The use of stem cells is promising for future cell-based therapy such as tissue regeneration and engineering. Although Embryonic Stem Cells (ESCs) are theoretically highly beneficial, there are some potential limitations of cell regulations and ethical consideration. Mesenchymal Stem Cells (MSCs) isolated from bone marrow stroma have been shown to possess adipogenic, osteogenic, chondrogenic, myogenic and neurogenic potential in vitro. However, bone marrow procurement is severely painful for donors and often requires general anesthesia. Moreover, only small numbers of cells can be harvested.
We previously hypothesized that human adipose tissue obtained from liposuction procedures also contains the same cell population as MSCs, because adipose tissue is mesenchymal in origin, like bone marrow stroma. Subsequent studies revealed that: (1) cell population (which we termed Processed Lipoaspirate [PLA] cells), observed by indirect immunofluorescence study of adipose tissue, consist of cells of mesenchymal origin that have little contamination with endothelial cells, smooth muscle cells and pericytes; (2) these PLA cells exhibit low levels of cell senescence even after multiple passage, as demonstrated by β-galactosidase staining assay; and (3) PLA cells can differentiate into adipogenic, osteogenic, chondrogenic and myogenic cells in vitro in lineage-specific culture media.
These findings suggest that human PLA might have a mesodermal stem cell population. Since human adipose tissue is plentiful, easily harvested in large quantity under local anesthesia with little patient discomfort, it may be an alternative stem cell source for mesenchymal tissue regeneration and engineering. This review highlights our previous research work on PLA cells and future clinical perspectives, particularly in the field of plastic and reconstructive surgery.

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Purpose: To determine the diagnostic effect of prostaglandin E₁ on contrast enhancement quality of CT during arterial portography (CTAP).
Materials and Methods: Our patients population included 30 patients (11 women, 19 men; age range, 41∼81 years) with liver tumors (23 hepatocellular carcinoma and 7 metastatic liver tumor) who had undergone angiography. We divided the 30 patients, who had undertaken CTAP twice, into two groups at random (group A; n=15, group B; n=15). In group A, first CTAP was performed without prostaglandin E₁. Approximately 5 minutes later, a second CTAP was again initiated 30 seconds after injection of prostaglandin E₁ under the same conditions. In group B, prostaglandin E₁ was injected before the first CTAP only. We measured the mean CT numbers and standard deviation (SD) numbers of anterior, posterior, medial and lateral segments in the liver at the same section of the CTAP using the same size and location of the regions of interest, and these values with and without prostaglandin E₁ were compared.
Results: 1) CT numbers: The CT numbers were significantly increased in the medial segment after the injection of prostaglandin E₁ (p<0.05) in all cases of both groups. On the other hand, they were clearly decreased in the posterior segment after the injection of prostaglandin E₁ (p<0.05) in both groups. There were no statistical differences in the CT numbers in the anterior and lateral segments in all patients. In addition, the CT numbers of anterior and posterior segments showed high attenuation compared with the medial and lateral segments in group A without prostaglandin E₁. 2) SD numbers: The SD numbers, which are an index of the homogeneous enhancement, were significantly decreased in the posterior, medial and lateral segments after the injection of prostaglandin E₁ (p<0.01, p<0.05, p<0.01, respectively) in both groups. There were no significant differences in the SD numbers in the anterior segment regardless of the injection of prostaglandin E₁ in all cases.
Conclusion: CTAP with injection of prostaglandin E₁ makes contrast enhancement of liver parenchyma more homogeneously than the conventional procedure, and it may be a useful technique for the detection of liver tumors.

