Chromosome analysis of aborted conceptuses of recurrent aborters positive for anticardiolipin antibody

OBJECTIVE

To elucidate the relationship between anticardiolipin antibody and recurrent abortion.

DESIGN

Prospective clinical study.

SETTING

Institutional practice in which patients with recurrent abortion were registered at the outpatient clinic for infertility of Niigata University Hospital.

PATIENT(S)

Five hundred sixty-one patients with recurrent abortions and 148 patients who were not recurrent aborters and who had experienced sporadic abortion.

INTERVENTION(S)

Aborted conceptuses for chromosome analyses were collected from the patients.

MAIN OUTCOME MEASURE(S)

The positive rate of anticardiolipin antibody was assessed in patients with recurrent abortion. Chromosome analyses of aborted conceptuses were performed in 10 patients with positive anticardiolipin antibody who had experienced another pregnancy that resulted in repeated abortion. Similar analyses of aborted conceptuses from 148 sporadic early abortions (controls) were performed.

RESULT(S)

The incidence of chromosome abnormalities in anticardiolipin antibody-positive recurrent aborters was 20.0% (2 of 10 cases), which was significantly lower than that of patients with sporadic abortion (60.1%, 89 of 148 cases).

CONCLUSION(S)

The low incidence of chromosome abnormalities in aborted conceptuses of patients with positive anticardiolipin antibody suggests that this antibody is strongly implicated in the genesis of recurrent abortions.

Tumor invasion and angiogenesis in early esophageal squamous cell carcinoma

BACKGROUND AND OBJECTIVES

Although the relationship between angiogenesis and tumor proliferation or malignant potential has been previously demonstrated in several studies, early stage of cancer invasion and angiogenesis has seldom been investigated.

METHODS

From the esophageal specimens of eight recently resected cases with esophageal squamous cell carcinoma, 25 areas of carcinoma-in-situ or microinvasive carcinoma were selected, and then a serial histologic investigation and immunohistochemical staining for the detection of Factor VIII-related antigen to investigate microvessels in the lamina propria mucosae beneath the lesions as a measure of angiogeneses and staining for laminin to visualize basement membrane was performed. Lymphocyte infiltration below the lesions were also estimated. In view of early cancerous invasion, histologic patterns of the growth of the lesions were divided into "flat," "expansive," and "downgrowth" patterns.

RESULTS

Although downgrowth patterns are thought to be more invasive, relationships between the histologic patterns, and basement membrane staining patterns, and lymphocyte infiltration patterns were not demonstrated. However, the angiogenetic ratio (the number of vessels/cm under the lesions divided by that under normal epithelium) was observed to be significantly and closely related to tumor invasion patterns (P < 0.01), although it was not related to the destruction of the basement membrane or lymphocyte infiltration below the lesions.

CONCLUSIONS

The angiogenesis of esophageal squamous cell carcinoma is closely correlated to the tumor invasion patterns in early esophageal cancerous lesions.

Reduction of radiation-induced xerostomia in nasopharyngeal carcinoma using CT simulation with laser patient marking and three-field irradiation technique

PURPOSE

Tumor control and reduction of postirradiation xerostomia in patients with nasopharyngeal carcinoma (NPC) using the three-field irradiation technique based on the CT-based simulation with laser patient marking was investigated.

METHODS AND MATERIALS

Seventy-eight patients with NPC were consecutively treated between 1983 and 1993. In 33 patients treated before 1987, target volume was determined using a conventional x-ray simulator with a reference of CT images, and the primary site was treated by the conventional parallel-opposed two-field technique (Group I). In 45 patients treated from 1987, target volume was determined using a CT simulator slice by slice, the treatment field was projected onto the patient's skin by a laser beam projector mounted on a C-arm, and the primary site was irradiated by a three-fields (anterior and bilateral) technique (Group II). In Group II, the shape of each field was determined using a beam's eye view to reduce the dose to the bilateral parotid glands. The three-field technique reduced the dose to the superficial lobe of parotid gland to about two-thirds of the dose given by the two-field technique. Radiation-induced xerostomia was evaluated by clinical symptoms and radioisotope sialography.

