Fourth national Japanese antimicrobial susceptibility pattern surveillance program: Bacterial isolates from patients with complicated urinary tract infections

INTRODUCTION

Antimicrobial susceptibility patterns of bacterial pathogens isolated from patients with complicated urinary tract infections were analyzed using the national surveillance data, comprising 793 bacterial strains from eight clinically relevant species.

MATERIALS AND METHODS

Data were collected for the fourth national surveillance project from July 2020 to December 2021 by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Disease, and the Japanese Society of Clinical Microbiology. Surveillance was supervised with the cooperation of 43 medical institutions throughout Japan.

RESULTS

Fluoroquinolone required a minimum inhibitory concentration (MIC) of 2-64 mg/L to inhibit the 330 tested Escherichia coli strains. The proportion of levofloxacin-resistant E. coli strains increased from 28.6% in 2008 to 29.6% in 2011, 38.5% in 2015, and 44.5% in 2021. The proportion of levofloxacin-resistant strains of Pseudomonas aeruginosa also increased from previous survey results, showing a continuing downward trend. Conversely, the proportion of levofloxacin-resistant strains of Enterococcus faecalis decreased relative to previous reports. Neither multidrug-resistant P. aeruginosa nor carbapenem-resistant Enterobacteriaceae were detected. For methicillin-resistant Staphylococcus aureus (MRSA), the proportion of vancomycin-susceptible strains (MIC of 2 μg/mL) decreased from 14.7% to 7.7%.

DISCUSSION

Bacterial strains that produced extended-spectrum β-lactamase included E. coli (82/330 strains, 24.8%), Klebsiella pneumoniae (11/68 strains, 16.2%), and Proteus mirabilis (4/26 strains, 15.4%). As compared to previous surveillance reports, these strains showed an increase in proportion over the years.

Impact of Polypharmacy and Risk Factors for Exacerbation of Lower Urinary Tract Symptoms in Patients with Urological Conditions: A Retrospective Study in a Japanese Municipal Hospital

Polypharmacy exacerbates lower urinary tract symptoms (LUTS). Japan exhibits a higher prevalence of concomitant medication use in drug therapy than other countries. Previous age- and sex-specific reports exist; however, none include patients of all ages. Therefore, this retrospective study determined the impact of polypharmacy and its associated risk factors on LUTS exacerbation in outpatients with urological conditions. We included patients receiving medication who visited the Department of Urology at the Gifu Municipal Hospital (Gifu, Japan) between January, 2018 and December, 2018. The association between LUTS and polypharmacy and the risk factors for LUTS exacerbation were investigated. Patients were categorized into two groups according to their polypharmacy status. We performed propensity score matching and compared the International Prostate Symptom Score (IPSS) between the groups using the unpaired t-test. Multiple logistic regression analysis was performed to examine the risk factors, including "polypharmacy" and "taking multiple anticholinergic medications" for LUTS exacerbation. When comparing the IPSS between the groups, the polypharmacy group was found to have significantly higher scores than the non-polypharmacy group in six items, including "total score" and "storage score." Multiple logistic regression analysis results showed high significance in three items, including "polypharmacy" (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.03-2.71) and "taking multiple anticholinergic medications" (OR = 8.68, 95% CI: 1.05-71.7). In conclusion, this study revealed that "polypharmacy" and "taking multiple anticholinergic medications" were risk factors for LUTS. Particularly, "polypharmacy" is associated with storage symptom exacerbation. Therefore, eliminating "polypharmacy" and "taking multiple anticholinergic medications" is expected to improve LUTS.

[Effectiveness of Pharmaceutical Intervention While Administering 5-Aminolevulinic Acid Hydrochloride through a Collaboration of Physicians and Pharmacists]

5-aminolevulinic acid hydrochloride is a highly effective drug in reducing tumor residuals in transurethral resection of the bladder tumors; however, hypotension is a serious side effect that causes clinical problems. To avoid serious side effects, a pharmacist, in consultation with a physician, decided to discontinue the antihypertensive medication, and the effect of this pharmaceutical intervention was examined retrospectively. This study included patients who received 5-aminolevulinic acid hydrochloride at Gifu Municipal Hospital and were instructed to continue receiving their usual antihypertensive medication on the day of surgery. The control group comprised 17 patients before the pharmaceutical intervention, and the intervention group comprised 18 patients after the pharmaceutical intervention. The difference in systolic blood pressure before and after 5-aminolevulinic acid hydrochloride administration was -19.4±22.5 mmHg in the control group and -2.8±16.0 mmHg in the intervention group. The intervention group showed a significantly lower decrease in blood pressure(p=0.019). Intervention to avoid hypotension through the collaboration between physicians and pharmacists may be effective in improving the safety of 5-aminolevulinic acid hydrochloride.

Prediction of presence of fastidious bacteria by the Fully Automated Urine Particle Analyzer UF-1000i in the case of ineffective antimicrobial therapy for urinary tract infection

INTRODUCTION

Recent studies have reported associations between fastidious bacteria that are difficult to grow and isolate in conventional urine culture conditions and urinary tract infections (UTIs). Because the Fully Automated Urine Particle Analyzer UF-1000i (hereinafter referred to as "UF-1000i") detects fastidious bacteria without being affected by culture conditions, owing to its flow cytometry-based principle, we evaluated the robustness of UF-1000i detection using clinical urine samples from patients with UTIs following ineffective antimicrobial therapy.

METHODS

A total of 150 patients diagnosed with UTIs were enrolled, and their laboratory findings were analyzed, focusing on the discrepancy in bacterial numbers between UF-1000i and conventional culture at each antimicrobial therapy effectiveness classification. In addition, gene identification was conducted by molecular analysis using 16S ribosomal RNA gene sequencing and next-generation sequencing (NGS) to elucidate the reason for the presence of fastidious bacteria in these samples.

RESULTS

The ineffective therapy cases showed more than 100-fold discrepancy in bacterial counts, with a higher proportion (30.8%) than effective therapy cases without secondary administration (5.7%) between the bacterial counts in UF-1000i and conventional culture methods. The presence rates of fastidious bacteria were 100% and 66.7% in discrepant cases of ineffective and effective without secondary administrations, respectively.

CONCLUSION

This study suggests that discrepancies in bacterial numbers between the conventional culture method and UF-1000i measurement at the primary visit can predict the presence of fastidious bacteria, especially in cases of ineffective antimicrobial therapy.

