Comparison of twice-daily injections of biphasic insulin lispro and basal-bolus therapy: glycaemic control and quality-of-life of insulin-naïve type 2 diabetic patients.

OBJECTIVE: The aim of this study was to evaluate twice-daily injections of biphasic insulin lispro vs. basal-bolus (BB) therapy with regard to quality-of-life (QOL) and glycaemic control in insulin-naïve type 2 diabetic patients. METHODS: Twenty-eight patients with type 2 diabetes were randomized to receive either twice-daily 50/50 premixed insulin lispro (Mix50 group) or BB (NPH insulin at bedtime and preprandial insulin lispro) therapy (BB group) for 12 weeks. Glycated haemoglobin (HbA1C), 1,5-anhydroglucitol (1,5-AG), blood plasma glucose level, body mass index (BMI), daily total insulin dosage and insulin therapy-related QOL (ITR-QOL) were studied. RESULTS: ITR-QOL was significantly better in the Mix50 than in the BB group (103.1 +/- 9.8 vs. 90.6 +/- 19.4; p < 0.05). HbA(1c) improved in both groups (from 11.1 +/- 2.1 to 6.9 +/- 1.0% with Mix50 vs. from 11.0 +/- 2.3 to 6.6 +/- 0.8% with BB therapy). CONCLUSION: These results might suggest that twice-daily injections of premixed rapid-acting insulin analogue therapy could achieve good glycaemic control and better QOL compared with BB therapy in insulin-naïve type 2 diabetes.

Perceptual continuation and depth in visual phantoms can be explained by perceptual transparency.

We try to explain perceptual continuation and depth in the visual-phantom illusion in terms of perceptual transparency. Perceptual continuation of inducing gratings across the occluder in stationary phantoms could be explained with unique transparency, a notion proposed by Anderson (1997 Perception 26 419-453). This view is consistent with a number of previous reports including that of McCourt (1994 Vision Research 34 1609-1617) who criticized the stationary phantom illusion from the viewpoint of his counterphase lightness induction or grating induction, which might involve invalid transparency. Here we confirm that the photopic phantom illusion (Kitaoka et al, 1999 Perception 28 825-834) really gives in-phase lightness induction and involves bistable transparency. It is thus suggested that perceptual continuation and depth in the visual-phantom illusion depend on perceptual transparency.

Two competing mechanisms underlying neon color spreading, visual phantoms and grating induction.

Neon color spreading is closely related to the photopic visual phantom illusion, since these two completion phenomena are characterized by in-phase lightness induction, and the only difference in the stimulus configuration is the difference in the inducer height. This idea was supported by the present study. Neon color spreading showed almost the same function of critical spatial frequency as photopic visual phantoms (Experiment 1), and the critical spatial frequency was constant as the inducer height was changed (Experiment 2). We also examined the relationship between neon color spreading and grating induction (characterized by counterphase lightness induction) in critical spatial frequency (Experiment 3) and in magnitudes of lightness induction (Experiment 4) as a function of the inducer height. The inducer height at which in-phase (neon color spreading) appearance gave way to counterphase (grating) induction was approximately 0.1 deg. These results suggest that neon color spreading shares a common neural mechanism with the photopic visual phantom illusion and that this mechanism is different from, and competes with, the mechanism of grating induction.

Similarity between Petter's effect and visual phantoms.

Here we draw attention to similarity between Petter's effect and the visual phantom illusion. Phantoms are visible when the spatial frequency of the inducing grating is low or the occluder is thin, whereas phantoms are invisible when the spatial frequency of the inducing grating is high or the occluder is thick. Moreover, phantoms are perceived in front of the occluder when they are visible, whereas the occluder is seen in front of the inducing gratings when phantoms are invisible. These characteristics correspond to Petter's effect, in which the thicker region tends to be perceived in front of the thinner region when two regions of the same lightness and of different sizes overlap, since 'thick' corresponds to low spatial frequency of the inducing grating or a thick occluder while 'thin' corresponds to high spatial frequency of the inducing grating or a thin occluder.

Last but not least.

