Robotic-assisted latissimus dorsi muscle flap for autologous chest reconstruction in poland syndrome.

BACKGROUND: As chest reconstructions in Poland syndrome are performed for patients at young ages, patients are generally concerned about conspicuous scars. Meanwhile, a robotic-assisted latissimus dorsi (LD) muscle harvest with inconspicuous scars has been performed for autologous breast reconstruction. As our experience with robotic-assisted LD flap harvest has increased over the years, we have made improvements in surgical techniques to optimize results. The purpose of this study was to introduce and identify the role of the refined robotic-assisted LD muscle flap harvest technique in autologous chest reconstruction in patients with Poland syndrome. METHODS: Autologous chest reconstruction using a robotic-assisted LD muscle flap harvest was performed for 21 patients with Poland syndrome. Subjective assessments were performed to evaluate improvement in chest deformity, patient satisfaction with overall outcomes, chest symmetry, and scars. Assessments by the operator and two independent evaluating investigators were carried out with patients' photographs. The complication rates and the time for robotic surgery were also evaluated. RESULTS: At the last visit, the average patient grades for improvement in chest deformity, satisfaction with overall outcomes, chest symmetry, and scars were 4.80, 4.72, 4.18, and 4.87, respectively. Assessments by the operator and two independent evaluating investigators demonstrated that improvement in chest deformity was achieved in all patients. No serious complications such as flap loss were recorded for any patient. The time for robotic surgery markedly decreased as experience accumulated. CONCLUSIONS: Surgical refinements for robotic-assisted LD flap harvest might be effective and reduce operative times for patients with Poland syndrome.

First Report of the Korean Lung Transplantation Registry.

BACKGROUND: The Korean Organ Transplantation Registry (KOTRY) began to register lung transplants in 2015. This is an initial report on the status of patients receiving lung transplants over the past 2 years. METHODS: We analyzed a total of 69 patients who received lung transplants in 2015 and 2016 and who registered with the KOTRY. RESULTS: The 69 patients were treated in 5 institutions. The average (SD) donor age was 39.2 (12.6) years; there were 40 male patients. The average (SD) recipient age was 55.7 (10.0) years, and the number of male recipients was 46. A total of 66 patients underwent bilateral lung transplantation, 3 underwent single-lung transplantation, and 1 underwent simultaneous heart-lung transplantation. The most frequent indication for lung transplantation was idiopathic pulmonary fibrosis (35 patients), followed by connective tissue disease-related interstitial lung disease (9) and acute respiratory failure (8). Prior to transplantation, 23 patients required ventilator care, and 12 required extracorporeal membrane oxygenation while on the waiting list. Episodes of acute rejection during follow-up were reported in 4, 2, 1, and 1 patients at 3, 6, 9, and 12 months, respectively. Infections requiring hospitalization were reported in 27, 10, 4, and 3 patients at 3, 6, 9, and 12 months, respectively. CONCLUSION: The establishment of KOTRY renders it possible to collect nationwide data on lung transplantation, improving research on the topic and clarifying clinical feasibility.

Isolated Acute Appendicitis Caused by Aspergillus in a Patient Who Underwent Lung Transplantation: A Case Report.

Invasive aspergillosis is an important cause of morbidity and mortality in patients who have undergone lung transplantation. Aspergillus infections usually involve the respiratory tract, with vascular invasion and subsequent dissemination. However, acute appendicitis associated with localized aspergillosis is rare, especially among patients who have undergone prophylaxis with voriconazole. We present a case of primary Aspergillus appendicitis diagnosed by histologic examination in a patient who underwent lung transplantation. A 51-year-old woman with dermatomyositis underwent lung transplantation for acute interstitial pneumonitis. According to our institution's protocol, the patient was treated with immunosuppressive therapy and prophylaxis with voriconazole, ganciclovir, and trimethoprim sulfamethoxazole during the post-transplantation period. Twenty-eight days after transplantation, the patient developed mild abdominal pain and paralytic ileus. There was no apparent infection sign. Abdominal computerized tomography indicated a wall defect of the appendix with multifocal fluid collection, mesenteric leave thickening, and pneumoperitoneum. These findings were consistent with perforated appendicitis, and the patient underwent an appendectomy. The histopathology examination of the resected appendix showed inflammation and abscess. Periodic acid-Schiff-positive and Grocott-Gomori methenamine silver-positive fungal hyphae with acute-angle branching were observed, demonstrating muscular invasion. A galactomannan antigen test obtained on the same day had negative results. The trough level of voriconazole was well maintained and was subsequently adjusted through monitoring of circulating drug concentration. Simultaneously, other potential sites of disseminated Aspergillus were considered and examined, but no other site of systemic Aspergillus infection was detected. Voriconazole treatment was maintained for 3 months, and no aspergillosis relapse or other invasive fungal infections were observed.

