Faster acquisition of magnetic resonance imaging sequences of the knee via deep learning reconstruction: a volunteer study

AIM

To evaluate whether deep learning reconstruction (DLR) can accelerate the acquisition of magnetic resonance imaging (MRI) sequences of the knee for clinical use.

MATERIALS AND METHODS

Using a 1.5-T MRI scanner, sagittal fat-suppressed T2-weighted imaging (fs-T2WI), coronal proton density-weighted imaging (PDWI), and coronal T1-weighted imaging (T1WI) were performed. DLR was applied to images with a number of signal averages (NSA) of 1 to obtain 1DLR images. Then 1NSA, 1DLR, and 4NSA images were compared subjectively, and by noise (standard deviation of intra-articular water or medial meniscus) and contrast-to-noise ratio between two anatomical structures or between an anatomical structure and intra-articular water.

RESULTS

Twenty-seven healthy volunteers (age: 40.6 ± 11.9 years) were enrolled. Three 1DLR image sequences were obtained within 200 s (approximately 12 minutes for 4NSA image). According to objective evaluations, PDWI 1DLR images showed the smallest noise and significantly higher contrast than 1NSA and 4NSA images. For fs-T2WI, smaller noise and higher contrast were observed in the order of 4NSA, 1DLR, and 1NSA images. According to the subjective analysis, structure visibility, image noise, and overall image quality were significantly better for PDWI 1DLR than 1NSA images; moreover, the visibility of the meniscus and bone, image noise, and overall image quality were significantly better for 1DLR than 4NSA images. Fs-T2WI and T1WI 1DLR images showed no difference between 1DLR and 4NSA images.

CONCLUSION

Compared to PDWI 4NSA images, PDWI 1DLR images were of higher quality, while the quality of fs-T2WI and T1WI 1DLR images was similar to that of 4NSA images.

Quantification of cytosine modifications in the aged mouse brain

Quantifying cytosine modifications in various brain regions provides important insights into the gene expression regulation and pathophysiology of neuropsychiatric disorders. In this study, we quantified 5-methylcytosine (5-mC), 5-hydroxymethylation (5-hmC), and 5-formylcytosine (5-fC) levels in five brain regions (the frontal lobe, cerebral cortical region without frontal lobe, hippocampus, basal ganglia, and the cerebellum) and the heart at three developmental periods (12, 48, and 101 weeks). We observed significant regional variations in cytosine modification. Notably, regional variations were generally maintained throughout development, suggesting that epigenetic regulation is unique to each brain region and remains relatively stable with age. The 5-mC and 5-hmC levels were positively correlated, although the extent of the correlations seemed to differ in different brain regions. On the contrary, 5-fC levels did not correlate with 5-mC or 5-hmC levels. Additionally, we observed an age-dependent decrease in 5-fC levels in the basal ganglia, suggesting a unique epigenetic regulation mechanism. Further high-resolution studies using animal models of neuropsychiatric disorders as well as postmortem brain evaluation are warranted.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Effects of Exercise on Functional Recovery in Patients with Bipolar Depression: A Study Protocol for a Randomized Controlled Trial

Treatment of bipolar disorder is prone to prolongation despite various treatments, including medication. The efficacy of exercise treatment (i.e., interventions involving physical exercise and sports intervention) for major depressive disorders has been reported for depressive symptoms, cognitive function, and sleep disturbances. However, its efficacy for bipolar disorder has yet to be established. We designed a randomized, controlled, double-blind clinical trial that includes 100 patients with bipolar disorder aged 20-65 years. This will be a cluster-randomized, two-group trial that will be conducted in ten psychiatric hospitals. The hospitals will be randomly assigned to an exercise intervention + treatment as usual (exercise) group or a placebo exercise intervention (stretching) + treatment as usual (control) group. Patients will be assessed using an extensive battery of clinical tests, physical parameters, sleep status, biological parameters (cytokines, neurotrophic factors), and genetic parameters (DNA and RNA) at baseline after a 6-week intervention period, at 10-week follow-up, and at 6-month follow-up. This innovative study may provide important evidence for the effectiveness of exercise in the treatment of bipolar depression based on clinical, biological, genetic, and physiological markers.

Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process

BACKGROUND

Postoperative delirium is associated with increased mortality. Therefore, it is important to manage delirium during the entire perioperative period. Preoperative anxiety is associated with poor prognosis in postoperative patients who have undergone cardiovascular surgery. This study aims to investigate the relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients (aged 65 years or older), considering the individual psychological characteristics, such as personality and stress coping skills in response to anxiety, as confounding factors.

METHODS

This prospective study included patients aged >65 years in a preoperative state before undergoing cardiovascular surgery. Subjects were divided into two groups based on whether they experienced postoperative delirium, or not. We compared clinical and demographic factors, preoperative psychiatric and psychological factors, and intraoperative and perioperative physical factors between the control and delirium groups. Multiple imputations were used to account for missing data.

RESULTS

Out of 168 subjects enrolled in this study, 26 (15.5%) developed postoperative delirium. Univariate analysis showed significant differences in age (P = 0.027), cognitive function (P = 0.007), agreeableness (P = 0.029), and the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score (P = 0.023) between the delirium and control groups. Multiple logistic regression analysis did not identify a significant association between preoperative anxiety and the onset of postoperative delirium. However, age (odds ratio (OR) = 1.114, P = 0.018), agreeableness (OR = 0.555, P = 0.008), and the APACHE-II score (OR = 1.227, P = 0.008) were identified as risk factors for postoperative delirium.

