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Background According to the etiological classification, anal fistulas in Crohn’s disease (CD) which derived from CD lesions are secondary lesions (s.l.). We classified s.l. as follows: In case of presence of clear CD lesion at the primary orifice (p.o.), it was classified as s.l.CD lesion (+), whereas in the absence of CD lesion, it was classified as a s.l.CD lesion (-). To examine the prognosis of patients that primary orifice (p.o.) is not on the dentate line and no clear CD lesion. Methods 17 patients who have been followed up for >5 years post-the first examination under anesthesia (EUA) were included in the study. To determine the therapeutic effect, we defined cases with closed fistula as cured, those in whom drain can be removed, but symptoms may exist as improved, those in whom drains cannot be removed as unchanged, and those in whom rectal amputation was required as worsened. The target cases were divided into s.l.CD lesion (+), and s.l.CD lesion (-), and the prognosis was examined. Results Nine and eight patients showed s.l.CD lesion (+), and s.l.CD lesion (-), respectively. The results are shown in the table 1. Among s.l. cases, more patients with CD lesion (-) underwent biotreatment before EUA than those with s.l.CD lesion (+); furthermore, biotreatment was started earlier after EUA in the former than in the latter. Nevertheless, the prognosis of CD lesion (-) cases tended to be poor. Conclusions Based on the findings, the prognosis of patients that p.o. is not on the dentate line and no clear CD lesion is poor.

Background Previous studies have shown proximal extension (PE) rate of ulcerative proctitis (UP) is approximately 50%. This rate teach us the importance of treating UP adequately. Basically, we have to treat them with topical 5-ASA. But in clinical practice, we sometimes experience the case whose inflammation remain endoscopically, even though the symptoms have been relieved. Should we strengthen our treatment at this situation, especially inflammation at lower rectum? We aimed to know PE rate of lower rectal UP and optimize the treatment. Methods We retrospectively investigated the medical charts of patients with UP from 2010 to 2020 at Kenseikai Nara Coloproctology Center. We excluded the patients with UP shrinking from left-sided or pancolitis as a result of the treatment. The cases with missing value were excluded too. Variables of interest included gender, onset age, disease location, initial mayo endoscopic subscore (MES) and treatment, and the time to PE. To compare the cohorts we used Fisher’s exact test and Mann-Whitney test. Proximal extension free survival (PEFS) was calculated using the Kaplan-Meier method. Results Sixty-five patients were recruited. Mean age was 42 years old, the ratio of males to females was 1.17. The number of lower rectal UP patients at first examination was 24. We observed MES 1 inflammation for 30 patients, and MES 2 for 35. Median follow-up duration was 73.5 months. PE occurred in 34 patients: 28 patients had left-sided colitis and 6 had pancolitis. Fifty-four patients were medicated and other 11 patients were just observed. Among the patients medicated, 23 patients were took only topical drugs, 18 were took only oral drugs and other 13 were took both. We couldn’t find any relationships between initial medication and PE rate. The multivariate analysis revealed that having peri-appendiceal red patch and lower rectal UP were reduce the risk of PE. MES was not related to PE (table 1). PEFS at 1 year, 2 year are 81%, 81% for lower rectal UP (Rb group), and 66%, 61% for the patients having the disease beyond middle Houston’s valve (Not-Rb group), though we couldn’t find significant difference (Fig.1). Among 34 patients having PE, we used biologics for only five patients and got their inflammation under control. Conclusion Patients with lower rectal UP is less likely to extent their disease location. There’s no difference between the route of treatment and PE rate, but it’s important to carefully check PE within first one year.