The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit.

The aim of this study was to evaluate nutritional care and outcomes in a medical intensive care unit (ICU) following multidisciplinary nutritional team (MNT) involvement. The authors retrospectively reviewed the data of all patients admitted to a medical ICU from April to October 2013 (pre-MNT period) and from April to October 2014 (post-MNT period). In total, 140 patients were included and allocated to the pre-MNT group (n=70) or the post-MNT group (n=70). The post-MNT group was more likely to use enteral nutrition (61.4 vs 37.1%, P=0.002). In terms of total calories and protein provided, the number of nutritional goal-achieved days during stays in ICU was significantly greater in the post-MNT group than in the pre-MNT group (63.7% vs 47.6%, P<0.05 and 44.3% vs 29.9%, respectively, P<0.05). The MNT activities resulted in significant improvements in terms of nutritional provision and adequacy in a medical ICU.

Extracorporeal Life Support as a Bridge to Lung Transplantation in Patients With Acute Respiratory Failure.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is being used more often as a bridge to transplantation (BTT) in patients with acutely decompensated end-stage lung disease in Korea. ECMO as a BTT may be the only rescue strategy for severe acute respiratory failure, but many centers still consider it to be a relative contraindication to lung transplantation because of its poor outcome. Because there are not enough lung donors, it is important to determine their optimal use. We reviewed and analyzed our experiences with the use of ECMO as a BTT in patients with acute respiratory failure. METHODS: This was a retrospective analysis of all patients with acutely decompensated end-stage lung disease treated with ECMO as a bridge to lung transplantation between March 2012 and February 2016. RESULTS: Of the 194 patients who underwent respiratory ECMO over a 4-year period, a BTT strategy was used for 19 patients (median age, 58 years) on our institution's lung transplantation waiting list (15 veno-venous, 3 veno-veno-arterial, 1 veno-arterial). Fourteen patients (73.7%) were successfully bridged to transplantation; however, 3 died while on the waiting list and 2 returned to their baseline functions without transplantation. The overall in-hospital survival rate was 57.9% (11 of 19), including the 9 (64.3%) patients who underwent transplantation. CONCLUSIONS: Our findings support the view that well-selected candidates with acutely decompensated end-stage lung disease may be safely bridged until a suitable donor is identified. ECMO is not able to reverse the course of patients; however, it could be a life-saving option for patients with acute respiratory failure requiring lung transplantation.

Spatiotemporal characteristics of swallowing in Parkinson's disease.

OBJECTIVES/HYPOTHESIS: The aim of this study was to quantitatively investigate spatiotemporal movement abnormalities during the pharyngeal phase of swallowing in individuals with Parkinson's disease (PD) and to investigate relationships between disease and dysphagia severities. STUDY DESIGN: Retrospective study. METHODS: We performed two-dimensional motion analysis of the hyoid bone, epiglottis, and vocal folds using videofluoroscopic images from 33 PD patients and 33 age-matched, healthy controls. The outcome measures were spatial and temporal movement variables during swallowing. Additionally, three subgroups of patients were compared based on the Hoehn and Yahr scale to identify the relationship between disease and dysphagia severities. RESULTS: Individuals with PD showed a reduced anterior hyoid bone displacement after normalization for each individual. The maximal angle of the epiglottic rotation was smaller in PD patients. The time to maximal displacement of the hyoid bone, epiglottis, and vocal folds were significantly delayed in PD patients (P = 0.001, 0.002, and < 0.001, respectively); the mean velocities of the hyoid bone and epiglottic movements were also reduced in PD patients (P < 0.001 and < 0.001, respectively). The velocity curves of the hyoid bone revealed more peaks in individuals with PD, representing incoordination during swallowing. Clinical disease severity was related to level of diet and supervision but not with dysphagia severity. CONCLUSION: This study shows that oropharyngeal bradykinesia, incoordination, reduced anterior hyoid bone movement, and decreased epiglottic rotation angle during swallowing are the most noticeable findings in individuals with PD. LEVEL OF EVIDENCE: N/A.