CONCLUSION

Agreeableness, one of the personality traits associated with preoperative anxiety, appears to be involved in the development of postoperative delirium as an independent psychological factor, regardless of age or physical factors.

POS1196 SARS-CoV-2 VACCINE ACCEPTANCE AND ASSOCIATED PSYCHOLOGICAL FACTORS IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

The mortality rate of coronavirus disease 2019 (COVID-19) in patients with rheumatic and musculoskeletal disease (RMD) is as high as approximately 10% [1]. Therefore, vaccination promotion is a critical issue. However, there are few reports on the psychological aspects of patient vaccine acceptance.

Objectives

To investigate the intention of patients with RMD to receive the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine and explore the psychological factors related to vaccine acceptance.

Methods

We conducted a questionnaire-based survey of 406 outpatients with RMD at Shiga General Hospital from July to October 2021. The questionnaire included the following sections: (1) vaccination status; (2) expectation of susceptibility to severe COVID-19; (3) expectation of vaccine efficacy; and (4) anxiety about the vaccine, which included concerns on I) the diminishing effect of the vaccine due to current treatment and II) the influence of vaccination on: i) primary disease status, ii) treatment, and iii) adverse reaction.

Results

There were 305 vaccinated and 101 unvaccinated individuals. Unvaccinated individuals were classified into the acceptance group (n=60) and hesitancy group (n=41) according to their vaccination status (Figure 1).

Figure 1.

SARS-CoV-2 vaccination status (n=406)

We compared the backgrounds and awareness of the patients on vaccination between the two groups. Univariate analysis did not show any difference in the backgrounds. The expectation of susceptibility to severe COVID-19 was similar in both groups. There were also no significant differences in the vaccine-related anxiety levels. However, the expectation of vaccine efficacy was higher in the acceptance group and significantly influenced vaccination intention as revealed by multivariate analyses (Table 1).

Table 1.

Awareness towards COVID-19 and SARS-CoV-2 vaccine associated with vaccination intention

Awareness towards COVID-19 and SARS-CoV-2 vaccineAcceptance(N=60)Hesitancy(N=41)UnivariateAnalysis§Multivariate Analysis||Median[IQR]Median[IQR]p-valuep-valueExpectation of susceptibility to severe COVID-19*2.0[1.0-3.0]2.0[1.5-2.5]0.84720.3440Expectation of vaccine efficacy†3.0[3.0-3.0]2.0[1.0-3.0]<0.0001¶<0.0001**Concerns about the diminishing effect of the vaccine due to current treatment‡2.0[1.0-3.0]3.0[2.0-3.0]0.04750.3600Concerns about the effect of vaccination on treatment‡3.0[1.0-3.0]3.0[2.0-4.0]0.01280.6232Concern about the effect of vaccination on primary disease status‡3.0[1.0-3.0]3.0[2.0-3.0]0.05760.7134Concern about the effect of vaccination on adverse reaction‡3.0[3.0-3.0]3.0[3.0-4.0]0.00930.8335

*0: Less likely to become severe~3: Very likely to become severe, †0: Not expected at all~4: Highly expected, ‡0: Not concerned at all ~4:Very concerned

§Pearson’s chi-square test or Wilcoxon test, ||Nominal logistic regression analysis, ¶ p<0.008 (after Bonferroni correction), ** p<0.05.

Conclusion

The perception of vaccine efficacy is strongly correlated with vaccine acceptance. In order to promote vaccination in patients with RMDs, this study suggests that emphasizing the efficacy of the vaccine may be more effective than alleviating anxiety about the adverse effects of the vaccine.

References

[1]Strangfeld, A. et al. Ann. Rheum. Dis. 2021; 80: 930–942.

Disclosure of Interests

Haruka Sugawara: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Yoichi Nakayama: None declared, Yuri Nishida: None declared, Yoshie Gon: None declared, Masaki Kamakura: None declared, Kenshi Ohbori: None declared, Naoko Sakane: None declared, Naomi Nakamura: None declared, Takahiko Utsumi: None declared, Akio Morinobu Speakers bureau: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd., Grant/research support from: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd.

Cell-type-specific DNA methylation analysis of the frontal cortices of mutant Polg1 transgenic mice with neuronal accumulation of deleted mitochondrial DNA

Bipolar disorder (BD) is a severe psychiatric disorder characterized by repeated conflicting manic and depressive states. In addition to genetic factors, complex gene–environment interactions, which alter the epigenetic status in the brain, contribute to the etiology and pathophysiology of BD. Here, we performed a promoter-wide DNA methylation analysis of neurons and nonneurons derived from the frontal cortices of mutant Polg1 transgenic (n = 6) and wild-type mice (n = 6). The mutant mice expressed a proofreading-deficient mitochondrial DNA (mtDNA) polymerase under the neuron-specific CamK2a promoter and showed BD-like behavioral abnormalities, such as activity changes and altered circadian rhythms. We identified a total of 469 differentially methylated regions (DMRs), consisting of 267 neuronal and 202 nonneuronal DMRs. Gene ontology analysis of DMR-associated genes showed that cell cycle-, cell division-, and inhibition of peptide activity-related genes were enriched in neurons, whereas synapse- and GABA-related genes were enriched in nonneurons. Among the DMR-associated genes, Trim2 and Lrpprc showed an inverse relationship between DNA methylation and gene expression status. In addition, we observed that mutant Polg1 transgenic mice shared several features of DNA methylation changes in postmortem brains of patients with BD, such as dominant hypomethylation changes in neurons, which include hypomethylation of the molecular motor gene and altered DNA methylation of synapse-related genes in nonneurons. Taken together, the DMRs identified in this study will contribute to understanding the pathophysiology of BD from an epigenetic perspective.

Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation

BACKGROUND

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes.

OBJECTIVE

Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT.

METHODS

First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters.

RESULTS

The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient = 0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient = -0.66).

CONCLUSION

These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.

Identification and functional characterization of the extremely long allele of the serotonin transporter-linked polymorphic region

SLC6A4, which encodes the serotonin transporter, has a functional polymorphism called the serotonin transporter-linked polymorphic region (5-HTTLPR). The 5-HTTLPR consists of short (S) and long (L) alleles, each of which has 14 or 16 tandem repeats. In addition, the extralong (XL) and other rare alleles have been reported in 5-HTTLPR. Although they are more frequent in Asian and African than in other populations, the extent of variations and allele frequencies (AFs) were not addressed in a large population. Here, we report the AFs of the rare alleles in a large number of Japanese subjects (N = 2894) consisting of two cohorts. The first cohort (case-control study set, CCSS) consisted of 1366 subjects, including 485 controls and 881 patients with psychosis (bipolar disorder or schizophrenia). The second cohort (the Arao cohort study set, ACSS) consisted of 1528 elderly subjects. During genotyping, we identified 11 novel 5-HTTLPR alleles, including 3 XL alleles. One novel allele had the longest subunit ever reported, consisting of 28 tandem repeats. We named this XL_28-A. An in vitro luciferase assay revealed that XL_28-A has no transcriptional activity. XL_28-A was found in two unrelated patients with bipolar disorder in the CCSS and one healthy subject in the ACSS who did not show depressive symptoms or a decline in cognitive function. Therefore, it is unlikely that XL_28-A is associated with psychiatric disorders, despite its apparent functional deficit. Our results suggest that unraveling the complex genetic variations of 5-HTTLPR will be important for further understanding its role in psychiatric disorders.

Promoter Activity-Based Case-Control Association Study on SLC6A4 Highlighting Hypermethylation and Altered Amygdala Volume in Male Patients With Schizophrenia

Associations between altered DNA methylation of the serotonin transporter (5-HTT)-encoding gene SLC6A4 and early life adversity, mood and anxiety disorders, and amygdala reactivity have been reported. However, few studies have examined epigenetic alterations of SLC6A4 in schizophrenia (SZ). We examined CpG sites of SLC6A4, whose DNA methylation levels have been reported to be altered in bipolar disorder, using 3 independent cohorts of patients with SZ and age-matched controls. We found significant hypermethylation of a CpG site in SLC6A4 in male patients with SZ in all 3 cohorts. We showed that chronic administration of risperidone did not affect the DNA methylation status at this CpG site using common marmosets, and that in vitro DNA methylation at this CpG site diminished the promoter activity of SLC6A4. We then genotyped the 5-HTT-linked polymorphic region (5-HTTLPR) and investigated the relationship among 5-HTTLPR, DNA methylation, and amygdala volume using brain imaging data. We found that patients harboring low-activity 5-HTTLPR alleles showed hypermethylation and they showed a negative correlation between DNA methylation levels and left amygdala volumes. These results suggest that hypermethylation of the CpG site in SLC6A4 is involved in the pathophysiology of SZ, especially in male patients harboring low-activity 5-HTTLPR alleles.

Association between anxious distress in a major depressive episode and bipolarity

PURPOSE

Mixed features in a major depressive episode (MDE) predict bipolar disorder (BD). The mixed features specifier included in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) could be restrictive because it excludes the symptoms common to both mania/hypomania and depression, including psychomotor agitation. On the other hand, an anxious distress (ANXD) specifier has also been introduced in the DSM-5, and psychomotor agitation has been defined as a severity of ANXD. In this study, we retrospectively investigated the association between presence of ANXD in an MDE and bipolarity.

PATIENTS AND METHODS

The subjects were patients admitted with an MDE to the Department of Psychiatry at Tokyo Women's Medical University Hospital from December 2014 to March 2016. Eligible patients were older than 20 years of age and met the DSM-5 criteria for major depressive disorder or BD. All data were extracted from medical records. The subjects were grouped according to whether they did or did not have ANXD. The demographics and clinical features of these groups were compared. Severity of illness was evaluated according to the Hamilton Rating Scale for Depression (HRSD) score on admission.

RESULTS

ANXD was present in 31 and absent in 33 of 64 patients with MDE. The HRSD score was significantly higher in the group with ANXD than in the group without ANXD (P=0.0041). Mixed features (P=0.0050) and suicide attempts (P=0.0206) were significantly more common in the group with ANXD than in the group without ANXD.

CONCLUSION

We found that the presence of ANXD in an MDE was associated with greater severity and more mixed features and suicide attempts. It is important to evaluate a patient with an MDE for ANXD so that a diagnosis of mixed depression is not missed. More studies in larger samples are needed to investigate further the association between ANXD in MDE and bipolarity.