New variations of the spiral illusion are demonstrated. They include spiral illusions of the Café Wall illusion and the Zöllner illusion, as well as other new orientation illusions. Thus the spiral illusion is not limited to the Fraser illusion. We discuss the role that detectors of spirals in a higher visual area might play in the spiral illusion.

Postsurgical sequential methotrexate/5-FU and leucovorin on outpatient basis for advanced colorectal carcinoma.

BACKGROUND/AIMS: The present study compared the effects of sequential methotrexate and 5-fluorouracil followed by leucovorin rescue (MFL), as an adjuvant chemotherapy versus a combination of UFT and mitomycin C (MMC), on patient survival and recurrence after surgery for colorectal carcinoma. METHODOLOGY: Between January 1990 and December 1997, a total of 55 patients with advanced colorectal cancer were treated postsurgically by adjuvant chemotherapy using MFL or UFT-MMC. Surgical treatment was performed according to standardized procedures for radical resection of colorectal cancer. The patients were divided into 2 groups after surgery. The MFL regimen consisted of MTX (100 mg/m2) and 5-FU (600 mg/m2) at hour 24, followed by leucovorin rescue. The UFT-MMC regimen consisted of MMC (12 mg/m2) intraoperatively and MMC (6 mg/m2) every other week after surgery for 2 months, and oral UFT (375 mg/m2/day), a combination of tegafur and uracil in a molar ratio of 1:4, was continued for 3 years or longer depending on the patients tolerance. RESULTS: The overall survival rates after surgery were significantly (P < 0.05) higher in the MFL than the UFT-MMC group. Recurrence rates were significantly lower in the MFL than the UFT-MMC group, especially for liver recurrence. Disease-free survival was significantly (P < 0.05) higher in the MFL than the UFT-MMC group. CONCLUSIONS: These results demonstrated the superiority of MFL therapy for improving postsurgical survival in patients with advanced colorectal cancer, in particular those patients with a high risk of recurrence following potential curative resection.

Hepatic undifferentiated (embryonal) sarcoma in an adult: a case report and review of the literature.

Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant tumour with a poor prognosis. The absence of specific symptoms, the rapid tumour growth, the normality of the common tumour markers, and the consequential delay in the diagnosis often result in significant enlargement of the tumour. To our knowledge, there have been only 42 reported cases of USL in adults worldwide during the 40 years since the clinicopathological entity of USL was defined. We report here a 27-year-old male with USL who has been treated successfully with surgical resection and adjuvant chemotherapy using ifosfamide, adriamycin and cisplatin. Although the prognosis of the disease remains generally poor, long-term survival has been achieved recently in patients with a combination of surgery and multi-agent chemotherapy.

Density of Helicobacter pylori infection evaluated semiquantitatively in gastric cancer.

Helicobacter pylori infection may play a role in the development of gastric cancer; however, a quantitative evaluation of the density of H. pylori infection has not been reported previously in relation to the histologic stage and type of cancer. This study was designed to compare the density of H. pylori infection to the histologic stage and type of gastric cancer. Between March 1996 and March 1998, surgical resection of primary lesion was performed in 50 patients with gastric cancer (39 men and 11 women with a mean age of 67 years) at our institution. Using immunohistochemical stains, the density of H. pylori infection was evaluated semiquantitatively at cancer site as well as noncancerous mucosa adjacent to cancer. This density was compared with the histologic stage and the type of gastric cancer. The severity of the mucosal atrophy was evaluated using the updated Sydney System. The prevalences and density of H. pylori infection decreased in proportion to advances in the cancer stage and the mucosal atrophy. In early cancer of the intestinal- and diffuse-type, the prevalence of H. pylori in adjacent sites was almost 90% and was significantly higher (p < 0.01) than that seen in the advanced cancer lesions. In the intestinal-type early cancer, the prevalence and density of infection was higher (p < 0.05) in the adjacent mucosa than in the cancer site, whereas in the diffuse-type early cancer, H. pylori was found in all cases at the cancer site and the adjacent site. In advanced cancer, the prevalence of H. pylori was about 40% in the adjacent site and about 10% in the cancer site in both histologic types. These figures were significantly lower (p < 0.01) than in the early cancers. The prevalence and density of infection did not differ in the intestinal- and diffuse-type gastric cancers, but did decrease with more advanced cancer stages. The changes in local environment of the advanced cancer may not be conducive to the survival of H. pylori. Thus, the prevalence of H. pylori may be affected by the histologic stage rather than the histologic type of gastric cancer, and the organism may play a similar role, but through different pathways, in the pathogenesis of both types of cancer.

