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Abstract Background In patients with schizophrenia, violent behavior is a clinically important factor that prevents their discharge. Clozapine is an effective antipsychotic medication for treatment‐resistant schizophrenia, and its usefulness for aggressive behavior has also been suggested. Case Presentation We present the case of a 38‐year‐old male patient diagnosed with schizophrenia who was successfully treated with clozapine after recurrent violent behavior. He was diagnosed with schizophrenia during his adolescence. He was hospitalized for treatment in his teens, but his hallucinations and delusions persisted even after discharge. In his 30s, he became noticeably emotionally unstable, and despite being treated for an adequate period with sufficient doses of several antipsychotics, his symptoms did not improve. This led to repeated hospitalizations triggered by violent behavior toward his parents and siblings within the home. During his fourth hospitalization, clozapine was initiated due to multiple incidents of violence toward nursing staff secondary to hallucinations and delusions. As the dose of clozapine was gradually increased with therapeutic drug monitoring, the patient's hostility, uncooperativeness, and suspiciousness markedly improved, and his aggressive behavior disappeared. He was discharged to a facility on day 194 after starting clozapine and has continued outpatient visits. Conclusion Clozapine was suggested to be effective for aggressive behavior in patients with treatment‐resistant schizophrenia and should be actively considered. In such cases, regular measurement of blood concentration is useful for adjusting the dosage of clozapine.

Summary:. A phyllodes tumor of the breast is a rare neoplasm, accounting for 0.3%–1% of all breast cancers. The size is 4–5 cm on average but sometimes the tumor grows more and involves the entire breast. As for treatment, complete surgical resection is the standard for localized breast phyllodes tumors. The reconstruction of a large defect is challenging. Herein, we present a case where a deep inferior epigastric artery perforator (DIEP) flap was used in breast reconstruction for a 48-year-old woman who was suffering from a giant phyllodes tumor. Immediate reconstruction was performed after tumor excision; the specimen weighed 4,230 g and the skin defect was 22 × 24 cm. The deep inferior epigastric artery and vein were anastomosed to the right internal mammary artery and vein, and the superficial inferior epigastric vein was anastomosed to the right lateral thoracic vein. The postoperative course was uneventful and the DIEP flap survived completely. In the setting of the reconstruction for a large defect, we must make maximum use of the limited human tissue available and ensure minimum damage, while also considering the functional and aesthetic outcome of the donor site. Various ideas and technologies have been reported that can assist in achieving this goal, but few reports have commented especially on the reconstruction of giant phyllodes tumor using autologous tissues. There were some other options for the way of the reconstruction such as a latissimus dorsi flap and a rectus abdominis flap. Compared with these approaches, using a DIEP flap has some disadvantages such as the need for the microsurgical skill and the risk of postoperative hernia. However, a DIEP flap provides the enough tissue to cover the large defect without any damage of the muscle. To our knowledge, this case was the largest phyllodes tumor reconstruction ever, in terms of the amount of the skin needed and resected tissue involved. Although more studies and longer follow-up will be required in the future, this case may show the usefulness of DIEP flaps for reconstruction of a giant phyllodes tumor.

An infant boy born to a mother with systemic lupus erythematosus developed multiple morphea and annular erythematous lesions. The annular lesions appeared on his face, back, chest and extremities one month after birth and faded within 7 months. The sclerotic lesions progressed until the age of 6 months and remain on his back, chest, right cheek, the nape of the neck and left shoulder at the age of 3 years. Histological findings in the sclerotic lesions were consistent with scleroderma. Serological tests, performed at 14 months of age, were within normal limits. The mother developed acute SLE and died of cardio-renal failure 8 months after the delivery. It is highly probable that maternal factors transferred through the placenta caused the sclerotic lesions in the infant. [ABSTRACT FROM AUTHOR]

Micrococcal nuclease (MNase) has been widely used for analyses of nucleosome locations in many organisms. However, due to its sequence preference, the interpretations of the positions and occupancies of nucleosomes using MNase have remained controversial. Next-generation sequencing (NGS) has also been utilized for analyses of MNase-digests, but some technical biases are commonly present in the NGS experiments. Here, we established a gel-based method to map nucleosome positions in Saccharomyces cerevisiae, using isolated nuclei as the substrate for the histone H4 S47C-site-directed chemical cleavage in parallel with MNase digestion. The parallel mapping allowed us to compare the chemically and enzymatically cleaved sites by indirect end-labeling and primer extension mapping, and thus we could determine the nucleosome positions and the sizes of the nucleosome-free regions (or nucleosome-depleted regions) more accurately, as compared to nucleosome mapping by MNase alone. The analysis also revealed that the structural features of the nucleosomes flanked by the nucleosome-free region were different from those within regularly arrayed nucleosomes, showing that the structures and dynamics of individual nucleosomes strongly depend on their locations. Moreover, we demonstrated that the parallel mapping results were generally consistent with the previous genome-wide chemical mapping and MNase-Seq results. Thus, the gel-based parallel mapping will be useful for the analysis of a specific locus under various conditions.

Background: Surveilling recurrent urothelial carcinoma (UC) requires frequent cystoscopy, which is invasive, expensive and time-consuming. An accurate urinary biomarker has the potential to reduce the number of cystoscopies required during post-treatment surveillance., Objective: To audit the clinical utility of a new surveillance protocol incorporating the Cxbladder Monitor (CxbM) test in real-world practice., Methods: Three hospitals implemented a new surveillance protocol. Patients were risk stratified, and then provided urine samples for CxbM testing. Low-risk CxbM-positive patients and all high-risk patients had cystoscopy at 2-3 months. Low-risk CxbM-negative patients had cystoscopy at ~ 12 months., Results: 443 CxbM tests were conducted on samples from 309 patients: 257 (83.2%) low-risk and 52 (16.8%) high-risk. No pathology-confirmed recurrences were seen in low-risk CxbM-negative patients (n = 108) during the first post-CxbM cystoscopy undertaken a mean ± SD 10.3 ± 3.9 months after testing. Three recurrences were detected during cystoscopy at 2.7 ± 3.4 months in 53 low-risk CxbM-positive patients. In 49 high-risk patients, 39 (79.6%) were CxbM-negative with no pathology-confirmed recurrences. Ten high-risk patients (20.4%) were CxbM-positive with four confirmed recurrences; 2 high-grade and 2 low-grade. The median time to first cystoscopy was 12.13 (95% CI: 11.97-12.4) months in patients with a CxbM-negative result versus 1.63 (95% CI: 1.13-2.3) months in patients with a CxbM-positive result (p < 0.00001). No positive cases were missed, no patients progressed to invasive or metastatic disease, and no patient died of cancer over 35 months of follow-up., Conclusions: CxbM accurately identified a high proportion of patients (77.8%) who were safely managed with only one cystoscopy per year. Including CxbM in the protocol for patient surveillance provided clinical utility by reducing the average number of annual cystoscopies by approximately 39%, thereby sparing patients the potential discomfort and anxiety, without compromising detection rates. No advantage was observed for risk stratification prior to CxbM.