa as well as metastases of the para-aortic lymph nodes. Twelve days after the operation, systemic chemotherapy with FOLFOX4 (8 courses), followed by FOLFIRI (8 courses) was administered. Six months later, CT examination determined that the metastases of Virchow's lymph nodes and the para-aortic lymph nodes had completely disappeared. Capecitabine was administered for approximately 1 year, and complete response was achieved. However, a pancreatic tumor measuring 2×3 cm was detected 44 months after the operation. Distal pancreatectomy was performed and pathological examination that included immunohistochemical staining (CK7 and CK20) of the tumor indicated the primary pancreatic cancer. The patient was treated with chemoradiotherapy after the operation and survived for 5 years and 9 months after the initial operation.

[Preoperative chemotherapy for advanced gastric cancer]

In the present study, we evaluated the outcome of preoperative treatment with S-1 and CDDP for the treatment of advanced gastric cancer. Fifty-five cases of advanced gastric cancer received pre-operative treatment with S-1 and CDDP. The tumor control rate( PR and CR according to RECIST criteria) was 55%. The clinical response and histological response to the treatment and curative resection were closely related to favorable postoperative survival. We noted that patients who demonstrated CR or PR received S-1 as postoperative treatment, whereas those with SD or PD were more likely to receive paclitaxel as postoperative treatment. Preoperative treatment with S-1 and CDDP was not only an effective initial treatment, but also demonstrated favorable results in a S-1 in vivo sensitivity test.

[A case of successful radical resection of rectal cancer with neo-adjuvant chemoradiotherapy]

In cases of advanced rectal cancer, preoperative chemoradiotherapy( CRT) serves to improve the local control rate, survival rate, radical resection rate, and/or probability of sphincter muscle preservation. According to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer, preoperative CRT is the standard treatment for rectal cancer in Europe and the United States. However, there is insufficient evidence in support of its efficacy and safety in Japan, and therefore, CRT needs to be evaluated in properly designed clinical trials. Recently, several studies have reported on the efficacy of preoperative CRT in Japan. Herein, we report a case of rectal cancer in which radical resection was successfully performed with neo-adjuvant CRT.

[A case of gastric cancer accompanied by disseminated carcinomatosis of the bone marrow successfully controlled by S-1 and cisplatin combination therapy]

We report a case of gastric cancer accompanied by disseminated carcinomatosis of the bone marrow treated with S-1 and cisplatin( CDDP) combination chemotherapy. The patient was a 68-year-old woman who was detected as having disseminated intravascular coagulation( DIC) during an examination for gastric cancer and she was diagnosed as having disseminated carcinomatosis of the bone marrow by lumbar puncture. She was immediately treated with S-1 and CDDP combination chemotherapy( S-1, 80 mg/body orally administered[ po] on days 1-21 and CDDP, 60 mg/body intravenously [iv] administered on day 8) and her DIC improved on the fourth day. Subsequently, the patient was treated with 3 courses of combination chemotherapy and she survived for 184 days from the initiation of the treatment. Although disseminated carcinomatosis of the bone marrow is associated with a poor prognosis, we believe that the duration of survival of our patient was extended due to initiation of chemotherapy at an early stage.

[A case of advanced gastric cancer with carcinomatous lymphangitis of the lung treated with docetaxel and S-1 combination chemotherapy]

A 67-year-old woman with complaints of cough and dyspnea was admitted; her chest radiographs and computed tomography (CT) scans revealed pulmonary carcinomatous lymphangitis. Endoscopic examination revealed advanced gastric cancer and the patient was treated with a combination of 40 mg/m2 docetaxel, administered on day 1, and S-1 100 mg/body/day, administered for 14 days followed by a 7-day interval, as 1 course despite her performance status( PS) being grade 3. After 2 courses of chemotherapy, CT showed that the carcinomatous lymphangitis had improved, and the patient was discharged with PS of grade 0. We report that combination chemotherapy with docetaxel and S-1 might be effective for the treatment of advanced gastric cancer with carcinomatous lymphangitis of the lung in patients with a poor systemic condition.