Delusional parasitosis in dementia with Lewy bodies: a case report

BACKGROUND

Dementia with Lewy bodies (DLB) is characterized by fluctuating cognitive impairments, recurrent visual hallucinations, the motor symptoms of parkinsonism and REM sleep behavior disorder. Various neuropsychiatric symptoms including hallucination and delusions occur frequently; however, delusional parasitosis is rare in DLB. Here, we report a case of DLB patient with delusional parasitosis.

CASE PRESENTATION

The patient was an 89-year-old woman. At the age of 88, she began to complain her oral cenesthopathy, and developed cognitive decline, delusional parasitosis and parkinsonism. As a result of examination, she was diagnosed as DLB and treated with combination of donepezil 5 mg/day and aripiprazole 1.5 mg/day, and her complaint was disappeared.

CONCLUSIONS

Further studies are needed to investigate the association between delusional parasitosis and underlying pathophysiology of DLB, and the utility of antipsychotics for delusional parasitosis in DLB has to be examined through more cases.

DNA methylation analyses of the candidate genes identified by a methylome-wide association study revealed common epigenetic alterations in schizophrenia and bipolar disorder

AIM

Schizophrenia (SZ) and bipolar disorder (BD) have been known to share genetic and environmental risk factors, and complex gene-environmental interactions may contribute to their pathophysiology. In contrast to high genetic overlap between SZ and BD, as revealed by genome-wide association studies, the extent of epigenetic overlap remains largely unknown. In the present study, we explored whether SZ and BD share epigenetic risk factors in the same manner as they share genetic components.

METHODS

We performed DNA methylation analyses of the CpG sites in the top five candidate regions (FAM63B, ARHGAP26, CTAGE11P, TBC1D22A, and intergenic region [IR] on chromosome 16) reported in a previous methylome-wide association study (MWAS) of SZ, using whole blood samples from subjects with BD and controls.

RESULTS

Among the five candidate regions, the CpG sites in FAM63B and IR on chromosome 16 were significantly hypomethylated in the samples from subjects with BD as well as those from subjects with SZ. On the other hand, the CpG sites in TBC1D22A were hypermethylated in the samples from subjects with BD, in contrast to hypomethylation in the samples from subjects with SZ.

CONCLUSION

Hypomethylation of FAM63B and IR on chromosome 16 could be common epigenetic risk factors for SZ and BD. Further comprehensive epigenetic studies for BD, such as MWAS, will uncover the extent of similarity and uniqueness of epigenetic alterations.

Superconductivity and magnetic fluctuations developing in the vicinity of strong first-order magnetic transition in CrAs

We report single crystal preparation, resistivity, and nuclear quadrupole resonance (NQR) measurements for new pressure-induced superconductor CrAs. In the first part, we present the difference between crystals made by different thermal sequences and methods, and show the sample dependence of superconductivity in CrAs. In the latter part, we show NQR data focusing the microscopic electronic state at the phase boundary between the helimagnetic and the paramagnetic phases. They suggest strongly that a quantum critical point is absent on the pressure-temperature phase diagram of CrAs, because of the strong first-order character of the magnetic transition; however, the spin fluctuations are observed in the paramagnetic phase. The close relationship between the spin fluctuations and superconductivity can be seen even in the vicinity of the first-order magnetic transition in CrAs.

Quasilinear quantum magnetoresistance in pressure-induced nonsymmorphic superconductor chromium arsenide

In conventional metals, modification of electron trajectories under magnetic field gives rise to a magnetoresistance that varies quadratically at low field, followed by a saturation at high field for closed orbits on the Fermi surface. Deviations from the conventional behaviour, for example, the observation of a linear magnetoresistance, or a non-saturating magnetoresistance, have been attributed to exotic electron scattering mechanisms. Recently, linear magnetoresistance has been observed in many Dirac materials, in which the electron–electron correlation is relatively weak. The strongly correlated helimagnet CrAs undergoes a quantum phase transition to a nonmagnetic superconductor under pressure. Here we observe, near the magnetic instability, a large and non-saturating quasilinear magnetoresistance from the upper critical field to 14 T at low temperatures. We show that the quasilinear magnetoresistance may arise from an intricate interplay between a nontrivial band crossing protected by nonsymmorphic crystal symmetry and strong magnetic fluctuations.

The electronic structure of the helimagnet CrAs is unusual due to its nonsymmorphic crystal symmetry. Here, the authors observe quasilinear magnetoresistance close to a pressure-driven superconducting transition, which may arise from the interaction of the band structure and magnetic fluctuations.

Identifying predictive clinical characteristics of the treatment efficacy of mirtazapine monotherapy for major depressive disorder

BACKGROUND

Mirtazapine, which is classified as a noradrenergic and specific serotonergic antidepressant, is widely prescribed for the treatment of major depressive disorder. The potential predictive factors of the efficacy of mirtazapine and the tolerability based on the incidence of oversedation and jitteriness/anxiety syndrome were evaluated.

PATIENTS AND METHODS

Patients with major depressive disorder were retrospectively investigated. Study subjects comprised 68 patients with depression who received mirtazapine as an initial antidepressant at the Department of Psychiatry of the Tokyo Women's Medical University Hospital from September 2009 to March 2013. The efficacy of mirtazapine monotherapy was evaluated based on the Clinical Global Impression Improvement score. Clinical characteristics were compared between remission and nonremission groups to determine the factors predicting the efficacy. Moreover, discontinuation rates due to adverse effects, including oversedation and jitteriness/anxiety syndrome, were examined, and the effects of confounding factors were evaluated.

