A reliable serum C-peptide index for the selection of an insulin regimen to achieve good glycemic control in obese patients with type 2 diabetes: an analysis from a short-term study with intensive insulin therapy

Insulin regimens achieving favorable glycemic control in patients with type 2 diabetes are expected to closely relate to residual insulin secretory ability. We herein attempted to identify a reliable C-peptide immunoreactivity (CPR) index as an insulin secretory marker that would contribute to the selection of an appropriate insulin regimen for patients with type 2 diabetes. We near-normalized blood glucose in 246 obese patients with type 2 diabetes using our protocol (which included short-term intensive insulin therapy, IIT), and administered an oral hypoglycemic agent (OHA). Based on responsiveness to OHA, patients were classified into three therapy groups: non-insulin therapy (n = 78), basal-insulin supported oral therapy (BOT) (n = 109), and multiple daily insulin injection (MDI) therapy (n = 59). Glucagon-loading CPR increment (ΔCPR), fasting CPR (FCPR), CPR2h after breakfast (CPR2h), ratio of FCPR to fasting plasma glucose (CPI), CPI2h after breakfast (CPI2h), and secretory unit of islets in transplantation (SUIT) were assessed with receiver operating characteristic (ROC) and multiple logistic analyses to discriminate the MDI group from the other therapy groups. ROC analysis revealed that CPR2h had the greatest area under the curve and specificity. Multiple logistic analysis identified CPR2h and CPI2h as the most significant explanatory variables for identifying patients assigned to the MDI group. A postprandial serum CPR marker such as CPR2h or CPI2h was shown to be the best index for predicting an appropriate insulin regimen to achieve good glycemic control in obese patients with type 2 diabetes.

Observation of a New Narrow Axial-Vector Meson a1(1420)

The COMPASS Collaboration at CERN has measured diffractive dissociation of 190  GeV/c pions into the π(-)π(-)π(+) final state using a stationary hydrogen target. A partial-wave analysis (PWA) was performed in bins of 3π mass and four-momentum transfer using the isobar model and the so far largest PWA model consisting of 88 waves. A narrow peak is observed in the f0(980)π channel with spin, parity and C-parity quantum numbers J(PC)=1(++). We present a resonance-model study of a subset of the spin-density matrix selecting 3π states with J(PC)=2(++) and 4(++) decaying into ρ(770)π and with J(PC)=1(++) decaying into f0(980)π. We identify a new a1 meson with mass (1414(-13)(+15))  MeV/c2 and width (153(-23)(+8))  MeV/c2. Within the final states investigated in our analysis, we observe the new a1(1420) decaying only into f0(980)π, suggesting its exotic nature.

Measurement of the charged-pion polarizability

The COMPASS collaboration at CERN has investigated pion Compton scattering, π(-)γ→π(-)γ, at center-of-mass energy below 3.5 pion masses. The process is embedded in the reaction π(-)Ni→π(-)γNi, which is initiated by 190 GeV pions impinging on a nickel target. The exchange of quasireal photons is selected by isolating the sharp Coulomb peak observed at smallest momentum transfers, Q(2)<0.0015  (GeV/c)(2). From a sample of 63,000 events, the pion electric polarizability is determined to be α(π)=(2.0±0.6(stat)±0.7(syst))×10(-4)  fm(3) under the assumption α(π)=-β(π), which relates the electric and magnetic dipole polarizabilities. It is the most precise measurement of this fundamental low-energy parameter of strong interaction that has been addressed since long by various methods with conflicting outcomes. While this result is in tension with previous dedicated measurements, it is found in agreement with the expectation from chiral perturbation theory. An additional measurement replacing pions by muons, for which the cross-section behavior is unambiguously known, was performed for an independent estimate of the systematic uncertainty.

Postprandial serum C-peptide value is the optimal index to identify patients with non-obese type 2 diabetes who require multiple daily insulin injection: Analysis of C-peptide values before and after short-term intensive insulin therapy

Aims/Introduction

Type 2 diabetes is a progressive disease characterized by a yearly decline in insulin secretion; however, no definitive evidence exists showing the relationship between decreased insulin secretion and the need for insulin treatment. To determine the optimal insulin secretory index for identifying patients with non‐obese type 2 diabetes who require multiple daily insulin injection (MDI), we evaluated various serum C‐peptide immunoreactivity (CPR) values.