[Hepatic arterial infusion with subsequent hepatectomy for a sigmoid colon cancer patient with hepatic metastases-a case report]

It is common to use systemic chemotherapy, instead of hepatic arterial infusion (HAI) of 5-fluorouracil (5-FU) or other cytotoxic agents, for unresectable hepatic metastases in colorectal cancer patients. Nevertheless, systemic administration of anticancer agents such as FOLFOX or FOLFIRI is sometimes difficult to continue for infirm patients. A 71-year-old female who had undergone sigmoidectomy for sigmoid colon cancer received HAI for 12 months because of big bilobar hepatic metastases and poor performance status. Thereafter, a two-stage hepatectomy(first, left lobe: second, S7+8 and S5) was performed successfully. She has been alive for 2.5 years after the first operation but with two small lung metastases in the left lobe. Because of bad performance status and her weak social and familial conditions, treatment with standard systemic chemotherapy could not be continued. In such cases, HAI should be performed if the metastases are limited to the liver.

[Triple synchronous primary lung carcinomas in the same lobe; report of a case]

A 78-year-old female was referred to our department due to 3 abnormal shadows in the left lower lobe, that were S6, S8 and S10 by chest computed tomography (CT). Bronchoscopy was performed, but definitive diagnosis was not obtained. The result of surgical biopsy for S10 nodule was squamous cell carcinoma and left lower lobectomy with lymph node dissection was performed. Other 2 lesion were both adenocarcinoma with mixed subtypes. According to the criteria of Warren and Gates, and Martini, these 3 carcinomas were all primary lung cancers.

[A case of the long-term survivor of rectal cancer who suffered from successive metastases to ovarium, peritoneum, liver, bone and para-aortic lymphonode]

A 37-year-old female, who had undergone a low anterior resection for lower rectal cancer, had been received chemotherapy (FOLFOX4, FOLFIRI) for 2 years because of right ovarian metastasis occurred and removed 9 months after the first operation. One month after 2 years of continued chemotherapy, progressive metastases happened to occur successively (rt lunge, left ovarium, liver, para-aortic lymphonode, Virchow lymphonode and bone). Right upper lobe pnemonectomy was performed first, then, peritonectomy, total hysterectomy with left oophorectomy and a partial resection of the small bowel were done. IRIS, as postoperative chemotherapy, performed with hepatic arterial infusion (HAI) of CPT-11 and 5- FU resulted in getting a minimal response for about 10 months. Because of the hepatic arterial thrombosis at 10 months after the previous operation, we could not continue HAI with systemic chemotherapy, that was resulted in the progresion of mutiple metastases, and that the patient died 62 months after the first surgery. Immunohistochemical analyses with MIB-1 stainning of four surgical specimens revealed 80% positive cells in the cancerous tissues.

[A case of transverse colon cancer without a recurrence lesion after five years from resection of hepatic metastasis]

The treatment of hepatic metastasis of colon cancer was in progress by new biochemical agents. Generally, a resection was the first alternative treatment against hepatic metastasis of colon cancer, but new antitumor agents were more effective than conventional antitumor agents. Disappearance of metastasis for colon cancer treated with only antitumor agents was commenced to report. We were experienced a case of transverse colon cancer without a recurrence lesion after five years from the resection of hepatic metastasis. A case was a 77-year-old man. He was operated against transverse colon cancer in February 2003. Pathological stage was ss, n0, Stage II. In April 2004, serum CEA was increased. CT examination was not detected a hepatic metastasis but ultrasound examination and MRI detected the metastasis at S7 lesion in the liver. In July 2004, he was admitted to S-1 and PSK until October 2004. In December 2004, the lesion of hepatic metastasis was reduced and serum CEA was decreased. But in September 2005, the metastatic lesion was re-grown. A resection for hepatic metastasis was executed in November 2005. After the resection for hepatic metastasis, he was admitted to UFT/ UZEL from January 2006 to October 2006. Present time( June 2011), the lesion of recurrence was not detected by several examinations (CT, MRI, Ultrasound etc).

[A case of colon cancer with long-term survival treated by resection of recurrence on the rectum and chemotherapy for lung metastasis]

A 69-year-old male was operated on sigmoidectomy for sigmoid colon cancer (SS, N2, H0, P0, M0, stage IIIb) 7 years ago. Two years later, he was diagnosed for rectal cancer and bilateral lung metastases by TBLB. We performed Mile's operation, and the rectal focus was pathologically diagnosed with a recurrence of sigmoid colon cancer. After surgery, chemotherapy with FOLFOX was started for bilateral lung metastases, resulting in CR during the 22 months. But bilateral lung metastases were exacerbated, and then we administered several other chemotherapies. Five years have passed since chemotherapy started, although the focuses tended to progress. Right now, he has been a chemotherapy outpatient for last 5 years.