RESULTS

The remission rate of mirtazapine monotherapy was 36.8% among the 68 enrolled subjects. The mean final doses in the remission and nonremission groups were 27.6±13.5 mg and 26.0±14.1 mg, respectively, and there was no significant difference between them. Multiple logistic analyses revealed that the absence of guilt (odds ratio [OR] =0.15; 95% CI [1.66-37.24], P=0.006) and the presence of psychomotor retardation (OR =4.30; 95% CI [1.30-16.60], P=0.016) were significantly related to the efficacy of mirtazapine monotherapy. The discontinuation rates due to oversedation and jitteriness/anxiety syndrome were 13.2% and 11.8%, respectively. Age did not differ significantly between patients with or without oversedation or jitteriness/anxiety syndrome (P=0.078 and P=0.579, respectively).

CONCLUSION

The absence of guilt and the presence of psychomotor retardation may predict the efficacy of mirtazapine, and mirtazapine may be tolerable for all ages.

A retrospective study of predictive factors for effective aripiprazole augmentation of antidepressant therapy in treatment-resistant depression

BACKGROUND

Several studies have evaluated the efficacy and tolerability of aripiprazole for augmentation of antidepressant therapy for treatment-resistant depression (TRD). Here, we investigated the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder and the clinical predictors of treatment efficacy in a Japanese population.

METHODS

Eighty-five depressed Japanese patients who underwent aripiprazole augmentation therapy after failing to respond satisfactorily to antidepressant monotherapy were included in the study. Treatment responses were evaluated based on Clinical Global Impression Improvement scores assessed 8 weeks after initiation of aripiprazole administration. We compared demographic and diagnostic variables, psychiatric medication variables, and clinical variables between remission and nonremission groups.

RESULTS

The aripiprazole augmentation remission rate was 36.5%. Multiple logistic regression analysis indicated that aripiprazole augmentation was significantly more effective for bipolar depression than for major depressive disorder, and both absence of comorbid anxiety disorders and current episode duration >3 months were significantly associated with the efficacy of aripiprazole augmentation.

CONCLUSION

Polarity of depression, comorbidity of anxiety disorders, and current episode duration may predict the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder. Among them, comorbidity of anxiety disorders was significantly related to the efficacy for TRD including only major depressive disorder. Additional studies are needed to examine the association between the efficacy of aripiprazole augmentation and bipolarity, and these findings should be validated further in a prospective study.

Effects of quetiapine on DNA methylation in neuroblastoma cells

Epigenetic regulation may be involved in the pathophysiology of mental disorders, such as schizophrenia and bipolar disorder, and in the pharmacological action of drugs. Characterizing the epigenetic effects of drugs is an important step to optimal treatment. We performed comprehensive and gene-specific DNA methylation analyses of quetiapine using human neuroblastoma cells. Human neuroblastoma cells were cultured with quetiapine for 8 days, and DNA methylation analysis was performed using Infinium HumanMethylation27 BeadChip. A total of 1173 genes showed altered DNA methylation. Altered DNA methylation predominantly occurred as hypomethylation within the CpG island compared to DNA isolated from non-treated cells. Gene ontology analysis revealed that these genes were related to the cellular process of intracellular protein binding. There was no common effect of quetiapine with three mood stabilizers (lithium, valproate, and carbamazepine). However, common DNA methylation changes in eight genes, including ADRA1A, which encodes adrenoceptor alpha 1A, were found with quetiapine and lithium treatments. Finally, bisulfite-sequencing analysis revealed that quetiapine decreased the DNA methylation level of the promoter region of SLC6A4, where hypermethylation with bipolar disorder and hypomethylation with mood stabilizers have been reported.

Proteomic analysis of lymphoblastoid cells derived from monozygotic twins discordant for bipolar disorder: a preliminary study

Bipolar disorder is a severe mental illness characterized by recurrent manic and depressive episodes. In bipolar disorder, family and twin studies suggest contributions from genetic and environmental factors; however, the detailed molecular pathogenesis is yet unknown. Thus, identification of biomarkers may contribute to the clinical diagnosis of bipolar disorder. Monozygotic twins discordant for bipolar disorder are relatively rare but have been reported. Here we performed a comparative proteomic analysis of whole cell lysate derived from lymphoblastoid cells of monozygotic twins discordant for bipolar disorder by using two-dimensional differential in-gel electrophoresis (2D-DIGE). We found approximately 200 protein spots to be significantly differentially expressed between the patient and the co-twin (t test, p<0.05). Some of the proteins were subsequently identified by liquid chromatography tandem mass spectrometry and included proteins involved in cell death and glycolysis. To examine whether these proteins could serve as biomarkers of bipolar disorder, we performed Western blot analysis using case–control samples. Expression of phosphoglycerate mutase 1 (PGAM1), which is involved in glycolysis, was significantly up-regulated in patients with bipolar disorder (t test, p<0.05). Although PGAM1 cannot be regarded as a qualified biomarker of bipolar disorder from this preliminary finding, it could be one of the candidates for further study to identify biomarkers of bipolar disorder.