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Background: The present study investigated the efficacy and safety of milnacipran, a serotonin noradrenalin reuptake inhibitor (SNRI), for the treatment of depression following mild and moderate traumatic brain injury (MMTBI). While other reports have been published on the use of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclics for the treatment of depression following MMTBI, no previous study has examined the use of a SNRI for this condition.
Methods: A six-week open study was conducted using 10 patients (4 males and 6 females) of ages ranging from 28 to 74 years. DSM-IV (diagnostic statistical manual of mental disorders, 4th Ed. American psychiatric association, 1994) was used to diagnose mood disorders. The severity of depression was measured with the 21-item Hamilton rating scale for depression (HAM-D). The cognitive state of the patients was assessed using the mini-mental state examination (MMSE).
Results: The maximum daily milnacipran dosage for the patients ranged from 30 to 150 mg. One patient experienced side effects, but none of the side effects were serious. On the basis of having a decrease in a final HAM-D score of more than 50%, the response rate for the nine patients was 66.7%, while in a final score of 7 or less, the remission rate for the nine patients was 44.4%. Furthermore, significantly greater improvement in cognitive function was seen in patients treated with milnacipran.
Conclusion: The results demonstrated that milnacipran is a safe and effective drug for depression following mild and moderate TBI and could be the first choice drug for the treatment of this condition.

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Objective: As the prevalence of white matter hyperintensities detected on T2 weighted MRI scans in patients with late-onset depression is higher than that in nondepressed patients, the concept of"vascular depression" (VDep) was introduced in 1997. However, the pathology of vascular depression has not been clarified. This study examined the differences in functional imaging between vascular and non-vascular depression (non-VDep).
Methods: We utilized ¹²³I-IMP single photon emission computed tomography (SPECT) to compare regional cerebral blood flows (rCBF) between 9 patients with VDep (Krishnan criteria) and 11 age- and sex-matched patients with non-VDep in both depressed and remitted states.
Results: In both VDep and non-VDep patients, mean rCBF increased significantly as depression improved, partially aided by changes in left anterior temporal blood flow. In addition, compared to non-VDep patients, the left anterior frontal rCBF for VDep patients was significantly lower in both depressed and remitted states.
Conclusions: Left anterior temporal rCBF therefore appears to represent a state marker that increases as symptoms associated with late-onset depression improve, regardless of vascular changes. Furthermore, in VDep patients, left anterior frontal rCBF was low in both states compared to non-VDep patients, and might not only represent a trait marker, but also correlated with the duration of disease and likelihood of recurrence and relapse.

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Purpose: To determine the effect of intrathecal injection of morphine 0.2 mg on postoperative analgesia, activity and satisfaction after elective cesarean section.
Method: Forty-five parturients who had previously undergone cesarean section with spinal anesthesia without intrathecal morphine were enrolled in this randomized, double-blinded study. Group 1 received hyperbaric bupivacaine 10 mg intrathecally (IT) and group 2 received morphine 0.2 mg IT in addition to hyperbaric bupivacaine 10 mg IT. All subjects received 20 mg piroxicam rectally at the end of surgery and 18 hours after surgery. Side effects in the first 24 hours after delivery were recorded by a trained nurse. Pain, nausea, pruritus, and satisfaction during the first 24 hours were self-rated using a visual analog scale. Subjects also recorded their memories of these symptoms after their previous cesarean sections. The time to first request for additional analgesics (30 mg pentazocine intramuscularly), total dose of pentazocine within 24 hours postoperatively and nurse observations of walking status within 24 hours postoperatively were also recorded.
Results: In the present cesarean sections, the duration of complete analgesia and the time to first request for additional analgesics were longer in group 2 than in group 1. Group 2 had higher satisfaction scores than group 1 in spite of their more severe pruritus and nausea during the first 24 hours after surgery. The percentage of patients who could not walk during the first 24 hours after cesarean section was higher in group 1 than in group 2.
Conclusion: The addition of morphine 0.2 mg to hyperbaric bupivacaine 0.5% by intrathecal injection reduced postoperative pain and analgesic use, and increased patient satisfaction following cesarean section. The combination of intrathecal injection of morphine and preventive NSAIDs can be easily administered in most hospitals, and is substantially less expensive than the new pain management technologies currently in use.