Common EEG spectral power characteristics during meditation in five meditation traditions

Introduction

Different meditation practices reportedly affect brain electric activity.

Objectives

To assess common characteristics in brain electric activity during the state of meditation across different meditation traditions.

Aims

Do meditation traditions share commonalities in EEG spectral power changes from task-free resting to meditation?

Methods

Data from 71 experienced meditators of five meditation traditions were analyzed (13 Tibetan Buddhists, 15 Qigong, 14 Shaja Yoga, 14 Ananda Marga Yoga, and 15 Zen). Power spectral results of multichannel EEG recordings (average reference) during meditation were compared with those during pre- and post-meditation task-free resting. Spectra were averaged across channels (19–58), and subject-wise normalized. Integrated power was computed for the eight independent frequency bands (delta through gamma).

Results

During meditation compared to the average of pre- and post-meditation resting, across the five traditions, there was a significant decrease of power in the alpha-2 band (10.5–12 Hz), and significant increases of power in the beta-3 (21.5–30 Hz) and gamma (35–44 Hz) bands; theta (6.5–8 Hz) band power showed an increase at p = 0.14.

Conclusions

The results indicate that EEG spectral power differences between task-free resting state EEG versus meditation state EEG show communalities that are shared by all five meditation traditions in spite of important differences in meditation techniques.

[A case of recurrent esophageal cancer with tracheal invasion treated by chemo-radiotherapy (CRT) after placement of tracheal stent that maintained complete response (CR) for two years]

Frequently advanced or recurrent esophageal cancer was invasive trachea and often causing hemoptysis, stenosis and dyspnea. Occasionally, these cases were treated by a placement of tracheal stent. The placement effect was quickly and a main symptom of dyspnea was improved dramatically. However, the most of the cases were in poor prognosis with advanced cancer treated by chemo-radiotherapy (CRT). We experienced a case of recurrent esophageal cancer with tracheal invasion treated by placement of tracheal expandable metallic stent (EMS). A case was a 73-year-old man (at first admission). He was performed esophagectomy with tracheotomy against esophageal carcinoma at cervical portion. Eighteen month later, a local recurrence with tracheal invasion was appeared. The tracheal covered stent was inserted at the recurrent site. After stenting, CRT was performed with 5-FU and docetaxel. The effect of CRT was complete response (CR). Hence, a stent was removed from trachea. No recurrence was observed at the site and maintained a CR condition for two years after CRT.

[An elderly colon cancer patient with hepatic, lunge and peritoneal metastases was treated by hepatic arterial infusion and systemic chemotherapy-a case report]

A-75 year-old man, diagnosed as ascending colon cancer with large bowel obstruction, multiple hepatic, lunge metastases and peritoneal dissemination, was treated with neoadjuvant chemotherapy (FOLFOX4: 2 courses) and subsequent ileocecal resection. Postoperative systemic chemotherapy with hepatic arterial infusion (HAI) of 5-FU was performed in the following fashion: FOLFOX4, FOLFIRI with or without bevacizumab or cetuximab was administered every 4 weeks and a weekly HAI twice every 4 weeks. By those treatments, the patient could maintain a 30-month long NC effect and a good performance status.

[The colon cancer patient with multiple hepatic metastases and peritoneal disseminations was treated by hepatic arterial infusion chemotherapy and resection of the metastatic peritoneal dissemination with successive systemic chemotherapy--a case report of the long term survivor]

A 33-year-old man, who underwent ileo-cecal resection and sigmoidectomy for concomitant cecal cancer and sigmoid colon cancer which was diagnosed during the emergent operation for the perforated acute appendicitis, suffered simultaneous multiple hepatic metastases. Postoperative hepatic aerial infusion chemotherapy with 5-FU was done (total dose 63 g), and the metastases were successfully disappeared (CR). Although 16-month passed from the operation, locoregional recurrence at the colorectal anastomosis and peritoneal dissemination were occurred. Aggressive resections of the recurrent sites (anterior resection of the rectum, ileum, ascending colon and other recurrent sites) and successive systemic administration of FOLFOX4(9-course), FOLFIRI (20-course) and capecitabine (15-course) were achieved. The patient survived for 4.5 years after the initial treatment.