Materials and Methods

We near‐normalized blood glucose with intensive insulin therapy (IIT) over a 2‐week period in 291 patients with non‐obese type 2 diabetes, based on our treatment protocol. After improving hyperglycemia, we challenged with oral hypoglycemic agent (OHA), and according to the responsiveness to OHA, patients were classified into three therapy groups: OHA alone (n = 103), basal insulin plus OHA (basal insulin‐supported oral therapy [BOT]; n = 56) and MDI (n = 132). Glucagon‐loading CPR increment (ΔCPR), fasting CPR (FCPR), CPR 2 h after breakfast (CPR2h), the ratio of FCPR to FPG (CPI), CPI 2 h after breakfast (CPI2h) and secretory unit of islets in transplantation (SUIT) were submitted for the analyses. Receiver operating characteristic (ROC) and multiple logistic analyses for these CPR indices were carried out.

Results

Many CPR values were significantly lower in the MDI group compared with the OHA alone or BOT groups. ROC and multiple logistic analyses disclosed that post‐prandial CPR indices (CPR2h and CPI2h) were the most reliable CPR markers to identify patients requiring MDI.

Conclusions

Postprandial CPR level after breakfast is the most useful index for identifying patients with non‐obese type 2 diabetes who require MDI therapy.

First measurement of chiral dynamics in π- γ → π- π- π+

The COMPASS Collaboration at CERN has investigated the π- γ → π- π- π+ reaction at center-of-momentum energy below five pion masses, sqrt[s]<5m(π), embedded in the Primakoff reaction of 190 GeV pions impinging on a lead target. Exchange of quasireal photons is selected by isolating the sharp Coulomb peak observed at smallest momentum transfers, t'<0.001  GeV2/c2. Using partial-wave analysis techniques, the scattering intensity of Coulomb production described in terms of chiral dynamics and its dependence on the 3π-invariant mass m(3π)=sqrt[s] were extracted. The absolute cross section was determined in seven bins of sqrt[s] with an overall precision of 20%. At leading order, the result is found to be in good agreement with the prediction of chiral perturbation theory over the whole energy range investigated.

Observation of a J(PC)=1-+ exotic resonance in diffractive dissociation of 190 GeV/c π- into π- π- π+

The COMPASS experiment at the CERN SPS has studied the diffractive dissociation of negative pions into the π- π- π+ final state using a 190  GeV/c pion beam hitting a lead target. A partial wave analysis has been performed on a sample of 420,000 events taken at values of the squared 4-momentum transfer t' between 0.1 and 1  GeV2/c2. The well-known resonances a1(1260), a2(1320), and π2(1670) are clearly observed. In addition, the data show a significant natural-parity exchange production of a resonance with spin-exotic quantum numbers J(PC)=1-+ at 1.66  GeV/c2 decaying to ρπ. The resonant nature of this wave is evident from the mass-dependent phase differences to the J(PC)=2-+ and 1++ waves. From a mass-dependent fit a resonance mass of (1660±10(-64)(+0))  MeV/c2 and a width of (269±21(-64)(+42))  MeV/c2 are deduced, with an intensity of (1.7±0.2)% of the total intensity.

"Type 1 on type 2" diabetes mellitus: autoimmune type 1 diabetes superimposed on established type 2 diabetes

OBJECTIVE

To investigate clinical features and pathophysiology of a rare form of new-onset type 1 diabetes mellitus that was superimposed on established type 2 diabetes.

PATIENTS AND METHODS

We retrospectively analyzed 126 consecutive type 2 diabetic patients, who were admitted to the hospital 2 or more times from July 2000 to December 2005 and had been repeatedly examined for islet-associated autoantibodies and insulin secretory capacity over a period of years.

RESULTS

We experienced 2 patients in whom autoantibodies including ICA, GADAb, and IA-2Ab were initially all negative, but in whom at least 1 of these antibodies later became positive, whose endogenous insulin secretion decreased, and who eventually reached an insulin-dependent stage. At the time of seroconversion of antibodies, the patients had 15 to 23 years' history of diabetes, and had microvascular complications specific to diabetes mellitus, and before seroconversion insulin secretory capacities were preserved. The patients had HLA types associated with susceptibility to Japanese type 1 diabetes mellitus.

