In recent years, primary gastrointestinal follicular lymphoma has been increasingly detected in the duodenum on esophagogastroduodenoscopy (EGD). Primary gastrointestinal follicular lymphomas are frequently distributed to multiple sites in the gastrointestinal tract. Therefore, investigation into the spread of follicular lymphomas in the small bowel is important in order to determine the most appropriate treatment strategy. The performance of double-balloon endoscopy (DBE) in the diagnosis of jejunoileal follicular lymphoma lesions has not been fully evaluated. We aimed to investigate the value of DBE in addition to computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the diagnosis of jejunoileal follicular lymphoma. DBE with biopsy was performed in seven patients with primary duodenal follicular lymphoma diagnosed by EGD, in order to investigate jejunoileal involvement. Jejunoileal follicular lymphoma lesions were detected by DBE in six out of the seven patients (three in the jejunum and three in the jejunum and ileum), whereas CT and (18)F-FDG-PET failed to detect the existence of these lesions. Endoscopic findings of the jejunoileal lesions revealed multiple white nodules and white villi, which were similar to those of duodenal lesions. DBE was more useful for the diagnosis of jejunoileal involvement in primary intestinal follicular lymphoma than CT and (18)F-FDG-PET. The use of DBE will become important for determining the most appropriate treatment for gastrointestinal follicular lymphoma.

The effects of exogenous purine supply on plasma concentration and urinary excretion of purine derivatives (PD), which include allantoin, uric acid, xanthine and hypoxanthine, were studied. Five sheep, totally nourished by intragastric infusion of volatile fatty acids and casein, were given an abomasal infusion of a mixture of adenosine and guanosine at three levels (5n0, 10n0 and 20n0 mmol\day) each in four infusion patterns (as one, two, or four 3-h infusion periods per day or infused continuously, P1 to P4 respectively). Urine was collected hourly over 24 h, and plasma samples were collected hourly for 7 h from the start of purine infusion. Both the plasma concentration of PD and its urinary excretion changed rapidly in response to the start and termination of purine infusion with a lag time of 2-3 h. Individual sheep differed considerably in the relative proportions of the different purine derivatives in the urine. The endogenous urinary PD excretion averaged 176 (p.. 28) µmol\kg W! n (& per day. Daily PD excretion in urine increased with the amount of purine infusion, but at each level the output decreased significantly in a gradient from P1 to P4. The response of total PD excretion (Y, mmol\day) to daily purine input (X, mmol\day) was predictable and followed the equation : Y l 0n81 (p0n02)Xj3n07(p0n81)i(u e −! n #(X/uj1ku), where u is the duration over which the daily input was infused expressed as a proportion of 24 h. The recovery of the infused purines averaged 81 %. When the infusion was given continuously, plasma PD concentration was relatively stable and was linearly correlated with the purine entry rate and daily PD excretion in the urine. The estimated glomerular filtration rate was 150 (p.. 16) litres\day and the estimated tubular transport maximum was 2n6 (p.. 1n3) mmol\day. It is concluded that due to the rapidity in the response of plasma and urinary PD to changes in the exogenous purine supply, spot measurements of PD in urine or plasma can be of no value for the estimation of exogenous purine uptake unless the purine supply is relatively constant throughout the day. Daily PD excretion in urine related to the exogenous purine uptake in a predictable and reproduceable manner and provides a reliable index for the estimation of the exogenous purine uptake.

Infectious pancreatic necrosis (IPN) is a well-known acute viral disease of salmonid species. We have identified quantitative trait loci (QTLs) associated with resistance to this disease in rainbow trout. We searched for linkage among 51 microsatellite markers used to construct a framework linkage map in backcross families of rainbow trout (Oncorhynchus mykiss), produced by crossing IPN-resistant (YN-RT201) and -susceptible (YK-RT101) strains. Two putative QTLs affecting disease resistance were detected on chromosomes A (IPN R S-1) and C (IPN R/S-2), respectively, suggesting that this is a polygenic trait in rainbow trout. These markers have great potential for use in marker-assisted selection (MAS) for IPN resistance and provide the basis for cloning of IPN resistance genes. Clarification of the genetic bases of complex traits has broad implications for fundamental research, but will also be of practical benefit to fish breeding.

Urinary purine derivative (PD) excretion was estimated to examine the effect of rumen protozoa on total PD excretion in goats fed hay and a concentrate diet. The effect of increasing protozoa number in the rumen on nitrogen (N) balance and urinary PD excretion was determined after inoculation. Protozoa increased slowly until 4 days after inoculation, and on the 5th day after inoculation rapidly, finally (10 days) reaching 4·1×105/ml of rumen contents similar to that before defaunation. Urinary N excretion showed a small (non-significant) decrease. Urinary PD excretion did not change until the 7th day, and then the level decreased on the 8th day after faunation presumably due to the effect of increased protozoa in the rumen. The mean urinary total PD excretion significantly (P<0·05) decreased in the defaunated group compared with that in the faunated group. Comparable changes were not seen in plasma PD level of faunated and defaunated groups.

