Recently, a new disease entity termed gastric adenocarcinoma of fundic gland type (GA-FG) was proposed. We treated five cases of GA-FG with endoscopic submucosal dissection. All tumors were small and located in the upper third of the stomach. Four tumors were macroscopically identified as 0-IIa and one was identified as 0-IIb. Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder. All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion. Lymphatic invasion was seen only in one case, while no venous invasion was recognized. All tumors were positive for pepsinogen-I  and MUC6 by immunohistochemistry. None showed p53 overexpression, and the labeling index of Ki-67 was low in all cases. All cases have been free from recurrence or metastasis. Herein, we discussed the clinicopathological features of GA-FG in comparison with past reports.

We identified and characterized a novel rat vitamin D receptor isoform (rVDR1), which retains intron 8 of the canonical VDR (rVDR0) during alternative splicing. In this isoform protein directed by the stop codon in this newly identified exon, a part of the ligand binding domain (86 amino acids) is truncated at the C-terminal end but contains 19 extra amino acids. The rVDR1 transcript was expressed at a level 1/15 to 1/20 of that of rVDR0 in the kidney and intestine in adult rats but not in embryos. The recombinant rVDR1 protein showed no ligand binding activity. Homo-and heterodimers of the recombinant rVDR0 and rVDR1 proteins bound to a consensus vitamin D response element (VDRE) but not to consensus response elements for thyroid hormone and retinoic acid. However, unlike rVDR0, rVDR1 did not form a heterodimeric complex with RXR on the VDRE. A transient expression assay showed that this isoform acted as a dominant negative receptor against rVDR0 transactivation. Interestingly, the dominant negative activities of rVDR1 differed among VDREs. Thus, the present study indicates that this new VDR isoform negatively modulates the vitamin D signaling pathway, through a particular set of target genes.Most of the biological actions of 1,25-dihydroxyvitamin D 3 [1,25(OH) 2 D 3 ], such as regulating calcium homeostasis and cytodifferentiation, are exerted through gene expression mediated by the nuclear vitamin D receptor (VDR) (for a review, see reference 8). VDR is a member of the nuclear receptor superfamily, which functions as a ligand-inducible transcription factor (for reviews, see references 2, 10, 13, and 39). This family includes nuclear receptors for steroid hormones, thyroid hormone, retinoic acid, and unknown ligands (orphan receptors). Together with the retinoid receptors (RAR␣, -␤, and -␥ and RXR␣, -␤, and -␥) and thyroid hormone receptors (TR ␣ and ␤), VDR forms a subfamily, based on structural and functional similarities, in the nuclear receptor superfamily. Like RARs and TRs, VDR heterodimerizes with RXR. These heterodimers bind distinct but similar target enhancer elements composed of two directly repeated core AGGTCA (or related hexamer core) motifs. The spacer between the two core motifs (3 bp [DR3] for RXR/VDR, 4 bp [DR4] for RXR/TR, and 2 [DR2] and [DR5] 5 bp for RXR/RAR) discriminates among these nuclear receptors for recognizing target enhancer elements (for reviews, see references 12, 19, 22, 41, and 50). In addition to the heterodimeric form of VDR with RXR, VDR forms a homodimer with some vitamin D response elements (VDRE), suggesting the presence of two signaling pathways for vitamin D (5, 48). Irrespective of the functional and structural similarities of these receptors, only one type of VDR protein has been found in sharp contrast to multiple subtypes and isoforms of RAR, RXR, and TR (17, 24, 53). The RAR and TR isoforms are generated by alternative splicing and/or by direction of differential promoters. Functional analysis by a transient-expression assay showed that the transactivational acti...

Basket and balloon catheters showed similar efficacies for endoscopic biliary stone extraction when stone size is 11 mm or smaller.

The long-term use of geniposide in herbal medicines appears to be associated with mesenteric phlebosclerosis.

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type, GA-FG-CCP) is a rare variant of well-differentiated adenocarcinoma, and has been proposed to be a novel disease entity. GA-FG-CCP originates from the gastric mucosa of the fundic gland region without chronic gastritis or intestinal metaplasia. The majority of GA-FG-CCPs exhibit either a submucosal tumor-like superficial elevated shape or a flat shape on macroscopic examination. Narrow-band imaging with endoscopic magnification may reveal a regular or an irregular microvascular pattern, depending on the degree of tumor exposure to the mucosal surface. Pathological analysis of GA-FG-CCPs is characterized by a high frequency of submucosal invasion, rare occurrences of lymphatic and venous invasion, and low-grade malignancy. Detection of diffuse positivity for pepsinogen-I by immunohistochemistry is specific for GA-FG-CCP. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP. Nearly all GA-FG-CCPs are treated by endoscopic resection due to their small tumor size and low risk of recurrence or metastasis.