Impact of COVID-19 on the mental health of primary schoolchildren during the later phase of the pandemic: A case report of an 18-month longitudinal survey in a Japanese primary school

Background

Drastic changes such as school closures and stay-at-home measures due to the global COVID-19 pandemic, may have long-term negative effects on children's mental health; however, longitudinal studies after 2021 are limited. This study aimed to observe the long-term effects of the COVID-19 pandemic on children's mental health by exploring changes in their mental health over a period of 18 months.

Study design

We conducted a longitudinal study at Chiba Prefecture in Japan, focusing on schoolchildren's mental health changes.

Methods

Data were obtained from the Strengths and Difficulties Questionnaire (SDQ) questionnaire conducted at single primary school three times from October 2021 to March 2023 which and included 183 participants. This study adopted a linear-mixed model to evaluate changes in children's SDQ scores, with sex and grade as the independent variables, and participants as a random effect.

Results

Regarding changes in SDQ scores, there were no significant changes in the total difficulty scores or in each subscale; Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention, Peer Problems, and Prosocial Behavior. There was no statistically significant interaction between changes in SDQ scores and sex.

Conclusions

This report indicates that the impact of the COVID-19 pandemic on the mental health of Japanese primary schoolchildren was negligible in the later phase of the pandemic. However, the impact may differ from country to country owing to factors such as social restrictions during the COVID-19 pandemic.

Effects of thienopyridine class antiplatelets on bleeding outcomes following robot-assisted radical prostatectomy

This study aimed to assess the effects of thienopyridine-class antiplatelet agents (including ticlopidine, clopidogrel, and prasugrel) on bleeding complications in patients who underwent robot-assisted radical prostatectomy. This cohort study used a database for robot-assisted radical prostatectomy at 23 tertiary centers nationwide between 2011 and 2022. Patients who received thienopyridines (thienopyridine group) were compared with those who received aspirin monotherapy (aspirin group). The primary outcome was the incidence of bleeding complications. High-grade complications were defined as Clavien-Dindo grade III or higher. The risks of these outcomes were evaluated using inverse probability of treatment weighted regression models. The study results demonstrated that thienopyridine therapy was associated with a higher risk of overall bleeding complications (OR: 3.62, 95%CI 1.54-8.49). The increased risks of the thienopyridine group were detected for low-grade bleeding complications (OR: 3.20, 95%CI 1.23-8.30) but not for high-grade bleeding complications (OR: 5.23, 95%CI 0.78-34.9). The increased risk of bleeding complications was not observed when thienopyridine was discontinued (OR: 2.52, 95%CI 0.83-7.70); however, it became apparent when it was continued perioperatively (OR: 4.35, 95%CI 1.14-16.61). In conclusion, thienopyridine increased the incidence of bleeding complications, particularly low-grade bleeding complications, following robot-assisted radical prostatectomy. These bleeding effects emerged when thienopyridine was continued perioperatively.

Prostate Biopsy May Not Be Indicated Early after Bacillus Calmette Guérin Treatment

Bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer frequently causes an intraprostatic BCG granuloma. We investigated the optimal timing for a prostate biopsy after BCG treatment by retrospectively analyzing the cases of 22 patients with non-muscle-invasive bladder cancer who underwent a prostate biopsy after BCG treatment at our institute (2013-2017). Biopsies were indicated for a rising prostate-specific antigen (PSA) level, positive digital rectal examination findings, or the appearance of de novo low apparent diffusion coefficient lesions on MRI. The control group was comprised of 28 age- and PSA-matched patients. The relationships among the cancer detection rate and the patients' PSA levels and MRI findings were analyzed. Prostate cancer was detected by biopsy in only 13.9% (3/22) of the patients in the BCG group but in 78.5% (22/28) of the control patients (p=0.0001). The three patients in the BCG group in whom prostate cancer was detected had all undergone the biopsy > 1 year after their BCG treatment. The remaining biopsies were performed within 1 year after BCG treatment and resulted in no diagnoses of prostate cancer. We suggest that performing a prostate biopsy early after BCG treatment is not informative or useful.