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Previously, we reported that morning bright light therapy improved sleep time and cognitive function in Alzheimer type of dementia. We conducted a double blind study to examine the effects of melatonin on the sleep-wake rhythm, cognitive and non-cognitive functions in Alzheimer type of dementia. The subjects were 9 persons given a placebo (PLA), and 11 given melatonin (3 mg)(MLT). The mean age was 79.2±6.4 (17 females and 3 males). The drugs were given at 20: 30 each day for 4 weeks. We checked sleep time and activity by Actigraph through one week before and the 4th week after drug administration. Cognitive and non-cognitive functions were evaluated with the clinical dementia rating scale (CDR), and Mini Mental State Examination (MMSE), and the Alzheimer's Disease Assessment Scale (ADAS). We successfully recorded Actigraph data from 18 patients (PLA8, MLT10). The mean sleep time change ratio and SD of the administration of PLA in the night was-0.2±13.7%, and MLT was 33.2±37.6%. The mean activity counts and SD of the administration of PLA in the night was 29.8±77.0%; in MLT it was-44.9±21.9%. Melatonin significantly prolonged the sleep time (p=0.017) and decreased activity (p=0.014) in the night (21: 00∼6: 00) in the MLT group, although no significant difference in sleep time or activity in the daytime (6: 00∼21: 00) was recognized between the two groups. In comparison with ADAS cognition score changes, the mean change and SD in the PLA was 0.3±3.7; in MLT it was-4.3±3.6 points. In comparison with ADAS non-cognition score, the mean change and SD in the PLA group was-0.8±1.0, in the MLT group it was-4.1±2.2 points. There were also significant differences between the PLA and the MLT groups in the comparison with the score improvement of ADAS cognition (p=0.017) and non-cognition (p=0.002), otherwise there was no significant difference in improvement of MMSE between both groups.
Melatonin administration had effect to improve sleep time and night activity, but no significant effect to improve daytime naps and activity. Although melatonin administration might has less strong effect on circadian rhythm than morning bright light therapy we previously reported, cognitive and non-cognitive functions were improved. Melatonin seemed to be useful for care of the Alzheimer type of dementia patients.

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Most studies concerning the structure and function of muscle spindles have utilized the hind limbs of experimental animals. However, little is known about muscle spindles of the back muscles. The purpose of this study was to investigate the sensory innervation of muscle spindles of the paravertebral muscle in the rat. The subjects were 10 normal male rats. The longissimus muscles were isolated and frozen in cooled isopentane (-160°C), and serial transverse sections were made with a cryostat. Histochemical preparations were then made using nicotinamide adenine dinucleotide tetrazolium reductase (NADH-TR) stain and modified Gomori-trichrome stain. The muscle spindles in each segment were identified microscopically by observing the equatorial and polar regions. NADH-TR staining was employed to distinguish nuclear bag1, nuclear bag2, and nuclear chain intrafusal muscle fibers. A total of 20 spindle poles were surveyed. The mean polar length of intrafusal fibers as well as that of each region (A, B, and C) were measured. NADH-TR staining also demonstrated the terminal sites of sensory fibers along intrafusal fibers. All spindle poles surveyed were innervated by secondary sensory fibers in addition to primary sensory fibers. Eight spindle poles were intermediate type muscle spindles that were innervated by one primary sensory fiber and one secondary sensory fiber. Twelve spindle poles were complex type muscle spindles that were innervated by one primary sensory fiber and multiple socondary sensory fibers. The mean length of the A region was 223.1±37.9 μm (n=8) for intermediate type spindles and 493.8±157.0 μm (n=12) for complex type spindles. The length of the A region was significantly longer in the complex type spindles than in the intermediate type spindles (p<0.001). The results suggest that the innervations of secondary sensory fibers were well developed in the longissimus muscle spindles in the rat. The morphological features of muscle spindles of the longissimus muscle may represent the structural basis for qualitatively different afferent discharges that relate to the characteristic types of locomotion served by paravertebral muscles.