[Paratesticular Low-Grade Fibromyxoid Sarcoma: A Case Report]

A 36-year-old man presented with painless swelling in the right side scrotum. Ultrasonography showed a hypoechoic tumor with mosaic pattern. Plain computed tomograghy (CT) revealed a 67 mm scrotal cystic lesion with low density area. We suspected an intrascrotal tumor and performed right side radical orchiectomy. The removed sample was yellow clear and elastic hard. A 7 cm multilocular cystic tumor was present on the head side of the normal testis. The cut-surface and the contents of the mass revealed a jelly-like viscous liquid. On the microscopic examination, the tumor was composed of mucinous stroma and spindle-shaped atypical cells with hyperchromatic oval nuclei and eosinophilic cytoplasm. There was a characteristic network of blood vessesls with hyperhyalinization in the myxoid zones. Immunohistochemically, CDK4, MDM2, AE1/AE3, S-100, Alpha-SMA and desmin were negative, but MUC4 showed focal cytoplasmic positivity in the neoplastic cells. In the reverse transcription polymerase chain reaction assay, no FUS-CREB3L2/FUS-CREB3L1 fusion transcripts were identified although the detectable messages of the housekeeping genes were noted. The tumour was finally diagnosed as a paratesticular low-grade fibromyxoid sarcoma. Postoperative course was uneventful and no recurrence or metastasis was seen four months after the operation.

Efficacy of cabazitaxel and the influence of clinical factors on the overall survival of patients with castration-resistant prostate cancer: A local experience of a multicenter retrospective study

AIM

To date, the optimal sequencing of life-prolonging therapies for patients with metastatic castration-resistant prostate cancer (mCRPC) remains unclear owing to a lack of prospective trials. This study aimed to evaluate the efficacy and safety of cabazitaxel (CBZ) treatment and examine the prognostic factors for oncological outcomes in patients with mCRPC who received CBZ after docetaxel (DOC).

METHODS

This multi-institutional retrospective study included 44 patients with mCRPC who received CBZ. All enrolled patients had histologically confirmed prostate cancer (PCa) with distant metastases and had received DOC before CBZ administration. The primary endpoint was the oncological outcomes, including the overall (OS) and progression-free survival (PFS). The secondary endpoints were adverse events due to CBZ and rates of ≥30% reduction in prostate-specific antigen (PSA) levels.

RESULTS

The median follow-up period was 9.2 months (range, 0.2-34 months). During this time, 34 patients (77%) died of PCa. The median OS and PFS were 12.2 (range, 0.2-34 months) and 1.4 months (range, 0.4-17 months), respectively. According to the PSA decline rate, patients who achieved a ≥30% reduction in PSA levels had significantly longer OS than those who showed a <30% reduction in PSA levels (P = 0.002). Regarding the number of cycles of CBZ, patients who received ≥4 cycles of CBZ showed significantly longer OS than those who received <4 cycles of CBZ (P < 0.001). Patients who had visceral metastasis showed significantly shorter OS than those without visceral metastasis (P = 0.012).

CONCLUSION

This study demonstrated that CBZ was effective and safe in Japanese local patients in a real-world setting. Patients with mCRPC who received ≥4 cycles of CBZ showed a ≥30% reduction in the serum PSA levels, and did not have visceral metastasis might achieve longer OS.

Comparison of MRI visualization between linearly placed iron-containing and non-iron-containing fiducial markers for prostate radiotherapy

OBJECTIVE

Visualizing the gold marker (GM) in CT and MRI is critical, especially for registration in high-precision radiotherapy. GM sizes vary. Large markers are easily visualized in MRI. Small GMs show fewer artefacts in CT but are harder to detect in MRI because the signal is influenced by metal in MRI. Therefore, we compared MRI visualization between linearly placed new iron-containing marker and non-iron containing marker.

METHODS

27 patients underwent CT/MRI fusion-based intensity-modulated radiotherapy. The gold markers were placed by urologists. An iron-containing Gold Anchor™ (GA) marker (diameter, 0.28 mm; length, 10 mm) was placed by using a 22 G needle on one side of the prostate linearly. A non-iron-containing VISICOIL™ (VIS) marker (diameter, 0.35 mm; length, 10 mm) was placed by using a 19 G needle on the opposite side linearly. T₂* weighted MRI was mostly performed. Two Radiation Oncologists and one Radiation Technologist evaluated and assigned visual quality scores (GA shape, CT artefacts, MRI signal voids).

RESULTS

The mean visualization scores of artefacts were similar between GA and VIS in planning CT. GM visualization in MRI of the prostate was better for GA than for VIS. The visibility of the linear shape of the GA was 3.4-4.1 points when the VIS was 5 points (1 is worst and 5 is best).

CONCLUSION

Visualization quality was similar between GA (iron-containing marker) and VIS (non-iron-containing marker) in planning CT, but was better for GA than for VIS in MRI. To achieve high-precision radiotherapy, an iron-containing gold marker was useful for CT and MRI registration. Advances in knowledge: An iron-containing fiducial marker was useful for CT and MRI registration, especially in high-precision radiotherapy, such as stereotactic body radiotherapy and intensity-modulated radiotherapy.

Comparison of MRI sequences in ideal fiducial maker-based radiotherapy for prostate cancer

Aim

Prostate contouring using CT alone is difficult. To overcome the uncertainty, CT/MRI registration using a fiducial marker is generally performed. However, visualization of the marker itself can be difficult with MRI. This study aimed to determine the optimal MRI pulse sequence for defining the marker as well as the prostate outline among five sequences.

Materials and methods

A total of 21 consecutive patients with prostate cancer were enrolled. Two gold fiducial markers were placed before CT/MRI examination. We used the following five sequences: T1-weighted spin-echo (T1WI; TR/TE, 400-650/8 ms); T2-weighted fast spin-echo (T2WI; 4000/80); T2*-2D-weighted gradient echo (T2*2D; 700/18); T2*-3D-weighted gradient echo (T2*3D; TR/TE1/deltaTE, 37/14/7.3); and contrast-enhanced T1-weighted spin-echo (CE-T1WI; 400-650/8). Qualitative image analysis of the sequences was performed by three observers. These observers subjectively scored all images on a scale of 1-3 (1 = unclear, 2 = moderate, 3 = well visualized). A higher score indicated better visualization.

Results

T2WI was significantly superior to the other sequences in terms of prostate definition. T2*2D and T2*3D were strongly superior to the other sequences and were significantly superior in terms of fiducial marker definition.

Conclusions

T2*2D and T2*3D are superior to the other sequences for prostate contouring and marker identification. Therefore, we recommend initial T2*3D and T2*2D examinations.

Efficacy of butylscopolamine in obtaining clear MR image for intensity-modulated radiotherapy for prostate cancer

Purpose

The use of butylscopolamine in magnetic resonance imaging (MRI) of the prostate is controversial in the context of diagnostic imaging where local invasion and the presence of metastases are evaluated. However, in radiation oncology, MRI is performed as part of the simulation process, and the objectives differ to the diagnostic setting. MRI is primarily used for accurate target delineation; hence, the use of an agent to reduce intestinal peristalsis and increase image quality may be beneficial. The impact of butylscopolamine on MRI for radiation oncology purposes has not previously been described. The aim of this study was to evaluate the efficacy of butylscopolamine in MRI acquired for radiation oncology simulation of the prostate.