Divalent cations enhance fluoride binding to Streptococcus mutans and Streptococcus sanguinis cells and subsequently inhibit bacterial acid production

One preventive effect of topical fluoride application is derived from the fact that fluoride can inhibit bacterial acid production. Furthermore, divalent cations such as Ca(2+) and Mg(2+) increase the binding of fluoride to bacterial cells. These findings suggest that exposure of oral bacteria to fluoride in the presence of divalent cations increases fluoride binding to bacterial cells and subsequently enhances fluoride-induced inhibition of bacterial acid production. This study investigated the effects of fluoride exposure (0-20,000 ppm F) in the presence of Ca(2+) or Mg(2+) prior to glucose challenge on pH fall ability by bacterial sugar fermentation, as well as fluoride binding to bacterial cells by exposure to fluoride, and fluoride release from bacterial cells during bacterial sugar fermentation, using caries-related bacteria, Streptococcus mutans and Streptococcus sanguinis. The pH fall by both streptococci was inhibited by exposure to over 250 ppm F in the presence of Ca(2+) (p < 0.01), whereas in the presence of Mg(2+), the pH fall by S. mutans and S. sanguinis was inhibited after exposure to over 250 and 950 ppm F, respectively (p < 0.05). The amounts of fluoride binding to and released from streptococcal cells increased with the concentration of fluoride the cells were exposed to in the presence of Mg(2+), but were high enough even after 250 ppm F exposure in the presence of Ca(2+). The enhanced inhibition of acid production in the presence of divalent cations is probably due to the improved efficiency of fluoride binding to bacterial cells being improved via these divalent cations.

Genome-wide DNA methylation and gene expression analyses of monozygotic twins discordant for intelligence levels

Human intelligence, as measured by intelligence quotient (IQ) tests, demonstrates one of the highest heritabilities among human quantitative traits. Nevertheless, studies to identify quantitative trait loci responsible for intelligence face challenges because of the small effect sizes of individual genes. Phenotypically discordant monozygotic (MZ) twins provide a feasible way to minimize the effects of irrelevant genetic and environmental factors, and should yield more interpretable results by finding epigenetic or gene expression differences between twins. Here we conducted array-based genome-wide DNA methylation and gene expression analyses using 17 pairs of healthy MZ twins discordant intelligently. ARHGAP18, related to Rho GTPase, was identified in pair-wise methylation status analysis and validated via direct bisulfite sequencing and quantitative RT-PCR. To perform expression profile analysis, gene set enrichment analysis (GSEA) between the groups of twins with higher IQ and their co-twins revealed up-regulated expression of several ribosome-related genes and DNA replication-related genes in the group with higher IQ. To focus more on individual pairs, we conducted pair-wise GSEA and leading edge analysis, which indicated up-regulated expression of several ion channel-related genes in twins with lower IQ. Our findings implied that these groups of genes may be related to IQ and should shed light on the mechanism underlying human intelligence.

Psychiatric consultation after kidney transplantation: a 10-year single-center study including outpatients in Japan

BACKGROUND

The aim of this study was to elucidate the clinical characteristics and frequency of psychiatric consultation in a routine clinical setting after kidney transplantation.

METHODS

Subjects were 1,139 consecutive recipients who received kidney transplantation at our hospital between January 1997 and September 2006. The hospital patient database was searched to determine whether these recipients received psychiatric consultation after their transplantation during this period.

RESULTS

Among 1,139 recipients, 118 (10%) received psychiatric consultation after their transplantation. There were significantly more women among these recipients (p = 0.036). Many of the recipients had received psychiatric consultation before transplantation (p < 0.0001) and had received dialysis for a long time (p = 0.018). There were three main psychiatric diagnoses according to ICD-10 diagnostic criteria in these 118 recipients: 42 (36%) had neurotic, stress-related, and somatoform disorders (F4); 35 (30%) had organic, including symptomatic, mental disorders (F0); and 27 (23%) had mood (affective) disorders (F3). The median length of time between kidney transplantation and initial psychiatric consultation was 57 days (interquartile range: 10-650 days). The lengths were 7 days (6-17 days) for F0, 75 days (18-650 days) for F4, 243 days (35-1,004 days) for F3, and 253 days (10-1,393 days) for other diagnostic groups. Significant differences were observed among these four groups (Jonckheere-Terpstra test, p < 0.001).

CONCLUSION

Our results show that appropriate psychiatric intervention is necessary not only in early stages after kidney transplantation but also over the long term.

Comprehensive DNA methylation analysis of human peripheral blood leukocytes and lymphoblastoid cell lines

DNA methylation is involved in development and in human diseases. Genomic DNA derived from lymphoblastoid cell lines (LCLs) is commonly used to study DNA methylation. There are potential confounding factors regarding the use of LCL-derived DNA, however, such as Epstein-Barr (EB) viral infection and artifacts induced during cell culture. Recently, several groups compared the DNA methylation status of peripheral blood leukocytes (PBLs) and LCLs and concluded that the DNA methylation profiles between them might be consistent. To confirm and extend theses results, we performed a comprehensive DNA methylation analysis using both PBLs and LCLs derived from the same individuals. Using the luminometric methylation assay, we revealed that the global DNA methylation level was different between PBLs and LCLs. Furthermore, the direction of change was not consistent. Comparisons of genome-wide DNA methylation patterns of promoter regions revealed that methylation profiles were largely conserved between PBLs and LCLs. A preliminary analysis in a small number of samples suggested that the methylation status of an LCL may be better correlated with PBLs from the same individual than with LCLs from other individuals. Expectedly, DNA methylation in promoter regions overlapping with CpG islands was associated with gene silencing in both PBLs and LCLs. With regard to methylation differences, we found that hypermethylation was more predominant than hypomethylation in LCLs compared with PBLs. These findings suggest that LCLs should be used for DNA methylation studies with caution as the methylation patterns of promoter regions in LCLs are not always the same as those in PBLs.

