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Caesium-137 ( 137 Cs) is a major anthropogenic radionuclide released into the environment as a result of the TEPCO Fukushima Daiichi Nuclear Reactor Station accident (occurring on March 11, 2011). Rice, being a staple food in Asian countries, including Japan, and is predominantly cultivated in paddy fields. Consequently, 137 Cs present in rice is absorbed from both soil and irrigation water, making it the most important crop for estimating internal radiation doses. In this study, over the 2018-2022 cultivation periods, flood water and pore water samples were collected biweekly from paddy fields. These samples were analyzed to measure the 137 Cs activity concentration, as well as the potassium (K + ) and ammonium (NH 4 + ) concentrations. Under anaerobic conditions, the 137 Cs  +  activity concentration in pore water increased markedly to reach a value 20-fold higher than that in flood water, correlating with NH 4 + concentration. However, despite the release of 137 Cs  +  caused by increased NH 4 + concentrations in pore water due to reduction processes, the 137 Cs + /K + ratio did not increase, which was attributed to the simultaneous release of K + . The competition between 137 Cs + and K + uptake by plants indicates that rice uptake of 137 Cs is not necessarily enhanced during the waterlogging period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The frayed edge site (FES) of micas, a partially weathered interlayer site, selectively adsorbs Cs radioisotopes. Despite extensive research on Cs + adsorption, the interactive dynamics of FES elements remain unclear. This study employs experimental and computational methods to examine how interlayer cations at the FES affect Cs stability. We measured the solid-liquid distribution coefficients of Cs + for partially expanded K- and Rb-fixed biotite using chemical extraction and adsorption methods. We evaluated the standard Gibbs free energy for the Cs exchange reaction between the FESs of K- and Rb-fixed muscovite models and bulk water, expanding the d 001 spacing from collapsed to fully expanded conditions. Our results reveal that the interlayer cation significantly influences Cs + affinity for FES, with the substitution of K + with Rb + largely reducing Cs + stability. The computational approach further disclosed that the K + to Rb + replacement only at the wedge-shaped part of the FES contributed to the decrease in Cs + stability whereas the replacement at other interlayer sites caused little impact. Our studies offer microscopic structural insights into FES, highlighting the critical role of the wedge-shaped part of FES in Cs + stability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Following the Fukushima Daiichi Nuclear Power Plant disaster in March 2011, the Japanese government initiated an unprecedented decontamination programme to remediate 137 Cs-contaminated soils and allow population return. This programme involved the removal of topsoil under farmland and residential land, and its replacement with "fresh soil" composed of granitic saprolite. However, decontamination was limited to these two land uses, without remediating forests, which cover 70 % of the surface area in the affected region. In this unprecedented context, the specific impact of this unique decontamination programme on 137 Cs transfers in river systems remains to be quantified at the catchment scale. In this study, based on the analysis of a sediment core collected in June 2021 in the Mano Dam reservoir draining a decontaminated catchment, the effects of soil decontamination on particle-bound 137 Cs dynamics and sediment source contributions in response to a succession of extreme precipitation events were retrospectively assessed. The sequence of sediment layer deposition and its chronology were reconstructed through the analysis of several diagnostic properties (organic matter, elemental geochemistry, visible colourimetry, granulometry) and contextual information. During abandonment (2011-2016), cropland contribution decreased (31 %). Concurrently, 137 Cs activity and deposition flux decreased (19 and 29%year -1 , respectively). Following decontamination (2017), sediment transfer increased (270 %) in response to increased contributions from decontaminated cropland and "fresh soil" (625 % and 180 % respectively). Meanwhile, forest contributions remained stable. In contrast, 137 Cs activity dropped (65 %), although 137 Cs deposition flux remained constant. Forests acted as a stable source of 137 Cs. Accordingly, 137 Cs deposition flux after decontamination (2016-2021) was similar to that observed during the 5-years period of land abandonment (2011-2016), as a result of the regrowth of spontaneous vegetation over farmland, protecting soil against erosion. Future research should further investigate the impact of longer land abandonment that prevailed in some regions decontaminated lately on the 137 Cs fluxes in the rivers., Competing Interests: Declaration of competing interest Olivier Evrard reports financial support was provided by French National Research Agency. Olivier Evrard reports financial support was provided by French Alternative Energies and Atomic Energy Commission (CEA). Olivier Evrard reports financial support was provided by French National Center for Scientific Research (CNRS). Thomas Chalaux-Clergue reports financial support was provided by French Alternative Energies and Atomic Energy Commission. Thomas Chalaux-Clergue reports financial support was provided by Japan Society for the Promotion of Science (JSPS). Olivier Evrard reports financial support was provided by Environmental Radioactivity Research Network Center (ERAN). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Iatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention., Methods: We performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022., Results: A total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5-28 + 6 weeks), and the median birth weight was 823 g (range 630-1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived., Conclusions: When inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis., Competing Interests: Declaration of Competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

Introduction: Inhaled nitric oxide (iNO) use is recommended for persistent pulmonary hypertension of the newborn in term and late preterm infants. Recently, iNO therapy to prevent bronchopulmonary dysplasia (BPD) or rescue for hypoxic respiratory failure and pulmonary hypertension secondary to BPD has increasingly been used in preterm infants after 7 days of postnatal age (in the postacute phase), despite its off-label use. However, the initiation criteria of iNO therapy for preterm infants in the postacute phase are varied. The aim of this scoping review is to identify the clinical and/or echo findings at the initiation of iNO therapy in preterm infants in the postacute phase., Methods and Analysis: We will search PubMed, Embase and the Japanese database 'Ichushi.' The following studies will be included in the review: randomised controlled trials, prospective/retrospective cohort studies, case-control studies and case series on iNO therapy for preterm infants in the postacute phase; studies published between January 2003 and August 2023; studies conducted in developed countries and studies written in English or Japanese. We will independently screen, extract and chart data using the population-concept-context framework following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will summarise the characteristics and findings of the included studies., Ethics and Dissemination: Obtaining an institutional review board approval is not required because of the nature of this review. A final report of review findings will be published and disseminated through a peer-reviewed journal and presentation at relevant conferences., Trial Registration Number: UMIN000051498., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The current standard operation for proximal gastric and gastroesophageal junction (P/GEJ) cancers with limited esophageal extension is total gastrectomy (TG). TG is associated with impaired appetite and weight loss due to the loss of gastric functions such as production of ghrelin and with anemia due to intrinsic factor loss and vitamin B 12 malabsorption. Theoretically, proximal gastrectomy (PG) can mitigate these problems by preserving gastric function. However, PG with direct esophagogastric reconstruction is associated with severe postoperative reflux, delayed gastric emptying, and poor quality of life (QoL). Minimally invasive PG (MIPG) with antireflux techniques has been increasingly performed by experts but is technically demanding owing to its complexity. Moreover, the actual advantages of MIPG over minimally invasive TG (MITG) with regards to postoperative QoL are unknown. Our overall objective of this study is to determine the short-term QoL benefits of MIPG. Our central hypotheses are that MIPG is safe and that patients have improved appetite after MIPG with effective antireflux techniques, which leads to an overall QoL improvement when compared with MITG., Methods: Enrollment of a total of 60 patients in this prospective survey-collection study is expected. Procedures (MITG versus MIPG, antireflux techniques for MIPG [double-tract reconstruction versus the double-flap technique]) will be chosen based on surgeon and/or patient preference. Randomization is not considered feasible because patients often have strong preferences regarding MITG and MIPG. The primary outcome is appetite level (reported on a 0-10 scale) at 3 months after surgery. With an expected 30 patients per cohort (MITG versus MIPG), this study will have 80% power to detect a one-point difference in appetite level. Patient-reported outcomes will be longitudinally collected (including questions about appetite and reflux), and specific QoL items, body weight, body mass index and ghrelin, albumin, and hemoglobin levels will be compared., Discussion: Surgeons from the US, Japan, and South Korea formed this collaboration with the agreement that the surgical approach to P/GEJ cancers is an internationally important but controversial topic that requires immediate action. At the completion of the proposed research, our expected outcome is the establishment of the benefit and safety of MIPG., Trial Registration: This trial was registered with Clinical Trials Reporting Program Registration under the registration number NCI-2022-00267 on January 11, 2022, as well as with ClinicalTrials.gov under the registration number NCT05205343 on January 11, 2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