CONCLUSIONS

Our findings suggest that autoimmune type 1 diabetes mellitus may be superimposed on well-established type 2 diabetes.

[Pulmonary pleomorphic carcinoma; report of 2 cases]

The 1st case was a 74-year-old male diagnosed as femoral neck fracture. Biopsy of the bone revealed metastatic adenocarcinoma. Chest computed tomography (CT) showed a mass lesion located in the right lower lobe. With a diagnosis of primary lung cancer (cT2N1M1), two-staged operation was performed. Pathological diagnosis was pleomorphic carcinoma [pT2N1M1 (OSS), stage IV]. He died 8 months after surgery due to metastasis to the thoracic spine. The 2nd case was a 80-year-old female who complained of lateral chest pain. Chest CT revealed a tumor in the right hilar region, which was diagnosed as adenocarcinoma by transbronchial lung biopsy. Only thoracic drainage was performed since metastases to the brain and the rib were demonstrated. She died 2 months after admission. Autopsy revealed pleomorphic carcinoma of the lung with metastasis to the brain, costa and mediastinal lymph nodes.

Optical-damage-free guided second-harmonic generation in 1% MgO-doped stoichiometric lithium tantalate

Room-temperature cw second-harmonic generation from telecom wavelengths, with 30% W(-1) cm(-2) efficiency and second-harmonic power levels up to 41 mW, was achieved in buried waveguides fabricated by reverse-proton exchange in 1% MgO-doped stoichiometric lithium tantalate without any evidence of optical damage. The technology proves suitable for the realization of efficient nonlinear frequency converters and all-optical devices.

Peroxisome proliferator-activated receptor (PPAR)alpha activation increases adiponectin receptors and reduces obesity-related inflammation in adipose tissue: comparison of activation of PPARalpha, PPARgamma, and their combination

We examined the effects of activation of peroxisome proliferator-activated receptor (PPAR)alpha, PPARgamma, and both of them in combination in obese diabetic KKAy mice and investigated the mechanisms by which they improve insulin sensitivity. PPARalpha activation by its agonist, Wy-14,643, as well as PPARgamma activation by its agonist, rosiglitazone, markedly improved insulin sensitivity. Interestingly, dual activation of PPARalpha and -gamma by a combination of Wy-14,643 and rosiglitazone showed increased efficacy. Adipocyte size in Wy-14,643-treated KKAy mice was much smaller than that of vehicle- or rosiglitazone-treated mice, suggesting that activation of PPARalpha prevents adipocyte hypertrophy. Moreover, Wy-14,643 treatment reduced inflammation and the expression of macrophage-specific genes in white adipose tissue (WAT). Importantly, Wy-14,643 treatment upregulated expression of the adiponectin receptor (AdipoR)-1 and AdipoR2 in WAT, which was decreased in WAT of KKAy mice compared with that in nondiabetic control mice. Furthermore, Wy-14,643 directly increased expression of AdipoRs and decreased monocyte chemoattractant protein-1 expression in adipocytes and macrophages. Rosiglitazone increased serum adiponectin concentrations and the ratio of high molecular weight multimers of adiponectin to total adiponectin. A combination of rosiglitazone and Wy-14,643 increased both serum adiponectin concentrations and AdipoR expression in WAT. These data suggest that PPARalpha activation prevents inflammation in WAT and that dual activation of PPARalpha and -gamma enhances the action of adiponectin by increasing both adiponectin and AdipoRs, which can result in the amelioration of obesity-induced insulin resistance.

Generation of globular fragment of adiponectin by leukocyte elastase secreted by monocytic cell line THP-1