Background Recently, the importance of top-down therapy is emphasised for early Crohn’s Disease (CD). Especially early use of biologics after onset may prevent rectal amputation or permanent stoma concrete of CD with perianal lesion (CDp). The aim of this study was to evaluate the risk factors of permanent stoma concrete for CDp, and especially we had an interest for the relationship between permanent stoma concrete and length of time it takes for infliximab (IFX) was started to use after onset. Methods This is a comparative retrospective study of CDp patients who received IFX therapy at Kenseikai Nara Coloproctology Center between 2002 and 2018. We analysed risk factors of their rectal amputation using logistic regression analysis. Patients were included if they had perianal lesions and received IFX. The cases who received IFX after rectal amputation and who have missing values were excluded. Variables of interest included gender, age at onset and diagnosis, disease duration and location, disease behaviour, smoking, perianal surgical history, timing of IFX use after anoperineal lesion’s onset. Late IFX use was defined as we started to use IFX 2 years after perianal lesion’s onset. Results Fifty-four patients were recruited. Mean age was 37 years old, the ratio of males to females was 3.5. Forty-one patients’ disease was located in the small and large intestine, and thirteen patients’ were located in the large intestine. Median follow-up duration was 149 months. Among 54 patients, 10 patients were received rectal amputation or permanent stoma concrete. The univariate analysis revealed that the risk factors for rectal amputation were smoking habit (OR 7.56, 95% CI 1.41–53.88, p-value = 0.007), penetrating type (OR 6.44, 95% CI 1.21–39.22, p-value = 0.013) and Late IFX use (OR 12.47, 95% CI 1.50–589.26, p = 0.011). A multivariate analysis revealed that smoking habit (OR 21.5, 95% CI 1.92–239, p = 0.013) smoking behaviour (OR 21.5, 95% CI 1.92–239.00, p = 0.013) and Late IFX use (OR 16.0, 95% CI 1.01–254, p = 0.049) were independent risk factor for rectal amputation (Table 1). Conclusion Smoking and late IFX use may be a significant risk factor of rectal amputation for CDp. Early use of biologics may prevent permanent stoma concrete for CDp.

Starting from a naphthol-based lead series with low oral bioavailability, we have identified potent TRPV1 antagonists with oral bioavailability in rats. These compounds emerged from SAR studies aimed at replacing the lead's phenol structure whilst maintaining potency. Compound rac-6a is an orally available TRPV1 antagonist with single-digit nanomolar activity. The enantiomers show a low eudismic ratio at the receptor level.

We have identified naphthol derivatives as inhibitors of the vanilloid receptor TRPV1 by high throughput screening. The initial lead showed high clearance in rats and has been optimized by enhancing the acidity of the phenol group. Compound 6b has reduced clearance, improved potency and is active in rat cystometry models of urinary incontinence after intravenous administration.

目的：腹腔鏡下手術時に腸管拡張を抑え，良好な術野展開を可能にするための最適な前処置法の確立．方法：腹腔鏡下手術を行った67例をmagnesium citrate（MGC，マグコロールP®高張液）またはpolyethylene glycol electrolyte solution（PEG，ニフレック®等張液）を前処置として使用した2群に割り付け，手術時の小腸および大腸の拡張をスコア化し比較検討する．結果：全症例および大腸癌症例において，MGCがPEGと比較し小腸（上部，中部，下部）および上行結腸，横行結腸の拡張を有意に抑制した．結語：MGC高張液を用いた前処置法は腹腔鏡下手術時の腸管拡張を抑制し，術野の展開を容易にすることで安全な手術を行うことに寄与すると考えられた．

症例は60歳代，男性で，下血を主訴に近医受診した．大腸内視鏡検査で，S状結腸に亜全周2型の腫瘍を認め，手術目的にて当院紹介受診となった．上腹部造影CT検査にてinteraorticからretrocavalに及ぶ多発性傍大動脈周囲リンパ節転移を認めた．S状結腸切除術を施行した．また，傍大動脈周囲リンパ節転移巣の一部を切除した．病理組織学的検査では，粘膜内から奬膜下層へかけて一部に腺腔形成をともないまたシート状に増生する腫瘍が混在し，一部には角化像もともなっていた．以上より腺扁平上皮癌と診断．病理組織学的進行度は，pSS，N1，P0，H0，M1（No. 216）， stage IVであった．退院後，m-FOLFOX6療法を6クール施行した．術後14カ月の，平成22年2月に施行した腹部CT造影検査にても傍大動脈周囲リンパ節転移に対してCRを維持しており，他に再発を認めておらず経過良好である．