Methods and materials

In total, 67 patients were enrolled in this study. Thirty-five patients received intramuscular injection of butylscopolamine (group A) and 32 patients did not (group B). Visualization of the prostate outline and detection of fiducial gold markers (GMs) in the prostate were evaluated on MRI. Two blinded radiation oncologists (ROs) and one radiation technologist (RT) scored the image quality of the detection of prostate outline and recognition of GMs in the prostate on a scale of 1-5 (1 = poor; 5 = excellent), and the results were evaluated using Mann-Whitney U test and p < 0.05 was considered as statistically significant.

Results

On MRI, group A was statistically superior to group B in terms of fiducial marker detection by two ROs (p < 0.01). However, there was no significant difference in RT scoring. Furthermore, on MRI, group A was statistically superior to group B in terms of the detection of the prostate outline by an RT.

Conclusions

Butylscopolamine is effective with respect to detection of the prostate outline and GM recognition (without endorectal coil). The addition of butylscopolamine is simple and cost efficient. We recommend the use of butylscopolamine routinely to obtain good MR images, particularly in the detection of GMs.

Initial experience of using an iron-containing fiducial marker for radiotherapy of prostate cancer: Advantages in the visualization of markers in Computed Tomography and Magnetic Resonance Imaging

Visualization of markers is critical for imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). However, the size of the marker varies according to the imaging technique. While a large-sized marker is more useful for visualization in MRI, it results in artifacts on CT and causes substantial pain on administration. In contrast, a small-sized marker reduces the artifacts on CT but hampers MRI detection. Herein, we report a new ironcontaining marker and compare its utility with that of non-iron-containing markers. Five patients underwent CT/MRI fusion-based intensity-modulated radiotherapy, and the markers were placed by urologists. A Gold Anchor™ (GA; diameter, 0.28 mm; length, 10 mm) was placed using a 22G needle on the right side of the prostate. A VISICOIL™ (VIS; diameter, 0.35 mm; length, 10 mm) was placed using a 19G needle on the left side. MRI was performed using T2*-weighted imaging. Three observers evaluated and scored the visual qualities of the acquired images. The mean score of visualization was almost identical between the GA and VIS in radiography and cone-beam CT (Novalis Tx). The artifacts in planning CT were slightly larger using the GA than using the VIS. The visualization of the marker on MRI using the GA was superior to that using the VIS. In conclusion, the visualization quality of radiography, conebeam CT, and planning CT was roughly equal between the GA and VIS. However, the GA was more strongly visualized than was the VIS on MRI due to iron containing.

The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy

This study was conducted by the Japanese Society of Chemotherapy and is the first nationwide study on bacterial pathogens isolated from patients with urinary tract infections at 28 hospitals throughout Japan between January 2008 and June 2008. A total of 688 bacterial strains were isolated from adult patients with urinary tract infections. The strains investigated in this study are as follows: Enterococcus faecalis (n = 140), Escherichia coli (n = 255), Klebsiella pneumoniae (n = 93), Proteus mirabilis (n = 42), Serratia marcescens (n = 44), and Pseudomonas aeruginosa (n = 114). The minimum inhibitory concentrations of 39 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. All Enterococcus faecalis strains were susceptible to ampicillin and vancomycin. Although a majority of the E. faecalis strains were susceptible to linezolid, 11 strains (7.8%) were found to be intermediately resistant. The proportions of fluoroquinolone-resistant Enterococcus faecalis, Escherichia coli, Proteus mirabilis, and S. marcescens strains were 35.7%, 29.3%, 18.3%, and 15.2%, respectively. The proportions of E. coli, P. mirabilis, K. pneumoniae, and S. marcescens strains producing extended-spectrum β-lactamase were 5.1%, 11.9%, 0%, and 0%, respectively. The proportions of Pseudomonas aeruginosa strains resistant to carbapenems, aminoglycosides, and fluoroquinolones were 9.2%, 4.4%, and 34.8%, respectively, and among them, 2 strains (1.8%) were found to be multidrug resistant. These data present important information for the proper treatment of urinary tract infections and will serve as a useful reference for periodic surveillance studies in the future.

[Disseminated nocardiosis presenting as retroperitoneal abscess: a case report]

A 64-year-old man presented to our emergency room with right back pain on July 10, 2009. At the emergency room, abdominal enhanced computed tomography revealed a cystic lesion in the retroperitoneum. Then he was referred to our department. We performed percutaneous drainage of the retroperitoneal lesion and aspirated white pus. The retroperitoneal cystic lesion proved to be an abscess. Microscopic examination of a Gram stained specimen of the abscess revealed gram-positive bacillary fragments ; therefore, we suspected the pathogen to be Nocardia. He had a history of chronic glomerulonephritis and had received treatment consisting of 20 mg prednisolone, and 75 mg cyclosporine per day. He was regularly visiting the department of cardiovascular for follow-up of chronic heart failure. On the day before his visit to our emergency room, his chest X-ray medicine had revealed a nodular shadow. Then he was referred to the department of respiratory medicine and was scheduled to receive a bronchoscopy later. We suspected the nodule of the lung also to be an abscess of Nocardia. Later, head computed tomography (CT) revealed a brain abscess the pathogen of which was Nocardia. Nocardia is a filamentous, gram-positive, branched bacterium and classified as an aerobic actinobacteria. Nocardia species are difficult to diagnose due to non-specific clinical and histological manifestation. We report this case of disseminated nocardiosis presenting as retroperitoneal abscess. The disseminated nocardiosis was diagnosed without delay by percutaneous drainage and appropriate treatment was provided.

[A case of mucinous tubular and spindle cell carcinoma of the kidney]

We report a case of mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney. A 68-years old female consulted a primary hospital with a chief complaint of back pain. Computed tomography revealed the tumor of the left kidney, so she was referred to our department. The tumor, 45 x 42 mm in length, was slightly enhanced, and that had well-defined margins. We performed radical nephrectomy. Pathological findings suggested MTSCC. MTSCC is a rare type of renal cell carcinoma composed of a combination of low-grade tubular cuboidal cells and spindle cells in a mucinous stroma. The immunohistochemistry is effective in its diagnosis.