Previous studies revealed that carboxyl-terminal fragment containing the globular domain of adiponectin exists in human plasma. Although it is proposed that the globular fragment is generated by proteolytic cleavage, the place and responsible enzyme of the cleavage are still unclear. In this study, we evaluated the activity to cleave adiponectin in culture medium of several cell lines in vitro. Adiponectin cleavage into several carboxyl-terminal fragments containing the globular domain was observed in the medium of phorbol 12-myristate 13-acetate-stimulated monocytic cell lines THP-1 and U937. The molecular masses of the major products were 25, 20, and 18 kDa. The cleavage was thought to be mediated by leukocyte elastase (also known as neutrophil elastase) based on the following observations. First, the cleavage was inhibited by serine-protease inhibitors [phenylmethylsulfonylfluoride, Pefabloc SC (Roche Diagnostics, Basel, Switzerland) and aprotinin] and by the leukocyte elastase-specific peptide inhibitor MeOSuc-AAPV-CMK. Second, no activity was detected after THP-1 cells had fully differentiated into macrophages. Third, purified leukocyte elastase cleaved adiponectin with the same cleavage pattern as THP-1 cells. Finally, leukocyte elastase secreted by activated neutrophils cleaved adiponectin into the globular fragments. Amino-terminal sequence analysis revealed that cleavage sites of adiponectin by purified leukocyte elastase were between 38Thr and 39Cys, 40Ala and 41Gly, 44Ala and 45Gly, 91Ala and 92Glu, and 110Ala and 111Ala (the numbering of the positions of the amino acids starts at the signal sequence), suggesting that the cleavage occurs in the collagenous domain. These data indicate that the cleavage of adiponectin by leukocyte elastase secreted from activated monocytes and/or neutrophils could be a candidate for the mechanism of the generation of the globular fragment of adiponectin.

A novel IKKβ inhibitor stimulates adiponectin levels and ameliorates obesity-linked insulin resistance

Adiponectin is an anti-diabetic and anti-atherogenic hormone that is exclusively secreted from fat cells. Serum adiponectin levels are reduced in obese patients and obese model mice, despite increased adipose tissue mass. Elucidation of the mechanism(s) by which plasma adiponectin levels are decreased in obese and diabetic patients would provide insight into the cause of obesity-induced diabetes and the development of therapeutic advances. In the present study, the regulation of adiponectin secretion was investigated using 3T3-L1 adipocytes and a diabetic-/obese-mouse model. A novel insulin sensitizer, IkappaB kinase beta (IKKbeta) inhibitor, ameliorated insulin resistance and up-regulated plasma levels of adiponectin without producing a significant change in body weight in KKAy mice that were fed a high-fat diet. The IKKbeta inhibitor cancelled the TNFalpha-mediated down-regulation of adiponectin secretion and simultaneously up-regulated the phosphorylation of Akt in 3T3-L1 adipocytes. Using dominant-negative mutants of Akt or PKClambda (downstream effectors of phosphoinositide 3-kinase), insulin-stimulated Akt activity was found to be important in the regulation of adiponectin secretion by insulin in 3T3-L1 adipocytes. These observations suggest that "insulin-stimulated Akt activity in adipocytes" may play an important role in the regulation of adiponectin secretion.

Reverse-proton-exchange in stoichiometric lithium tantalate

Buried waveguides with nearly symmetrical refractive index profile and high homogeneity were obtained by applying the reverse-proton-exchange technique to MgO doped stoichiometric lithium tantalate, a promising nonlinear material due to its low coercive field and high damage threshold. By characterizing several samples fabricated under different experimental conditions, we identified a fabrication procedure in which the annealing and the reverse-exchange processes are performed at the same temperature, and the diffusion of hydrogen ions towards the substrate is negligible during the burial step. These fabrication conditions are simpler than the conventional ones used for lithium niobate. Accurate empirical laws were found, relating the fabrication conditions to the optical parameters.

Insulin/Foxo1 pathway regulates expression levels of adiponectin receptors and adiponectin sensitivity

Adiponectin/Acrp30 is a hormone secreted by adipocytes, which acts as an antidiabetic and antiatherogenic adipokine. We reported previously that AdipoR1 and -R2 serve as receptors for adiponectin and mediate increased fatty acid oxidation and glucose uptake by adiponectin. In the present study, we examined the expression levels and roles of AdipoR1/R2 in several physiological and pathophysiological states such as fasting/refeeding, obesity, and insulin resistance. Here we show that the expression of AdipoR1/R2 in insulin target organs, such as skeletal muscle and liver, is significantly increased in fasted mice and decreased in refed mice. Insulin deficiency induced by streptozotocin increased and insulin replenishment reduced the expression of AdipoR1/R2 in vivo. Thus, the expression of AdipoR1/R2 appears to be inversely correlated with plasma insulin levels in vivo. Interestingly, the incubation of hepatocytes or myocytes with insulin reduced the expression of AdipoR1/R2 via the phosphoinositide 3-kinase/Foxo1-dependent pathway in vitro. Moreover, the expressions of AdipoR1/R2 in ob/ob mice were significantly decreased in skeletal muscle and adipose tissue, which was correlated with decreased adiponectin binding to membrane fractions of skeletal muscle and decreased AMP kinase activation by adiponectin. This adiponectin resistance in turn may play a role in worsening insulin resistance in ob/ob mice. In conclusion, the expression of AdipoR1/R2 appears to be inversely regulated by insulin in physiological and pathophysiological states such as fasting/refeeding, insulin deficiency, and hyper-insulinemia models via the insulin/phosphoinositide 3-kinase/Foxo1 pathway and is correlated with adiponectin sensitivity.