[Port Site Recurrence After Laparoscopic Nephrectomy for Renal Cell Carcinoma --Report of Two Cases and Literature review-]

CASE 1

A male in his 60s underwent a right transperitoneal laparoscopic partial nephrectomy procedure for a right renal tumor. Rupture of a renal cyst located close to the tumor occurred intraoperatively. The histopathological diagnosis was clear cell renal cell carcinoma (CCRCC), pT1aN0M0, G2, v0, with negative resection margins. At 84 months after surgery, computed tomography (CT) revealed a 10 mm mass in the rectus abdominis muscle at the camera port site used for the partial nephrectomy. An open lumpectomy was then performed and the histopathological diagnosis was CCRCC. One year later, a 40 mm sized mass was detected in the mesentery of the small intestine by CT, which was removed laparoscopically with part of the mesentery and diagnosed as CCRCC. Since that surgery, the patient has been free from recurrence for 8 years.

CASE 2

A male in his 60s underwent a left retroperitoneal laparoscopic nephrectomy procedure for a left renal tumor. The histopathological diagnosis was CCRCC, pT1aN0M0, G1, v0, with negative resection margins. At 31 months after surgery, CT revealed a 32 mm mass in the retroperitoneal cavity at the right hand port site used for the laparoscopic nephrectomy. The mass was removed with part of the twelfth rib and erector spinae muscles in a lump, and the histopathological diagnosis was CCRCC. Since that surgery, the patient has been free from recurrence for 19 months. For the treatment of solitary port site recurrence of renal cell carcinoma after a laparoscopic radical/partial nephrectomy, we recommend surgical resection for a good prognosis.

Uroflowmetry is a viable surrogate for urethroscopy in evaluation of anatomical success following urethroplasty

OBJECTIVES

This study aimed to investigate the utility of uroflowmetry in predicting anatomical success following urethroplasty based on real-world clinical data.

METHODS

Data from 100 male patients who underwent urethroplasty for urethral strictures at our institute were analyzed. Postoperative anatomical success was determined as the passage of a 16.2 Fr flexible endoscope after approximately 4 months following the procedure. Sensitivity and specificity of the maximal flow rate (Q_max ), average flow rate (Q_ave ), and Q_max  - Q_ave for anatomical success were determined, along with receiver operating characteristic analysis. The optimal cutoff was set using Youden's index.

RESULTS

Anatomical success was observed in 67%. Voided volumes in the success and failure groups were equivalent: 252 ± 121 versus 242 ± 91 ml, respectively. In 18 cases, voided volumes were <150 ml. Parameters of uroflowmetry were all significantly higher in the anatomical success group when compared to those in the failure group: the mean value of Q_max was 26.1 versus 15.0 ml/s; Q_ave , 14.2 versus 9.1 ml/s; and Q_max  - Q_ave , 11.9 versus 5.9 ml/s, respectively (p < 0.0001 for each parameter). The area under the curve was 0.8082 for Q_max , 0.7727 for Q_ave , and 0.8186 for Q_max  - Q_ave . Optimal cutoff values for Q_max and Q_max  - Q_ave were 20 and 6 ml/s, which predicted anatomical success with 86% and 87% positive predictive value, respectively.

CONCLUSION

This analysis presents statistically valid cutoffs by which uroflowmetry can be used as a viable surrogate of anatomical success following urethroplasty in clinical practice.

[A Case of Giant Multilocular Prostatic Cystadenoma Resected by Laparoscopic Pelvic Cystectomy : A Case Report]

A 60-year-old man visited our hospital to treat a large cystic mass in the pelvis which had been found by abdominal ultrasonography in December 201X. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a multilocular cyst with a maximum diameter of about 10 cm. CT-guided drainage and sclerotherapy with minocycline reduced the size of tumor by 40%, but symptoms such as difficulty of defecation and urinary frequency appeared a year and a half later due to re-enlargement of the cysts. Laparoscopic resection of the multilocular cysts was performed, and all cysts were removed almost completely using transrectal ultrasonography. The multilocular cyst was positive for NKX3.1 by immunohistochemical staining, and was diagnosed as a giant multilocular prostatic cystadenoma. After surgery, the symptoms such as difficulty of defecation and urinary frequency were relieved promptly. One year after the surgery, the patient was free from recurrence of the disease.

Why upright standing men urinate more efficiently than in supine position: A morphological analysis with real-time magnetic resonance imaging

PURPOSE

Few studies have examined the effects of body position on urination efficiency morphologically. We aimed to dissect out the anatomical changes of pelvic organs during urination in the upright and supine positions by a real-time magnetic resonance imaging (rtMRI) system.