[Case report of inflammatory pseudotumor that occurred at the ureteropelvic junction]

A 60-year-old woman underwent detailed examinations for hepatic disorders and pancreatic tumor at the Department of Internal Medicine. A tumor mass in her left renal pelvis and a thickened wall in her left ureter were observed on computed tomography (CT) and magnetic resonance imaging (MRI) images. Retrograde ureteropyelography and drip infusion pyelography images showed a stenosis in 1 vertebral body from the left ureteropelvic junction. Urinary cytology finding was class III-a; however, malignancy could not be disregarded. Since the patient continued to experience severe dorsal pain, a left nephroureterectomy was subsequently performed at the patient's request. Pathological tests showed no malignant findings, and based on the chronic pyelonephritis, we diagnosed her condition as an inflammatory pseudotumor. Not many inflammatory pseudotumors are found in the urinary tract, and even fewer are manifest in the renal pelvis and ureter. Although inflammatory pseudotumors are generally benign, cases of repeated local recurrence exist. Therefore, a meticulous follow-up observation is required.

[Prostate cancer detected from pleural effusion: two case reports]

Prostate cancer is rarely detected from abnormal chest radiographs. We report two cases of prostate cancer detected from pleural effusion. Case 1 is a 76-year-old man who consulted the department of internal medicine of our hospital with dyspnea and abdominal fullness. Pleural effusion and multiple hepatic tumors of unknown origin were pointed out, but he refused any further investigation or treatment for them. Six months later, he consulted a family doctor with urinary frequency and lumbago. Increased serum prostate specific antigen (PSA) level to 864 ng/ml was recognized, then he was referred to our department. Under diagnosis of prostate cancer, T4NOM1c, maximal androgen blockade (MAB) was performed. Serum PSA level was decreased once to 8.1 ng/ml, but then rose gradually and he died 13 months after the beginning of the therapy. Case 2 was a 78-year-old man who was referred to our department to determine the origin of carcinomatous pleuritis detected in a routine general check up of hepatitis C. The serum PSA level was increased to 12,900 ng/ml, and the diagnosis was prostate cancer, T3aNOM1c. Although MAB was performed, the serum PSA level did not decrease markedly. He died 16 month after the beginning of the therapy.

[Synergetic responses after administration of interleukin-2 and Interferon-alpha combined with gamma knife radiosurgery in a patient with multiple lung and brain metastases: a case report]

A 51-year-old man with left renal tumor and multiple lung metastases was admitted to our hospital for treatment. Left nephrectomy was performed, and pathological diagnosis was renal cell carcinoma (clear cell carcinoma, G2, pT3a). Initially, Interferon-alpha (IFN-alpha) therapy was started for lung metastases. About 40 days after surgery, head magnetic resonance imaging revealed brain metastases, and therefore gamma knife radiosurgery(GKS) was performed. Since chest computed tomography showed no change in lung metastases, we tried a combination of interleukin-2 (IL-2) and IFN-alpha therapy to elininate those metastases. As a result, neither lung nor brain metastases could be detected at the 4th month follow-up examination. At 5 months after the IL-2 and IFN-alpha therapy, the patient attempted suicide. Therefore, the IL-2 and IFN-alpha therapy was stopped and an antidepressant was prescribed. Now 11 months after withdrawal of the IL-2 and IFN-alpha, the patient's mental condition remains stable. No recurrence of the cancer has been detected by CT.

[Clinical study of male urethritis in Oogaki Municipal Hospital]

We studied 181 patients diagnosed with male urethritis at Oogaki Municipal Hospital from April 2002 to March 2004. Twenty-two out of 92 patients diagnosed with gonococcal urethritis (GU) and 52 out of 89 patients diagnosed with non-gonococcal urethritis (NGU) were positive for Chlamidia trichomatis by polymerase chain reaction (PCR). Most patients of male urethritis were in their twenties. Of GU patients, 39 (67%) were infected from commercial sex workers (CSWs). Of NGU patients, 12 (30%) were infected from CSWs, 24 (40%) from girl friends and 4 (10%) from their Twenty-eight (48%) out of GU patients were infected through oral sex. spouse. Eighty-three GU patients were treated with SPCM (2 g, one shot). Fifty-five patients could be evaluated for the efficacy of treatment. Elimination rate of Neisseria gonorrhoeae was 100% and 14 out of 18 patients with persisting urethritis had C. trichomatis. Eighty-two NGU patients were treated with minocycline, tosufloxacin, levofloxacin, gatiflixacin or clarithromycine. Sixty-six patients could be evaluated for the efficacy of treatment. Forty-one patients were diagnosed with non-gonococcal chlamydial urethritis (NGCU) and 25 patients were diagnosed with non-gonococcal, non-chlamydial urethritis (NGNCU). The clinical curative rate of NGCU and NGNCU was 93% (38/41) and 80% (20/25), respectively.

[Renal hemangiopericytoma discovered at a health screening: a case report]

We report a case of renal hemangiopericytoma which was incidentally discovered by ultrasonography at a health screening. A 58-year-old man was admitted to our hospital for close examination of the renal tumor. Computed tomography revealed the left renal tumor, 60 x 50 mm in size, which was well enhanced with contrast medium. Magnetic resonance imaging revealed an isointensity mass (T1-weighted) and high-intensity mass (T2-weighted) at the left kidney. Radical nephrectomy was performed on suspicion of left renal cell carcinoma. Histopathological examination revealed renal hemangiopericytoma. The present case is the 7th in the Japanese literature.

Bacillus Calmette-Guérin instillation treatment for carcinoma in situ of the upper urinary tract

OBJECTIVE

To analyse the efficacy and safety of bacillus Calmette-Guérin (BCG) perfusion treatment forcarcinoma in situ (CIS) of the upper urinary tract.

PATIENTS AND METHODS

Six patients with cytologically diagnosed CIS of the upper urinary tract were treated by BCG instillation via retrograde catheterization using a 6 F ureteric catheter or an 8 F indwelling JJ ureteric stent between the ureter and bladder. BCG (Tokyo 172 strain, 80 mg in 100 mL normal saline) was instilled weekly for 4 or 8 weeks. The efficacy and safety of the treatment was assessed.

RESULTS

The mean (range) follow-up was 22 (9-38) months; none of the patients died, and all were negative for cytology in urine collected from the upper urinary tracts. However, one patient had recurrent CIS in the prostatic urethra; the patient was treated by intravesical BCG instillation. In all patients, positive cytology became negative after one or two instillations of BCG. The ureter became stenotic in two patients. Although irritative symptoms occurred in all patients, such side-effects disappeared in a few months and were not clinically significant.

CONCLUSION

In these six patients retrograde BCG instillation for CIS of the upper urinary tract was effective and safe. Based on the cytology results after only two BCG treatments, the dose or number of BCG instillations could possibly be reduced, but further study is needed.