The objective of this study was to investigate the influence of corticosteroids on the masseter wet weight and changes after discontinuation of the administration by comparison with those of hind leg skeletal muscles. Thirty-five male Wister rats, 9 weeks old, were used for the experiment. As a corticosteroids, dexamethasone was administered in drinking water for 14 days in consentrations 0.5 and 3.0 μg/ml administration groups: LD (Low Dose group) and HD (High Dose group), respectively. A 21-day recovery period was set after the discontinuation. Recovery groups: LD-r and HD-r. Non-treated groups: CO (CO-b, CO, CO-r). After the experimental period, the superficial masseter and the rectus femoris and gastrocnemius were excised, and the wet weights were measured. The wet weights of each muscle were significantly lower in the LD and HD than in the CO (p < 0.05). More significant wet weight losses of hind leg were noted in the HD (p < 0.05). The wet weight reduction rates of the rectus femoris and gastrocnemius relative to those in the CO were 50 and 44% in the HD, but that of the masseter was only 25%. The reductions recovered to weights similar to those in the CO-r after the discontinuation in the LD-r, but the weights in the HD-r were significantly lower than those in the other 2 groups (p < 0.05). Dexamethasone reduced the wet weight of the superficial masseter in the growing rats, but the influence was smaller than that on the hind leg muscles, suggesting that the reduction can be recovered by discontinuation when the corticosteroids is not administered at high doses.

A 79-year-old woman with symptomatic pyloric stenosis was diagnosed with advanced gastric cancer. CT revealed that the tumor had invaded into the pancreatic head.Since no contraindications were found at laparotomy, we performed pancreatoduodenectomy. The histopathologic diagnosis was pT4b (panc), pN3a (11/35), P0, CY0, H0, M0, pStage ⅢC, R0. The patient received adjuvant chemotherapy with S-1 for 1 year. The patient has survived without recurrence for more than 2 years. The efficacy of pancreatoduodenectomy for advanced gastric cancer is still controversial. Pancreatoduodenetomy may be indicated for selected cases of advanced gastric cancer, if an R0 resection can be achieved.

後腹膜に発生した脂肪肉腫は稀ではないが,傍直腸脂肪組織内に発生した脂肪肉腫の報告例は無い.また脂肪肉腫に対する治療後長期にわたり予後を観察した症例の報告例は少ない.今回術後8年間無再発生存している傍直腸脂肪組織内に発生した脂肪肉腫の一例を経験したので報告する.症例は34歳女性で,第2子出産の際,産婦入科医に直腸腫瘤を指摘されて来院.腫瘍は腹膜翻転部直下の直腸左側のいわゆる"pararectal space"に存在.術前に経皮針生検検査施行し,脂肪肉腫の診断を得た後に手術を施行した.周囲組織への浸潤を認めなかったので,腹会陰式直腸切断術は施行せず,摘出術のみとした.術後の化学療法,放射線療法は施行していない.文献的考察を加えて報告する.

患者は34歳の男性. 2年前発症の潰瘍性大腸炎(UC)患者.重症の全大腸炎型の診断にて近医入院し中心静脈栄養,プレドニゾロン,メサラジン,顆粒球除去療法(GCAP)が施行された. 2カ月にわたって治療されるも症状改善せず当院紹介入院となった.転院時,呼吸困難,発熱,低酸素血症,胸部X線像にて両肺にびまん性の淡いスリガラス状の陰影を認めた.カリニ肺炎による間質性肺炎と診断し, ST合剤を投与した.これにより呼吸状態が改善し,結腸亜全摘,一時的回腸瘻, S状結腸粘液瘻造設術を行った. UCの治療経過中にステロイド剤や免疫抑制剤, GCAPなどが併用される.これによって免疫不全をきたし日和見感染症を合併することもある.内科的治療の限界を見極め,感染合併症を引き起こす前に手術に踏み切ることが重要と考える.