To mitigate radioactive cesium from soil to plant, increasing and maintaining the exchangeable potassium (ExK) level during growth is widely accepted after Tokyo Electric Company's Fukushima Dai-ichi Nuclear Plant accident in Japan. This is because the antagonistic relationship between soil solution K and 134 Cs + 137 Cs (RCs) concentrations changes the transfer factor (TF: designated as the ratio of radioactivity of plant organ to soil) of RCs. As the relationship between ExK and TF depends on the soil types, crop species, and other environmental factors, the required amount of ExK should be set to a safe side. Eleven years after the accident, as the activity of 134 Cs was almost negligible, 137 Cs became the main RCs in most of the agricultural fields in Fukushima Prefecture. We propose a new indicator, the concentration ratio of plant 137 Cs to soil exchangeable 137 Cs (Ex 137 Cs), instead of TF, which showed a better correlation with ExK even among soils with different properties (or mineralogy)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status., (© 2022 Wiley Periodicals LLC.)

Purpose: After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG)., Patients and Methods: The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy., Results: We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy., Conclusions: Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Non-exchangeable K released from soil minerals can reduce radiocesium transfer to plants, as well as exchangeable K. We investigated the effect of non-exchangeable K on radiocesium transfer to soybean, and the non-exchangeable K extraction method most suitable for estimating the transfer risk. In Fukushima Prefecture, Japan, 106 soils were collected from 89 soybean fields during 2014-2018 to analyze non-exchangeable K contents using three methods: boiling nitric acid extraction, tetraphenyl‑boron extraction, and mild tetraphenyl‑boron extraction. The non-exchangeable K contents quantified by the former two methods were dependent on the amount of micas, which are K-bearing minerals. The non-exchangeable K content by mild tetraphenyl‑boron extraction depended on the amount of K fertilizer application and K-fixing minerals but not on micas, indicating that it reflects fertilizer K fixed by the minerals. The soil-to-plant transfer factor of radiocesium was most correlated with the non-exchangeable K content by the mild extraction (r s = -0.67). This correlation was also stronger than that between exchangeable K and the transfer factor (r s = -0.40). As non-exchangeable K content increased, the exchangeable radiocesium fraction decreased, indicating that radiocesium was fixed together with K. Additionally, multiple regression analysis indicated that non-exchangeable K by the mild extraction significantly decreased the transfer factor even if the exchangeable radiocesium fraction was kept constant. Thus, the fixed K was considered to repress radiocesium transfer to soybean through both radiocesium fixation and K supply. With the criterion of total extracted K, the sum of exchangeable and non-exchangeable K, as 65 mg K 2 O 100 g -1 by the mild extraction, fields with high and low transfer factors were able to be differentiated more effectively than with a current criterion of exchangeable K as 50 mg K 2 O 100 g -1 . The results revealed that mild tetraphenyl‑boron extraction is effective for estimating radiocesium transfer to soybean., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Pancreatic serous neoplasms are rare tumors that are usually benign. However, histopathological differentiation between benign (serous cystadenoma) and malignant (serous cystadenocarcinoma) lesions is difficult. We present the case of a patient with pancreatic serous cystadenocarcinoma that was diagnosed with liver metastasis 7 years after the resection of the primary serous neoplastic lesion. A woman in her 60 s was diagnosed with pancreatic serous cystadenoma based on imaging and histopathological examination findings. The tumor was resected, and the patient was followed up every 6 months to monitor tumor progression. At 7 years after the resection of the primary lesion, liver tumors showing marked flare-like contrast enhancements were detected on arterial phase computed tomography findings and on dynamic magnetic resonance imaging findings acquired 60 s after the administration of a contrast agent. Laparoscopic segmental hepatectomy of S4 and S6 was performed to resect these tumors. Histopathological examination revealed that these tumors were metastatic and developed from the primary lesion. Therefore, a diagnosis of serous cystadenocarcinoma was confirmed. The flare-like contrast enhancement around the metastatic liver lesions on computed tomography and dynamic magnetic resonance images may be an indicator of serous cystadenocarcinoma with liver metastasis that could assist in diagnosis., (© 2021. Japanese Society of Gastroenterology.)