Gene cloning, nucleotide sequencing, and purification and characterization of the D-stereospecific amino-acid amidase from Ochrobactrum anthropi SV3

The gene encoding the D-stereospecific amino-acid amidase from Ochrobactrum anthropi SV3 was cloned and sequenced. Analysis of 7.3 kb of genomic DNA revealed the presence of six ORFs, one of which (daaA) encodes the D-amino-acid amidase. This enzyme, DaaA, is composed of 363 amino-acid residues (molecular mass 40 082 Da), and the deduced amino-acid sequence exhibits homology to alkaline D-peptidase from Bacillus cereus DF4-B (32% identity), DD-peptidase from Streptomyces R61 (29% identity), and other penicillin-recognizing proteins. The DaaA protein contains the typical SXXK, YXN, and H(K)XG active-site motifs identified in the penicillin-binding proteins and beta-lactamases. The daaA gene modified in the nucleotide sequence upstream from its start codon was overexpressed in Escherichia coli. The activity of the recombinant DaaA enzyme in cell-free extracts of E. coli was 33.6 U. mg-1 with D-phenylalaninamide as substrate, which is about 350-fold higher than in extracts of O. anthropi SV3. This enzyme was purified to electrophoretic homogeneity by ammonium sulfate fractionation and three column chromatography steps. On gel-filtration chromatography, DaaA appeared to be a monomer with a molecular mass of 40 kDa. It had maximal activity at 45 degrees C and pH 9.0, and was completely inactivated in the presence of phenylmethanesulfonyl fluoride or Zn2+. DaaA had hydrolyzing activity toward D-amino-acid amides with aromatic or hydrophobic side chains, but did not act on the substrates for the DD-peptidase and beta-lactamase, despite their sequence similarity to DaaA. The characteristics of the recombinant DaaA are similar to those found for the native enzyme partially purified from O. anthropi SV3.

[Bacillus Calmette-Guerin intravesical instillation treatment for carcinoma in situ of the bladder. Gifu BCG Instillation Therapy Research Group]

We performed a retrospective long-term study to evaluate the efficacy of intravesical instillation of Tokyo 172 strain Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder. Between 1989 and 1998, 42 patients with CIS of bladder underwent intravesical instillation of BCG. In the follow-up period from 6 to 116 months (mean: 37.3 months), the efficacy rate of intravesical BCG instillation for CIS of the bladder was 81.0%. Two patients died from the bladder cancer. The non-recurrence rate in patients with grade 2 carcinoma (19 cases) was not significantly different from that in those with grade 3 carcinoma (23 cases). However, the recurrence rate in patients with secondary CIS (15 cases) was significantly higher than in those with primary CIS (27 cases). The recurrence of CIS was observed in 7 of 42 cases. In 6 of 7 patients, CIS recurred within one year after treatment. Total cystectomy was performed in 10 of 42 patients, and pathological findings of muscle layer invasion were detected in 8 patients. Although side effects occurred in 33 patients (77.5%), no clinically significant side effects were observed. Our results suggest that intravesical BCG therapy may be useful for the treatment of CIS of the bladder.

Identification of active sites in amidase: evolutionary relationship between amide bond- and peptide bond-cleaving enzymes

Mainly based on various inhibitor studies previously performed, amidases came to be regarded as sulfhydryl enzymes. Not completely satisfied with this generally accepted interpretation, we performed a series of site-directed mutagenesis studies on one particular amidase of Rhodococcus rhodochrous J1 that was involved in its nitrile metabolism. For these experiments, the recombinant amidase was produced as the inclusion body in Escherichia coli to greatly facilitate its recovery and subsequent purification. With regard to the presumptive active site residue Cys203, a Cys203 --> Ala mutant enzyme still retained 11.5% of the original specific activity. In sharp contrast, substitutions in certain other positions in the neighborhood of Cys203 had a far more dramatic effect on the amidase. Glutamic acid substitution of Asp191 reduced the specific activity of the mutant enzyme to 1.33% of the wild-type activity. Furthermore, Asp191 --> Asn substitution as well as Ser195 --> Ala substitution completely abolished the specific activity. It would thus appear that, among various conserved residues residing within the so-called signature sequence common to all amidases, the real active site residues are Asp191 and Ser195 rather than Cys203. Inasmuch as an amide bond (CO-NH2) in the amide substrate is not too far structurally removed from a peptide bond (CO-NH-), the signature sequences of various amidases were compared with the active site sequences of various types of proteases. It was found that aspartic acid and serine residues corresponding to Asp191 and Ser195 of the Rhodococcus amidase are present within the active site sequences of aspartic proteinases, thus suggesting the evolutionary relationship between the two.

Mycoplasma genitalium in the cervices of Japanese women

BACKGROUND

Mycoplasma genitalium is considered a cause of nongonococcal urethritis in men. This organism also is a cause of genital infections in women, and has been detected in women attending sexually transmitted disease clinics in the United Kingdom and Denmark, although its prevalence is unknown in Japanese women.

GOALS

To determine the prevalence of M. genitalium in the cervices of women with cervicitis or adnexitis as well as in asymptomatic pregnant women in Japan.

STUDY DESIGN

Two hundred women who attended obstetric and gynecologic clinics were recruited. Sixty-four women had cervicitis, 53 had adnexitis, and 3 had both. Eighty pregnant women were asymptomatic for infection. Cervical swab specimens were examined for M. genitalium using a polymerase chain reaction-based assay.

RESULTS

Five (7.8%) of 64 women with cervicitis and 3 (5.7%) of 53 women with adnexitis were positive for M. genitalium. After exclusion of Chlamydia-positive women, 5 (8.8%) of 57 women with cervicitis, and 2 (4.1%) of 49 women with adnexitis were positive for M. genitalium. In none of 80 asymptomatic pregnant women, including a Chlamydia-positive woman, was M. genitalium detected. Overall, 7 (6.6%) of 106 women with Chlamydia-negative genital infections were positive for the M. genitalium. This prevalence was significantly greater than that in asymptomatic pregnant women (P < 0.05).

CONCLUSIONS

A significantly greater prevalence of M. genitalium was demonstrated in Japanese women with Chlamydia-negative cervicitis or adnexitis, compared with that in asymptomatic pregnant women. This study suggests that M. genitalium may play a pathogenic role in a portion of cases with Chlamydia-negative genital infections.

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%).