Lysophosphatidylcholine as a prognostic marker in community-acquired pneumonia requiring hospitalization: a pilot study.

Clinical prediction indicators such as the pneumonia severity index (PSI) and CURB-65 score are useful, but they are complex and often not followed. Therefore, biomarkers that improve hospital outcome predictions are emerging. This study evaluated the prognostic value of a new sepsis biomarker, serum lysophosphatidylcholine (LPC) concentrations, in community-acquired pneumonia (CAP) patients. We prospectively collected blood samples from emergency department CAP patients on days 1 and 7 (post-admission) and analyzed their plasma LPC concentrations. We retrospectively reviewed patient medical records and analyzed correlations between plasma LPC concentrations and clinical parameters and hospital outcomes. A total of 56 CAP patients were included in this study; 24 (42.9 %) required intubation and 15 (26.8 %) died. The mean LPC concentrations on days 1 (p = 0.015) and 7 (p = 0.002) of hospitalization were significantly lower in the non-survivors. Day 1 LPC concentrations were inversely correlated with the PSI (ρ = -269) and CURB-65 scores (ρ = -386). For predicting hospital mortality, the day 1 LPC concentration was comparable with the CURB-65 or PSI scores. Day 1 LPC cut-off levels <29.6 µmol/L were associated with hospital CAP outcomes, including the need for mechanical ventilation, vasopressors, intensive care unit admission, and hospital mortality. Additionally, day 7 LPC concentrations were correlated with in-hospital mortality. Initial serum LPC concentrations predicted hospital outcomes in CAP patients requiring hospitalization. These values were correlated with prognostic markers, such as the PSI and CURB-65 scores. Additionally, follow-up LPC measurements predicted the clinical course of CAP patients.

Relationship between socioeconomic status and anemia prevalence in adolescent girls based on the fourth and fifth Korea National Health and Nutrition Examination Surveys.

BACKGROUND/OBJECTIVES: We studied the relationship between socioeconomic status (SES), represented by household income, and the prevalence of anemia and iron deficiency anemia (IDA) among adolescent girls in Korea. SUBJECTS/METHODS: The samples were based on the data from a four-year (2008-2011) collection for the Korea National Health and Nutrition Examination Survey (1312 girls, age 10-18 years). The survey included demographic, anthropometric, biochemical and nutritional parameters. A multiple regression analysis after adjusting for age, body mass index (BMI), red blood cell count, white blood cell count and red meat intake was performed. Anemia was defined as hemoglobin level lower than 11.5 g/dl for ages 10-11 years and 12.0 g/dl for ages 12-14 years. Iron deficiency was defined as serum ferritin level below 15 µg/l. RESULTS: The prevalences of anemia and IDA in Korean girls were 5.3 and 4.2%, respectively. Girls with anemia were older, taller, weighed more, had higher BMI, had higher portion of menarche experience and consumed less red meat than girls without anemia. Girls with higher income had lower anemia prevalence and consumed more iron and vitamins. Logistic regression analysis showed a decreasing trend in anemia prevalence as household income increased. Correlation analysis demonstrated that there is a relationship between household income and serum hemoglobin and ferritin levels (P=0.003 and P=0.026, respectively). CONCLUSIONS: Higher SES leads to lower prevalence of anemia and IDA in Korean adolescent girls. This may be due to the fact that higher SES individuals consume more iron and vitamin C.

Clinical validity of tissue carcinoembryonic antigen expression as ancillary to serum carcinoembryonic antigen concentration in patients curatively resected for colorectal cancer.