[A case of recurrence gastric cancer patient who was post operated and multi drug chemotherapy was effective for administration of S-1 and docetaxel combination therapy]

Recently, chemotherapy against gastric cancer has been diversified with an appearance of new agents such as S-1, capecitabine, CPT-11, oxaliplatin, paclitaxel and docetaxel. But a prognosis of advanced or recurrent gastric cancer patient, who was failure of first- and second-line chemotherapy, was poor. We reported that a case of recurrence gastric cancer patient who was post operated and multi drug chemotherapy was effective for administration of S-1 and docetaxel combination therapy. A case was a 50-year-old man. He underwent distal gastrectomy and administered of multi anticancer drugs until about eight years after operation. But multi lung and liver and lymph-node metastases were appeared. We administered S-1 and docetaxel combination chemotherapy. After two courses, multi metastatic lesions were reduced in size, and tumor markers were decreased. The same combination therapy was administered for six courses, but metastatic lesions were increased again. At one hundred four months after the operation, he died in the palliative care unit.

[A case of unresectable cardiac gastric cancer patient who maintained a long-term QOL with chemotherapy and detention of metallic stent]

A case was a 66-year-old man. He visited our hospital for dysphagia, abdominal distention and body weight loss. He was underwent gastro-endoscopy and made a diagnosis of the advanced cardiac gastric cancer. The early esophageal and gastric cancer also detected. Furthermore, computed tomography was performed and detected multiple liver and spleen, para-aortic lymph-node metastases and the ascites (suspected for dissemination). We decided that curative resection was impossible. Therefore, we performed an abdominal puncture to remove the ascites and combination chemotherapy with S-1 and docetaxel. The combination therapy was effective. The main tumor and multiple metastatic lesions were reduced. But after six months, a tumor marker was increased. The anticancer drug was changed to S-1 and CDDP. After eight months from the first-line chemotherapy started, the stenosis was appeared at esophago-gastric junction. We performed balloon dilation, and a metallic stent was detention with gastroscopy and radiography at stenotic lesion. He improved swallowing and discharged from hospital. After eleven months from the first-line chemotherapy started, he was died of increased liver metastases and peritonitis carcinomatousa.

[Primary lung cancer that I was preoperative and needed discrimination for and one example of the repetition cancer of the colon]

The patient was a 59-year-old woman. We performed chemotherapy using S-1 after resection of sigmoid carcinoma because the patient was diagnosed with metastatic lung tumor. The mass was regarded as metastases and reduced in size. We performed pulmonary segmentectomy. Frozen section pathological diagnosis revealed that it was primary lung cancer.

[Sternal metastasis of breast cancer; report of a case]

A 51-year-old woman presented with a painful sternal lump. Nine years earlier she had undergone right modified mastectomy for breast cancer, followed by chemotherapy. Computed tomography and bone scintigraphy demonstrated a solitary sternal bone metastasis. The patient was treated by partial sternectomy. Thereafter, the sternal defect was reconstructed with Marlex mesh and rectus abdominis myocutaneous flap. The postoperative course was uneventful. The patient subsequently developed brain metastasis and died within 52 months after sternal resection. The stability of the chest wall was well preserved for the duration of follow-up.

Parasitism by Dermocystidium ranae in a population of Rana esculenta complex in Central Italy and description of Amphibiocystidium n. gen

We report the enigmatic parasite Dermocystidium ranae in a green frog population (Solomeo, Umbria, Italy) of the Rana esculenta complex, consisting of the parental species R. lessonae (L) and hybrid form R. esculenta (E). In this population a rapid 50% decline of the parental form L was observed. Large dermal U-shaped cysts of D. ranae were found primarily on the ventral aspect of infected individuals, with a significantly higher incidence of infection in the parental species compared to the clonal hybrid. In each form, however, there was little pathological change associated with infection, and the cause of the recent declines of R. lessonae at this site remains unknown. In this paper we present the first ultrastructural description of an amphibian Dermocystidium sp. and we review the taxonomy of Dermocystidium, Dermosporidium and Dermomycoides spp. from amphibians. We conclude that Dermosporidium multigranulare Broz & Kulda, 1954 is synonymous with Dermocystidium ranae Guyénot & Naville, 1922 and, due to lack of sufficient differences between genera and significant dissimilarities with fish Dermocystidium spp., the 3 amphibian genera are synonymous. We propose that they should be designated to a new genus, Amphibiocystidium n. gen., and Dermocystidium retained for those species parasitic in fish.

Atrial natriuretic peptide (ANP) system in frog skin

In this study the ultrastructure of Rana esculenta skin is described. Cytochemical methods were used to localize guanylate cyclase in the presence of atrial natriuretic peptide and immunocytochemical methods showed the presence of the atrial natriuretic peptide in various levels of skin. The peptide is mainly found in the epithelium and in the lymph sacs of the tela subcutanea. Its receptors are located in the same zones and are indicated by guanylate cyclase activity. We demonstrate that frog skin is a target organ for atrial natriuretic peptide and propose that, at this level, the peptide carries out an important osmoregulatory role.