METHODS

Thirteen healthy male volunteers aged 26-60 years were included in the study. The sagittal real-time two-dimensional images were taken to evaluate urinary efficiency, along with change in six morphological indices at the time of storage and the beginning of voiding, in both upright ant supine positions.

RESULTS

Urination was more efficient in upright position than in supine position, as expressed by higher average rate of bladder emptying (9.9 ± 4.2 vs. 6.8 ± 2.9 ml/s, p < 0.05) and also by fewer participants showing significant residual urine (1/13 vs. 7/13, p < 0.05). At the onset of voiding in standing position, the levator ani (LA) muscle moves downward and backward followed by descent of the bladder neck and rotation of the prostate around the symphysis. Such changes were expressed by two morphological indices. One was posterior vesicourethral angle at the start of voiding, 152 ± 7 versus 140 ± 1 in upright and supine position (p < 0.05). The other index was the change in angle between the LA line and pubo-coccygeal line in upright and supine position, 9.4 ± 9.9 versus 1.6 ± 7.9 before voiding (p < 0.05) and 30.2 ± 14.0 versus 17.3 ± 12.9 after the start of voiding (p < 0.05).

CONCLUSION

The dynamic relaxation of LA seemed to be a key movement that enables more efficient urination in standing position than in supine position.

Clinical Utility of Germline Genetic Testing in Japanese Men Undergoing Prostate Biopsy

Background

Multiple common variants and also rare variants in monogenic risk genes such as BRCA2 and HOXB13 have been reported to be associated with risk of prostate cancer (PCa); however, the clinical setting in which germline genetic testing could be used for PCa diagnosis remains obscure. Herein, we tested the clinical utility of a 16 common variant–based polygenic risk score (PRS) that has been developed previously for Japanese men and also evaluated the frequency of PCa-associated rare variants in a prospective cohort of Japanese men undergoing prostate biopsy.

Methods

A total of 1336 patients undergoing first prostate biopsy were included. PRS was calculated based on the genotype of 16 common variants, and sequencing of 8 prostate cancer–associated genes was performed by multiplex polymerase chain reaction based target sequencing. PRS was combined with clinical factors in logistic regression models to assess whether addition of PRS improves the prediction of biopsy positivity.

Results

The top PRS decile was associated with an odds ratio of 4.10 (95% confidence interval = 2.46 to 6.86) with reference to the patients at average risk, and the estimated lifetime absolute risk approached 20%. Among the patients with prostate specific antigen 2-10 ng/mL who had prebiopsy magnetic resonance imaging, high PRS had an equivalent impact on biopsy positivity as a positive magnetic resonance imaging finding. Rare variants were detected in 19 (2.37%) and 7 (1.31%) patients with positive and negative biopsies, respectively, with BRCA2 variants being the most prevalent. There was no association between PRS and high-risk rare variants.

Conclusions

Germline genetic testing could be clinically useful in both pre- and post-PSA screening settings.

Assessment of the viability and treatment response of bone metastases in patients with metastatic castration-resistant prostate cancer using choline PET/CT

This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 11C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) 11C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on 11C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 11C-choline-PET/CT scans, respectively. In 27 cases (48.2%), 11C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ± 3.21, 5.95 ± 3.96, 6.73 ± 5.04, and 7.91 ± 3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.

Accurate Monitoring of the Response of Bone Metastases to Treatment in Patients with Prostate Cancer Using Choline PET/CT

We here report 2 cases of castration-resistant prostate cancer (CRPC) observed two times on ¹¹C-choline positron emission tomography computed tomography (PET/CT), which was useful to discriminate viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and to determine the viability of bone metastases, regardless of whether sclerosis was present or not. Because one case demonstrated disappearance of abnormal ¹¹C-choline uptake of osteoblastic metastatic lesions after abiraterone therapy and no new lesions at other sites, suggesting nonviable bone metastases, we can assume a complete metabolic response. Because the other case demonstrated a decrease in the existing, abnormal ¹¹C-choline uptake of osteoblastic metastatic lesions, but multiple new appearances of osteoblastic and nonosteoblastic lesions with abnormal ¹¹C-choline uptake after radium-223 therapy suggesting multiple viable bone metastases, we can assume progressive metabolic disease. ¹¹C-choline PET/CT could help in assessing the treatment response of bone metastases in patients with metastatic CRPC.