Predictors of efficacy in lithium augmentation for treatment-resistant depression

BACKGROUND

Lithium augmentation is widely applied for treatment-resistant depression, however, the clinical predictors of its efficacy regarding polarity and bipolarity are unknown.

METHODS

We retrospectively examined the predictive value of clinical variables in 79 depressed patients who underwent lithium augmentation after failure to respond to antidepressant monotherapy. Lithium augmentation efficacy was evaluated by Clinical Global Impression Improvement assessment 4 to 8 weeks after initiating lithium administration; subjects with scores of 1 and 2 were defined as responders, and those with scores of 3 to 7 as non-responders. Clinical variables, including demographic and diagnostic variables, psychiatric medication, and clinical variables, were compared between groups. The bipolarity of patients with major depressive disorder as a final diagnosis was evaluated in association with the lithium augmentation efficacy. Data were analyzed using a chi-square test or Fisher's test.

RESULTS

The lithium augmentation efficacy rate was 41% among 79 enrolled patients (14 dropped out, 32 responders, and 33 non-responders). Lithium augmentation was significantly more effective for patients with a final diagnosis of bipolar disorder than with major depressive disorder (p=0.03). Subjects with more than three major depressive episodes showed a significant response to lithium augmentation (p=0.004). The rate of a family history of major depressive disorder/bipolar disorder in a first-degree relative was significantly higher in responders (34%) than in non-responders (7%, p=0.01), consistent with the association between the efficacy of lithium augmentation and bipolarity in major depressive disorder (responders=27% vs. non-responders=3%, p=0.03).

LIMITATION

The study was retrospective and severity was not analyzed.

CONCLUSION

Bipolar disorder, frequency of major depressive episodes, and family history of major depressive disorder/bipolar disorder in a first-degree relative were detected as predictors of lithium augmentation efficacy. Among them, family history of major depressive disorder/bipolar disorder in a first-degree relative was the most reliable predictor of lithium augmentation efficacy for bipolar disorder and major depressive disorder.

Kondo scaling of the pseudogap in CeOs4Sb12 and CeFe4P12

CeOs(4)Sb(12) and CeFe(4)P(12) are classified as Kondo semiconductors, which show coupled changes in electrical transport, thermodynamic and magnetic properties with a low-temperature semiconductor-like electrical resistivity. We have carried out core level and valence band photoemission spectroscopy on single crystal CeOs(4)Sb(12) and CeFe(4)P(12) to study their electronic structure and the evolution of states at the Fermi level as a function of temperature (∼10-300 K). The Ce 3d core level spectra show the presence of f(0), f(1) and f(2) final states with very different relative intensities in the two compounds. Single-impurity Anderson model calculations provide f electron counts of n(f) = 0.97 and 0.86 per Ce atom, suggestive of a low- and high-T(K) (= single ion Kondo temperature) for CeOs(4)Sb(12) and CeFe(4)P(12), respectively. The high-resolution temperature-dependent near-Fermi level spectra show pseudogaps of energy ∼ 50 meV and ∼ 110 meV in the valence band density of states (DOS) of CeOs(4)Sb(12) and CeFe(4)P(12), respectively. The temperature dependence of the DOS at the Fermi level follows the change in effective magnetic moment estimated from magnetic susceptibility for both materials, confirming the Kondo nature of the pseudogap in CeOs(4)Sb(12) and CeFe(4)P(12). A compilation of measured pseudogaps using photoemission and optical spectroscopy identifies the charge gaps Δ(C) for Ce-based Kondo semiconductors and provides a direct relation with T(K) given by Δ(C) ∼ 2k(B)T(K). In conjunction with the known behaviour of the spin gaps Δ(S) ∼ k(B)T(K), the results establish the coupled energy scaling of the spin and charge gaps in Kondo semiconductors.

Excitation spectrum of PrOs(4)Sb(12) under a magnetic field

The evolution of the magnetic excitation spectrum of the heavy fermion superconductor PrOs(4)Sb(12) was studied by inelastic neutron scattering on crossing the critical field H(c2) for superconductivity at low temperature. The peak positions in energy and the peak intensities of the modes of the triplet split by magnetic field confirm the known crystal field parameters for PrOs(4)Sb(12) in T(h) symmetry. A selective broadening of the lineshape occurs on increasing the magnetic field: the linewidth of the upper mode of the triplet increases while the one of the middle mode does not.

Anomalous duality of 4f electrons in filled skutterudite CeOs4Sb12

We study the electronic structure of the filled skutterudite CeOs4Sb12 using photoemission spectroscopy (PES). Soft x-ray excited Ce 3d-4f resonant PES confirms the existence of Ce 4f states at the Fermi level (EF). Temperature dependent high-resolution laser-PES spectra reveal a pseudogap formation around EF, which can be explained in terms of the hybridization gap. Simultaneously, a sharp feature is formed just above EF with decreasing temperature. The heavy-fermion-like specific heat is attributed to the occupation of this feature. The results identify the origin of the anomalous coexistence of heavy-fermion and pseudogap behavior in terms of a symmetry dependent hybridization.