A novel transporter involved in cobalt uptake

Cobalt is an essential component of a low molecular-mass nitrile hydratase (L-NHase) from Rhodococcus rhodochrous J1. We have found a new gene, nhlF, in the DNA region sandwiched between nhlBA encoding L-NHase and amdA encoding amidase, which are involved in the degradation of nitriles. The product of nhlF, NhlF, shows a significant sequence similarity with those of hoxN from Alcaligenes eutrophus, hupN from Bradyrhizobium japonicum, nixA from Helicobacter pylori, and ureH from Bacillus sp., which are considered to be involved in nickel uptake into these cells. Sequence and hydropathy plot analyses have shown that NhlF encodes a 352-amino acid (aa) protein with eight hydrophobic putative membrane-spanning domains. nhlF expression in R. rhodochrous ATCC 12674 and Escherichia coli JM109 confers uptake of 57Co in their cells, but not of 63Ni. The expression of both nhlF and nhlBA in R. rhodochrous ATCC 12674 exhibited higher NHase activity than nhlBA expression. These findings together with the inhibitory effect by uncouplers (CCCP and SF6847) for the cobalt uptake suggest that NhlF mediates the cobalt transport into the cell energy-dependently finally to provide L-NHase.

Transcriptional regulation of the Rhodococcus rhodochrous J1 nitA gene encoding a nitrilase

The 1.4-kb downstream region from a nitrilase gene (nitA) of an actinomycete Rhodococcus rhodochrous J1, which is industrially in use, was found to be required for the isovaleronitrile-dependent induction of nitrilase synthesis in experiments using a Rhodococcus-Escherichia coli shuttle vector pK4 in a Rhodococcus strain. Sequence analysis of the 1.4-kb region revealed the existence of an open reading frame (nitR) of 957 bp, which would encode a protein with a molecular mass of 35,100. Deletion of the central and 3'-terminal portion of nitR resulted in the complete loss of nitrilase activity, demonstrating that nitR codes for a transcriptional positive regulator in nitA expression. The deduced amino acid sequence of nitR showed similarity to a positive regulator family including XylS from Pseudomonas putida and AraC from E. coli. By Northern blot analysis, the 1.4-kb transcripts for nitA were detected in R. rhodochrous J1 cells cultured in the presence of isovaleronitrile, but not those cultured in the absence of isovaleronitrile. The transcriptional start site for nitA was mapped to a C residue located 26 bp upstream of its translational start site. Deletion analysis to define the nitA promoter region suggested the possible participation of an inverted repeat sequence, centered on base pair -52, in induction of nitA transcription.

Prevalence of Mycoplasma genitalium in men with gonococcal urethritis

A significant association of Mycoplasma genitalium with non-gonococcal urethritis has been reported, but the prevalence of this mycoplasma in men with gonococcal urethritis has not been so well studied. In this study, we examined urethral swab specimens from 45 Japanese male patients with gonococcal urethritis for the presence of M. genitalium by using a polymerase chain reaction-based assay. We also sought Chlamydia trachomatis by an enzyme immunoassay (Chlamydiazyme). Of the 45 specimens, 2 (4.4%) were positive for the mycoplasma and 12 (26.7%) were positive for C. trachomatis. The findings suggest that M. genitalium may be a cause not only of non-gonococcal urethritis but also of postgonococcal urethritis.

Comparison among performances of a ligase chain reaction-based assay and two enzyme immunoassays in detecting Chlamydia trachomatis in urine specimens from men with nongonococcal urethritis

We evaluated the performances of a ligase chain reaction (LCR)-based assay and two enzyme immunoassays (Chlamydiazyme and IDEIA) in the detection of Chlamydia trachomatis in urine specimens. We compared the results of testing urine specimens by these assays with those of urethral swab culture by examining samples from 131 men with nongonococcal urethritis. Discrepant results were analyzed by testing urethral swab specimens for C. trachomatis by a PCR-based assay. After the resolution of discrepant results, the sensitivity of urethral swab culture was 85.3%, whereas those of the LCR assay, Chlamydiazyme, and IDEIA with urine specimens were 94.1, 82.4, and 94.1%, respectively. The LCR assay and IDEIA were more sensitive than was urethral swab culture. In addition, the LCR assay, with a sensitivity equal to that of IDEIA, was more specific. Overall, the LCR assay proved to be superior to the enzyme immunoassays in detecting C. trachomatis in urine specimens. Testing urine specimens by LCR assay should be a helpful alternative method for diagnosing C. trachomatis urethral infection in men with nongonococcal urethritis.

A novel gene cluster including the Rhodococcus rhodochrous J1 nhlBA genes encoding a low molecular mass nitrile hydratase (L-NHase) induced by its reaction product

The 3.5 kilobases (kb) of the 5'-upstream region from nhlBA encoding a cobalt-containing low molecular mass nitrile hydratase (L-NHase) from Rhodococcus rhodochrous J1 was found to be required for the amide-dependent expression of nhlBA in experiments using a Rhodococcus transformation system. Sequence analysis of the 3.5-kb fragment revealed the presence of two open reading frames (nhlD and nhlC) in this fragment. NhlD has similarity to regulators MerR, CadC, and ArsR. NhlC has similarity to the regulators AmiC, for the expression of an aliphatic amidase from Pseudomonas aeruginosa, and NhhC, for the expression of a high molecular mass nitrile hydratase from R. rhodochrous J1. Assays of NHase activity of transformants carrying nhlD deletion or nhlC deletion mutations suggest a negative regulatory role for nhlD and a positive regulatory role for nhlC in the process of the L-NHase formation. Assays of NHase and amidase activities and Western blot analyses of each Rhodococcus transformant carrying various deletion plasmids, have shown that nhlBA and amdA encoding an amidase, which is located 1.9 kb downstream of nhlBA, were regulated in the same manner. These findings present the genetic evidence for a novel gene cluster controlling the expression of L-NHase, which is induced by the reaction product (amide) in the "practical microorganism" R. rhodochrous J1.

Characterization of the gene cluster of high-molecular-mass nitrile hydratase (H-NHase) induced by its reaction product in Rhodococcus rhodochrous J1

The 4.6-kb region 5'-upstream from the gene encoding a cobalt-containing and amide-induced high molecular mass-nitrile hydratase (H-NHase) from Rhodococcus rhodochrous J1 was found to be required for the expression of the H-NHase gene with a host-vector system in a Rhodococcus strain. Sequence analysis has revealed that there are at least five open reading frames (H-ORF1 approximately 5) in addition to H-NHase alpha- and beta-subunit genes. Deletion of H-ORF1 and H-ORF2 resulted in decrease of NHase activity, suggesting a positive regulatory role of both ORFs in the expression of the H-NHase gene. H-ORF1 showed significant similarity to a regulatory protein, AmiC, which is involved in regulation of amidase expression by binding an inducer amide in Pseudomonas aeruginosa. H-ORF4, which has been found to be uninvolved in regulation of H-NHase expression by enzyme assay for its deletion transformant and Northern blot analysis for R. rhodochrous J1, showed high similarity to transposases from insertion sequences of several bacteria. Determination of H-NHase activity and H-NHase mRNA levels in R. rhodochrous J1 has indicated that the expression of the H-NHase gene is regulated by an amide at the transcriptional level. These findings suggest the participation of H-ORF4 (IS1164) in the organization of the H-NHase gene cluster and the involvement of H-ORF1 in unusual induction mechanism, in which H-NHase is formed by amides (the products in the NHase reaction), but not by nitriles (the substrates).