Aplasia Cutis Congenita (ACC) in the scalp is a rare congenital malformation. The treatment for ACC with large defects involving the scalp, bone, and the dura is challenging. Local debridement of necrotic tissue is important to prevent lethal complications such as infection and meningitis. However, debridement has the risk of damaging the sagittal sinus or the dura. Recent developments in ultra-high-frequency ultrasound(US) systems provide frequencies of 70 MHz and capability resolution as fine as 30 μm, which could allow precise imaging of small and thin anatomical structures. The study aimed to describe the methods of precise evaluation of the defect in the scalp and safe debridement using ultra-high-frequency US. This is the first report on direct observation of a newborn's brain using ultra-high-frequency US. The boy was delivered spontaneously with a large defect of the scalp and bone. After 14 days, due to signs of infection, local debridement was performed carefully under ultra-high-frequency US-based evaluation. The dura, the sagittal sinus, and the small anatomical structures such as arachnoid granulations could be observed. Because the brain herniation gradually aggravated, dural reconstruction using fascia lata and scalp reconstruction using transposition flap was performed. Finally, good skin coverage over the defects was obtained. This method minimizes the risk of damaging the sagittal sinus and the brain parenchyma, which may cause fatal complications. Although further clinical investigations will be required to confirm its efficacy, ultra-high-frequency US has the potential to be a useful device for ACC treatment., Competing Interests: Disclosure: The authors have no financial interest in relation to the content of this article., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Surgical management has not been encouraged in patients with trisomy 18 (T18) and congenital heart diseases due to poor survival. This study aimed to investigate (1) the appropriateness of palliative surgeries followed by intracardiac repair (ICR) (i.e., two-stage ICR) for patients with a large ventricular septal defect (VSD) and T18, and (2) its impact on their long-term outcomes., Methods: Medical charts of patients with VSD and T18 who underwent two-stage ICR at the Japanese Red Cross Medical Center between January 2005 and December 2019 were retrospectively reviewed. Demographic data, timing, and types of palliative surgeries, information related to ICR, peri- and postoperative clinical information, postoperative survival, and cause of death were collected. The long-term prognosis of patients treated with two-stage ICR was compared with that of patients treated with primary ICR and palliative surgery without ICR., Results: Overall, 18 (2 male, 16 female) patients underwent two-stage ICR. Pulmonary artery banding was the initial palliative surgery in all patients after a median duration of 19.5 (range 6-194) days of life. The median age and the mean body weight at the time of ICR were 18.2 (7.6-50.7) months and 6.0 ± 1.0 kg, respectively. The mean pulmonary artery pressure and pulmonary vascular resistance index before ICR were 19.1 ± 7.3 mmHg and 3.4 ± 2.0 U m 2 , respectively. Overall, 17/18 (94%) patients were discharged after ICR. Fourteen (78%) patients were alive during data collection. None of the patients died of cardiac insufficiency, and the median duration of survival was 46.3 (14.3-186.4) months since birth. Most patients required cardiac medications rather than pulmonary vasodilators at the last follow-up. During the study period, three patients underwent primary ICR, and 46 underwent palliative surgery without ICR. Of those who underwent primary ICR, two died in the hospital on the first and 48 th day following ICR, and the third died 179 days after the ICR. The Log-rank test revealed a significantly longer survival for the patients treated with two-stage ICR compared with those treated with palliative surgery without ICR (P = 0.003)., Conclusion: Two-stage ICR improves the long-term survival of patients with VSDs and T18. This safe surgical strategy can also prevent pulmonary hypertension in such patients.

Background: Remote-access thyroidectomy and its cosmetic merit have been widely accepted, but remote-access parathyroidectomy has not become common. There are few reports about the risks and effectiveness of a remote-access endoscopic parathyroidectomy. Herein, we evaluated the risks and benefits of total endoscopic parathyroidectomy (TEP) for patients with primary hyperparathyroidism (PHPT). We retrospectively compared the surgical outcomes of TEP and open minimally invasive parathyroidectomy (MIP)., Methods: We analyzed the cases of 28 patients with PHPT who were scheduled to undergo a MIP at Mita Hospital (Tokyo) during the period from April 2015 to March 2019, all of whom were presumed preoperatively to have a single adenoma., Results: Eleven of the patients underwent a TEP (10 females, one male; mean age 54.2 years). The other 17 patients underwent an open MIP (11 females, 6 males; mean age 63.5 years). The younger patients and the females tended to select endoscopic surgery as their treatment. The operation time was significantly longer in the TEP group compared to the open MIP group (106 vs. 50 min; P<0.001). Common postoperative complications (such as recurrent laryngeal nerve paralysis and seroma) did not occur in this series. For the TEP patients who did not undergo a partial thyroidectomy, the mean amount of drainage on the first postoperative day was only 19±10 mL. The operative cure rate of the minimally invasive parathyroidectomies was 96.4%., Conclusions: TEP is a good surgical procedure for hyperparathyroidism caused by a single adenoma, and it achieves superior cosmetic results without increasing the rate of complications., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-526). The authors have no conflicts of interest to declare., (2021 Gland Surgery. All rights reserved.)