Postsurgical sequential methotrexate, fluorouracil, and leucovorin for stages 3 and 4 gastric carcinoma: A preliminary study.

BACKGROUND AND OBJECTIVES: The present study compared the effects of sequential methotrexate and fluorouracil followed by leucovorin rescue (MFL), as an adjuvant chemotherapy vs. UFT (a combination of uracil and tegafur), on patient survival and recurrence following surgery for advanced gastric carcinoma. METHODS: Between July 1990 and June 1998, a total of 54 patients with advanced gastric cancer were treated postoperatively by adjuvant chemotherapy using MFL or UFT. Surgical treatment was performed according to standardized procedures for radical resection of gastric cancer. The patients were stratified into two groups following surgery. The MFL regimen consisted of methotrexate (100 mg/m2) and 5-fluorouracil (600 mg/m2) at hour 3, followed by leucovorin rescue. The oral UFT (375 mg/m2/day), a combination of tegafur and uracil in a molar ratio of 1:4, was continued for 3 years or longer depending on the patients tolerance. RESULTS: In stage 3 gastric cancer, the overall survival rates following surgery was significantly (p < 0.05) higher in the MFL than the UFT group. Difference in disease free survival was not statistically significant between the groups. Recurrence rates showed a trend (p = 0.08) to decrease in the MFL than the UFT group. In stage 4 gastric cancer, no significant difference was obtained in the overall survival rates between the groups. CONCLUSIONS: The present results suggested the superiority of MFL treatment for improving postoperative survival in patients with advanced gastric cancer, in particular for those patients with a high risk of recurrence following potential curative resection. In patients with stage 4 gastric cancer, however, MFL treatment showed similar effects as UFT on the postsurgical survival of the patients.

Modified rapid urease test for Helicobacter pylori detection in relation to an immunohistochemical stain.

BACKGROUND: The rapid urease test and touch cytology have been used for the rapid detection of Helicobacter pylori infection. Recently, a modified rapid urease (MRU) test, which provides results in 20 min has been available on a commercial basis. To date, few reports have evaluated the accuracy of this test. This study evaluated the sensitivity, specificity, and accuracy of the MRU test and touch cytology to detect H. pylori in relation to the density of H. pylori infection determined semi-quantitatively by using immunohistochemical stains. METHODS: Biopsy specimens obtained from a total of 60 patients who underwent endoscopy for evaluation of gastroduodenal diseases were studied by using the MRU test, Giemsa stain for touch smear tissue and histological methods. An immunohistochemical stain was used as a standard, and the density of H. pylori infection was graded according to the number of individual bacteria seen as follows: grade 0 = 0; grade 1+ = 1-9; grade 2+ = 10-29; grade 3+ = 30-99; grade 4+ > or = 100. The severity of gastritis was evaluated histologically in each specimen and compared with the density of H. pylori infection. RESULTS: The MRU test had an overall sensitivity of 73%, specificity of 100% and accuracy of 85%. The Giemsa stain had a sensitivity of 91%, specificity of 100% and accuracy of 95%.The sensitivities of the MRU test and Giemsa stain decreased in mild H. pylori infection. In the MRU test, the sensitivity was 47% when the density of H. pylori infection was 1+, while 80-100% sensitivities were obtained when the densities of infection were > or = 2+. With the Giemsa stain, the sensitivity was 80% when the density was 1+, while the sensitivity increased to 100% when the densities were > or = 2+. The severity of gastritis determined by the Rauws scores showed a positive correlation with the density of H. pylori infection as evaluated by immunohistochemical staining. CONCLUSIONS: The MRU test had high sensitivity and specificity for moderate to severe H. pylori infection, but it may result in false-negative results in tests for mild infection. As the MRU test has the advantages of shorter incubation times and low cost, a combination of the MRU test and the Giemsa stain for touch cytology may be the most time- and cost-efficient tests in a clinical setting for the diagnosis of H. pylori infection.