A series of 2-amino-3-cyano-4-alkyl-6-(2-hydroxyphenyl)pyridine derivatives was synthesized and evaluated as IkappaB kinase beta (IKK-beta) inhibitors. Substitution of an aminoalkyl group for the aromatic group at the 4-position on the core pyridine ring resulted in a marked increase in both kinase enzyme and cellular potencies, and provided potent IKK-beta inhibitors with IC(50) values of below 100 nM.

A series of 2-amino-3-cyano-4-alkyl-6-(2-hydroxyphenyl)pyridine derivatives was synthesized and evaluated as I kappaB kinase beta (IKK-beta) inhibitors. Modification of a novel IKK-beta inhibitor 1 (IKK-beta IC(50)=1500 nM, Cell IC(50)=8000 nM) at the 4-phenyl ring and 6-phenol group on the pyridine core ring resulted in a marked increased in biological activities. An optimized compound, 2-amino-6-[2-(cyclopropylmethoxy)-6-hydroxyphenyl]-4-piperidin-4-yl nicotinonitrile, exhibited excellent in vitro profiles (IKK-beta IC(50)=8.5 nM, Cell IC(50)=60 nM) and a strong oral efficacy in in vivo anti-inflammatory assays (significant effects at 1mg/kg, po in arachidonic acid-induced ear edema model in mice).

IkappaB kinase beta (IKK-beta) is a serine-threonine protein kinase critically involved in the activation of the transcription factor Nuclear Factor kappa B (NF-kappaB) in response to various inflammatory stimuli. We have identified a small molecule inhibitor of IKK-beta. Optimization of the lead compound resulted in improvements in both in vitro and in vivo potency, and provided IKK-beta inhibitors exhibiting potent activity in an acute cytokine release model (LPS-induced TNFalpha).

Patients with ulcerative colitis (UC) have elevated/activated myeloid lineage leucocytes and may respond favorably to adsorptive granulocyte/monocyte apheresis (GMA). However, there are patients who respond well to GMA, and patients who do not benefit. Therefore, predictive factors of GMA efficacy need to be defined.In a prospective multicenter setting, 200 UC patients at 32 institutes received one GMA session per week over 10 weeks. Patients who achieved remission were followed for 12 months. The Clinical Activity Index (CAI) ≤3 meant remission, and response meant CAI decreased by ≥3. Quality of life was evaluated by the Inflammatory Bowel Disease Questionnaire (IBDQ).After final GMA, remission, response and no response rates were 67.0%, 15.0% and 18%, respectively. The remission group had a significant decrease in myeloid leucocytes and platelets. Corticosteroid dose decreased (P0.001); 49 of 97 patients on corticosteroids became steroid-free. Baseline CAI was lower in the remission group versus non-remission (P0.01), whereas IBDQ was higher in the remission group versus non-remission (P0.05). After 12 months, 52 of 134 patients had maintained remission. Disease duration was longer in the relapsed group versus maintained remission group (P = 0.041). Male gender, first UC episode and corticosteroid responder were significant factors for maintaining remission, whereas corticosteroid dependent UC was associating with relapse.Selective myeloid leucocyte depletion was effective for remission induction and improving patients' quality of life. Baseline demographics such as disease activity level, duration and corticosteroid dependency appear to predict response to GMA. Additionally, patients with a first UC episode who were drug naive responded well to GMA and achieved a favorable long-term disease course by avoiding pharmacologics from an early stage of their inflammatory bowel disease. These findings should help to end unnecessary use of medical resources by targeting GMA to patients who may respond well.