Diagnostics of a He(+) beam extracted from a compact magnetic bucket-type ion source

Performance of a compact He(+) ion source was investigated before installing it to the experiment system developed for studying the efficiency of autodetachment neutralization from He(-) to He(0). Dependence of the extracted ion current upon the plasma parameters and that upon the extraction voltage indicated that the source performance was limited by space charge effect. The beam emittance was measured with a multislit system for various operation conditions. The experimentally determined emittance agreed well with the emittance obtained from ion trajectories calculated with input plasma parameters measured by a Langmuir probe. The beam current density of 60 mA/cm(2) and the emittance of less than 25pi mm mrad are expected to deliver enough current to the downstream of the He(-) neutralizer system to clarify factors affecting the final He(0) intensity.

Energy straggling of low-energy ion beam in a charge exchange cell for negative ion production

Energy straggling in a charge exchange cell, which is frequently used for negative ion production, was studied experimentally and compared with the results of theoretical evaluation. The change of the energy spectrum of a He(+) beam due to charge exchange processes in argon gas was measured in the energy range of 2-6 keV. Energy straggling by multiple collisions is expressed by the energy loss formula due to inelastic and elastic processes. The impact parameter is related to the elastic scattering angle, and the geometry of the charge exchange cell and other components of the beam transportation system determines the maximum acceptable scattering angle. The energy spread was evaluated taking the integral limit over the impact parameter into consideration. The theoretical results showed good agreement with those of actual measurement.

A beam transport system for an intense He(-) beam source

We have been developing a test stand for fast He(0) beam production. One of the major issues is how to transport effectively the He(+) and He(-) beams from which the He(0) beam is produced. The beam should be focused in two transverse focal points, the center of the charge exchange cell and the electrostatic accelerator. We studied the beam transport system and effect of space charge neutralization in the test stand by experiments and calculation.

[Establishment of a comprehensive anti-suicide project in an urban city]

For the establishment of an effective comprehensive anti-suicide policy, a multifaceted strategy including primary, secondary, and tertiary prevention measures is needed. In urban cities, however, there are many obstacles to projects such as comprehensive programs for suicide prevention. In Sendai city, which has a population of approximately 1,000,000, a comprehensive anti-suicide project was launched as a public enterprise as a pioneer among ordinance-designated cities in Japan. This project was supported by several important factors. 1) A series of epidemiological observation and intervention studies on depression among the elderly had previously been conducted in a large residential district. As a result, a comprehensive community program for depression among the elderly was implemented as a public enterprise and a subsequent decreasing trend in the later-life suicide rate was found. 2) The municipal authorities recognized the importance of the anti-suicide program and made an effort to reorganize the existing health-related programs in terms of suicide prevention. 3) the action of the municipality was facilitated by the passing of an anti-suicide law by the National Diet in 2006 and the establishment of fundamental principles for a comprehensive anti-suicide policy by the National Diet in 2007. 4) The activities of nongovernmental groups also influenced the municipality. In order to establish a comprehensive anti-suicide program in urban cities with a large population, an interaction model in which various governmental and nongovernmental networks influence and activate each other should be considered.

Regulation of human protein Z gene expression by liver-enriched transcription factor HNF-4alpha and ubiquitous factor Sp1

BACKGROUND AND OBJECTIVES

Protein Z (PZ), which regulates blood coagulation, is mainly synthesized in the liver. Its plasma level varies widely among individuals, and is highly sensitive to Warfarin. The mechanism for the basic transcription of the human PZ gene, however, has not been reported. The aim of this study was to elucidate the mechanism of gene regulation for PZ by characterizing its 5'-flanking region.

METHODS AND RESULTS

A reporter gene assay using the human hepatoma cell line, HepG2, identified a minimal promoter region (site A) and two enhancer regions (sites B and C) in the PZ gene. DNase I footprinting and electromobility shift assays revealed binding of the liver-enriched transcriptional factor hepatocyte nuclear factor (HNF)-4alpha to site A, the ubiquitous transcriptional factor Sp1 to sites A and C, and an unidentified factor to site B. The co-transfection of an HNF-4alpha expression vector with reporter gene constructs to the non-hepatic cell line HeLa resulted in a significant increase of PZ promoter activity.

CONCLUSIONS

HNF-4alpha plays a crucial role in human PZ gene expression in hepatocytic cells, and Sp1 is also important. These findings provide the first step toward understanding the mechanisms of the varying plasma PZ levels in individuals under physiological and pathological conditions.

DDBJ with new system and face

DDBJ (http://www.ddbj.nig.ac.jp) collected and released 1 880 115 entries or 1 134 086 245 bases in the period from July 2006 to June 2007. The released data contains the high-throughput cDNAs of cricket and high-quality draft genome of medaka among others. Our computer system has been upgraded since March 2007. Another new aspect is an efficient data retrieval tool that has recently been equipped and served at DDBJ. It is called All-round Retrieval for Sequence and Annotation, which enables the user to search for keywords also in the Feature/Qualifier of the International Nucleotide Sequence Database Collaboration (http://www.insdc.org/). We will also replace our home page with a more efficient one by the end of 2007.