Urinary retention in adult hypospadias patient resolved by unroofing of a mildly enlarged prostatic utricle

INTRODUCTION

A prostatic utricle is a congenital saccular indentation in the prostatic urethra and frequently enlarged in hypospadias patients. We present a case of urinary retention associated with a mildly enlarged utricle.

CASE PRESENTATION

A 20-year-old male, who underwent multiple repair procedures for hypospadias during childhood, was referred to us for dysuria. Retrograde urethrogram, voiding cystourethrogram, and cystoscopy results revealed only a mildly enlarged prostatic utricle, with no apparent lower urinary tract obstruction or urethral valves. A meatotomy was performed under suspicion of meatal stenosis, though urinary retention occurred following that procedure. Transrectal ultrasonography revealed flapping of the prostatic urethra floor over the utricle. Transurethral unroofing of the utricle relieved the dysuria.

CONCLUSION

A mildly enlarged prostatic utricle can cause dysuria. To the best of our knowledge, no case similar to the present has been previously reported.

Advancement of hepatic fibrosis among general women with/without NAFLD

Background

Nonalcoholic fatty liver disease (NAFLD) is increasing, being prevalent at 30% of the general population worldwide. A part of NAFLD develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Hepatic fibrosis plays an important role in their pathogenesis. However, it is unclear how hepatic fibrosis is observed and advanced in NAFLD among general population. To investigate the hepatic fibrosis among general population, we prospectively observed hepatic fibrosis using serum markers.

Methods

The subjects were 228 women who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed from 2005 to 2014. NAFLD was defined as fatty liver by abdominal ultrasonography; consuming ethanol &lt; 20 g/day; and being none hepatitis B and C carriers. NAFLD were confirmed after two-time consecutive examination, because its disappearance is ambiguous in some cases. Hepatic fibrosis was evaluated using serum M2BPGi and Type IV collagen 7s. The comparison of their changed values between groups was done using the ANOVA adjusted for age. The association between their change and related factors was done using general linear regression model.

Results

The prevalence of NAFLD was 31.6% at baseline. In the 5-year observation, the NAFLD + =&gt; NAFLD + ( ++) group was 23.7%; − +, 2.6%; + −, 7.9%; and - - (control), 65.8%. The values of M2BPGi and Type IV collagen 7s were higher in ++, -+, +- groups than controls at baseline. The change of M2BPGi values was observed in all groups, including controls, and the changed values were higher in ++ and -+ groups. Higher creatinine levels were positively associated with change of M2BPGi values. In contrast, the change of Type IV collagen 7s was not apparent.

Conclusions

This study suggested hepatic fibrosis was advanced with age among general women without NAFLD, and the presence of NAFLD enhanced hepatic fibrosis more.

Key messages

Hepatic fibrosis may be slightly developing with age among general population, and will be enhanced with fatty liver. It is important to prevent fatty liver development to control risk factors, such as obesity and metabolic syndrome, to reduce the risk of NASH, liver cirrhosis and hepatocellular carcinoma.

Comprehensive unhealthy lifestyle is associated with alcohol consumption as J-shaped curve

Background

Alcohol consumption is a confirmed risk factor for cancer as well as cardiovascular and other diseases. Decreased and increased risks with light and heavy consumption, respectively (J-shaped associations), were reported for total mortality. However, whether alcohol itself or its related-factors are involved in this association, is unclear. This study examined the background characteristics of comprehensive lifestyles and clinical factors according to alcohol consumption, using data from a baseline survey of large-scaled cohort study conducted among the general Japanese using Breslow’s healthy lifestyle index.

Methods

The study subjects were 23,885 males and 28,165 females aged 35 to 69 years, who were enrolled in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. To determine unhealthy lifestyle scores, smoking, exercise, sleeping duration, breakfast consumption, eating between meals, and obesity were combined. The odds ratios (ORs) of unhealthy lifestyles and clinical factors according to alcohol consumption were estimated using a logistic regression model.

Results

The ORs of combined unhealthy lifestyles decreased among light drinkers in males (0.73, 0.67-0.80) and females (0.88, 0.82-0.95), and increased among heavy drinkers (1.52, 1.27-1.83; 2.15, 1.44-3.20, respectively). These associations were not found for each unhealthy lifestyle and atherosclerosis-related factors, except for less breakfast intake in males and less frequent habitual exercise in females.