Soluble glass bolus (SGB) with selenium (Se) was administered intraruminally to Se-deficient Philippine does to determine its effect on milk Se and to correlate the Se contents of does' milk and blood of does and kids. Five months after the Se administration, the does in the treated group (n = 14) had higher (p < 0.01) Se content in their blood (62.2 vs 25.7 micrograms/L) and milk (5.1 vs 2.5 micrograms/L) than does in control group (n = 13). Consequently, the blood Se of the kids (n = 14) from the treated does was higher (p < 0.05) than those kids (n = 13) in the control group (28.0 vs 5.1 micrograms/L). Blood and milk Se of does and blood Se of their kids correlated (p < 0.01) with each other. The increased Se level of does' milk because of Se supplementation was not regarded as a health hazard to humans.

Albinism in animals is generally a recessive trait, but in Japan a dominant oculocutaneous albino (OCA) mutant strain has been isolated in rainbow trout (Oncorhyncus mykiss). After confirming that this trait is not due to a tyrosinase gene mutation that causes OCA1 (tyrosinase-negative OCA), we combined the amplified fragment length polymorphism (AFLP) technique with bulked segregant analysis (BSA) to map the gene involved in dominant oculocutaneous albinism. Four AFLP markers tightly linked to the dominant albino locus were identified. One of these markers was codominant and we have it converted into a GGAGT-repeat microsatellite marker, OmyD-AlbnTUF. Using this pentanucleotide-repeat DNA marker, the dominant albino locus has been mapped on linkage group G of a reference linkage map of rainbow trout. The markers identified here will facilitate cloning of the dominant albino gene in rainbow trout and contribute to a better understanding of tyrosinase-negative OCA in animals.

A 20-year-old man was admitted to hospital with episodes of passing painless bloody stools and syncope. When he arrived, he was in a state of shock with severe dehydration. Laboratory data showed a hemoglobin (Hb) level of 8.6 g/dL. Esophagogastroduodenoscopy and colonoscopy did not show the cause of bleeding. Capsule endoscopy (PillCam SB 2; Given Imaging, Yoqneam, Israel) was then carried out. The video sequence showed a stenotic structure of the lower ileum and shallow ulcers with oozing on the edge of the stenosis (• " Fig. 1). Gradually, the area around the capsule filled with blood, and the capsule stayed in exactly the same position for the last 3.5 hours of the battery's life. To confirm the diagnosis and collect the capsule, enteroscopy with a double-balloon enteroscope (EN-450P5/20; Fujinon, Saitama, Japan) was performed under fluoroscopic guidance via the anal route 1 day after capsule endoscopy. A large diverticulum, in which there was a shallow ulcer and with stenosis in the middle, was found about 60 cm proximal to the ileocecal valve (• " Fig. 2 a). UCTN-Unusual cases and technical notes E199

Objectives To explore the therapeutic role of deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab. Patients and methods Forty-one patients with synchronous metastatic renal cell carcinoma who received nivolumab plus ipilimumab as first-line systemic therapy at our affiliated institutions were retrospectively evaluated. We focused on the prognosis, including tumor responses in primary kidney and metastatic lesions in patients treated with deferred cytoreductive nephrectomy. In addition, the overall survival according to nephrectomy status (i.e. deferred cytoreductive nephrectomy vs. upfront cytoreductive nephrectomy vs. without cytoreductive nephrectomy) was compared. Results During a median follow-up period of 12.0 months, seven (30%) patients received deferred cytoreductive nephrectomy at a median time of 10.4 months after nivolumab plus ipilimumab initiation. All the patients showed tumor shrinkage in their primary kidney lesions, including six (86%) patients with ≥30% of shrinkage. Metastatic lesions were also shrunk by ≥30% in six (86%) patients, including two (29%) obtaining complete response. At the last time of follow-up, three (43%) patients were disease-free. The overall survival rate after nivolumab plus ipilimumab initiation tended to be higher in patients with deferred cytoreductive nephrectomy compared with those with upfront cytoreductive nephrectomy (1-year survival rate: 100% vs. 72.4%, P = 0.0587) and those without cytoreductive nephrectomy (vs. 58.2%, P = 0.0613). Conclusions The present retrospective data showed that deferred cytoreductive nephrectomy had the potential to exert a therapeutic effect in a subset of patients who obtained favorable tumor responses to nivolumab plus ipilimumab for a certain period. Prospective randomized clinical trials are needed to confirm the prognostic impact of deferred cytoreductive nephrectomy after frontline immunotherapy in synchronous metastatic renal cell carcinoma.