AIM: Although serum carcinoembryonic antigen (CEA) level is prognostic in colorectal cancer, the prognostic role of tumour CEA expression is unclear. The aim of this study is to identify the prognostic and surveillance roles of tissue CEA expression along with serum CEA concentration in patients curatively resected for colorectal cancer. METHOD: Between January and December 2003, 294 patients who underwent curative resection for colorectal cancer were included in the study. Correlation of tissue CEA expression with overall survival (OS), disease-free survival (DFS) and elevated serum CEA concentration at tumour recurrence were analysed. RESULTS: Tissue CEA expression was positive in 215 patients (73.1%). CEA expression was an independent prognostic factor for OS [hazard ratio (HR) = 2.537, 95% confidence interval (CI) = 1.065-6.042, P = 0.035] and DFS (HR = 3.090, 95% CI = 1.405-6.795, P = 0.005). Elevation of serum CEA at tumour recurrence was significantly lower in patients without than with tissue CEA expression (14.3 vs 57.6%, P = 0.045). Moreover, when patients were grouped according to a combination of serum CEA elevation and tissue CEA expression, those with tissue CEA expression and elevated serum CEA (group 3) had significantly poorer OS and DFS (P < 0.001 each) than those without CEA expression and elevated serum CEA (group 1) and those with either tissue CEA expression or elevated serum CEA (group 2). OS (P = 0.006) and DFS (P = 0.027) were both significantly greater in group 1 than in group 2. CONCLUSION: Tissue CEA expression is a prognostic factor in patients with colorectal cancer. Analysis of tissue CEA expression may be helpful in determining the clinical utility of serial measurements of serum CEA as surveillance in patients with curatively resected colorectal cancer.

Developmental expression and subcellular distribution of synaptotagmin 11 in rat hippocampus.

Synaptotagmins are required for Ca(2+)-dependent membrane-trafficking in either neuronal synaptic vesicles or cellular membranes. Previous reports suggested that the synaptotagmin 11 (syt11) gene is involved in the development of schizophrenia based on the genomic analysis of patients. Parkin protein binds to the C2 domains of Syt11 which leads to the polyubiquitination of Syt11. However, where and how Syt11 performs its role in the brain is largely unknown. Here, we report that Syt11 is expressed mainly in the brain. In addition, exogenously expressed Syt11 in HEK293 cells can form higher molecular weight complex via its transmembrane domain. Also, Syt11 is targeted to both dendrite and axon compartments. Immunocytochemistry showed that Syt11 is juxtaposed to postsynaptic markers in both excitatory and inhibitory synapses. Both neuroligin 1 and 2, which are postsynaptic cell adhesion molecules and differentially induce excitatory and inhibitory presynapses, respectively, recruit Syt11 in neuron coculture. Immunogold electron microscopy analysis revealed that Syt11 exists mainly in presynaptic neurotransmitter vesicles and plasma membrane, and rarely in postsynaptic sites. These results suggest that Syt11 may contribute to the regulation of neurotransmitter release in the excitatory and inhibitory presynapses, and postsynapse-targeted membrane trafficking in dendrites.

Ministry of Health clinical practice guidelines: management of gambling disorders.

The Ministry of Health (MOH) has published clinical practice guidelines on Management of Gambling Disorders to provide doctors and patients in Singapore with evidence-based guidance on the management of gambling disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Management of Gambling Disorders for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=26136). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

QF-PCR-based prenatal detection of aneuploidy in a southeast Asian population.

OBJECTIVES: We have investigated the efficacy of using quantitative fluorescent polymerase chain reaction (QF-PCR) for the prenatal recognition of aneuploidy in chromosomes 13, 18, 21, X and Y. A total of 1115 samples, from mainly southeast Asian patients, were analysed and compared in a blind trial to the results previously obtained cytogenetically. METHODS: A multiplex PCR involving 15 short tandem repeat (STR) sequences was used. The probability of two or more of these markers being informative was calculated, and this required the multiplex PCR to be modified. RESULTS: The QF-PCR and previous cytogenetic results concurred, except for two products of conception (POC). One of these may be a case of complete uniparental disomy that was not recognized cytogenetically. The other was tetraploid, and as such appeared normal using QF-PCR. A mosaic trisomy 18 was correctly identified. The population sample was of a mainly Chinese, ethnic origin, and the allele frequency, size and heterozygosity appeared more restricted than the population groups analysed hitherto. CONCLUSION: The QF-PCR methodology is an efficient cost-effective method of screening for major chromosome aneuploidy, and, for certain referral categories, could be used alone. It also appears to be applicable to patients of different ethnic origins.