RESULTS

The 5-year survival rate and disease-free survival rate were 46.6 and 31.2% in Group I, and 46.8 and 46.5% in Group II. A large variation in the volume of parotid glands were demonstrated, ranging from 9 cm3 to 61 cm3 among patients treated with CT simulation. Forty percent of the patients in Group II showed no or mild xerostomia, whereas all of the patients in Group I showed moderate to severe xerostomia (p < 0.01). The radioisotope sialography study showed that the mean secretion ratio by acid stimulation was improved from 3.8% in the Group I to 15.2% in the Group II (p < 0.01).

CONCLUSIONS

CT simulation was useful to determine the size and shape of each field to reduce the dose to the parotid gland, of which size varies largely among individual patients. The three-field technique based on CT simulation with laser patient markings is suggested to result in superior complication-free survival in terms of salivary dysfunction than did the conventional two-field technique with x-ray simulatior for NPC.

Quantification of glycated hemoglobin by electrospray ionization mass spectrometry

Glycated hemoglobin, considered to be the best index for the treatment of diabetes mellitus, was measured by electrospray ionization mass spectrometry (ESI/MS) according to the method proposed by Morris et al. at the 44th ASMS Conference on Mass Spectrometry and Allied Topics, 1996. They compared the values obtained by MS and affinity chromatography. Here, the values obtained by ESI/MS were compared with those obtained by high-performance liquid chromatography and by latex agglutination immunoassay. Whole blood samples were diluted 500 fold with 0.2% formic acid-50% acetonitrile solution and 5 microliters of the diluted solution was injected with the ESI/MS system (TSQ 7000) via a sample loop. The within-run and between-run relative standard deviations of the ratio of glycated and non-glycated beta-chain were less than 5%. The correlation coefficients between ESI/MS and conventional methods were higher than 0.96. However, considerable discrepancies were observed among methods. ESI/MS will allow reproducible measurements of glycated hemoglobin and will be useful in the quality control of HbA1c measurement by other principles and also in routine clinical laboratory tests.

Excessive formation of basement membrane substance in clear-cell carcinoma of the ovary: diagnostic value of the "raspberry body" in ascites cytology

Formation of basement membrane-like substance or so-called collagen core was characteristic of clear-cell carcinoma of the ovary in ascites cytology. The hyaline extracellular material was stained light green in Papanicolaou smears and pinkish to purplish red in Giemsa preparations and was frequently observed within the cancer cell clusters in all ten samples of clear-cell carcinoma. Such a structure termed "raspberry body" was focally seen in one of 30 specimens of serous cystadenocarcinoma and one of 30 samples containing reactive mesothelial cells. The "raspberry body" was not found in ascitic fluid from ten patients with mucinous cystadenocarcinoma and two with endometrioid carcinoma. Overproduction of the acidic-charged basement membrane substance was confirmed by 1) cytochemical positivity for periodic acid-Schiff, alcian blue (pH 2.5 or pH 1.0), colloidal iron, and periodic acid-methenamine silver, 2) immunocytochemical demonstration of laminin and type 4 collagen, and 3) ultrastructural identification of excessive formation of the basal lamina. Recognition of the "raspberry body" helps cytopathologists make a cytologic diagnosis of this chemotherapy-resistant malignancy disseminated in ascitic fluid.

Antisense E1AF transfection restrains oral cancer invasion by reducing matrix metalloproteinase activities

E1AF is a newly identified human ets-family transcription factor. We have reported that E1AF can up-regulate transcription of matrix metalloproteinase (MMP) genes and confers invasive phenotype on human cancer cells. HSC3 is an oral squamous-cell-carcinoma-derived cell line, and it manifests high levels of E1AF and MMP-1 and -9 gene expression that are associated with invasive potential. We reconstructed an E1AF antisense expression vector, transfected HSC3 cells with the vector, and obtained HSC3AS cells that express E1AF antisense RNA. HSC3AS showed decreasing mRNA and protein levels of MMP-1, -3, and -9. Moreover, HSC3AS showed lower invasive potential in vitro three-dimensional raft culture and in vivo implantation into nude mice. These results imply that transfection of antisense E1AF inhibits tumor invasion by down-regulating MMP genes.