Phytoavailable K in soil is a key to control the transfer factor of radiocesium from soil to brown rice. The transfer factors were determined for paddy fields cultivated in 2017 and 2018 under different K fertilization regimes in Fukushima Prefecture, Japan. Two phytoavailable forms of K, the exchangeable and nonexchangeable K contents were investigated for the surface soil sampled after the transplanting and fertilization as well as after harvest of rice in the same paddy fields. The exchangeable K content largely decreased from after transplanting and fertilization to after harvest, and the exchangeable K of the soil after harvest was negatively correlated with the transfer factor (r s  = -0.70, p < .001). Most soil samples after harvest showed that the transfer factors exponentially increased as the exchangeable K decreased; however, some of the samples indicated considerably low transfer factors (<0.005) despite being exchangeable K deficient, i.e., exchangeable K < 25 mg K 2 O 100 g -1 . Even though this value before usual fertilization has been effectively used as a threshold to determine whether supplemental K fertilization is required to reduce the radiocesium content in brown rice, additional screening was needed to estimate this radiocesium transfer more precisely. Thus, we found that not only the exchangeable K but also nonexchangeable K contents had a negative correlation with the transfer factor (r s  = -0.60, p < .001) of the soil samples after harvest but were not correlated with each other (r p  = -0.10). Furthermore, the results revealed that soil with nonexchangeable K > 50 mg K 2 O 100 g -1 indicated a considerably low transfer factor, even if exchangeable K deficient. Thus, via our field-scale experiments, we concluded that the criterion nonexchangeable K > 50 mg K 2 O 100 g -1 can be used as another threshold for use along with that of exchangeable K to differentiate soil with a low radiocesium transfer rate from exchangeable K deficient soil., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Early definitive diagnosis of necrotizing enterocolitis (NEC) based on Bell's staging criteria is difficult because there are few observable changes on abdominal imaging and blood chemistry tests at the onset of the disease., Purpose: To investigate whether prostaglandin E-2 major urinary metabolite (PGE-MUM) can be a useful surrogate marker reflecting the disease state and severity of NEC in infants., Methods: Infants were enrolled in this study between January 2014 and December 2016. NEC diagnosis was based on Bell's staging criteria > Stage II or necrotic bowel observed at surgery. After diagnosis, PGE-MUM level was measured and compared with that of the other disease and healthy infant groups., Results: Median PGE-MUM value was highest in the NEC group (576 [65-3672] μg/g•Cre/BSA × 1000), followed by the other disease group (94 [57-296] μg/g•Cre/BSA × 1000) and the healthy infant group (19 [10-44] μg/g•Cre/BSA × 1000) (sensitivity: 92.3%, specificity: 81.5%, accuracy: 85.0%; p < 0.01). PGE-MUM level correlated with improved status of NEC, length of necrotic intestine, and Bell's staging criteria., Conclusions: PGE-MUM level may be a useful surrogate biomarker reflecting the disease state of NEC. The method of urine sample collection is also advantageous, being noninvasive for infants. This is the first study reporting PGE-MUM level in NEC., Type of Study: Study of diagnostic test., Level of Evidence: LEVEL II., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Radiocesium (RCs) is selectively adsorbed on interlayer sites of weathered micaceous minerals, which can reduce the mobility of RCs in soil. Therefore, soils developed from mica-deficient materials (e.g. serpentine soils) may have a higher risk of soil-to-plant transfer of RCs. Soils were collected from three serpentine soil profiles; Udepts in Oeyama, Japan, and Udepts and Udox in Kinabalu, Malaysia. Soil was sampled every 3 cm from 0 to 30 cm depth and sieved to isolate soil particles of ≤20 μm diameter for the assessment of radiocesium interception potential (RIP) after a series of pretreatments. One subset was treated with H 2 O 2 to remove organic matter (OM). Another subset was further treated with hot sodium citrate to remove hydroxy-Al polymers (Al(OH)x). RIP untreated was <0.4 mol kg -1 whereas mica-K content was <0.02% by weight for ≤20-μm soil particles from Udepts and Udox in Kinabalu, Malaysia, values as low as those of non-micaceous minerals (e.g. kaolinite and smectite). Neither OM nor Al(OH)x removal resulted in a large increase in RIP value for these soils. These results clearly indicated that serpentine soils in Malaysia have very few RCs selective adsorption sites due to the absence of micaceous minerals. In contrast, soil from Udepts in Oeyama, Japan showed average RIP untreated of 5.6 mol kg -1 and mica-K content of 0.72% by weight for the ≤20-μm particles. Furthermore, the RIP value was significantly increased to an average of 22.5 mol kg -1 after removing both OM and Al(OH)x. These results strongly suggest that weathered micaceous minerals primarily control the ability to retain RCs. These micaceous minerals cannot originate from serpentine minerals, and are probably incorporated as an exotic material, such as Asian dust. This hypothesis is supported by the δ 18 O value of quartz isolated from the ≤20-μm soil particles from Oeyama, Japan (+16.13‰±0.11‰), very similar to that of Asian dust. In conclusion, serpentine soils in Japan may exhibit a reduced risk of soil-to-plant transfer of RCs due to the historical deposition of Asian dust., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Weathered micaceous minerals (micas) are able to release potassium ion (K + ) and fix caesium-137 ( 137 Cs), both of which reduce soil-to-plant transfer of 137 Cs. Among micas, trioctahedral micas such as biotite is expected to have a stronger ability to supply nonexchangeable K + and a higher amount of Cs fixation sites than dioctahedral micas such as illite. Although biotite is predominant in granitic soils (G soils), illite is mainly dominant in sedimentary rock soils (S soils). Therefore, we hypothesized that G soils have a lower 137 Cs transfer risk than S soils because of this difference in mineralogy. The objective of the present study was to determine the transfer factor (TF) of 137 Cs and stable Cs (SCs) and to elucidate the determinant factors of TFs for G and S soils in Fukushima, Japan. Pot experiments were carried out with rice (Oryza sativa L. cv. Hokuriku 193) in G and S soils to determine the TF of 137 Cs (TF- 137 Cs) and stable Cs (TF-SCs) under K-deficient conditions. TF- 137 Cs and TF-SCs were highly correlated, and both were significantly lower for G soils than for S soils. Higher TF values were shown for soils with lower amounts of exchangeable and nonexchangeable K or with higher percentages of exchangeable 137 Cs (ex 137 Cs). The percentage of ex 137 Cs was negatively correlated with the amount of Cs fixation sites, represented by the radiocaesium interception potential. Thus, we concluded that smaller TF values for G soils were caused by a stronger ability to supply nonexchangeable K + and a higher amount of Cs fixation sites. These findings will contribute to the establishment of soil screening techniques based on 137 Cs transfer risk in Fukushima prefecture., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: In perinatal medicine, inhaled nitric oxide (iNO) has been an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn (PPHN) and hypoxemic respiratory failure (HRF). Its use in more premature infants, however, is controversial. To evaluate the current clinical practices regarding use of acute iNO in extremely preterm infants, a nationwide survey was conducted in Japan., Methods: A questionnaire survey was conducted from May to September, 2015. Questionnaires about PPHN and iNO treatment were sent to the doctor in charge of the neonatal care unit in 213 perinatal medical centers (PMC) that possessed iNO equipment in Japan., Results: A total of 143 of the 213 PMC provided responses (67.1%). A diagnosis of PPHN was made exclusively on echocardiography in all PMC. On definitive PPHN diagnosis, iNO was selected in the majority of the PMC (72%) and started from ≤10 p.p.m. in most PMC (49.7%) for extremely preterm infants. During iNO therapy, cardiac function was checked on echocardiography by a neonatologist every ≤8 h. iNO weaning was started when differential peripheral oxygen saturation (SpO 2 ) disappeared, or when SpO 2 reached 100% and so on. After iNO concentration reached 5 p.p.m., it was decreased gradually and carefully in five steps, taking 12-24 h to go from 5 to 0 p.p.m., Conclusions: Inhaled nitric oxide was predominantly used in extremely preterm infants as early rescue therapy for PPHN based on echocardiography performed by a neonatologist., (© 2018 Japan Pediatric Society.)

The Kamchatka Peninsula is a prominent and wide volcanic arc located near the northern edge of the Pacific Plate. It has highly active volcanic chains and groups, and characteristic lavas that include adakitic rocks. In the north of the peninsula adjacent to the triple junction, some additional processes such as hot asthenospheric injection around the slab edge and seamount subduction operate, which might enhance local magmatism. In the forearc area of the northeastern part of the peninsula, monogenetic volcanic cones dated at <1 Ma were found. Despite their limited spatiotemporal occurrence, remarkable variations were observed, including primitive basalt and high-Mg andesite containing high-Ni (up to 6300 ppm) olivine. The melting and crystallization conditions of these lavas indicate a locally warm slab, facilitating dehydration beneath the forearc region, and a relatively cold overlying mantle wedge fluxed heterogeneously by slab-derived fluids. It is suggested that the collapse of a subducted seamount triggered the ascent of Si-rich fluids to vein the wedge peridotite and formed a peridotite-pyroxenite source, causing the temporal evolution of local magmatism with wide compositional range.