Conclusions

The present study suggests that the J-shaped association between comprehensive unhealthy lifestyle and alcohol consumption may be an important background factor of the association between alcohol consumption and risk of total mortality. Further study for total mortality with them is warranted.

Key messages

This study showed comprehensive unhealthy lifestyles were observed not only among heavy drinkers, but also among non-drinkers. Light drinkers have more healthy lifestyles, which contribute to their better health.

Immunosuppression Modification by Everolimus With Minimization of Calcineurin Inhibitors Recovers Kidney Graft Function Even in Patients With Very Late Conversion and Also With Poor Graft Function

BACKGROUND

Although kidney graft survival within 5 years after transplantation is now achieved in >95% of recipients, chronic graft deterioration remains a factor limiting long-term survival. Chronic nephrotoxicity induced by calcineurin inhibitors (CNIs) is one of the major causes of chronic graft injury; thus, minimization of CNIs by administration of everolimus (EVR) is expected to relieve their toxic effects.

METHODS

Fifty-six kidney transplant recipients receiving CNI-based immunosuppression (tacrolimus, n = 34; cyclosporine, n = 22) were analyzed. The average posttransplant period at conversion was 7.4 years and no less than 3 years. Conversion of immunosuppression was accomplished by reducing CNI by 40% in dose and beginning EVR at 1 or 1.5 mg. Changes in graft function were examined, and adverse effects were evaluated.

RESULTS

Significant improvement in graft function was observed quickly after EVR administration, and it had persisted for 1 year after conversion as a 7% increase in estimated glomerular filtration rate. No obvious acute rejection was observed. Further analyses concerning "timing of EVR conversion" and "graft function at conversion" were performed. Graft function was significantly improved even in patients with late conversion at 2 to 10 years. The estimated glomerular filtration rate was significantly improved even in patients with poor function.

CONCLUSIONS

We concluded that this modification to the immunosuppressive regimen, as expected, reduced CNI nephrotoxicity. Our results showed that even patients with very late conversion or poor graft function also benefited from EVR conversion with CNI minimization.

[A Case of Retroperitoneal Serous Cyst Treated by Open Fenestration : A Case Report]

A 47-year-old woman came to our hospital with left lower abdominal pain in April 2013. An abdominal computed tomographic (CT) examination revealed left hydronephrosis secondary to a 7 cm retroperitoneal cyst near the left common iliac artery and ureter. Serum tumor markers including CEA, CA19-9, and CA125 were negative. Although CT guided needle aspiration of the cyst successfully relieved severe left flank pain, the cyst again increased in size, causing left hydronephrosis, though examinations for fluid tumor markers and cytology were negative. Two months later, the patient underwent open fenestration. The final pathological results demonstrated a mesothelial cyst without malignant findings. Six months after the operation, the patient was doing well without recurrence of symptoms.

[The safety and efficacy of sunitinib using a modified regimen (2 weeks on/1 week off) for treatment of metastatic renal cell carcinoma]

We prospectively investigated the safety and efficacy of sunitinib using a modified regimen (2 weeks on/1 week off) in 24 patients (22 males, 2 females ; age range 39-86 years, median 64 years) with metastatic renal cell carcinoma (RCC). During the observation period (3-62 weeks, median 21 weeks), thrombocytopenia was seen in 13 (54.2%), leukopenia in 11 (45.8%), hand-foot syndrome in 5 (20.8%), hypertension in 4 (16.7%), and hypothyroidism in 3 (12.5%) patients, while grade 3 or higher adverse events were found in 4 (16.7%), 1 (4.2%), 1 (4.2%), 2 (8.3%), and 0 patients, respectively. Of the 21 patients evaluable for response, 5 (23. 8%) showed partial response, 8 (38.1%) stable disease, and 8 (38.1%) progressive disease. This new modified regimen may lead to a reduction in adverse events for treatment of patients with metastatic RCC as a substitute for the standard dosing regimen of sunitinib.