Three elemental illusions determine the Zöllner illusion.

We have discovered an apparent contraction illusion of acute angles in a special form of the Zöllner figure at the intersecting angles between 36 degrees and 83 degrees (i.e., a reversal of the Zöllner illusion). The necessary condition for this illusion is that inducing lines are long enough and the induced line (test line) is single. When an illusory line is used as the induced line, the magnitude of contraction increases. Short inducing lines give no illusion or a slight expansion of acute angles at the intersecting angle of 45 degrees. We have ascertained that the source of this expansion is the narrow region in the vicinity of the induced line, whereas the source of the contraction is much broader regions. Furthermore, we have discovered another expansion mechanism, which is generated by the symmetrical configuration of the standard Zöllner figure.

Jejunal pouch to avoid stricture after esophagojejunostomy with circular stapler.

BACKGROUND: Anastomotic stricture is one of the most common problems in esophagojejunostomy using the end-to-end anastomosing (EEA) instrument (Auto Suture Co, Norwalk, CT) after total gastrectomy. To alleviate the stricture, several methods, such as incision to the scar, balloon dilatation, and steroid injection are available. To avoid stricture, the jejunal pouch may allow use of a larger EEA than Roux-en-Y (ReY) reconstruction does. STUDY DESIGN: A total of 45 patients underwent curative total gastrectomy and esophagojejunostomy with jejunal pouch construction (27 patients) or ReY (18 patients), using the EEA. The effects of jejunal pouch construction with a large EEA on avoidance of stricture and benefit to nutritional status were investigated by comparing it with the ReY in terms of postoperative morbidity, postprandial symptoms, and nutritional parameters (serum protein, serum albumin, body weight). RESULTS: EEA28 or larger could be used in 25 patients in the pouch group and 8 patients in the ReY group (p < 0.05). Stricture developed in one patient in the pouch group and in four patients in the ReY group (p < 0.05). Postprandial symptoms were experienced less frequently (p < 0.05) in the pouch group than in the ReY group. When stricture and symptoms were analyzed according to the size of EEA, they occurred more frequently (p < 0.05) in the patients with EEA25 than those with EEA28 or EEA31. No significant differences were evident in nutritional parameters. CONCLUSIONS: The choice of jejunal pouch technique allowed the use of a larger EEA than that of ReY reconstruction, resulting in avoidance of anastomotic stricture and postprandial symptoms, though little benefit in nutritional status was evident to the patients after total gastrectomy.

Cloning and expression of yellowtail ascites virus segment A.

cDNA of yellowtail ascites virus (YAV) segment A encoding a polyprotein of VP2, NS, and VP3 has been cloned. Comparison of the nucleotide and the deduced amino acid sequences showed very high homology between YAV and other aquatic birnaviruses. The two small open reading frames (VP5) besides the 5' terminus of the VP2 gene were found on segment A of YAV. Proteins encoded by cDNAs from segment A and the serotype-specific epitope region on VP2 were expressed using a baculovirus vector. Western blot analysis confirmed that a polyprotein was expressed and processed into VP2 and VP3 in insect cells infected with the recombinant baculovirus containing the complete polyprotein coding region. In the case of expression in silkworm larvae, only VP3 was detected in hemocytes and fat body of silkworm larvae infected with the recombinant virus. The recombinant fusion protein consisting of VP2 epitope region and polyhedrin was expressed in insect cells and cross-reacted with a mouse monoclonal antibody against VP2 which had a neutralizing activity to YAV.

A case of colon cancer recurrence with P-glycoprotein treated by methotrexate, fluorouracil, and leucovorin.

