Schizophrenia is a chronic, disabling disorder, which commonly emerges in adolescence and young adulthood. While pharmacological treatment with currently available second-generation antipsychotics exerts beneficial effects on the positive symptoms of schizophrenia, they have little effect on negative symptoms or cognitive deficits. Because these two types of symptoms are enduring, and negatively impact social functioning throughout the course of the illness, there is an urgent requirement to develop new effective therapeutic approaches to manage them. Negative symptoms have proven difficult to assess accurately because of their complexity, even with commonly used clinical rating scales such as the Scales for Assessment of Negative Symptoms (SANS). In this context, new “next-generation” assessment tools have recently been developed, which include items representing the five domains encompassed by the two established clusters of negative symptoms (diminished expression and avolition), and enable the detection of changes in severity. Despite various therapeutic approaches to alleviating negative symptoms, there are currently no established methods available for clinical practice. Cognitive deficits are also a core feature in the majority of people with schizophrenia, with impaired performance observed across many cognitive domains, including verbal memory, working memory, attention, and executive functions. Such cognitive deficits are likely associated with either reduced or inefficient function of related distributed neural networks. Psychosocial treatments for cognitive impairments in schizophrenia seem promising given the beneficial effects of cognitive remediation therapy on such impairments, as well as on social functioning, as substantiated in several meta-analytic studies with modest effect sizes. Furthermore, using functional neuroimaging techniques, the size of these therapy-induced beneficial changes in neurocognitive performance has been demonstrated to be correlated with the degree of the changes in brain activation during performing some cognitive tasks in the prefrontal and temporal cortices. This suggests neurobiological effects are exerted by psychosocial cognitive remediation treatments.

In congestive heart failure (CHF), sympathetic nervous system is hyperactive. This article reviews current understandings about central and peripheral neural mechanisms underlying sympathetic hyperactivation in this pathological condition. During the development of CHF, renin-angiotensin system (RAS) activities and angiotensin II–mediated oxidative stress become enhanced. Here, on the basis of findings obtained from animal studies, it is examined how RAS overactivation and oxidative stress in central and peripheral nervous systems of CHF mediate sympathetic hyperactivation. Mechanisms by which exercise training in CHF ameliorates RAS overactivation, oxidative stress and sympathetic hyperactivation are also investigated.

Background We investigated the distinguishing pathological features of bilateral ovarian tumors using magnetic resonance (MR) imaging

Methods Eighty-six patients with bilateral ovarian tumors on MR imaging were evaluated. The pathological diagnosis was investigated, and the results were subjected to statistical analysis using Mann-Whitney U test, Fisher’s exact test, Chi-squared test and receiver operating characteristic (ROC) curve to determine the features useful for the differentiation of distinct types of lesions.

Results The diagnosis of bilateral ovarian tumors was confirmed in eighty-one patients and the majority of the lesions were further classified into serous carcinoma (n = 36), mature teratoma (n = 20) and metastasis (n = 12). We assessed the existence of factors useful for the MR imaging differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors. Cancer antigen (CA) 125 serum level and maximum tumor diameter were significantly different between metastasis and serous carcinoma and similarly, between metastasis and primary malignant ovarian tumors. MR imaging morphology, ascites and peritoneal implants did not show any significant difference between the different types of lesions.

Conclusion Within our patient cohort, most bilateral ovarian tumor lesions were determined to be serous carcinoma, mature teratoma or metastasis. CA 125 serum level and maximum tumor diameter are useful markers for the differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors.

Background ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and ¹²³I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson’s disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD.

Methods A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination.

Results For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS.

Conclusion A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD.

Background Indirubin, a constituent of the Chinese herbal medicine “Qing-Dai,” has anti-cancer and anti-inflammatory activities. We aimed to evaluate the efficacy of indirubin for ameliorating colonic inflammation in a mouse model of inflammatory bowel disease.

Methods Mice with dextran sulfate sodium (DSS)-induced acute and chronic colitis were treated with indirubin in their diet. Clinical and histologic changes were evaluated. In addition, colon levels of interleukin-6, a critical pro-inflammatory mediator, was detected by enzyme-linked immunosorbent assay.

Results In the model of acute colitis, indirubin treatment improved the loss of body weight. Histology of colonic tissue revealed that indirubin treatment improved the histology grading of colitis (P = 0.02), the extent of submucosal fibrosis (P = 0.018), the number of mucosal toluidine blue-positive cells (P = 0.004) and colon length (P = 0.01). In the model of chronic colitis, indirubin treatment had no significant effect on pathologic findings except for colon length (P = 0.003). However, indirubin administration significantly reduced colon levels of interleukin-6 in the chronic-colitis model (P = 0.001).

Conclusion Our study clearly showed that oral intake of indirubin can improve murine DSS-induced colitis (which mimics human inflammatory bowel disease).

We present an unusual case of cystic pilomatricoma. A 13-year-old Japanese boy was referred to our department for evaluation of a 10-day history of a small reddish nodule on his right cheek. Histopathological examination showed a well-circumscribed cystic structure showing a central empty cavity in the dermis. The wall of the cyst was composed of basophilic cells. Inner layers of the wall were covered with flattened epithelial cells having trichohyalin granules. Based on these findings, a diagnosis of cystic pilomatricoma was made. To our knowledge, there has been no report of cystic pilomatricoma with an empty cavity. Dermatologists should be aware of pilomatricoma in the early stage showing a central empty cavity.

We report a case of squamous cell carcinoma manifested as a cutaneous horn. A 92-year-old man was referred to our department for evaluation of a 3-month history of a keratotic cutaneous horn on the left side of his neck. The height of the cutaneous horn was larger than the diameter of erythema at the base. Histopathological examination showed a hyperkeratotic horn developing over a mass of large atypical keratinocytes with large hyperchromatic and pleomorphic nuclei. Based on these findings, a diagnosis of squamous cell carcinoma was made. A recent study showed that cutaneous horns in association with invasive squamous cell carcinoma had a tendency to have less height than the diameter of the base. In our case, however, the height of the cutaneous horn was larger than the diameter of the base, indicating that invasive squamous cell carcinoma sometimes shows a cutaneous horn that is higher than the diameter of the base. Thus, clinical finding of erythema at the base of the cutaneous horn would be a reliable feature for early detection of squamous cell carcinoma.

One complication of an autogenous arteriovenous fistula (AVF) for hemodialysis is the formation of a venous aneurysm. The treatment of a massive aneurysmal AVF generally involves ligation or resection with the use of prosthetic interposition. We present the case of a 46-year-old man in whom an AVF aneurysm was successfully treated by placating the excess free wall of the aneurysm with sutures. This method is a simple and effective intervention for managing aneurysm-associated complications. In addition, this approach helps to maintain the benefits of autogenous access while conserving future dialysis sites.