Fat-tailed gene flow in the dioecious canopy tree species Fraxinus mandshurica var. japonica revealed by microsatellites

Pollen flow, seed dispersal and individual reproductive success can be simultaneously estimated from the genotypes of adults and offspring using stochastic models. Using four polymorphic microsatellite loci, gene flow of the wind-pollinated and wind-seed-dispersed dioecious tree species, Fraxinus mandshurica var. japonica, was quantified in a riparian forest, in northern Japan. In a 10.5-ha plot, 74 female adults, 76 male adults and 292 current-year seedlings were mapped and genotyped, together with 200 seeds. To estimate dispersal kernels of pollen and seeds, we applied normal, exponential power, Weibull, bivariate t-distribution kernels, and two-component models consisting of two normal distribution functions, one with a small and one with a large variance. A two-component pollen flow model with a small contribution (26.1%) from short-distance dispersal (sigma = 7.2 m), and the rest from long-distance flow (sigma = 209.9 m), was chosen for the best-fitting model. The average distance that integrated pollen flows inside and outside the study plot was estimated to be 196.8 m. Tree size and flowering intensity affected reproduction, and there appeared to be critical values that distinguished reproductively successful and unsuccessful adults. In contrast, the gene flow model that estimated both pollen and seed dispersal from established seedlings resulted in extensive seed dispersal, and the expected spatial genetic structures did not satisfactorily fit with the observations, even for the selected model. Our results advanced small-scale individual-based parentage analysis for quantifying fat-tailed gene flow in wind-mediated species, but also clarified its limitations and suggested future possibilities for gene flow studies.

On methods of spatial analysis for genotyped individuals

Spatial autocorrelation methods have commonly been applied to individual-based spatial genetic studies, although their properties and the relations among the statistics have not been carefully examined. This paper first introduces a reformulation of widely used spatial statistics using point processes. When Moran's I statistics are applied to allele frequencies within an individual, the frequencies are no longer continuous variables but have only three discrete values and specific interpretations of Moran's I statistics and the number of alleles in common (NAC) can be expressed as the weighted sum of join-count statistics. The distributions of minor genotypes are amplified in Moran's I depending on the allele frequency in the population, while NAC uses a constant weighting system. Under the point process framework, spatial analysis can be conducted on the common theoretical base, from individual locations to genetic distributions of different levels, (for example, genotype and allele). The methodology is demonstrated by application to field data for molecular ecological studies of Fagus crenata population dynamics.

[Local advanced lung cancer invaded thoracic vertebral bodies with unruptured cerebral aneurysm]

A 57-year-old man presented with the chief complaint of left shoulder pain in June 2001, and paridrosis of left upper trunk and left upper limb in July 2001. Head magnetic resonance imaging (MRI) showed 8 mm sized unrupture aneurysm of left middle cerebral artery, and chest computed tomography (CT) showed the lung tumor invaded thoracic vertebral bodies. The local advanced lung carcinoma (cT4N0M0) and unrupture aneurysm of left middle cerebral artery was diagnosed. The prevented clipping of unrupture aneurysm was performed at 11th September 2001, and left upper lobectomy, hemivertebrectomy and reconstruction of thoracic vertebral body (Th 3-5) with Modul' ICS at 12th October 2001. The pathological findings revealed squamous cell carcinoma. The staging was pT4N0M0, IIIB. The postoperative course was uneventful. After the radiotherapy (50 Gy), chemotherapy (gemcitabine and vinorelbine) was performed. But the radiation pneumonia was occurred and chemotherapy was intermitted. The steroid was administrated due to the radiation pneumonia, and the complication was improved. He discharged at 17th April 2002 and had no recurrence. The prevented clipping of unrupture cerebral aneurysm and the reconstruction of thoracic vertebral body (Th 3-5) with Modul' ICS were useful for the radical operation of the local advanced lung cancer.

The appearance of a different DNA sequence may decrease nucleotide diversity

Nucleotide diversity may be decreased when a different DNA sequence type appears in a population. This undesirable property in a genetic diversity index is demonstrated by mathematical examples. The possibility of this phenomenon in natural populations is briefly discussed.

FR901451, a novel inhibitor of human leukocyte elastase from Flexibacter sp. I. Producing organism, fermentation, isolation, physico-chemical and biological properties

A novel human leukocyte elastase (HLE) inhibitor, FR901451 was discovered in the fermentation broth of a bacteria. The bacteria was identified as Flexibacter sp. No. 758. FR901451 has a molecular weight of 1269 and a molecular formula of C60H79N13O18. The mode of inhibition against HLE is competitive, with a Ki value of 9.8 x 10(-9) M.

