Quorum Sensing Inhibitors against Chromobacterium violaceum CV026 Derived from an Actinomycete Metabolite Library.

Quorum sensing (QS) is a microbial signaling system that regulates the expression of many virulence genes. Herein, we studied five compounds-No. 1: (E)-2-methyl-3- (4-nitro-phenyl)-acrylaldehyde; No. 29-2: pimprinine [5-(1H-indol-3-yl)-2-methyloxazole]; No. 48: (2E,4E)-2-methyl-5-phenyl-2,4-pentadienoic acid; No. 74: (3E,5E)-5-methyl-6-(4-nitrophenyl)-hexa-3,5-dien-2-ol; and No. 130: methyphenazine-1-carboxylate-derived from an actinomycete metabolite library. These compounds were confirmed to be QS inhibitors that reduced violacein production in Chromobacterium violaceum CV026. Additionally, compounds No. 1, No. 74, and No. 130 significantly reduced fluorescent pigment production in Pseudomonas aeruginosa ATCC 27853.

A male case of an undifferentiated carcinoma with osteoclast-like giant cells originating in an indeterminate mucin-producing cystic neoplasm of the pancreas. A case report and review of the literature.

We report a rare male case of an undifferentiated carcinoma with osteoclast-like giant cells originating in an indeterminate mucin-producing cystic neoplasm of the pancreas. A 59-year-old Japanese man with diabetes visited our hospital, complaining of fullness in the upper abdomen. A laboratory analysis revealed anemia (Hemoglobin; 9.7 g/dl) and elevated C-reactive protein (3.01 mg/dl). Carbohydrate antigen 19-9 was 274 U/ml and Carcinoembryonic antigen was 29.6 ng/ml. A computed tomography scan of the abdomen revealed a 14-cm cystic mass in the upper left quadrant of the abdomen that appeared to originate from the pancreatic tail. The patient underwent distal pancreatectomy/splenectomy/total gastrectomy/cholecystectomy. The mass consisted of a multilocular cystic lesion. Microscopically, the cyst was lined by cuboidal or columnar epithelium, including mucinous epithelium. Sarcomatous mononuclear cells and multinucleated osteoclast-like giant cells were found in the stroma. Ovarian-type stroma was not seen. We made a diagnosis of osteoclast-like giant cell tumor originating in an indeterminate mucin-producing cystic neoplasm of the pancreas. All surgical margins were negative, however, two peripancreatic lymph nodes were positive. The patient recovered uneventfully. Two months after the operation, multiple metastases occurred in the liver. He died 4 months after the operation.

Laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen: report of a case.

A 67-year-old man underwent an investigation of epigastric pain and weight loss. Preoperative imaging findings suggested the presence of a tumor, which developed as an epidermoid cyst and originated from an intrapancreatic accessory spleen; however, the possibility of malignancy could not be ruled out. We therefore performed a laparoscopic-assisted distal pancreatectomy with a splenectomy for both diagnostic and treatment purposes. Five laparoscopic ports were created. After the spleen and pancreatic tail were dissected from the retroperitoneum laparoscopically, they were pulled out through a 7-cm left subcostal incision and resected with an endoscopic linear stapler. The operative time was 227 min and the blood loss was 400 ml. The postoperative course was uneventful. The final pathological diagnosis was in agreement with the preoperative diagnosis. This case demonstrates that the minimally invasive approach of laparoscopic surgery can be used safely and successfully for difficult-to-diagnose pancreatic tumors. This is the first report describing a laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen.

Laparoscopic-assisted limited liver resection: technique, indications and results.

BACKGROUND/PURPOSE: The purpose of this work was to evaluate the short-term results of laparoscopic-assisted limited liver resection. METHODS: We analyzed the clinical outcome in 17 patients (mean age 70 +/- 8 years) who had undergone laparoscopic-assisted limited liver resection from March 2006 to December 2008. Preoperative diagnoses were HCC in 13 patients and metastasis of colon cancer in 4. The operation consisted of laparoscopic mobilization of the target liver lobe, followed by open liver resection through a 7- to 10-cm extraction site. RESULTS: Mean tumor size was 3.0 +/- 1.1 cm (range 1.2-5 cm). The mean operative time was 362 +/- 85 min. The mean blood loss was 451 +/- 413 ml, and no blood transfusion was required in any patient. There were no intraoperative complications, and conversion to laparotomy was needed in one case. Postoperative complications developed in 4 cases (4 infections, 24%), all of which were improved by conservative management. However, there was no postoperative mortality. None of the patients had any peritoneal carcinomatosis or port-site or resection site recurrence during a mean follow-up of 18 +/- 9.6 months. According to the analysis of the tumor location, the criterion for an adequate tumor location in the right lobe for this operation was set with the tumor at a distance of more than 5 cm from the inferior vena cava and the root of the hepatic vein (5 cm rule). CONCLUSION: Laparoscopic-assisted limited liver resection is feasible and well tolerated. Accumulation of more data may be needed for evaluation of long-term outcome.

Usefulness of multi-slice CT in a case with internal fistulas in Crohn's disease.