(Ss)-3-(p-Tolylsufinyl)-2-furaldimine was synthesized, and condensation of the chiral furaldimine with lithium ester enolates has been examined. The product distribution of the reaction is dependent upon reaction conditions and on the kind of the substituent placed on the esters. Disubstituted ester enolate resulted in the exclusive formation of (4R)-beta-lactam, while unsubstituted, tert-butyl ester enolate preferentially gave (3R)-beta-amino ester. With the monosubstituted ester enolates, the condensation afforded (4R)-beta-lactams and/or (3R)-beta-amino esters as major products. This method has been applied to an efficient route to chiral furyl beta-lactams.

This study investigates how “the career anchors” are functioning in the decision-making of change of occupation and/or becoming independent, and consequently how are these factors contributed to the satisfaction of that decision. The author tested the hypothesis by the structural equation model with latent variables, by using the data gathered from the 231 persons who achieved change of occupation or independence within the past two years, whose age was from twenty-five to sixty.Regard to the career anchors, five factors namely “managerial”, “special”, “autonomous”, “stable”, and “creative” were identified through factor analysis. Although these career-orientation did not relate to change-ofoccupation satisfaction directly, however “managerial” and “special” factors contributes to change-of-occupation satisfaction through the parameter of “substantial target”. On the other hand, “stable” factor contributes negative to change-of-occupation satisfaction through indirect parameter of “uneasy” factor. Finally “autonomous” and “creative” factors were not significantly related to change-of-occupation satisfaction.

われわれは子宮内避妊リング (intrauterine device: IUD)による骨盤腹膜炎に起因する直腸S状結腸狭窄を呈した症例を経験した.患者は46歳,女性.主訴は下腹部痛,排便困難.血液検査所見で著明な炎症反応を認めた.注腸X線検査,内視鏡検査で直腸S状結腸に狭窄所見を認めた.下腹部CTでは子宮筋腫,右卵巣嚢腫が疑われ, S状結腸の腸管壁肥厚が疑われた.大腸癌あるいは炎症による直腸S状結腸狭窄,腸閉塞と診断し,手術を施行した.開腹所見では回腸末端,右卵巣が子宮後方に癒着しており,直腸S状結腸は漿膜面の炎症性変化があり,腸管は非常に硬くなっていた.付属器炎などからの骨盤腹膜炎による直腸S状結腸狭窄と診断し直腸切除術を行った.術後5カ月で腹腔内膿瘍が再燃し,保存的治療で軽快しないため開腹ドレナージ術を行った.術後IUDを抜去された後,現在まで良好に経過している.

肛門周囲膿瘍を契機に重症化した非定型的潰瘍性大腸炎(以下UC) の症例を経験したので文献的考察を加え報告する.症例は24歳,男性.平成6年 (22歳)発症時より全大腸炎型のUCと診断され,治療により緩解していた.平成8年12月下旬に肛門周囲膿瘍を契機に炎症が再燃した.9時から3時方向にかけて坐骨直腸窩膿瘍を認め, seton法で膿瘍ドレナージを行った.ステロイド大量投与に反応せず下血が持続した.大量下血を認めたため,平成9年1月8日緊急手術(大腸亜全摘,一時的回腸瘻, S状結腸粘液瘻造設術)を行った.切除標本では上行結腸,下行結腸,S状結腸に区域性に縦走潰瘍を認めたが,病変間の粘膜は肉眼上健常にみえた.術後合併症を生じることなく経過したが,難治性痔瘻となった.痔瘻が治癒するまでまち,初回手術より8カ月後回腸嚢下部直腸吻合術を行った.以後痔瘻の再発はなく経過良好である.