Simultaneous determination of phospholipid hydroperoxides and cholesteryl ester hydroperoxides in human plasma by high-performance liquid chromatography with chemiluminescence detection

A method was developed for the simultaneous determination of phosphatidylcholine hydroperoxides (PCOOH) and cholesteryl ester hydroperoxides (CEOOH). Lipid hydroperoxides (LOOH) were quantitatively extracted from human plasma with a mixture of n-hexane and ethyl acetate, and separated by column-switching high-performance liquid chromatography using one aminopropyl column and two octyl columns followed by chemiluminescence detection. LOOHs could be completely separated from each other and detected at picomole levels. The results of method validation tests were satisfactory. This method was then applied to determine LOOH in normal human plasma; the levels of PCOOH and CEOOH found were 36.0+/-4.0 nM (mean+/-S.D., n=6) and 12.3+/-3.1 nM (mean+/-S.D., n=6), respectively.

Fluoroquinolone treatment failure in gonorrhea. Emergence of a Neisseria gonorrhoeae strain with enhanced resistance to fluoroquinolones

BACKGROUND AND OBJECTIVES

Although emergence of clinical isolates of Neisseria gonorrhoeae with decreased susceptibilities to fluoroquinolones and treatment failures in gonorrhea have been reported, there have been no clinical reports that fluoroquinolone treatments actually select quinolone-resistant strains, nor have isolates that exhibited clinically significant resistance been analyzed for resistance mechanisms.

GOALS

To report a case of fluoroquinolone treatment failure in gonorrhea and emergence of a posttreatment isolate with enhanced resistance to fluoroquinolones; and to study mechanisms of quinolone resistance in the isolates from this patient.

STUDY DESIGN

A patient with gonococcal urethritis treated with ofloxacin, 200 mg, three times daily for 5 days is described. Pretreatment and posttreatment isolates were tested for minimum inhibitory concentrations (MICs) of antimicrobial agents and analyzed for alterations in DNA gyrase and topoisomerase IV. They were also examined for ofloxacin uptake.

RESULTS

Treatment failure with multiple doses of ofloxacin was observed in this case of gonorrhea. The pretreatment isolate showed decreased susceptibilities to fluoroquinolones (MIC of ofloxacin, 1.0 mg/l; MIC of ciprofloxacin, 0.25 mg/l), and had amino acid changes of Ser-91-->Phe in GyrA and Ser-87-->Ile in ParC. The posttreatment isolate exhibited an increase in resistance to fluoroquinolones (MIC of ofloxacin, 8.0 mg/l; MIC of ciprofloxacin, 1.0 mg/l). This isolate had identical alterations in GyrA and ParC, but exhibited significantly reduced uptake of ofloxacin. This isolate also showed a small decrease in susceptibilities to cephalosporins.

CONCLUSIONS

Alterations in DNA gyrase and topoisomerase IV confer clinically significant resistance to fluoroquinolones in N. gonorrhoeae strains. Treatment with multiple doses of fluoroquinolones is likely to bring about selection of more fluoroquinolone-resistant strains of N. gonorrhoeae and to influence susceptibilities to cephalosporins.

Subcellular organelle analysis applying confocal laser scanning microscopy to the steroid-producing epithelial ovarian tumor: a technical note

An epithelial ovarian tumor with steroid production was examined in a 70-year-old postmenopausal female. The stromal cells of this tumor were rather dense and occasionally characterized by luteinization or hyperthecosis, which has been associated with steroidogenesis. Subcellular visualization using confocal laser scanning microscopy (CLSM) successfully led to the identification of 3 beta-hydroxysteroid dehydrogenase (HSD) in both mitochondria-like small particles and endoplasmic reticulum-like linear profiles, and P450-aromatase also in endoplasmic reticulum-like linear profiles, on the three-dimensional images.

Safety and efficacy of oral flecainide acetate in patients with cardiac arrhythmias

We retrospectively studied the clinical efficacy and safety of oral flecainide in 38 patients with symptomatic arrhythmias. Patients received 100 to 200 mg daily of flecainide for a mean of 25 months (range 8 to 50 months). All patients had normal cardiac function. Paroxysmal atrial fibrillation (PAF) was observed in 29 patients (76%). Other forms of arrhythmia included paroxysmal atrial flutter, seen in 3 patients (8%); premature atrial contraction and ventricular premature contraction, each seen in 2 patients (5%); and supraventricular tachycardia and ventricular tachycardia, each seen in 1 patient (3%). A complete response was obtained in 15 (52%) of 29 patients with PAF and a partial response in 8 patients (27%). The remaining 6 patients (21%) showed no response. A complete response was also obtained in 7 of 9 patients with other forms of arrhythmia. There were no differences in cardiac function and ECG parameters before and after treatment. Flecainide was withdrawn in 4 patients due to the development of electrocardiographic abnormalities. Three of these patients showed an atrial proarrhythmic effect. Abnormal ST elevations in the precordial leads were observed in 1 patient who received 200 mg of flecainide daily. In conclusion, flecainide was effective treatment for supraventricular and ventricular arrhythmias, but attention must be paid to the drug's potential proarrhythmic adverse effects.