DNA gyrase mutations in quinolone-resistant clinical isolates of Neisseria gonorrhoeae

Eight quinolone-resistant clinical isolates of Neisseria gonorrhoeae were shown to carry mutations in their GyrA proteins. Six isolates had a single amino acid change of serine to phenylalanine at the position corresponding to Ser-83 in Escherichia coli. In addition to the change of serine to phenylalanine, two isolates had another change of aspartic acid to asparagine at the position corresponding to Asp-87 in E. coli.

[Detection of Mycoplasma genitalium from male patients with non-gonococcal urethritis by polymerase chain reaction]

Mycoplasma genitalium causes urethritis in non-human primates, but studies on its pathogenicity in man have been hampered by the difficulty in isolating this oragnism in culture. We have used a specific polymerase chain reaction to examine the role of M. genitalium in non-gonococcal urethritis (NGU). Oligonucleotide primers were used to amplify a 281 bp of 140-KDa adhesin gene of M. genitalium. A characteristic PCR product was amplified, when M. genitalium DNA was template for the PCR. No amplified product was detected in Mycoplasma pneumoniae DNA, Mycoplasma hominis DNA or other bacterial DNAs. M. genitalium DNA was detected in urethral swabs from 17 (14.9%) of 114 men with NGU. Three (9.1%) of the 33 men with Chlamydia-positive NGU and 14 (17.3%) of the 81 with Chlamydia-negative NGU were positive for M. genitalium DNA, but 29 men without urethritis were negative. The prevalence of M. genitalium in NGU and in Chlamydia-negative NGU was significantly higher than that in the normal control. These findings suggest that M. genitalium would be a cause of NGU.

[Clinical investigation of clean intermittent catheterization]

We evaluated 120 patients with neurogenic bladder treated by clean intermittent self catheterization (CIC) in our department. These cases were divided into 2 groups: early treatment cases in which CIC started within 1 year after onset of dysuria, and late treatment cases in which CIC started after more than 1 year. Urinary tract infections (UTI) were recognized in 35% of the early treatment cases and 80% of the late treatment cases in the subsequent period. Pyelonephritis was experienced in 4% of the early treatment cases and 12% of the late treatment cases. Antibiotics therapy was considered unnecessary for asymptomatic UTIs. After CIC treatment, hydronephrosis detected by intravenous pyelography (IVP) and ultrasonography was improved in 18 of the 20 cases, and no cases showed deteriorated renal function. In the cases with neurogenic bladder after radical operations of the uterus or rectum, 45% of the early treatment cases have become free from CIC within 3 months postoperatively, and 84% eventually became free. Most of the late treatment cases have been continuing CIC. We considered that CIC was unnecessary when the residual urine was less than 100ml based on the periodical urinalysis and observation of renal function.

[Infection in genitourinary cancer patients during cancer chemotherapy]

To examine the frequency and the type of infection during cancer chemotherapy in the urological field, we studied the causes of fever in 67 patients with genitourinary cancer. Twenty-six patients had developed a fever of higher than 38 degrees C. Although fever without proven infection was seen in 11 patients (42.3%), fever caused by pyelonephritis was the most common infection. There was a relationship between fever and the presence of hydronephrosis. Fever was observed more often in patients with a leucocyte count of less than 2,000 white blood cell/mm3. In conclusion, we recommend the interruption of cancer chemotherapy or the use of granulocyte colony-stimulating factor for the prevention of infection, when the leukocyte count is less than 2,000 cell/mm3, especially in patients with hydronephrosis.

Detection of micrometastatic prostate cancer cells in lymph nodes by reverse transcriptase-polymerase chain reaction

We have developed a highly sensitive method for detecting prostate cancer cells using reverse transcriptase-polymerase chain reaction (RT-PCR) with primers specific for prostate-specific antigen gene. Forty-four lymph nodes obtained from 22 patients with prostate cancers were analyzed by RT-PCR to detect metastatic prostate cancer cells. RT-PCR could detect prostate-specific antigen mRNA in five lymph nodes with histologically and/or immunohistochemically identifiable metastases and in four lymph nodes with negative histological and immunohistochemical analyses for metastases. RT-PCR was a more sensitive method than histology and immunohistochemistry in detecting metastatic prostate cancer cells and could be applied for diagnosing micrometastases of prostate cancer to lymph nodes. This highly sensitive RT-PCR will be a relevant tool to allow a more accurate clinical assessment of lymph node metastases of prostate cancer and to understand lymphatic dissemination of prostate cancer biologically.

Amidase coupled with low-molecular-mass nitrile hydratase from Rhodococcus rhodochrous J1. Sequencing and expression of the gene and purification and characterization of the gene product

The cloned 9.4-kb insert of plasmid pNHJ20L containing low-molecular-mass nitrile hydratase (L-NHase) gene from Rhodococcus rhodochrous J1 [Kobayashi, M. et al. (1991) Biochim. Biophys. Acta 1129, 23-33] was digested with various restriction enzymes, and the trimmed fragments were inserted into pUC18 or pUC19. A 1.96-kb EcoRI-SphI region located 1.9-kb downstream of the L-NHase gene was found to be essential for the expression of amidase activity in Escherichia coli; the gene arrangement of the amidase and the NHase in R. rhodochrous J1 differed from those in Rhodococcus species including N-774 and Pseudomonas chlororaphis B23. The nucleotide-determined sequence indicated that the amidase consists of 515 amino acids (54626 Da) and the deduced amino acid sequence of the amidase had high similarity to those of amidases from Rhodococcus species including N-774 and P. chlororaphis B23 and to indole-3-acetamide hydrolase from Pseudomonas savastanoi. The amidase gene modified in the nucleotide sequence upstream from its start codon expressed 8% of the total soluble protein in E. coli under the control of lac promoter. The level of amidase activity in cell-free extracts of E. coli was 0.468 unit/mg using benzamide as a substrate. This amidase was purified to homogeneity from extracts of the E. coli transformant with 30.4% overall recovery. The molecular mass of the enzyme estimated by HPLC was about 110 kDa and the enzyme consists of two subunits identical in molecular mass (55 kDa). The enzyme acted upon aliphatic amides such as propionamide and also upon aromatic amides such as benzamide. The apparent Km values for propionamide and benzamide were 0.48 mM and 0.15 mM, respectively. This amidase was highly specific for the S-enantiomer of 2-phenylpropionamide, but could not recognize the configuration of 2-chloropropionamide. It also catalyzed the transfer of an acyl group from an amide to hydroxylamine to produce the corresponding hydroxamate.