A 68 year-old female underwent right hemicolectomy for an advanced cecum cancer and had been well without any evidence of recurrence for a year after surgery. Despite post-operative treatment with oral Tegafur (400 mg/m2/day), CEA level increased gradually beginning 15 months after surgery. Sequential chemotherapy with methotrexate (MTX) and 5-Fluorouracil (5-FU), followed by leucovorin rescue (MFL) was started on an outpatient basis, and has been continued every 4 weeks since then. It consisted of MTX (100 mg/m2) and 5-FU (600 mg/m2) started 24 hours after MTX, followed by oral leucovorin (15 mg/body) started 30 hours after MTX 6 times at intervals of 6 hours. CEA level declined initially, but increased slowly for 3 years on MFL, although no evidence of recurrence was detected by imaging studies with computed tomography, ultrasound, and scintigram. Four years after surgery, a tumor recurrence developed in the abdominal wall. The patient underwent resection of the tumor, resulting in a decline of the CEA level. She has been alive and well for 5 years on MFL after the primary surgery. Both the original tumor and recurrent tumor showed immunoreactivity for P-glycoprotein. The present case demonstrates the feasibility of using MFL on an outpatient basis, and its potential to suppress the colon cancer growth with P-glycoprotein expression.

Photopic visual phantom illusion: its common and unique characteristics as a completion effect.

An illusion similar to the stationary visual phantom illusion presented earlier by Gyoba (1983, Vision Research 23 205-211) is reported. This illusion is visible in photopic vision and we have tentatively named it the 'photopic phantom illusion'. A typical example of this illusion is a white and light-gray square-wave grating occluded by a black region. In this figure, a phantom grating running across the occluder with clear contours but less contrast, is seen. The critical spatial frequencies of photopic phantoms have been measured and compared with those of scotopic phantoms that have been reported previously, revealing a great resemblance between them. We discuss the characteristics of this illusion in terms of transparency, stereoscopic viewing, and perceptual completion.

Density of Helicobacter pylori infection in patients with peptic ulcer perforation.

BACKGROUND: A lack of change in prevalence of severe ulcer complications requiring emergency operation has been reported, despite the common use of histamine-2 (H2)-receptor antagonists and proton pump inhibitors. This may be attributable to use of ulcerogenic drugs or Helicobacter pylori (HP) infection, or both. In this study, HP infection was evaluated semiquantitatively in patients with peptic ulcer who required surgery, and the severity of histologic change was investigated. METHODS: We reviewed a total of 113 consecutive patients (98 men and 15 women) operated on for perforation, hemorrhage, or stenosis of gastroduodenal ulcer between January 1986 and December 1995. Detection of HP was carried out by immunohistochemical staining. We graded the density of HP infection according to the number of individual HP bacteria counted in a highly magnified visual field (x 1,000 of light microscopy). The grade of HP infection was defined as follows: (0) = 0; (1+) = 1-9; (2+) = 10-29; (3+) = 30-99; (4+) > or = 100. The severity of gastritis was evaluated by histologic examination using the criteria of Rauws. RESULTS: Although the number of operations for gastroduodenal ulcer declined significantly, the rate of emergency operation for gastroduodenal ulcer increased from 60% to 90%, with the result that the frequency of operations for perforation or bleeding remained virtually constant and that for stenosis significantly decreased. HP infection was more prevalent in perforated ulcer (92%) than hemorrhagic ulcer (55%) or stenotic ulcer (45%). The grades of HP infection were 3.0 +/- 0.14 (mean +/- SEM) in perforated ulcer, 2.3 +/- 0.34 in hemorrhagic ulcer, and 2.5 +/- 0.22 in stenotic ulcer. Perforated ulcer was associated with significantly more severe HP infection and gastritis changes than hemorrhagic ulcer or stenotic ulcer. CONCLUSIONS: This study indicates that patients with perforated ulcer were infected with HP more severely than those with hemorrhagic ulcer or stenotic ulcer at the time of surgery. A close relationship was observed between the perforated ulcer and the density of HP infection determined semiquantitatively using immunohistochemical stain.