A new triterpene lactone from the roots of Patrinia scabiosaefolia.

A new triterpene lactone named patrinolide A (1) has been isolated from the roots of Patrinia scabiosaefolia (Valerianaceae). Its structure was determined to be 11beta,21beta-dihydroxy-3-oxooleanan-28,13beta-olide on the basis of spectral analysis, including 2D-NMR techniques. Key words: Patrinia scabiosaefolia, Valerianaceae, Lactone, Patrinolide, 11beta,21beta-dihydroxy-3-oxooleanan-28,13beta-olide.

Effects of various implant materials on regeneration of calvarial defects in rats.

The purpose of the present study was to determine the best implant material, the best conditions to substitute absorbable membrane for non-absorbable membrane, and the factors influencing guided regeneration of critical size defects using experimental rats. An 8-mm circular transosseous calvarial bony defect was made and implant materials, such as demineralized freeze-dried bone (DFDB), absorbable membrane (BioMesh; Samyang Co., Seoul Korea), non-absorbable membrane (Millipore filter; Micro Filtration System, MA, USA) or a combination of these materials, was placed on the defect. As for the results of sequential time-based guided bone regeneration, histological, histochemical, immunohistochemical and histomorphometric aspects were observed, and a statistical comparative analysis was performed, with control group of a soft tissue flap. Bone formation was significantly enhanced when DFDB was retained within the defect with a protective absorbable membrane. Inframembranous DFDB-filling was required to prevent membrane collapse and to preserve spaces for bone regeneration. The absorbable membrane which was recommended to overcome the disadvantages of the non-absorbable membrane should remain intact for more than 5 weeks in order for it to be effective. The macrophages recruited by grafts were involved partly in decreasing bone regeneration via the sequential events of releasing fibronectin, and in chemotactic effect of the fibronectin to fibroblasts and collagen lay-down. Thus, the activity of new bone formation was dependent upon the physical barrier effect of the membrane, such as the preserving ability to secure spaces and the suppression ability of early infiltration of collagen and epithelium, inducible ability of inflammation by the implant material, and potential in guiding bone regeneration of the grafts.

Chronically and acutely exercised rats: biomarkers of oxidative stress and endogenous antioxidants.

The responses to oxidative stress induced by chronic exercise (8-wk treadmill running) or acute exercise (treadmill running to exhaustion) were investigated in the brain, liver, heart, kidney, and muscles of rats. Various biomarkers of oxidative stress were measured, namely, lipid peroxidation [malondialdehyde (MDA)], protein oxidation (protein carbonyl levels and glutamine synthetase activity), oxidative DNA damage (8-hydroxy-2'-deoxyguanosine), and endogenous antioxidants (ascorbic acid, alpha-tocopherol, glutathione, ubiquinone, ubiquinol, and cysteine). The predominant changes are in MDA, ascorbic acid, glutathione, cysteine, and cystine. The mitochondrial fraction of brain and liver showed oxidative changes as assayed by MDA similar to those of the tissue homogenate. Our results show that the responses of the brain to oxidative stress by acute or chronic exercise are quite different from those in the liver, heart, fast muscle, and slow muscle; oxidative stress by acute or chronic exercise elicits different responses depending on the organ tissue type and its endogenous antioxidant levels.

Protection of rat hepatocytes exposed to CCl4 in-vitro by cynandione A, a biacetophenone from Cynanchum wilfordii.

To identify hepatoprotective agents from plant sources we use primary cultures of rat hepatocytes injured by CCl4. The hepatoprotective agents are the compounds that mitigate the injury caused by CCl4. Using this system we have investigated the biochemical mechanisms involved in the hepatoprotective activity of cynandione A, a biacetopherone, isolated from the roots of Cynanchum wilfordii Hemsley (Asclepiadaceae). Cynandione A (50 microM) significantly reduced (approximately 50%) the release into the culture medium of glutamic pyruvic transaminase and sorbitol dehydrogenase from the primary cultures of rat hepatocytes exposed to CCl4. Glutathione, superoxide dismutase, catalase and glutathione reductase play important roles in the cellular defence against oxidative stress. Cynandione A appeared to protect primary cultured rat hepatocytes exposed to CCl4 from significant drops in the levels of each of these four specific markers. Cynandione A also ameliorated lipid peroxidation by up to 50% as demonstrated by a reduction in the production of malondialdehyde. These results suggest that cynandione A protected the hepatocytes from CCl4-injury by maintaining the level of glutathione and by inhibiting the production of malondialdehyde, due to its radical scavenging properties.