[A study of methicillin-resistant Staphylococcus aureus (MRSA) infection in urological field]

Out of 110 strains of Staphylococcus aureus isolated from 1985 to 1990, isolation rate of methicillin-resistant S. aureus (MRSA) was investigated. Nineteen strains of 59 S. aureus from outpatients and 20 strains of 51 S. aureus from inpatients were determined as MRSA. Isolation frequency of MRSA from inpatients was increasing in the recent two years. Coagulase type, enterotoxin type and production of toxic shock syndrome toxin-1 (TSST-1) were examined in 22 strains of MRSA. Coagulase type II (86%), enterotoxin type C (68%) and TSST-1 positive strain was most dominant. Susceptibility of MRSA to 4 antimicrobial agents were measured, MRSA were sensitive to vancomycin (VCM), arbekacin (ABK) and minocycline, but resistant to flomoxef. Thirty-four patients from whom MRSA was isolated including 20 patients from urine, 13 from pus and 1 from blood, were analyzed clinically. Pyuria was not recognized in some cases in whom MRSA was isolated from their urine. Concomitant polymicrobial infection was frequently noted in those patients with MRSA in their urinary tract. These facts show that the pathogenic role of MRSA in the urinary tract infection was not significant. On the other hand, when MRSA was isolated from pus or blood, serious infections could be caused by MRSA, especially in compromised host. Regarding the treatment in these cases, administration of VCM or ABK was though to be necessary.

[Diagnosis of gonococcal urethritis and chlamydial urethritis by polymerase chain reaction]

A polymerase chain reaction (PCR) method was compared to standard methods (cultures for Neisseria gonorrhoeae and Chlamydia trachomatis and an enzyme-immunoassay for C. trachomatis) in diagnosis of gonococcal and chlamydial urethritis in 40 male patients with urethritis. Gonococcal urethritis was diagnosed by detection of a 206 bp DNA fragment amplified by PCR with N. gonorrhoeae-specific primers. Chlamydial urethritis was diagnosed by detection of a 242 bp DNA fragment amplified by PCR with C. trachomatis-specific primers. Gonococcal and chlamydial urethritis, gonococcal and non-chlamydial urethritis, non-gonococcal and chlamydial urethritis, and non-gonococcal and non-chlamydial urethritis were diagnosed in 8, 10, 14 and 8 patients, respectively, by the PCR method. In 9 patients with gonococcal and chlamydial urethritis, 10 with gonococcal and non-chlamydial urethritis, 12 with non-gonococcal and chlamydial urethritis, and 9 with non-gonococcal and non-chlamydial urethritis, diagnosed by the standard methods, the coincidence rates of the PCR to the standard methods were 78% (7/9), 90% (9/10), 100% (12/12), and 89% (8/9), respectively. The overall coincidence rate between the PCR and the standard methods in diagnosis of urethritis were high (90%). In addition, N.gonorrhoeae and C.trachomatis could be simultaneously detected from one urethral sample in approximately 6 hours by means of the PCR. Thus, the PCR method could clinically be applied and would offer several advantages to diagnosis of urethritis, compared to the standard methods.

[Detection of Ureaplasma urealyticum by polymerase chain reaction]

A polymerase chain reaction (PCR) procedure for detection of Ureaplasma urealyticum was developed. A set of oligonucreotides based on sequences within the 16S ribosomal RNA gene from U. urealyticum were used as extension primers for the PCR. A DNA fragment of 397 bp was amplified by the PCR, when U. urealyticum DNA was template for the PCR. No amplified product was detected from other bacterial DNA including those of Mycoplasma genus. The amplified DNA fragment of 397 bp was detected on agarose gel electrophoresis, when DNA of > or = 10(2) cells of U. urealyticum per PCR was used as template for the PCR. Thus, the PCR procedure was shown to be a simple, rapid and specific method for detection of U. urealyticum and could be applied to detection of U. urealyticum from clinical specimens.

Nitrilase from Rhodococcus rhodochrous J1. Sequencing and overexpression of the gene and identification of an essential cysteine residue

The amino acid sequences of the NH2 terminus and internal peptide fragments of a Rhodococcus rhodochrous J1 nitrilase were determined to prepare synthetic oligonucleotides as primers for the polymerase chain reaction. A 750-base DNA fragment thus amplified was used as the probe to clone a 5.4-kilobase PstI fragment coding for the whole nitrilase. The nitrilase gene modified in the sequence upstream from the presumed ATG start codon was expressed to approximately 50% of the total soluble protein in Escherichia coli. The predicted amino acid sequence of the nitrilase gene showed similarity to that of the bromoxynil nitrilase from Klebsiella ozaenae. The 5,5'-dithiobis(2-nitrobenzoic acid) modification of the nitrilase from R. rhodochrous J1 resulted in inactivation with the loss of one sulfhydryl group/enzyme subunit. Of 4 cysteine residues in the Rhodococcus nitrilase, only Cys-165 is conserved in the Klebsiella nitrilase. Mutant enzymes containing Ala or Ser instead of Cys-165 did not exhibit nitrilase activity. These findings suggest that Cys-165 plays an essential role in the function of the active site.

[Comparison of polymerase chain reaction and IDEIA Chlamydia in detection of Chlamydia trachomatis from first-voided urine of male urethritis patients]

We have reported a method for detection of Chlamydia trachomatis by polymerase chain reaction (PCR) with two oligonucleotides based on sequences within the major outer membrane protein gene from C. trachomatis serovar L2. In the previous report, in addition to treatment of the mixture of first-voided urine (FVU) sediment and 1 ml of urine with proteinase K. DNA purification by phenol extraction was necessary for preparation of template DNA for PCR. In this study, FVU sediment was suspended in 1 ml of Chlamydiazyme dilution buffer and a part of the suspension was treated with proteinase K for DNA extraction. The DNA extraction solution could be used as template for PCR without purification of DNA by phenol extraction. One hundred FVU specimens obtained from male urethritis patients were examined with the two methods (PCR and IDEIA) for detection of C. trachomatis. In 33 of 100 specimens, the DNA fragments of C. trachomatis was amplified by the PCR and in 32 of 100, the chlamydial antigen was detected by IDEIA. The positive and negative coincidence rate of the PCR to IDEIA were 93.8% (30.32) and 95.6% (65/68) respectively, resulting in a high overall coincidence rate at 95%. Thus, the improved method with PCR using FVU as a specimen is proved to be a useful, non-invasive diagnostic tool for diagnosis of chlamydial urethritis.