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We report a case of adversive seizures featuring neck rotation and conjugate deviation induced by the hyperventilation maneuver. At the age of 6 years the patient suffered from conjugate deviation to the left. She herself felt no symptoms other than oculomotor symptoms. Hyperventilation induced an adversive seizure and ictal EEG showed sharp waves in the right frontal, central, and parietal areas. No brain image showed abnormal findings. Zonisamide completely attenuated her attacks. It is well known that hyperventilation induces absence seizures, and it has been reported that hyperventilation can induce complex partial seizures. However, no previous reports have described patients diagnosed as having adversive seizures with conjugate deviation induced by hyperventilation. We report the present case because, although its epileptogenesis is unknown, the patient is a rare case not only clinically but also electrophysiologically.

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Eleven cases of injury of the superficial radial nerve on the wrist joint, caused by intravenous injection of a needle. Paralysis occurred immediately after injection of a needle into the cephalic vein of the wrist joint, which was immediately recognized by the patients themselves. Six patients who had only sensory disturbance without causalgia were subjected to follow-up observation; 5 patients with causalgia were administered with steroid infiltration injection 3 to 5 times. Of the latter 5 patients, one patient underwent surgery because the steroid infiltration injection showed no effects. Four patients (36.4%) completely recovered within three months, while 7 patients (63.6%) continued to show nervous symptoms. We concluded that intravenous injection of a needle should be performed at the wrist joint only when it is inevitable.

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Chronic glomerulonephritis syndrome is one of clinical classification in primary glomerulonephritis. Clinical classification of primary glomerulonephritis consists of five groups. (WHO 1995)
They are acute nephritic syndrome, rapidly progressive nephritic syndrome, recurrent or persistent hematuria (proteinuria), chronic nephritic syndrome, and nephrotic syndrome. After therapy or renal biopsy, they have interaction with one another and many cases are followed up as chronic glomerulonephritis.
In the long term clinical course, it is most important thing that not to deteriorate renal function by therapies. (blood pressure control, low protein diet, salt restriction) If there are not only glomerular change but also interstitial and vessel changes in renal biopsy the prediction of prognosis will be poor so it will be necessary to administer medication under strict observation.

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External auditory canal cholesteatoma (EACC) is not a rare lesion. Conservative treatment under an operating microscope is appropriate for most cases. On the other hand, squamous-cell carcinoma of middle ear and external auditory canal is less common. We report a case of a 66-year-old man. He suffered from squamous-cell carcinoma following EACC. A biopsy from the external auditory canal was not useful for diagnosis. A biopsy during the first operation revealed squamous-cell carcinoma. The patient was treated by extended radical mastoidectomy and radiotherapy continuously. There is no evidence of recurrence after 14 months.

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Cisplatin is a widely used drug in cancer chemotherapy and resistance to cisplatin is a major limitation for its successful application. Intracellular inactivation of cisplatin and detoxification of reactive oxygen species (ROS) by glutathione (a crucial cellular antioxidant) is a mechanism for cisplatin resistance. During cDNA microarray analyses of differential gene expression between a cisplatin-resistant A2780CP70 human ovarian carcinoma cell line and its parental A2780 cell line, we discovered that frataxin gene expression was frequently overexpressed in the cisplatin-resistant variant. Decreased expression of frataxin protein is associated with Friedreich's ataxia (FRDA) which is a neurodegenerative disease involving ROS-mediated cellular damage. Recent evidence suggests that frataxin might detoxify ROS via activation of glutathione peroxidase and elevation of thiols. To exploit potential involvement of frataxin gene in the development of resistance to cisplatin, we compared the levels of frataxin gene and protein in the cisplatin-resistant A2780CP70 ovarian carcinoma cell line and its parental A2780 cell line. We found that frataxin mRNA and protein expressions were elevated in the cisplatin-resistant cells. Our results suggest a potential role for cisplatin as an inducer of frataxin expression and implies that this gene may be a potential target for modulating the response to cisplatin. This is the first report showing an association between frataxin exprression and cisplatin resistance.

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