Ultrastructural analysis and cytochemical localization of atrial natriuretic peptide-stimulated guanylate cyclase in internal gills of Bufo bufo tadpoles

In this study on the internal gills of the larvae of Bufo bufo we examined the ultrastructural features and, using cytochemical methods, showed the localization of guanylate cyclase in the presence of atrial natriuretic peptide. The gill apparatus consists of a series of arches each with a dorsal part or gill rakers with filtering and glandular functions. In the epithelium, cells were found that contain granular secretions similar to those atrial natriuretic factor-immunoreactive granules of larval Bufo arenarum gill rakers. The ventral portion of the gill arches is made up of gill tufts with a respiratory function. The cytochemical localization of the guanylate cyclase in the presence of exogenous atrial natriuretic peptide demonstrates that the internal gills of the larvae are an important target organ for the peptide and therefore, it is proposed that, at this level, the atrial natriuretic peptide carries out an important osmoregulatory role.

Morphological and ultrastructural study of carpal organ in adult female wild swine

The carpal organ of adult female wild swine is a sweat-type gland which secretes an odorous substance. The gland consists of 5-7 lobes, each made up of lobules with convoluted glandular tubules. The gland secretion is transported in large excretory canals which empty from 5 to 7 clearly visible pores. An ultrastructural examination showed that the glandular tubules are made up of single-layered epithelium with different types of cells. One type, with rather electron-dense cytoplasm, is secretory cells full of granular material which empties into the tubule lumen. A second cell type has a glycogen-rich, transparent cytoplasm. Its role appears to be secreting a watery, electrolyte-containing liquid. In the intermediate zone of the tubules, there is a third type of cell with transparent cytoplasm. Its ultrastructural characteristics seem to indicate that its function is to reabsorb the excess watery component. In the wall of the glandular tubules, outside the epithelium, there are myoepithelial cells which facilitate the movement of the secretions toward the collector canal.

Ultracytochemical localization of guanylate cyclase after stimulation with natriuretic peptides in frog choroid plexus

The ultracytochemical localization of particulate guanylate cyclase (GC) has been studied in Rana esculenta choroid plexus after activation with rat atrial natriuretic peptide (ANP), porcine brain natriuretic peptide (BNP) and porcine C-type natriuretic peptide (CNP). This study shows that the three peptides are activators of GC in the choroid plexus as demonstrated by the presence of reaction products at the level of the epithelium and sinusoids. In the apical zone of the epithelial cells predominantly BNP seems to activate GC, while ANP and CNP activate GC mainly at the level of the lateral surfaces. Moreover, ANP stimulates the enzyme along the basal membrane of the epithelial cells as well as the membranes of the endothelium of the sinusoids. In the presence of CNP, enzyme stimulation can also be found at the level of the endocellular membranes. These results confirm that the choroid plexus is an organ with receptors for the natriuretic peptides which are involved in the processes of osmoregulation and the control of cerebrospinal fluid production.

Cytochemical localization of adenylate cyclase in the limb buds of Bufo bufo

The importance of cyclic nucleotides in the regulation of the processes of differentiation and embryonic development is known. The possible role that cyclic adenosine monophosphate (cAMP) plays during the development of the posterior limb of Bufo bufo is studied by the cytochemical localization of adenylate cyclase (AC), an enzyme that catalyzes the synthesis of the cyclic nucleotide. The method is based on the reaction between the enzyme AC and its specific substrate AMP-PNP (5'-adenylylimidodiphosphate) in the presence of lead. The lead precipitates that form as secondary reaction products are evidence of enzymatic activity. Reaction products are present only at the epithelial level in the limb bud; initially, such products are visible only at the base of the bud, particularly on the epithelial fascia located at the boundary with the body. During successive elongation and toe formation, AC activity is only present on the cells of the proximal portion of each new segment. Enzymatic activity is never present in correspondence to the ectodermal apical crest. cAMP is probably not involved in the processes of cellular proliferation but, rather, in the processes of inducing differentiation of the internal mesenchymal cells.