A case of Crohn's disease with an ileo-ileo fistula, ileal strictures and an ileo-cyst fistula is reported. Laparoscopic operation that included partial ileoectomy, ileal stricturoplasty and dissection of the ileo-cyst fistula was performed. Multi-slice computed tomography (MSCT) that was performed before the operation showed an ileo-cyst fistula that was not detected by small bowel follow-through or MRI. In this case, MSCT, including multi-planar reconstruction images, was significantly useful for evaluation of internal fistulas in Crohn's disease.

Laparoscopic function-preserving surgery for early gastric cancer in the upper third of the stomach: vagus-sparing proximal gastrectomy with side-to-side esophagogastric-tube anastomosis.

OBJECTIVE: Proximal gastrectomy with an anti-reflux procedure has been a treatment option for gastric cancer in the upper third of the stomach. For early gastric cancer, laparoscopic function-preserving gastrectomy with limited lymphadenectomy can be performed. Objective of this study was to develop a new surgical technique for gastric cancer in the upper third of the stomach. METHODS: We present here our totally laparoscopic proximal gastrectomy with vagus-sparing lymphadenectomy and gastric-tube reconstruction. Six patients (five males and one female; mean age 74 years) with gastric cancer in the upper third of the stomach underwent the procedure. Detailed operative procedure and preliminary results were presented. RESULTS: We have successfully performed the procedure with no conversion to open surgery. The mean operative time and blood loss were 413 minutes and 85 mL. No intraoperative and postoperative complications occurred except for reflux esophagitis in one patient. At the mean follow up of 25 months, all patients were alive without any sign of recurrence. CONCLUSION: Although long-term follow up and a larger number of patients are required to evaluate functional outcomes and oncological adequacy, our new technique provides a minimally invasive surgical option for early gastric cancer in the cardiac area.

Laparoscopy-assisted resection of an appendiceal mucinous cystadenoma.

We present a 48-year-old man with a complaint of dull right-lower abdominal pain who was diagnosed with mucocele of the appendix. He underwent laparoscopy-assisted resection of the tumor. In the procedure, the entire right colon was freed from the retroperitoneal structures without rupturing the tumor; and ileocecal resection and anastomosis were performed extracorporeally. The pathological diagnosis of the tumor was mucinous cystadenoma of the appendix, measuring 9.0 cm × 8.0 cm × 4.0 cm. The postoperative course was uneventful, and he had no recurrent disease at a 2-year follow up. When resecting an appendiceal mucinous tumor laparoscopically, it is essential (1) to keep the tumor intact during manipulation, and to use a wound-protecting device when delivering the lesion; (2) to consider the extent of tumor resection with a negative surgical margin as well as prophylactic lymph node dissection in cases of suspected adenocarcinoma, even though the oncological adequacy of the laparoscopic procedure for carcinoma remains to be elucidated; and (3) to check whether any mucinous fluid has accumulated in the abdominal cavity, which represents an indication for open surgery.

Approaches to subjective midpoint of horizontal lines in unilateral spatial neglect.

Patients with unilateral spatial neglect usually bisect longer lines with greater rightward errors, while they sometimes err leftward for very short lines (e.g., 25 mm). We analysed movements of eye fixation from the time before line presentation to elucidate whether patients with neglect approach the subjective midpoint differently for lines of various lengths. Four patients with left neglect bisected 200 mm, 100 mm, and 25 mm lines that appeared across the centre of a liquid crystal display (LCD) monitor. The fixation immediately before line presentation was located on average near the centre of the lines. Three of the patients approached the subjective midpoint point directly from the left side in more than 70% of the 200 mm and 100 mm trials. The subjective midpoint frequently deviated leftward on the "attended" segment between the leftmost point of fixation and the right endpoint, while it was displaced rightward on the total extent. The three patients initially explored the 25 mm lines searching for the left endpoint. They thereafter bisected the same lines with leftward errors approaching the subjective midpoint from the left side. The remaining patient searched beyond the right endpoint and in turn approached the subjective midpoint from the right side in about half of the trials and independently of line length. In the 200 mm and 100 mm trials, the subjective midpoint divided the attended right segment nearer to the right endpoint. On the attended right extent of a line, patients with neglect may place the subjective midpoint toward the side from which they approached that point. In the bisection of very short lines, approaches from the left endpoint may cause leftward errors of the subjective midpoint. For longer lines, however, approaches from the left side may result in rightward error of bisection for the total length, as the leftward extent from the fixation immediately before line presentation is hardly explored.

How do patients with neglect see a horizontal line? Analysis of performances in coloured line bisection task.