Cloning of adiponectin receptors that mediate antidiabetic metabolic effects

Adiponectin (also known as 30-kDa adipocyte complement-related protein; Acrp30) is a hormone secreted by adipocytes that acts as an antidiabetic and anti-atherogenic adipokine. Levels of adiponectin in the blood are decreased under conditions of obesity, insulin resistance and type 2 diabetes. Administration of adiponectin causes glucose-lowering effects and ameliorates insulin resistance in mice. Conversely, adiponectin-deficient mice exhibit insulin resistance and diabetes. This insulin-sensitizing effect of adiponectin seems to be mediated by an increase in fatty-acid oxidation through activation of AMP kinase and PPAR-alpha. Here we report the cloning of complementary DNAs encoding adiponectin receptors 1 and 2 (AdipoR1 and AdipoR2) by expression cloning. AdipoR1 is abundantly expressed in skeletal muscle, whereas AdipoR2 is predominantly expressed in the liver. These two adiponectin receptors are predicted to contain seven transmembrane domains, but to be structurally and functionally distinct from G-protein-coupled receptors. Expression of AdipoR1/R2 or suppression of AdipoR1/R2 expression by small-interfering RNA supports our conclusion that they serve as receptors for globular and full-length adiponectin, and that they mediate increased AMP kinase and PPAR-alpha ligand activities, as well as fatty-acid oxidation and glucose uptake by adiponectin.

Natural history of sigmoid colon cancer: report of a patient observed for 4 years

We report a case of sigmoid colon cancer that was left untreated for a period of 4 years, because the patient declined treatment. A 59-year-old man was found to have an early carcinoma of the sigmoid colon measuring approximately 12 mm in diameter. The lesion, initially a flat cancer, increased in height and became sessile 4 months later. Subsequently, the central portion of the lesion became ulcerated, leaving an elevated ring along its periphery. The lesion eventually evolved into an ulcerated, invasive cancer. This sequence has not been observed with colonoscopy before.

Angle-multiplexed hologram storage in LiNbO(3):Tb, Fe

We have performed hologram multiplexing with a cw laser at lambda=532 nm in a near-stoichiometric LiNbO(3) :Tb, Fe crystal that exhibits a visible absorption band induced by UV light. When 50 plane-wave holograms were angle multiplexed from the UV preexposed state, the recording sensitivity gradually decreased, owing to bleaching of the induced absorption. However, a conventional recording schedule of multiplexing many holograms of equal diffraction efficiency can be used in this photochromic material. The gradual decrease in recording sensitivity throughout multiplexing can be compensated for by the increased erasure-time constants of later-written holograms. An M/# of 1.73 was obtained in a crystal of 3.3-mm thickness.

Quasinondestructive holographic recording in photochromic LiNbO3

We have observed quasinondestructive holographic storage with a continuous-wave laser at lambda = 532 nm in near-stoichiometric LiNbO3 doped with Tb and Fe. This crystal showed an exceptionally long grating decay time and also exhibited a fast color change upon exposure to ultraviolet (UV) light. It was demonstrated that the grating recorded from the UV-exposed, colored state can be continuously read out over 9 h at a reading intensity as high as 8 mW/cm(2). In addition, the written grating could be easily erased with UV illumination which returned the crystal back to the original colored state.

[A case of arteriovenous fistula of the lung]

A 29-year-old male was admitted to our hospital for further evaluation of left sided paresis, cyanosis, clubbing finger. The laboratory data revealed polycythemia and hypoxemia. Cerebralarteriogram showed right middle cerebral artery occulusion. Cardiofunctional test showed atrial fibrillation, lower left ventricular function. Cardiac catheterization, pulmonary arteriography and three dimensions CT were performed. Right to left shunt rate was 20.4%. A single large pulmonary arteriovenous fistura with a feeding artery (A10) and a draining vein (V10) was found clearly. In this cases, arteriovenous fistula was large, blood flow was thought to be rapid. We thought transcatheter embolization was not useful. And we performed right lower lobectomy. Postoperative course was not eventful. Cyanosis disappeared, clubbing finger was cured.