[Quality of life in patients with advanced ovarian cancer who underwent cytoreductive surgery followed by chemotherapy]

The aim of this study was to determine the influence of cytoreductive surgery followed by chemotherapy on quality of life (QOL) in patients with advanced ovarian cancer. A total of 33 patients, who underwent the treatment after telling the truth and gave us the information on QOL 11 to 42 months after the discharge, were entered into the present study. Survival and length of hospital stay were calculated. QOL including emotional and physical well-being were assessed with a structure questionnaire which gives 110 points as full marks. The estimated 5-year survival rate was 49.6%. The mean survival time and length of hospital stay were 1,257 and 382 days, respectively. The mean QOL score was estimated to be 93.2. THe scores for both sociality and mentality showed a tendency to increase after completion of the treatment. Thirty-two of 33 cases (97.0%) obtained a good response for telling the truth. Alopecia and emesis due to chemotherapy were serious problems for patients. The present study showed that telling the truth was useful for well-informed consent and the QOL of patients with advanced ovarian cancer was not disturbed by cytoreductive surgery or chemotherapy.

Biochemical and cytochemical analyses of BNP-stimulated guanylate cyclase in frog choroid plexus

This study shows that in the choroid plexus of Rana esculenta particulate guanylate cyclase (GC) is appreciably stimulated by porcine brain natriuretic peptide (BNP). Ultracytochemical tests for GC show that BNP notably increases the enzymatic reaction product along the apical surfaces of the epithelial cells. It can therefore be hypothesized that the apical zone of the epithelial cells possess receptors which have a particular affinity for BNP produced in the central nervous system and dumped into the cerebrospinal fluid. These results, together with those of a previous study [32], confirm that the choroid plexus is an organ which has receptors for the natriuretic peptides which are involved in the processes of osmoregulation and the control of cerebrospinal fluid production.

Response of guanylate cyclase to atrial natriuretic factor in epithelial cells of the frog choroid plexus

This study shows that the choroid plexus of Rana esculenta contains a guanylate cyclase particulate (GCp), similar to that identified in Mammalia, that is quite sensitive to the atrial natriuretic factor (ANF). The cytochemical tests for GCp show that ANF increases the enzymatic reaction products. Deposits are observed on the apical portion, at the basal level and along the lateral edges of the epithelial cells, with the exclusion of some intercalary epithelial cells with reaction-lacking microvilli. In particular, ANF seems to intensely stimulate the GCp activity along the lateral membranes of the epithelial cells delimiting enlarged intercellular spaces, which are probably dilated for the transport of water and solutes. These data confirm the osmoregulatory role of the hormone and its control of cephalorachidian liquid composition.

Ultrastructural and cytochemical analysis for adenyl cyclase in frog choroid plexus

An ultrastructural and cytochemical analysis of the anterior choroid plexus in adult Rana esculenta was undertaken. The epithelial cells are implicated in the production of cephalorachidian liquid by transporting metabolites from the blood and by synthesizing and secreting activity. The epithelial cells are also capable of re-absorbing catabolites from the cephalorachidian liquid. The presence of adenylate cyclase, along the basal and lateral membranes in some epithelial cells and along the apical membranes of others, leads us to hypothesize that the epithelium of the plexus is made up of two cell types, one type with a secretory function and another type with an absorption function.

Ultrastructure of the paraphysis in Bufo bufo larvae

A study of the ultrastructure and function of the paraphysis in Bufo bufo larvae was carried out. The structure is a tubular-ramified gland made up of numerous tubules with monolayered epithelial walls surrounded by connective tissue and sinusoids. The epithelial cells secrete glycoprotein to contribute to production of the cephalorachidian fluid. The role of the paraphysis in the transport of fluids and electrolytes from the blood to the cephalorachidian fluid in regulation of ionic and osmotic homeostasis is discussed.

Activity trends of adenylate and guanylate cyclases and cAMP and cGMP levels during the first embryonic stages of Bufo bufo

1. During the first stages of embryonic development of Bufo bufo, the levels of cAMP and cGMP showed interesting opposite trends analogous to the trends of their respective enzymes. 2. In the late segmentation, the high increase of guanylate cyclase specific activity and the corresponding rise of embryonic level of cGMP, could indicate the involvement of this nucleotide in cellular proliferation. 3. During the following stage of the gastrulation, the increase of adenylate cyclase specific activity, coupled to the loss of guanylate cyclase specific activity, could suggest the importance of cAMP in the phenomena of differentiation induction. 4. Furthermore, the cytochemical investigation of adenylate and guanylate cyclase localization seems to confirm the prominent role of cAMP during the differentiation phases.