Twelve patients with left unilateral spatial neglect were examined with a newly devised "coloured line bisection task". They were presented with a horizontal line printed in blue on one side and in red on the other side; the proportions of the blue and red segments were varied. Immediately after placement of the subjective midpoint, the line was concealed and the patients were asked to name the colours of the right and left ends. Five patients who identified the left-end colour almost correctly had no visual field defect, while the other seven whose colour naming was impaired on the left side had left visual field defect. The rightward bisection errors were similarly distributed in the fair and poor colour-naming patients except for two patients from the latter group. The lesions of the fair colour-naming patients spared the lingual and fusiform gyri, which are known to be engaged in colour processing. Patients with neglect whose visual field is preserved may neglect the leftward extension of a line but not the colour in the neglected space. The poor colour-naming patients frequently failed to name the left-end colour that appeared to the left of their subjective midpoint, which indicates that they hardly searched leftward beyond that point. In such trials, they reported that the left end had the same colour as the right end. The results suggest that in patients with neglect and left visual field defect, both the leftward extent and the colour of a line may be represented on the basis of the information from the attended right segment.

[A case of advanced gastric cancer with a tumor embolus in the portal vein successfully treated with TS-1 and CDDP].

A 71-year-old man was admitted to our hospital in February 2002 with a diagnosis of advanced gastric cancer with a tumor embolus in the portal vein. TS-1 (120 mg/day) was administered orally daily for 21 days, and CDDP (90 mg/day) was infused intravenously on day 8. After 1 course of this regimen, medication was discontinued in accordance with the patient's request. The patient was readmitted with a history of tarry stools in July 2003. Despite no cancer treatment for almost 1.5 years, the primary lesion and the metastatic lymph nodes had decreased significantly in size and the tumor embolus in the portal vein had disappeared completely on the CT scan. He was therefore treated with TS-1 alone (120 mg/day) under a 4-weeks-on and 2-weeks-off regimen. After 1 course of TS-1 administered alone, the primary lesion showed a further significant decrease in size as viewed by GI endoscopy, and biopsies did not reveal any evidence of malignancy.

Image of a line is not shrunk but neglected. Absence of crossover in unilateral spatial neglect.

Patients with left unilateral spatial neglect following right hemisphere lesions usually err rightward when bisecting a horizontal line. For very short lines (e.g. 25 mm), however, leftward errors or seemingly 'right' neglect is often observed. To explain this paradox of crossover in the direction of errors, rather complicated models have been introduced as to the distribution of attention. Neglect may be hypothesized to occur in representational process of a line or estimation of the midpoint on the formed image, or both. We devised a line image task using a computer display with a touch panel and approached the representational image of a line to be bisected. Three patients with typical left neglect were presented with a line and forced to see its whole extent with cueing to the left endpoint. After disappearance of the line, they pointed to the right endpoint, the left endpoint, or the subjective midpoint according to their representational image. The line image between the reproduced right and left endpoints was appropriately formed for the 200 mm lines. However, the images for the shorter 25 and 100 mm lines were longer than the physical lengths with overextension to the left side. These results proved the context effect that short lines may be perceived longer when they are presented in combination with longer lines. One of our patients had an extensive lesion that involved the frontal, temporal, and parietal lobes, and the other two had a lesion restricted to the posterior right hemisphere. The image for a fully perceived line may be represented far enough into left space even when left neglect occurs after a lesion that involves the right parietal lobe. The patients with neglect placed the subjective midpoint rightward from the centre of the stimulus line for the 100 and 200 mm lines and leftward for the 25 mm lines. This crossover of bisection errors disappeared when the displacement of the subjective midpoint was measured from the centre of the representational line image. Left neglect may occur consistently in estimation of the subjective midpoint on the representational image, which may be explained by a simple rightward bias of attentional distribution.

Organization of the biosynthetic gene cluster for the polyketide macrolide mycinamicin in Micromonospora griseorubida.

Mycinamicin, composed of a branched lactone and two sugars, desosamine and mycinose, at the C-5 and C-21 positions, is a 16-membered macrolide antibiotic produced by Micromonospora griseorubida A11725, which shows strong antimicrobial activity against Gram-positive bacteria. The nucleotide sequence (62 kb) of the mycinamicin biosynthetic gene cluster, in which there were 22 open reading frames (ORFs), was completely determined. All of the products from the 22 ORFs are responsible for the biosynthesis of mycinamicin II and self-protection against the compounds synthesized. Central to the cluster is a polyketide synthase locus (mycA), which encodes a seven-module system comprised of five multifunctional proteins. Immediately downstream of mycA, there is a set of genes for desosamine biosynthesis (mydA-G and mycB). Moreover, mydH, whose product is responsible for the biosynthesis of mycinose, lies between mydA and B. On the other hand, eight ORFs were detected upstream of the mycinamicin PKS gene. The myrB, mycG, and mycF genes had already been characterized by Inouye et al. The other five ORFs (mycCI, mycCII, mydI, mycE, and mycD) lie between mycA1 and mycF, and these five genes and mycF are responsible for the biosynthesis of mycinose. In the PKS gene, four regions of KS and AT domains in modules 1, 4, 5, and 6 indicated that it does not show the high GC content typical for Streptomyces genes, nor the unusual frame plot patterns for Streptomyces genes. Methylmalonyl-CoA was used as substrate in the functional units of those four modules. The relationship between the substrate and the unusual frame plot pattern of the KS and AT domains was observed in the other PKS genes, and it is suggested that the KS-AT original region was horizontally transferred into the PKS genes on the chromosomal DNA of several actinomycetes strains.