Isolation, identification, and biological activities of oxidative metabolites of FK506, a potent immunosuppressive macrolide lactone

To characterize structures and biological activities of FK506 metabolites, FK506 was incubated with liver microsomes prepared from phenobarbital-treated rats in the presence of NADPH generating system under aerobic condition. Oxidative metabolites formed in the reaction medium were isolated and identified. Purified samples were analyzed by HPLC, mass spectrometry, and NMR spectroscopy. M-I, M-II, and M-III were the O-demethylated metabolites at the 13-, 31-, and 15-positions of FK506, respectively, and M-IV was the monohydroxylated metabolite at the 12-position. M-I was the dominant metabolite in this reaction system. M-II and M-III retained the tetrahydropyrane ring in their structures like FK506, but M-I and M-IV had rearranged structures in which the tetrahydropyrane ring was changed to a tetrahydrofuran ring. Measuring the immunosuppressive activity in the mouse mixed lymphocyte reaction system, IC50 values for M-I, M-II, M-III, M-IV, and FK506 were 1.65, 0.23, > 127, 5.52, and 0.15 nM, respectively. Reactivity of the metabolites with mouse anti-FK506 monoclonal antibody was studied and immunocross-reactivity of M-I, M-II, M-III, and M-IV with the antibody were nil, 109.0, 90.5, and 8.8% of FK506, respectively. These results indicate that rat hepatic microsomes oxidatively metabolize FK506 to four metabolites, and some of them exhibit pharmacological activity.

Solvent dependence of optical rotation of (S)-N-[1-(2-fluorophenyl)- 3,4,6,7-tetrahydro-4-oxo-pyrrolo[3,2,1-jk][1,4]benzodiazepine-3-yl]- 1H-indole-2-carboxamide

A new cholecystokinin-A antagonist, (S)-N-[1-(2-fluorophenyl)- 3,4,6,7-tetrahydro-4-oxo-pyrrolo[3,2,1-jk][1,4]benzodiazepine-3-yl]- 1H-indole-2-carboxamide (FR120480; 1), is a chiral compound that shows considerable solvent dependence of its optical rotation. Not only the absolute values, but also the signs (+ or -) for this compound change in various solvents. The optical rotation of 1 inherently correlated to the electron donating property characterized by donor number of the solvent. The 1H NMR study implied that hydrogen bonds were formed between electron donor groups of the solvents and the NH groups of indole and amide of 1. In accordance with the NMR results, X-ray crystallography of the tetrahydrofuran solvate of 1 showed that hydrogen bond formation occurred between the oxygen atom of tetrahydrofuran and the amide group of 1.

[Studies on the beneficial effect of levocarnitine chloride (LC-80) on organic acidemias, especially propionic acidemia and methylmalonic acidemia]

The beneficial effect of LC-80 in the therapy for organic acidemias, especially propionic acidemia and methylmalonic acidemia, was compared with those of its optical isomers, d-carnitine chloride (d-isomer) and dl-carnitine chloride (dl-isomer) in rat liver mitochondria. LC-80 at concentrations of 5 and 10 mM did not inhibit the mitochondrial function, while the d-isomer at a concentration of 5 mM significantly reduced the respiratory control ratio (RCR) of mitochondria. In addition, the dl-isomer at concentrations of 10 and 20 mM also significantly reduced RCR in a concentration-dependent manner. Thus, it seems likely that the d-isomer inhibits the mitochondrial function. On the other hand, the inhibition of mitochondrial function induced by a preincubation with propionate (4.76 mM) was significantly reversed by LC-80 (5 and 10 mM) in a concentration-dependent manner, while the d-isomer (5 mM) had no effect on the inhibitory effect of propionate. Moreover, although the dl-isomer (10 and 20 mM) significantly reversed the inhibitory effect of propionate as compared with the d-isomer, its effect was significantly weaker as compared with the effect of LC-80. The substrate specificity of rat liver mitochondrial carnitine acetyltransferase (CAT) was more potent with propionyl CoA than with acetyl CoA. Kinetic studies indicate that the d-isomer is a competitive inhibitor of CAT. These results suggest that LC-80 is useful in the clinical treatment of organic acidemias, whereas the d-isomer has a harmful effect in clinical application.