消痔霊は,中華人民共和国にて開発された硬化剤で,水溶性局所用注射剤である.明礬およびタンニン酸を主成分とし,内痔核・直腸脱等に適応がある.これまではGoligher III・IV度の内痔核に対しては手術療法が優先されたが,それらの内痔核に対しても十分な効果が認められた.注射方法は,四歩注射法といい,痔核本体の最も上端・痔核の底面・表面そして下端の4箇所に適切な量を注射する.注射量は痔核の大きさによるが,全体で30～60ml程度を使用する.注射部位が不適切であったり,注射量の過不足があると痔核の残存・合併症を引き起こす可能性があり,注射手技の充分な習得を要する.1991年7月より2001年6月までに,計483回施行したが,重大な合併症もなく,痔核の残存・再発に対しては,追加投与を行い有効であった.進行した内痔核に対する非手術的治療法として,第一選択としてよい治療法である.

The stereoselective total synthesis of reveromycin A (1), a potent inhibitor of eukaryotic cell growth, has been accomplished on the basis of the stereocontrolled construction of the 6,6-spiroketal system, efficient succinylation of the tert-alcohol under high pressure, and the introduction of the unsaturated side chains.

TOKAI PULP has 600 tpd kraft pulp mill with 2 digester. The measurment of Kappa number is very important parameter of pulping process. In TOKAI PULP mill, we have installed BTG automatic Kappa number measurement system in 1996 instead of the previous semiautomatic measurement system.This time we report the performance of the past 3 years of this BTG automatic Kappa numbermeasurement system.

1-[2-(p-Tolylsulfinyl)]pyrrolyl α,β-unsaturated enones served as efficient dienophiles in the Diels–Alder reaction, where the use of aluminium chloride or a lanthanide triflate effected the cycloaddition with cyclopentadiene, affording the endo adduct with high diastereoselectivity. In particular, for the sulfinyl dienophile, the chiral auxiliary (i.e. the sulfinyl pyrrole) was recovered after use without any loss of optical purity.

Fournier's gangrene is a specific type of necrotic fascitis. It is a fulminating infection characterized by a rapid progress of necrosis of subcutaneous tissue covering from the lower abdomen to the scrotum. It is necessary to detect the disease as early as possible and to perform incision, drainage snd debridement completely and without hesitation. A 51-year-old man who had a past history of diabetes mellitus was seen at our hospital because of pain, swelling, and redness of the perianal area and perineum to the right upper leg. Computed tomography revealed a widespread low-density area, from the perianal lesion to the right thigh. Colonoscopic examination showed type 2 advanced cancer in the lower portion of the rectun. Debridement of necrosed tissue was performed. Leakage of contrast material from the rectum into the pelvic cavity was detected on fluoroscopic study after surgery, suggesting that penetration of the rectal cancer might have caused the disease in this patient.

Among malignant lymphomas of the intestine, those arising in the rectum are rare, especially Burkitt lymphoma. A 54-year-old woman visited another clinic because her stool was positive for occult blood. A breast-like submucosal tumor at Rb region of the rectum was revealed by colonoscopy and barium enema study. Carcinoid tumor was suspected and an endoscopic polypectomy was performed. Histological diagnosis was malignant lymphoma with positive cut end. Then she was referred to the hospital. After admission, a low anterior resection with D3 lymph nodes dissection was performed. Histological grading was sm3, n0, H0, P0, M (-), and stage I. Histological and imunohistological diagnosis of the resected specimen was Burkitt lymphoma B-cell type. She has been doing well without any evidence of recurrence for six months after surgery. In this paper, we clinico-pathologically reviewed 85 cases of malignant lymphoma of the rectum reported in Japan from 1981 to 1996. And 30 cases of rectal malignant lymphoma in which lymph node metastases were noted were reviewed with regard to the relationship between macroscopic findings, max size of the tumor and the grade of invasion.