A case of epithelioid hemangioendothelioma associated with an artery

We report a case of epithelioid hemangioendothelioma (EHE) arising in the left elbow of a 67-year-old woman. The tumor was characterized by centrifugal growth and association with the brachial artery, causing complete occlusion. Immunohestochemical and electron microscopical features were typical of EHE. The patient was free of local recurrence or disease metastasis for more than 3 years after tumor resection, but subsequently died of respiratory failure due to a primary lung cancer.

Effects of low-dose phenytoin administered to newborn mice on developing cerebellum

To examine correlations between dose levels of phenytoin (PHT) and neurotoxic effects on cerebellar development, we administered 10, 17.5, 25, and 35 mg/kg PHT suspended in sesame oil orally to newborn Jcl:ICR mice once a day during postnatal days 2-4 and determined plasma PHT concentrations during the administration period. Mortality rates were 12.5% and 35.2% in males and 15.3% and 33.3% in females for the 25 and 35 mg/kg PHT-treated groups during the PHT treatment, respectively. In the 25 and 35 mg/kg PHT-treated groups, total brain weight, the size of the cerebellum, and cerebellar weight were significantly reduced on postnatal day 21. However, in the 10 and 17.5 mg/kg PHT-treated groups, total brain weight and the size and weight of the cerebellum did not differ from those of the control group. Histologically, the number of pyknotic cells in the external granular layer (EGL) in the 25 and 35 mg/kg PHT-treated groups was increased on postnatal day 5, and the EGL was thicker than in the control group on postnatal day 14. Some of the Purkinje cells in the 35 mg/kg PHT-treated group showed degeneration. Plasma PHT levels were 10.7 +/- 2.2 and 24.6 +/- 2.6 micrograms/ml in the 25 and 35 mg/kg PHT groups on the third day of PHT treatment, respectively. In the 25 mg/kg PHT group, plasma PHT level was found to be in the therapeutic range for humans, 10-20 micrograms/ml. Accordingly, during pregnancy, epileptic women should be carefully given PHT at the lowest effective dose while plasma PHT levels are monitored properly. These findings emphasize the importance of pharmacokinetics in evaluating of phenytoin-induced developmental neurotoxicity.

Asymmetrical regulation of blood pressure in the rat medulla

The effects of microinjection of serotonin-1 (5-HT1) antagonist methiothepin and 5-HT1 agonist buspirone into the nucleus reticularis parvocellularis were investigated in the anaesthetized rats. Methiothepin produced an increase in arterial blood pressure when injected into the left side, but it did a decrease when injected into the right side. On the contrary, buspirone produced a decrease in arterial blood pressure when injected into the left side, but it did an increase when injected into the right side. These findings provide the clue to clarify that there is a reciprocal regulation of arterial blood pressure between the left and right sides in the rat medulla.

Prevalence of Mycoplasma genitalium in asymptomatic men in Japan

We aim to clarify the prevalence of Mycoplasma genitalium in asymptomatic men in Japan. First-catch urine specimens were obtained from 187 asymptomatic Japanese men and examined for the presence of M. genitalium using a polymerase chain reaction (PCR)-based assay. Two (1.1%) of 187 first-catch urine specimens were positive for M. genitalium. The prevalence of M. genitalium in urine specimens of asymptomatic men in Japan is lower than that in asymptomatic men in the UK (6%) and Denmark (9%).