Background: We previously showed that glycated albumin (GA) is a useful glycemic control indicator in patients with neonatal diabetes mellitus (NDM), and that age-adjusted GA (Aa-GA) can reflect more accurately glycemic control status. Here, we investigated whether the age at diagnosis influences Aa-GA at diagnosis of NDM., Methods: Eight patients with NDM whose GA was measured at diagnosis (age at diagnosis: 39 ± 18 days; GA: 31.3 ± 7.6%; Aa-GA: 47.1 ± 10.3%; plasma glucose: 525 ± 194 mg/dl) were included. Aa-GA was calculated as follows: Aa-GA = GA × 14.0/[1.77 × log-age (days) + 6.65]. Correlations of GA or Aa-GA at diagnosis with its logarithmically transformed age in days (log-age), plasma glucose, and their product were investigated., Results: GA at diagnosis was not significantly correlated with log-age or plasma glucose. On the other hand, Aa-GA at diagnosis was significantly positively correlated with plasma glucose (R = 0.75, P = 0.031) and was more strongly positively correlated with the product of plasma glucose and log-age (R = 0.82, P = 0.012) although it was not correlated with log-age., Conclusion: Aa-GA at diagnosis is influenced by both age in days and plasma glucose. This finding is likely to show the aspect that age in days is almost equal to diabetes duration because glycemic control indicators including GA reflect the weighted mean of plasma glucose., (© 2016 Wiley Periodicals, Inc.)

Background: Glycated albumin is a useful glycaemic control indicator for neonatal diabetes mellitus. However, glycated albumin concentrations in infants are lower than those in adults and increase in an age-dependent manner. Based on our investigation of non-diabetic subjects, we proposed the possibility that the reference range for adults may be used regardless of age, provided that age-adjusted glycated albumin is employed. In the present study, we evaluate the usefulness of age-adjusted glycated albumin in neonatal diabetes mellitus patients., Methods: Six neonatal diabetes mellitus patients (four patients with permanent neonatal diabetes mellitus and two patients with transient neonatal diabetes mellitus) were included. Measured glycated albumin or age-adjusted glycated albumin was compared to calculated glycated albumin, which was determined using calculation formulae we had reported based on past blood glucose over the 50 days before measurement of glycated albumin., Results: Measured glycated albumin was significantly lower than calculated glycated albumin (20.5 ± 4.9% versus 28.2 ± 6.1%; p < 0.0001), whereas age-adjusted glycated albumin was equivalent to calculated glycated albumin, showing no significant difference (27.5 ± 6.8% versus 28.2 ± 6.1%). Measured glycated albumin concentrations in patients with transient neonatal diabetes mellitus in remission were lower than the reference range for adults, whereas age-adjusted glycated albumin concentrations were within the reference range for adults., Conclusion: We demonstrated that age-adjusted glycated albumin concentrations were consistent with calculated glycated albumin. Age-adjusted glycated albumin is therefore a useful glycaemic control indicator for neonatal diabetes mellitus patients., (© The Author(s) 2015.)

The radiocesium interception potential (RIP) of bulk soil (RIP) can reliably be used to predict the magnitude of soil-to-plant radiocesium transfer. There has been some controversy about which soil properties control the RIP, although the RIP is theoretically proportional to the amount of frayed edge sites in micaceous clay minerals. The RIP was determined for 97 paddy soils in three regions (Hama-dori, Naka-dori, and Aizu) in Fukushima Prefecture, Japan, and the relationships between selected physicochemical properties and the RIP were analyzed. The mean (± standard deviation) of the RIP for the 97 soils was 1.67 (±0.87) mol kg, and the range was 0.34 to 5.36 mol kg. Pearson correlation analysis revealed that the RIP positively correlated best ( < 0.01) with the clay fraction K content as a mass fraction of the bulk soil (clay-K) and negatively correlated with the total C content and the phosphate absorption coefficient ( < 0.05). Therefore, clay-K, an indicator of the amount of micaceous clay minerals in a soil, was confirmed as being useful for estimating the magnitude of the RIP for paddy soils in Fukushima. The RIP was invariably low if either the total C content exceeded 6.0% or the phosphate absorption coefficient exceeded 1500 mg kg, suggesting that these parameters could be useful for screening soils with particularly low RIP values., (Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.)

The concentration of radiocesium ((134)Cs and (137)Cs) in agricultural fields around Fukushima Dai-ichi Nuclear Power Plant (FDNPP) was elevated after the accident in March 2011. Evaluation of soil properties that influence phytoavailability of radiocesium is important for optimal soil management to minimize radiocesium transfer to crops. In this study, soybean grain and soil samples (0-15 cm) were collected from 46 locations in Fukushima Prefecture in 2011, and (137)Cs concentrations were measured. (137)Cs concentration ranges were 11-329 Bq kg(-1)-dry in soybean grain samples, and 0.29-2.49 kBq kg(-1)-dry in soil samples. The radiocesium interception potential (RIP) values in the soil samples ranged from 0.30 to 8.61 mol kg(-1). RIP negatively correlated with total carbon content and oxalate-extractable Si and Al + 1/2 Fe in the soils, suggesting that soils rich in organic matter and poorly crystalline clays tended to have lower RIP in this region. The soil-to-plant transfer factor for (137)Cs, analyzed in relation with various soil characteristics, varied by two orders of magnitude and was significantly negatively correlated with RIP and exchangeable K concentration in soil. The results show that RIP is useful for evaluating the efficiency of radiocesium transfer from soil to plants in this region., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The accuracy of most HbA1c analysis methods is affected by the presence of increased fetal hemoglobin (HbF). The objective of this study was to investigate the age at which HbA1c measurements become useful for monitoring glycemic control in patients with neonatal diabetes mellitus (NDM)., Methods: We retrospectively analyzed the data of 5 NDM patients diagnosed at 38±20 days of age, who each had several available HbA1c measurements during the first year of life, with a control group of HbA1c values over the course of 1 year for 13 patients with type 1 diabetes mellitus (T1DM). Mean blood glucose (MBG) levels derived from premeal or premeal plus bedtime blood glucose measurements prior to HbA1c measurements were compared to HbA1c values., Results: The NDM patients' age at which the difference in the HbA1c/MBG ratios became not significant between the NDM patients and the T1DM patients was 21 weeks of age and over. Even after the HbA1c was adjusted for HbF, this ratio was significantly lower in the NDM patients at <21 weeks of age than in the T1DM patients., Conclusions: HbA1c can be a useful glycemic control marker for NDM patients >20 weeks of age., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Recently, GATA6 heterozygous loss-of-function mutations were reported to cause pancreatic agenesis and congenital heart defects (PACHD [OMIM:600001]). However, the molecular mechanisms resulting from premature termination codons have not been examined in this disorder. The objective of this study was to perform a genetic analysis of a patient with PACHD. A female patient presented with ventricular septal defect, patent ductus arteriosus, and congenital diaphragmatic hernia at birth. Permanent neonatal diabetes mellitus and pancreatic exocrine deficiency due to pancreatic agenesis was diagnosed at 1 month of age. PCR-direct sequencing of GATA6 revealed that the patient is heterozygous for a novel de novo nonsense mutation of c.1477C>T, p. Arg493X in exon 5. RT-PCR direct sequencing of the RT-PCR products of total RNA from peripheral blood of the patient for the region encompassing exons 4-6 revealed only the wild-type allele. This finding provides the evidence for the occurrence of nonsense-mediated mRNA decay (NMD) in the p.Arg493X mutation. Quantitative RT-PCR analysis revealed that the expression of GATA6 transcript in the patient was less than half compared with normal control samples. This is the first evidence that GATA6 haploinsufficiency is caused by NMD in vivo, and we conclude that GATA6 haploinsufficiency causes not only PACHD but may affect other organs derived from the endoderm. Further screenings of GATA6 mutations in patients with various forms of diabetes and/or congenital heart disease with other visceral malformation may reveal the impact of GATA6 mutations on diabetes and congenital malformation., (© 2013 Wiley Periodicals, Inc.)