静的な咬合と全身状態との関係についての報告は多数見受けられるが, 動的な咬合の中の等尺性収縮である噛みしめ行動が, 全身に影響を及ぼすのかについて, 明確な見解は得られていない.そこで本研究では, 特に下顎安静時, 咬合時と, 随意性努力で噛みしめを行った場合について, 体調節機構, 特に平衡調節に影響を与えるか否かについて重心動揺を測定し, 検討した後, 以下の結論を得た.1.閉眼時における下顎安静時と100%噛みしめ時と比較して, 咬合時, 10%噛みしめ時, 50%噛みしめ時の方が, 重心の移動距離および移動速度が小さくなる傾向が認められた.2.重心移動から求められた各種面積に関しては, 1名を除いて咬合時, 10%噛みしめ時, 50%噛みしめ時のいずれかが小さな値を示す傾向がうかがわれた.3.重心は, 全体的に後方へ偏位する傾向が認められた.4.下顎安静時と咬合時におけるわずかな顎位の変化量では, 重心動揺の各測定値には有意な差が認められなかった.

Two types of chiral sulfoxides as Diels-Alder dienophiles were synthesized and high levels of diastereoselectivity were observed in cycloadditions. 2-Furyl and 2-thienyl α, β-enones, bearing a chiral sulfinyl group in the heterocycle, served as efficient dienophiles in Diels-Alder reactions, where the catalytic use of aluminium chloride or a lanthanide triflate effected the cycloaddition with cyclopentadiene affording the endo adduct with high diastereoselectivity, ranging from 91% to 98%.

A 5 kb DNA fragment encoding a hemolysin was cloned from the fish pathogenic bacterium Vibrio anguillarum using the cosmid vector charomid9-36. An open reading frame of the hemolysin gene (VAH1) was 2253 bp and corresponded to a protein of 751 amino acid residues. The deduced amino acid sequence of the VAH1 gene and the previously reported Vibrio cholerae EI Tor hemolysin, V. vulnificus cytolysin-hemolysin, Aeromonas hydrophila AHH1 hemolysin, and A. salmonicida ASH4 hemolysin showed a significant degree of sequence homology, and the overall amino acid identities were 57.3%, 25.8%, 46.2%, and 43.7%, respectively. DNA hybridization analysis under high-stringent conditions using VAH1 as a probe, demonstrated that VAH1 hybridized with 25 out of 28 strains of V. anguillarum including serotypes A to I, but did not hybridize with other species of Vibrio, A. hydrophila or A. salmonicida. The targeted DNA fragment of VAH1 was successfully amplified from V. anguillarum-infected fish tissues by PCR.

Hetero Diels-Alder reactions of optically active 3-(p-tolylsulfinyl)-2-furaldehyde with 1-methoxy-3-(trimethylsilyloxy)-buta-1,3-diene (Danishefsky's diene) in the presence of a Lewis acid has been examined. The reaction in the presence of 1.0 equiv. of Ln(OTf)3 (Ln = Yb, Nd and Sm) followed by acidic work-up produced in good yields (68–88%) the hetero Diels-Alder adduct with high diastereoisomeric excesses (93–98% d.e.'s), whereas in the presence of an NMR shift reagent, tris(2,2,6,6-tetramethyl-3,5-heptanedionate)europium [Eu(thd)3] the corresponding diastereoisomer was obtained as the major adduct in excellent yield with 77% d.e.

The Diels–Alder reaction of chiral 2-(3-tolyl p-sulfinyl)furyl α,β-unsaturated ketones 3 and 4 with cyclopentadiene in the presence of a Lewis acid proceeds smoothly to give the corresponding endo adducts 5a and 6a, respectively, in excellent yield with high diastereoselectivity.

Stereoselective reduction of chiral 3-(p-tolylsulfinyl)-2-thienyl ketones with diisobutylaluminum hydride (DIBAL) or lithium tri-sec-butylborohydride (L-Selectride) has been achieved. Reduction of the ketones with DIBAL in the presence of a Lewis acid or with L-Selectride afforded predominantly the thienyl carbinols, while the reduction with DIBAL alone gave the other diastereoisomeric alcohols as the major product. This method has been successfully applied to an efficient route to chiral thienyl alcohols.