Esophageal metastasis from prostate cancer: diagnostic use of reverse transcriptase-polymerase chain reaction for prostate-specific antigen

An extremely rare case of esophageal metastasis from prostate cancer is reported. A 65-year-old man presented with anorexia and back pain. Upper gastrointestinal X-ray fluoroscopy and endoscopy revealed a shallow longitudinal ulcer, with converging mucosal folds, approximately 5 cm above the esophagogastric junction. The histological diagnosis of the biopsied specimen was adenocarcinoma. Blood biochemistry revealed elevated serum prostate-specific antigen (PSA) and gamma-seminoprotein levels. Ultrasonography of the prostate disclosed a hypoechoic lesion in the left lobe, and needle biopsy led to the diagnosis of prostatic adenocarcinoma. Since there was no finding suggestive of a primary lesion, apart from that in the prostate, we conducted reverse transcriptase-polymerase chain reaction (RT-PCR) for PSA. PSA-positive mRNA was demonstrated in the tissue of the esophageal tumor. There are three reports on metastasis to the esophagus from prostate cancer, but this is the first case of esophageal metastasis from prostate cancer without any evidence of metastasis to other organs. The importance of RT-PCR for the diagnosis of primary lesions of metastatic cancer is discussed.

Rapid screening of point mutations of the Neisseria gonorrhoeae parC gene associated with resistance to quinolones

To detect quinolone resistance-associated mutations within the Asp-86, Ser-87, Ser-88, and Glu-91 codons of the Neisseria gonorrhoeae parC gene, we developed a rapid and simple assay based on amplification of the regions of the parC gene containing the mutations sites by PCR and digestion of the PCR products with restriction enzymes. By using the method of primer-specified restriction site modification, artificial SalI, PstI, EcoRI, and HinfI restriction sites were created in the regions containing the Asp-86, Ser-87, Ser-88, and Glu-91 codons, respectively. The mutations generating alterations at Asp-86, Ser-87, Ser-88, and Glu-91 were detected as failures of SalI, PstI, EcoRI, and HinfI to digest the respective PCR products. Fifty-five clinical strains of N. gonorrhoeae were examined for mutations in the parC gene by this assay. Appropriate mutations at either the Asp-86, Ser-87, Ser-88, or Glu-91 codon were detected in each of 11 strains in which a mutation had previously been observed by DNA sequencing. This rapid and simple assay could be a useful device for screening genetic alterations in the parC gene associated with resistance to quinolones in N. gonorrhoeae.

Terminology of developmental abnormalities in common laboratory mammals (version 1)

This paper presents the first version of an internationally-developed glossary of terms for structural developmental abnormalities in common laboratory animals. The glossary is put forward by the International Federation of Teratology Societies (IFTS) Committee on International Harmonization of Nomenclature in Developmental Toxicology, and represents considerable progress toward harmonization of terminology in this area. The purpose of this effort is to provide a common vocabulary that will reduce confusion and ambiguity in the description of developmental effects, particularly in submissions to regulatory agencies worldwide. The glossary contains a primary term or phrase, a definition of the abnormality, and notes, where appropriate. Selected synonyms or related terms, which reflect a similar or closely related concept, are noted. Nonpreferred terms are indicated where their usage may be incorrect. Modifying terms used repeatedly in the glossary (e.g., absent, branched) are listed and defined separately, instead of repeating their definitions for each observation. Syndrome names are generally excluded from the glossary, but are listed separately in an appendix. The glossary is organized into broad sections for external, visceral, and skeletal observations, then subdivided into regions, structures, or organs in a general overall head to tail sequence. Numbering is sequential, and not in any regional or hierarchical order. Uses and misuses of the glossary are discussed. Comments, questions, suggestions, and additions from practitioners in the field of developmental toxicology are welcomed on the organization of the glossary as well as on the specific terms and definitions. Updates of the glossary are planned based on the comments received.

Effects of coffee cherry on the activation of splenic lymphocytes in mice

We previously observed that the ingestion by mice of a hot water extract (CC) and the methanol-extracted and water-soluble fraction (CC-W) of coffee cherry, the residue remaining after the removal of coffee beans from the fruit, enhanced the differentiation of thymocytes and the activation of peripheral T-lymphocytes; and the anti-mammary tumour effects of coffee cherry extract was considered to be associated with this immunomodulation. To study further these effects, mitogen response and some immune parameters were examined in a high mammary tumour strain of SHN mice. While the T-lymphocyte response to concanavalin A was not significantly changed by either CC or CC-W, the lipopolysaccharide response was significantly enhanced by both treatments. The proportion of CD45R/B220+ (B) cells in the splenic lymphocytes was significantly increased by CC, and the percentage of activated (CD25+) cells in B-lymphocytes was increased by CC and CC-W. These data indicate that coffee cherry extract can enhance B-lymphocyte response, and suggest that this immunopotentiation contributes to the antitumourigenic role of coffee cherry.