Relationships between Radiocesium Interception Potential (RIP) and mineralogical characteristics of the clay fraction isolated from 97 paddy soils (Hama-dori, n = 25; Naka-dori, n = 36; Aizu, n = 36) in Fukushima Prefecture, Japan were investigated to clarify the mineralogical factors controlling the (137)Cs retention ability of soils (half-life 30.1 y). Of all the fission products released by the Fukushima accident, (137)Cs is the most important long-term contributor to the environmental contamination. The RIP, a quantitative index of the (137)Cs retention ability, was determined for the soil clays. The composition of clay minerals in the soil clays was estimated from peak areas obtained using X-ray diffraction (XRD) analyses. The predominant clay mineral was smectite in soils from Hama-dori and Aizu, while this was variable for those from Naka-dori. Native K content of the soil clays was found to be an indicator of the amount of micaceous minerals. The average RIP for the 97 soil clays was 7.8 mol kg(-1), and ranged from 2.4 mol kg(-1) to 19.4 mol kg(-1). The RIP was significantly and positively correlated with native K content for each of the geographical regions, Hama-dori (r = 0.76, p < 0.001), Naka-dori (r = 0.43, p < 0.05), and Aizu (r = 0.76, P < 0.001), while it was not related to the relative abundance of smectite. The linear relationship between RIP and native K content not only indicate a large contribution of micaceous minerals to the (137)Cs retention ability of the soil clays, but also could be used to predict the (137)Cs retention ability of soil clays for other paddy fields in Fukushima and other areas., (© 2013.)

Trisomies 18 and 21 are genetic disorders in which cells possess an extra copy of each of the relevant chromosomes. Individuals with these disorders who survive birth generally have a shortened life expectancy. As telomeres are known to play an important role in the maintenance of genomic integrity by protecting the chromosomal ends, we conducted a study to determine whether there are differences in telomere length at birth between individuals with trisomy and diploidy, and between trisomic chromosomes and normal chromosomes. We examined samples of peripheral blood lymphocytes (PBLs) from 31 live neonates (diploidy: 10, trisomy 18: 10, trisomy 21: 11) and estimated the telomere length of each chromosome arm using Q-FISH. We observed that the telomeres of trisomic chromosomes were neither shorter nor longer than the mean telomere length of chromosomes as a whole among subjects with trisomies 18 and 21 (intra-cell comparison), and we were unable to conclude that there were differences in telomere length between 18 trisomy and diploid subjects, or between 21 trisomy and diploid subjects (inter-individual comparison). Although it has been reported that telomeres are shorter in older individuals with trisomy 21 and show accelerated telomere shortening with age, our data suggest that patients with trisomies 18 and 21 may have comparably sized telomeres. Therefore, it would be advisable for them to avoid lifestyle habits and characteristics such as obesity, cigarette smoking, chronic stress, and alcohol intake, which lead to marked telomere shortening., (© 2013.)

Background: Reticulated platelets (RPs) are newly synthesized platelets. Recently, an automatic method was established to detect RPs as a percentage of the immature platelet fraction (IPF%). Although, neonates often develop thrombocytopenia at some time during their hospitalization, the details of IPF% in neonates remain unclear. We, therefore, studied the relations between IPF% and other factors to gain a more detailed understanding of IPF% in neonates., Methods: The following clinical data were obtained from the medical records of 105 neonates who met our inclusion criteria: Gestational age, birth weight, IPF% and platelet count of neonatal peripheral blood at birth, and perinatal data. The subjects were divided into three groups: Group A, birth weight standard deviation score (SDS) ≥ -2 standard deviation (SD) and ≤ +2 SD; Group S, < -2 SD; and Group L, > +2 SD., Results: IPF% correlated negatively with platelet count at birth in the whole study population. IPF% was 2.8 ± 1.3% in term neonates, and IPF correlated negatively with gestational age and birth weight. Platelet count correlated positively with birth weight SDS in the whole study population and in Group S. IPF% correlated negatively with birth weight SDS in the whole study population and in Group S. In neonates with a platelet count below 25 × 10(4)/μl, IPF% correlated negatively with platelet count. Among other neonates, however, IPF% remained almost constant., Conclusion: Monitoring of IPF% is useful for estimating the function of thrombocytopoiesis in neonates and preterm infants.