To improve cleanliness in steel requires a reduction in total oxygen content. The combined EAF-LF-RH-CC process of manufacturing utilized several technologies which reduce total oxygen content. In high carbon chromium bearing steels, total oxygen content has decreased annually and is now 5 ppm on the average.1) Along with reduced oxygen conent, reduction of the number of oxide inclusions larger than 10 μm has further extended the fatigue life of bearing steel, which was once considered close to the completion. The fatigue life in bearing steels with these smaller inclusions is 5 times longer than that of conventional steels.A recent study showed that large inclusions can be reduced in size by preventing ladle contamination, air oxidation and flow out ladle slag.

Mitochondrial serine hydroxymethyltransferase, l-serine: tetrahydrofolate 5,10-hydroxymethyl-transferase (EC 2.1.2.1), (m-SHMT) was extracted and highly purified from Euglena gracilis z. The specific activity increased from the crude extract with 10% yield up to 580-fold through the following steps: ammonium sulfate fractionation, DEAE-cellulose column chromatography and rechromatography, and affinity chromatography with l-lysine-Sepharose 4B. The molecular weight of the purified m-SHMT was 88,000 by gel filtration through Sephadex G-200, and 44,000 by SDS-PAGE. One mol of the purified enzyme contained two mol of pyridoxal 5′-phosphate (PLP), indicating that the enzyme is a dimer. Characteristics of the enzyme were examined and compared with SHMTs of other origins. The m-SHMT of Euglena gracilis z had l-threonine aldolase activity as did s-SHMT of the same origin in addition to the usual SHMT activity.

The current treatment plan for squamous cell anal canal carcinoma using chemoradiotherapy (CRT) is becoming more standardized. We use CRT rather than surgery to select the appropriate treatment. We experienced 4 patients treated with abdominoperineal resection(APR), of which 1 underwent adjuvant CRT. We also experienced 3 patients treated with radiotherapy(RT) and 2 treated with CRT. A patient treated with RT underwent APR because of radiation colitis. RT and CRT are advantageous for quality of life and are expected to be effective for controlling the disease. We hope that the standard treatment plan for anal cancer in Japan will be determined on the basis of histological features.

A case of intraosseous lipoma in the frontal bone was reported. A 62-year-old woman had a hard tumor affecting the right frontal bone. The slowly growing tumor was first noticed when she was in her late teens. The completely excised right frontal lesion was composed of mature adipose tissue with abundant fibrous stroma. Intraosseous lipoma affecting the skull is extremely rare, with only 17 cases having been reported previously. Presurgical diagnosis of intraosseous lipoma of the skull is difficult because of its non-specific radiological features. Pathological study is indispensable for a correct diagnosis.

A man in his early seventies underwent low anterior resection and partial resection of the liver for the rectal cancer and liver metastasis. However, 4 months after the surgery, he was found to have a liver tumor at S5 and S7 by abdominal CT scan. Then, he underwent chemotherapy (mFOLFOX6), but the metastatic tumor was progressive. We selected FOLFIRI + cetuximab regimen for second-line therapy to resect the metastatic tumor. As the metastatic lesion was become smaller after 4-course of the regimen including cetuximab, we decided to perform a radical resection. We conducted a right lobectomy of the liver, and the tumor was completely resected.

A woman in her fifties underwent a right hemicolectomy (D3) for cancer of the ascending colon in October 2007, definitively and pathologically diagnosed as papillary adenocarcinoma invading to the subserosa, and no metastasis was detected to lymph node. But 13 months after the surgery, she was found to have a mass near the anastomosis by an abdominal CT scan. Colonoscopy showed an evaluating lesion with ulcer in the anal side of the anastomosis. We tried to resect the metastasis, but it was not resectable because of the invasion to the pancreas. The mFOLFOX regimen was effective. After the chemotherapy (6 courses), we decided to perform a radical resection. We conducted pancreatoduodenectomy in May 2009. She is still alive 12 months after surgery.