Visualization and hypervascularization of the haemorrhoidal plexus in vivo using power Doppler imaging transanal ultrasonography and three-dimensional power Doppler angiography

AIM

The purpose of this study was to demonstrate the distribution of haemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids.

METHOD

One-hundred and three patients with haemorrhoids were studied. Using power Doppler imaging (PDI) transanal ultrasound and three-dimensional power Doppler angiography (3D-PDA), the course of the arteries supplying the haemorrhoids was identified. Measurement of the PDI area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line.

RESULTS

The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1% of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from Grade 1 to Grade 4 (P < 0.0001). The PDI areas in Grades 1, 2, 3 and 4 were 0.04 ± 0.03, 0.18 ± 0.07, 0.38 ± 0.18 and 0.96 ± 0.32 cm(2) (P < 0.05).

CONCLUSION

The distribution of haemorrhoidal arteries varies widely in both number and position. Using PDI transanal ultrasonography and 3D-PDA it was possible to visualize the haemorrhoid plexus and the course of the haemorrhoidal artery in vivo.

Loss of Secreted Frizzled-Related Protein-1 expression is associated with poor prognosis in intrahepatic cholangiocarcinoma

AIMS

Secreted Frizzled-Related Protein-1 (SFRP1) is a well-known negative regulator of the wingless type (Wnt)-β-catenin pathway and its inactivation plays an important role in the development and progression of many cancers. In this study, we aimed to determine the clinical significance of SFRP1 expression in intrahepatic cholangiocarcinoma (IHCC) and to define the relationship to Wnt-β-catenin pathway.

METHODS

Fifty IHCC patients who had liver resection were enrolled in this study. SFRP1 protein expression was examined by immunohistochemistry in tumor tissues. The patients were divided into two groups: SFRP1 positive (n = 30) and negative (n = 20). Clinicopathological characteristics were analyzed.

RESULTS

SFRP1 significantly correlated with curability (Cur A, B vs. C, p = 0.029); and recurrent pattern (intrahepatic vs. extrahepatic, p = 0.010). The negative SFRP1 group had significantly poorer prognosis, and 5-year survival rates were 8.1% of the negative SFRP1 group and 44.6% of the positive SFRP1 group, respectively. Moreover, the disease-free survival rate in the negative SFRP1 group was significantly poorer (p < 0.001). Multivariate analysis revealed that loss of SFRP1served as an independent prognostic factor in IHCC for both overall (HR, 2.923; 95% CI, 1.30-6.56; p = 0.009) and disease-free (HR, 2.631; 95% CI, 1.31-5.27; p = 0.006) survival. In addition, SFRP1 expression negatively correlated to β-catenin expression (p = 0.005).

CONCLUSIONS

Those results suggested that the loss of SFRP1 could be a poor prognostic factor for IHCC, through the Wnt-β-catenin pathway.

Three-dimensional power Doppler transanal ultrasonography, to monitor haemorrhoidal blood flow after Doppler-guided ALTA sclerosing therapy

AIM

The study aimed to use power Doppler imaging (PDI) transanal ultrasonography to produce three-dimensional power Doppler angiography images of haemorrhoidal tissue and to monitor the effects of Doppler-guided aluminium potassium sulfate and tannic acid (DGALTA) sclerotherapy.

METHOD

Ninety-six haemorrhoids in 43 patients were examined using PDI transanal ultrasonography, and DGALTA sclerotherapy was performed from April 2011 to April 2012. DGALTA sclerotherapy was conducted using a four-step injection process with pulse wave Doppler ultrasound under perianal local anaesthesia.

RESULTS

A three-dimensional power Doppler angiography image of the blood flow in haemorrhoidal tissue was produced using PDI transanal ultrasonography. The cross-sectional area of blood flow in the haemorrhoidal tissue (PDI area) significantly decreased after DGALTA sclerotherapy. The PDI areas in the preoperative state and 1 and 3 months after treatment were 0.35±0.27, 0.03±0.05 and 0.04±0.05 cm(2) (P<0.0001).

CONCLUSION

A three-dimensional power Doppler angiography image of the haemorrhoidal tissue was technically possible and showed blood flow in the haemorrhoidal tissue to be significantly decreased after DGALTA sclerotherapy.

Bipedal locomotion by the normally quadrupedal Japanese monkey, M. Fuscata: strategies for obstacle clearance and recovery from stumbling

This study explored how the normally quadrupedal Japanese monkey adjusts to treadmill perturbations, when trained to walk bipedally. The monkey was required to use the left hindlimb to clear an obstacle that was fixed on the left side of a treadmill belt. The monkey either cleared the obstacle (CL: cleared locomotion), or stumbled over it (SL: stumbled locomotion). For CL, it changed its left hind limb's kinematics according to the obstacle's height and position relative to the left foot. In SL, the monkey used a "defensive posture", which included a rapid lowering of the right foot and forelimb movements, to stabilize the perturbed posture and thereby prevent falling. Then, with powerful extensions of its lower limb joints, the monkey raised its center-of-mass to the appropriate level for continuation of normal bipedal walking. The results show that M. Fuscata recruited both anticipatory and reactive neural mechanisms to accommodate to the obstacle.

Messenger RNAs from chick muscle encode a motoneuronal survival-promoting factor

The survival of motoneurons requires a trophic factor derived from the target muscles, but the nature of this trophic factor is not known. We examined whether skeletal muscle expresses mRNAs encoding survival-promoting factors for motoneurons. Messenger RNAs were purified from hindlimbs of chick embryos and injected into Xenopus oocytes for translation. The media conditioned by incubation of the injected oocytes were applied to chick embryos during the natural cell death period of lumbar motoneurons. This procedure significantly reduced the magnitude of natural motoneuronal death. The conditioned media also promoted the survival of motoneurons cultured from chick embryos.