Although it is well known that phytoavailability of radiocaesium is gradually lost after its deposition on the ground by fixation to soil minerals, the decreasing rates during early period after the deposition is not yet quantitatively evaluated. In this study, stable Cs was added to 5 types of soil, including Andosols, a sand-dune regosol and a smectic lowland soil, in a laboratory soil incubation experiment to assess the aging effect of radiocaesium. Aliquots of a soil sample were put into pots and incubated in an artificial climate chamber. Orchardgrass or red clover was cultivated for 28 d in soil pots containing one of the allophanic Andosol samples seven times during about 1200 d using new pots for each cultivation. The soil-to-plant transfer factors of Cs declined exponentially until about 100 d and were almost constant thereafter. The extractabilities of Cs by water and 1 M NH4OAc solution from this allophanic Andosol soil sample also decreased with time and their decreasing patterns were similar to that of the transfer factor. The temporal changes of extractabilities of Cs in other soil samples were also examined 6 times during about 600 d. Rate of decline for the extracted yield of the added Cs by 1 M NH4OAc varied widely among all the soil types. Two allophanic Andosol samples showed relatively higher extractabilities in comparison with the other soils throughout the incubation experiment, which may be attributable to the lower contribution of Cs specific sorption sites to total cation exchange capacity of the allophonic Andosol soil samples., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Patients administered anti-cholinergic agents, as first-line therapy for an overactive bladder (OAB) are often unable to continue medical treatment because of dry mouth. We assessed oral health in patients with OAB using the General Oral Health Assessment Index (GOHAI), an oral health-related quality of life questionnaire. We investigated 75 patients with OAB who were receiving continuous administration of anti-cholinergic agents. The OAB symptom score, as well as GOHAI and our original dry mouse score were determined by self-administered questionnaires. The mean age of the subjects was 70.9±10.2 years, the median period of anti-cholinergic agent use was 20 (1-116) months and the mean OAB symptom score was 6.3±3.1. The GOHAI score for all patients was 51.9±8.4 and not significantly different from the national normal value (p＝0.22). On the other hand, the score in patients with a severely dry mouth was 49.2±8.6, which was worse than the national normal value (p＝0.04). The psychosocial functioning score in patients with a severely dry mouth was significantly lower than in those with a slightly dry mouth (p＝0.02). Our results indicate that dry mouth in patients with OAB is significantly associated with worsening of oral health. GOHAI is useful as a screening test to assess the quality of life in patients with OAB.

We report a case of alveolar capillary dysplasia, wherein duodenal atresia was diagnosed during the third trimester. A 36-year-old mother was referred to our hospital for polyhydramnios at 31 weeks' gestation. Duodenal atresia was suspected from the ultrasonographic findings, which showed gastric dilation. Other findings noted were enlarged, highly echogenic lungs, a spherical heart and an increased lung-thorax transverse area ratio. A male infant was born at 37 weeks' gestation. The findings of serial radiography of the infant's upper gastrointestinal tract were compatible with the diagnosis of duodenal atresia; however, he developed persistent pulmonary hypertension of the newborn eight hours after birth and died at five days of age. The autopsy revealed alveolar capillary dysplasia and duodenal obstruction. We propose that the detection of duodenal atresia should prompt the physician to conduct a thorough ultrasonographic examination to rule out associated anomalies, such as alveolar capillary dysplasia, which can be detected by the presence of highly echogenic lungs., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

A 67-year-old man presented with macroscopic hematuria. Transrectal prostatic needle biopsy was performed because of elevated prostate specific antigen (PSA) (3.85 ng/ml) and palpation of hard nodules at the prostate. Pathological diagnosis was leiomysarcoma. Computed tomography revealed several pulmonary metastases. Radical cysto-prostatectomy and construction of ileal conduct were performed. Adjuvant radiotherapy (50 Gy) was also performed. During follow-up, the size of the pulmonary metastases increased, and we decided to start systemic chemotherapy 7 months after surgery. The chemotherapy consisted of gemcitabine (900 mg/m2 on day 1 and day 8), and docetaxel (100 mg/m2 on day 8). After eight courses, there was 20% reduction in the size of some pulmonary metastases. He remained alive 21 months after diagnosis.

We have performed transurethral enucleation with bipolar system (TUEB) on 60 patients since April 2008. The patients were 61 to 81 years old (average 71.7 years old), and estimated prostate volumes were 25 cm3 to 80.43 cm3 (average 51.1 cm3). The weight of prostate removed was 8 g to 56 g (average 27.4 g) during the operations which lasted between 40 min to 200 min (average 117.5 min). The International Prostate Symptom Score (IPSS), quality of life index (QOL) maximum flow rate (Q max) and average flow rate (Qave) were recorded before operation, and at 1 and at 3 months after operation. The results indicated a high safety with TUEB compared to TUR-P even for beginners. In conclusion, TUEB may become the most common approach in the treatment of BPH.

A 74-year-old man visited our hospital, because of high prostate specific antigen (PSA). Retropubic radical prostatectomy was performed for prostatic cancer. Suddenly right inguinal lesion pain appeared at 25 days after operation with disturbance of gait. Pelvic magnetic resonance imaging (MRI) demonstrated inflammatory change in right pubic bone, pectineal muscle, adductor muscle, which suggested the diagnosis of osteomyelitis of the pubis. After long-term administration of antibiotic therapy, osteomyelitis of the symphysis pubis and gait possible. There was no recurrence of osteomyelitis of the symphysis pubis at one year after operation. In addition to our case, we review the 8 cases of osteomyelitis of the pubis after radical prostatectomy previously reported in Japanese publications.

We retrospectively analyzed the records of 21 patients with penile carcinoma treated between January 1993 and February 2007. According to TMN classification (UICC 2002), 9, 8, 2 and 2 patients belonged to stages I, II, III and IV, respectively. During the follow up period of 4 to 144 months (median 15 months), the overall 5-year survival rate was 75.8%. All three patients having N2 died within one year. Lymph node metastasis (p = 0.001) and organ metastasis (p = 0.007) were found to be unfavorable prognostic factors for patients with penile cancer.

From February 2005 to April 2007, 48 consecutive patients with BPH underwent holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation. The first 14 cases (group 1) underwent HoLEP according to Gilling's method. In the next consecutive 17 cases (group 2), in addition to HoLEP performed as in group 1, the urethral external sphincter was stimulated electrically with a needle electrode inserted in a transperineal manner to prevent sphincteric injury. In the latter 17 consecutive cases (group 3), we used a modified HoLEP procedure, which partially preserved the apical adenoma in the 10-to 2-o'clock position. International Prostate Symptom Score, quality of life index, urinary flow (Qmax) data, and postvoid residual urine were significantly improved postoperatively in each group, there being no differences among them with the exception that group 3 had better Qmax data than group 3 at one month after operation. On the other hand, postoperative transient urinary incontinence was significantly reduced in group 3 on the day of discharge and 1 month after the operation. These results demonstrate that our modified HoLEP procedure is a promising method to avoid postoperative transient urinary incontinence.

We report a case of lung and lymph node metastasis treated with carbon ion radiotherapy after radical nephrectomy five years earlier. The patient was a 70-year-old woman. She was diagnosed with lung and neck lymph node metastasis by chest computed tomography four years after surgery. The metastatic mass increased gradually despite interferon-alpha and interleukin-2 treatment. Carbon ion radiotherapy was applied to the metastatic mass, and it has not increased in size to date. Carbon ion radiotherapy is thus regarded as an effective treatment for metastatic renal cell carcinoma masses, and it can be an important option for treatment of renal cell carcinoma.