Comparison of urinary component levels in 4 strains of mice with different physiological characteristics

Changes in urinary component levels before, during and after reproduction were examined with 1H-nuclear magnetic resonance (NMR) in four strains of female mice with different mammary tumour potential and related characteristics (SHN, SLN, GR/A and C3H/He). Regardless of the variations in these changes among the strains, the urinary component levels reflected physiological changes during reproduction and some strain-specific characteristics. The urinary excretion of citrate, 2-oxoglutarate and lactate increased from the virginal stage to pregnancy and declined during lactation in all strains, indicating a marked change in sugar metabolism during reproduction. SHN and SLN, which are from the same basal stock, showed a similar pattern and the level, of several components were lower than those of GR/A and C3H/He. The levels of some lower components were compensated for by higher urine excretion. The levels of taurine and betaine, both essential for fetal and pup growth, increased at lactation in only GR/A, reflecting the poorer pup growth observed in this strain. Finally, the 1H-NMR method was useful to estimate not only the metabolic but also the physiological changes of the animals without invasion, pain or distress and would thus contribute to animal welfare in the animal experiments.

Alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV in quinolone-resistant clinical isolates of Klebsiella pneumoniae

We determined a partial sequence of the Klebsiella pneumoniae parC gene, including the region analogous to the quinolone resistance-determining region of the Escherichia coli gyrA gene, and examined 26 clinical strains of K. pneumoniae for an association of alterations in GyrA and ParC with susceptibilities to quinolones. The study suggests that in K. pneumoniae DNA gyrase is a primary target of quinolones and that ParC alterations play a complementary role in the development of higher-level fluoroquinolone resistance.

Cloning of the cDNA encoding rat Presenilin-1

We isolated rat presenilin-1 (PS-1; also called S182 previously) cDNA from total brain RNA by using a reverse transcription-polymerase chain reaction (RT-PCR) technique with primers homologous to the conserved sequences of human and mouse PS-1. Rat PS-1 cDNA encoded 468 amino acids (aa) and the deduced aa sequence was highly homologous to those of the human (88.4%) and mouse (92.7%). Northern blot analysis of the rat PS-1 cDNA revealed two mRNA species in rat neurotypic pheochromocytoma and glioma cell lines (PC-12 and C6, respectively) that migrated at rates corresponding to approximately 3.0 and 7.5 kb.

Mutations in a hydrophilic part of the core gene of hepatitis C virus in patients with hepatocellular carcinoma in China

We investigated the association between hepatocellular carcinoma (HCC) and the genomic characteristics of the hepatitis C virus (HCV) isolated from residents of the inshore region of the Yangtze River, an area that has one of the highest incidence of HCC in China. We determined the genomic heterogeneity of HCV, and the sequence divergence of the HCV core gene in individuals with chronic hepatitis and HCC. HCV genotype II was predominant among these isolates, which were homologous to other Chinese and Japanese HCV isolates. The rate of nucleotide substitutions in the core gene was significantly greater for isolates from HCC patients than for those from individuals with chronic hepatitis. The nucleotide substitutions were unevenly scattered along the core gene; a cluster of missense mutations was apparent in the region encoding the second hydrophilic domain of the core protein. The rate of occurrence of missense mutations per nucleotide substitution was significantly greater in this clustering variable region (CVR) of the core gene than in the remaining core gene sequence. These observations suggest that mutations in the CVR may be involved in the pathogenesis of chronic HCV infection during hepatocellular carcinogenesis.

Antimicrobial activity of a new fluoroquinolone, DU-6859a, against quinolone-resistant clinical isolates of Neisseria gonorrhoeae with genetic alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV

The in-vitro antimicrobial activity of DU-6859a, a new fluoroquinolone, was tested against 55 clinical isolates of Neisseria gonorrhoeae. The MIC of DU-6859a inhibiting 90% (MIC90) of the isolates with genetic alterations of both the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV was 0.125 mg/L. The MIC90 for isolates with alterations of GyrA alone or without alterations of GyrA or ParC was 0.03 mg/L and 0.004 mg/L, respectively. The potency of DU-6859a against clinical isolates bearing genetic alterations associated with quinolone resistance was significantly greater than that of currently available fluoroquinolones.