Apparent contraction of edge angles.

The corner effect, the Münsterberg illusion, and the Café Wall illusion are explained by a model postulating that the corner effect is an orientation illusion specific to corner edges and that the perceived orientations of these edges are shifted toward angle contraction. It is also assumed that the effect is greatest when the corner edges show the same or similar edge contrast at the corner. This model yields three new types of illusions: the 'checkered illusion', the 'illusion of shifted gradations', and the 'illusion of striped cords'. Each of them gives many variations making a three-dimensional impression.

Tumor angiogenesis and mode of metastasis in patients with colorectal cancer.

Neovascularization promotes tumor growth by facilitating nutrient exchange and by the paracrine effect. To investigate the relationship between tumor angiogenesis and patient outcome in colorectal cancer, 133 primary tumors were immunostained for CD34 antigen. Blood vessels within five microscopic fields at x200 were counted, and the mean was assigned. Mean patient age was 62.9 years, mean follow-up was 56.4 months, and mean vessel count was 112 (range, 23-298). Cox proportional hazards model and multivariate logistic regression analyses showed that the vessel count was the most important prognostic factor and correlated significantly with hematogenous, but not peritoneal or lymph node, metastasis.

Improvement of in vitro chemosensitivity assay for human solid tumors by application of a preculture using collagen matrix.

The use of [3H]thymidine incorporation assay (TIA) to evaluate the drug response of tumor cells has been recognized as a useful chemosensitivity assay for fresh human tumor specimens. However, its low evaluability has been a disadvantage for clinical application. To overcome this drawback, we have applied a preculture stage prior to the TIA. This preculture requires plating the tumor cell suspension onto a collagen matrix for 24 h. In 29 fresh human tumor specimens, a significant increase in both cell viability (P < 0.05) and [3H]thymidine incorporation (P < 0.001) of the cultured cells was observed with preculturing; the composition of cancer cells (epithelial membrane antigen positive) and stromal cells (vimentin positive) did not change. In comparisons between 66 specimens that were precultured and 705 specimens that were not, the evaluability rate increased significantly from 48.5% (342/705) to 75.8% (50/66; P < 0.0001) after preculturing. No significant change in in vitro chemosensitivities was observed. When the clinical responses for cancer chemotherapy were retrospectively compared with the in vitro sensitivities of the corresponding drugs on 16 patients who had measurable lesions, the correlation between the two was satisfactorily strong; the prediction accuracy for sensitivity was 83.3% (5/6), the prediction accuracy for resistance was 95.0% (19/20), and the overall correlation was 92.3% (24/26). These results indicate that TIA with preculturing yields increased rates of evaluability, preserving in vitro drug responses of cultured tumor cells, and has an improved potential to be used for determining clinical chemotherapy.

Tumor vascularity correlates with the prognosis of patients with esophageal squamous cell carcinoma.

BACKGROUND: Angiogenesis is essential for the growth of solid tumors. Intratumoral microvessel count, which represents a measure of tumor angiogenesis, has been associated with the overall survival of patients with a variety of malignancies. However, little is known about the significance of neovascularization in esophageal squamous cell carcinoma. METHODS: In this study, the role of tumor angiogenesis as a prognostic indicator was examined in esophageal squamous cell carcinomas from 43 patients. Vascular endothelial cells were stained with anti-CD34 and anti-von Willebrand factor monoclonal antibodies before being quantitated by light microscopy (x 200). RESULTS: Significant correlation between vessel counts for two antibodies was observed, although counts for CD34 were approximately three times higher. Intratumoral vessel counts were significantly higher in tumors with deeper penetration. Multivariate analyses indicated that vessel counts determined by either CD34 or von Willebrand factor staining, as well as lymph node metastasis, were identified as significant and independent prognostic factors in patients with esophageal squamous cell carcinoma. CONCLUSIONS: These findings support the hypothesis that tumor angiogenesis is closely related to the overall survival of patients with esophageal squamous cell carcinoma. The extent of tumor vascularity may serve as a reliable prognostic marker with which patients at risk for recurrence can be identified.