We developed a system for bioconverting diverse compounds using P450s produced in Escherichia coli. Vectors for the expressing various P450 cDNAs quickly and easily in E. coli were developed by using several restriction enzyme sites. Three types of P450 (2C2, 2C29, and 2D22) were produced using these plasmids. Substrates were directly added to the incubation medium and metabolized. To obtain pure product from the medium, we first tried production of P450 in synthetic medium. The amount of another P450 2C43 produced in the synthetic medium was similar to the amount produced in Luria broth (LB) medium. Next, estradiol, a steroid, was added as a substrate, incubated, and the metabolite was extracted and analyzed by high-performance liquid chromatography. The metabolite extracted from synthetic medium was purer than that obtained from LB medium. Three P450s (2C29, 2C2, and 2A4) metabolized testosterone at different positions. P450 2C29 metabolized 7-ethoxycoumarin, androstendione, and dehydroepiandrosterone in this medium. P450s produced in the synthetic medium may be useful for producing various modified compounds for high-throughput screening.

We present a case of a 70-year-old man with an anamnesis of intra-cerebral bleeding that resulted in right half of the body paralysis and right diaphragm paralysis, The present clinical history indicated hepatocellular carcinoma (HCC) caused by hepatitis C and liver cirrhosis during a regular hospital visit, and the patient had a total of 4 TAEs enforced from three years before. A 4 x 3.5 cm neoplasm at the left adrenal was detected by CT inspection this time. The diagnosis was a metastatic adrenal gland tumor from HCC. Since HCC is controlled by TAE, the metastatic lesions were not found in other organs and were isolated, of 10 cm or less in size. Hence, laparoscopic adrenalectomy was performed in March, 2006. He started having a meal from the 2nd day after the operation. He left the hospital on the 9th day. Pathologial diagnosis was a metastatic adrenal gland tumor from moderately differentiated hepatocellular carcinoma. When observing the adaptation standard strictly to the high-risk case, it was thought that the metastatic tumor extraction under laparoscopic surgery could become a low stress cure in consideration of QOL being useful as a local treatment for cancer.

We have performed holmium laser enucleation of prostate (HoLEP) in 14 cases since February 2005. The patient's age ranged from 62 to 84 years old (average: 75). The preoperative results of International Prostate Sympton Score (IPSS), quality of life index, maximum urinary flow rate and residual urine volume were compared with those 3 months after surgery. The mean operation time, the mean estimated prostate volume and the mean enucleated prostate volume were 143 min, 50 cm3 and 35 g, retrospectively. All cases showed improvement in each parameter, and all but one case recovered continence in 3 months after surgery. A periurethral abscess had developed in the patient, suffering from incontinence. We concluded that HoLEP is an effective treatment. The relatively higher incidence of urinary incontinence in HoLEP remains to be resolved in the future.

Two partial cDNA clones (Protein kinase C alpha and Protein kinase C iota), each of which encoded a different member of PKC-protein family, were isolated using RT-PCR from mRNA of Bombyx mori. The full-length cDNAs were isolated using SMART-RACE. The cDNAs were expressed in HepG2 cells and the recombinant proteins were partially purified using an affinity chromatography. Protein kinase C alpha (BPKC alpha) showed a calcium-dependent kinase activity of histones. Whereas protein kinase C iota (BPKC iota) showed a calcium-independent activity. Bisindolyl maleimide I, a PKC inhibitor, inhibited these kinase activities. Furthermore, in vitro BPKC alpha interacted and phosphorylated two proteins expressed in the brain of Bombyx mori: Rab protein, which plays important roles in the vesicle transport in the brain, and bMBD2/3, which is a methyl DNA-binding protein and regulates transcription. These results suggest that these PKCs phosphorylate various substrate proteins and function in the brain of Bombyx mori.

A case of renal oncocytoma associated with acquired cystic disease of kidney (ACDK) in a 56-year-old man is reported. He had received hemodialysis for 15 years because of chronic renal failure. Computed tomography (CT) was performed because of distention in the upper abdomen, revealing a right renal tumor. He underwent laparoscopic right nephrectomy, and was diagnosed with renal oncocytoma. There have been reported 8 cases of renal oncocytoma in hemodialysis patients, and our case was the third one associated with ACDK in the literature.

We report a case of bladder hernia. A 68-year-old man was admitted to our hospital for the management of prostate cancer. An egg-sized soft mass was palpated at his right inguinal region. Magnetic resonance imaging and cystography revealed that the mass was a bladder hernia. During radical prostatectomy, we had to resect the bladder hernia for safe regional lymphadenectomy. This hernia was the extraperitoneal type. The stage of prostate cancer was pT3b N0 M0. This is the third reported case of inguinal bladder hernia associated with prostate cancer in Japan.

A cDNA clone encoding methyl DNA binding domain-containing protein (bMBD2/3) was obtained by homology searches using a Bombyx mori fat body cDNA library. The cDNA encoded a polypeptide with 249 amino acids sharing 54% similarity with the methyl DNA binding protein from Drosophila melanogaster. To characterize the biochemical properties of bMBD2/3, the clone was expressed in Escherichia coli as His-tagged protein. The recombinant protein was purified to homogeneity using Ni-NTA superflow resin and heparin agarose. The protein showed specific methyl DNA binding activity and was phosphorylated by protein kinase in vitro. Immunoblotting using the purified antibody indicated that bMBD2/3 was expressed in almost all tissues. Using west-western blotting analysis, some proteins that interact with bMBD2/3 were identified in the brain. This is the first report that insect MBD is phosphorylated and is present in adult tissues. These results suggest that bMBD2/3 plays important roles in the DNA methylation-specific transcription of Bombyx mori.

Rab proteins play fundamental roles in the regulation of membrane traffic. Previously, from the brain of Bombyx mori we isolated two cDNA clones (BRab1 and BRab14), each of which encoded a different member of Rab-protein family and was expressed in Escherichia coli and purified using an affinity chromatography. In this study, one cDNA clone (BRab8) was isolated from a cDNA library from the brain of B. mori. The recombinant protein was expressed in E. coli and purified. Next, the phosphorylations of these three purified BRab proteins were examined, using mammalian protein kinases in vitro. Protein kinase C (PKC) phosphorylated BRab8 and BRab14 proteins. Protein kinase A faintly phosphorylated BRab8 and BRab14 proteins. Calcium/calmodulin-dependent protein kinase faintly phosphorylated BRab8 protein. Next, brains of B. mori were dissected and homogenized. The homogenate showed a calcium-dependent protein kinase activity of BRab8 and BRab14 proteins. So PKC from the brain of B. mori was partially purified by a sequence of chromatographies on DEAE-Cellulofine and affinity chromatography. This PKC phosphorylated BRab8 and BRab14 proteins. These results suggest that the function of Rab proteins in the brain of B. mori is regulated by calcium-dependent protein kinases.