Cynandione A from Cynanchum wilfordii protects cultured cortical neurons from toxicity induced by H2O2, L-glutamate, and kainate.

Oxidative stress has been implicated as a primary cause of neuronal death in certain neurodegenerative disorders and in aging brains. Natural products have been used in Asian societies for centuries for treating such neurodegenerative disorders as senile dementia. In an effort to identify active neuroprotective compounds from these products, we have employed cultures of rat cortical neurons as our screening system. A methanolic extract from dried roots of Cynanchum wilfordii Hemsley (Asclepiadaceae) significantly mitigated the neurotoxicity induced by H2O2 in this screening system. Activity-guided fractionation using several chromatographic techniques resulted in the isolation of the neuroprotective compound, cynandione A, a biacetophenone. At a concentration of 50 microM, cynandione A significantly reduced neurotoxicity induced by H2O2. Cynandione A significantly attenuated decreases in levels of glutathione, superoxide dismutase, and other enzymes that participate in the cellular defense against oxidative stress. Furthermore, cynandione A alleviated neurotoxicity induced by the excitotoxic neurotransmitter, L-glutamate, the neurotoxicity induced by kainate, but not that mediated by N-methyl-D-aspartate. Cynandione A was demonstrated to be a natural antioxidant as it facilitated the breakdown of hydrogen peroxide in vitro; however, no mechanism was uncovered to explain its neuroprotectant effects against glutamate and kainate. Therefore, cynandione A may be efficacious in protecting neurons from oxidative stress mediated via activation of alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate/kainate receptors since it exerted significant neuroprotective effects on cultured cortical neurons.

Crystal structure of the hexameric traffic ATPase of the Helicobacter pylori type IV secretion system.

The type IV secretion system of Helicobacter pylori consists of 10--15 proteins responsible for transport of the transforming protein CagA into target epithelial cells. Secretion of CagA crucially depends on the hexameric ATPase, HP0525, a member of the VirB11-PulE family. We present the crystal structure of a binary complex of HP0525 bound to ADP. Each monomer consists of two domains formed by the N- and C-terminal halves of the sequence. ADP is bound at the interface between the two domains. In the hexamer, the N- and C-terminal domains form two rings, which together form a chamber open on one side and closed on the other. A model is proposed in which HP0525 functions as an inner membrane pore, the closure and opening of which is regulated by ATP binding and ADP release.

Grafting of large defects of the jaws with a particulate dentin-plaster of paris combination.

OBJECTIVE: The purpose of this report is to show the usefulness and discuss the effects of a particulate dentin and plaster of paris combination as a bone graft material in jaw defects. STUDY DESIGN: This was a retrospective evaluation of 10 patients with jaw defects who underwent grafting with a combination of particulate dentin and plaster of paris. The material was used when the defects were more than 20 mm in diameter. The ratio was 2:1 by weight. Patients were examined for any evidence of infection and recurrence during the follow-up periods. RESULTS: During a mean follow-up of 52.2 months (range, 50 to 57 months), patients had minor immediate postoperative complications. These complications were swelling and perforation; they were treated without problems through use of incision and drainage, antibiotic treatment, and buccal flap. CONCLUSIONS: On the basis of the results that we obtained radiographically and clinically, it may be concluded that the particulate dentin plaster mixture is a useful and readily available material for bone substitute.

Enzymatic synthesis of a dihydrobenzofuran neolignan by oxidative coupling.

The oxidative dimerization of ferulic acid has been carried out using horse-radish peroxidase as catalyst to give a dihydrobenzofuran neolignan (1), the structure of which was elucidated as (2SR,3RS)-2,3-dihydro-2-(4-hydroxy-3-methoxyphenyl)-3-n-buto xycarbonyl-5-(2E-carboxyethenyl)-7-methoxybenzofuran by spectroscopic analyses. This compound showed more potent cytotoxicity against several tumor cell lines than the starting material.