Stoichiometric Mg:LiNbO(3) as an effective material for nonlinear optics

Photorefractive damage, optical absorption, photoconductivities, and photogalvanic currents of stoichiometric LiNbO(3) single crystals with different Mg doping levels have been investigated. Nominally pure stoichiometric LiNbO(3) shows lower photorefractive damage resistance than congruent crystal; however, stoichiometric crystals doped with MgO of more than 1.8 mol. % exhibit no measurable photorefractive damage at 532 nm to intensities of as much as 8 MW/cm(2) . This remarkable damage resistance can be attributed not only to increased photoconductivity but also to decreased photogalvanic current. Stoichiometric Mg:LiNbO(3) also demonstrates the shortest absorption edge, 302 nm, and a single-domain nature with low scattering losses.

Identification and characterization of a novel human cortistatin-like peptide

Expressed sequence tags (ESTs) that showed significant homology to rat cortistatin (CST) were found in a human fetal brain cDNA library. A protein coded by the cDNA showed 55% identity to rat preprocortistatin in amino acid. Similarly in the generation of mature peptides from rat preprocortistatin, it was expected that cleavage at dibasic amino acids in the C-terminal portion of the coded protein might produce at least two different sizes of mature peptides with 29 and 17 amino acid residues, respectively. We chemically synthesized the predicted mature peptide with 17 amino acid residues (hCS-17) and examined its biological activities. It bound to all human somatostatin receptor (SSTR) subtypes in almost the same manner as rat CST-14. It also inhibited cAMP production induced by forskolin through SSTRs. Administration of hCS-17 to the cerebral ventricle showed flattening of cortical and hippocampal electroencephalograms in rats. These results indicate that a bioactive peptide encoded by the cDNA is a human counterpart corresponding to rat CST.

[Analysis of colonic motility by fast Fourier transform]

Colonic motility curve was continuously recorded in dog using a strain gauge force transducer and the curve was analyzed by fast Fourier transform. (1) The basic pattern of the colonic motility curve was a gradually increasing and decreasing contractile wave. (2) The frequency components of the basic contractile wave showed a trimodal distribution with peaks at around 1, 20 and 80 mHz. (3) The 1 mHz component showed a sine curve and represented the slow, big motion in the basic contractile wave. (4) The 20 mHz component represented the relatively rapid, gradually increasing and decreasing, big motion in the basic contractile wave. (5) The 80 mHz component represented the rapid, small motion in the basic contractile wave. (6) The fundamental frequency components of the colonic contractile wave were unchanged before and after defecation. (7) For the antiperistaltic wave which disappeared during transmission, the peaks of the wavelength components weakened during transmission and the wave progressed to a multi-modal curve. Our findings indicate that fast Fourier transform is an extremely useful method in elucidating colonic motility.

[Dynamic MR imaging of the pituitary gland by the fast spin echo (RARE) sequence]

The Fast Spin Echo (RARE: Rapid Acquisition with Relaxation enhancement) sequence for the dynamic MRI of the pituitary gland was performed in 18 patients suspected of the intracranial lesions. The SNR of the plain image of 5 pituitary glands was measured on the FSE 400 and 200/17/8/2 (TR/effective TE/echo train length/excitation) and the spin echo 100/11/2 (TR/TE/excitation) sequence. The FSE (TR = 400) provided the highest SNR than others, The FSE sequence was able to acquire increased spatial resolution and reduced acquisition time, and was the significant sequence for the dynamic MRI of the pituitary gland.

[Determination of potential doubling time using in vitro continuous labeling method with bromodeoxyuridine: estimation in head and neck squamous cell carcinoma]

Using in vitro continuous labeling with bromodeoxyuridine and immunohistochemical staining, potential doubling time (Tpot) was calculated in 24 patients with head and neck carcinoma treated with radiotherapy. There was no evident correlation between Tpot and tumor response in the cases treated with external irradiation. However, in one case of T2N0 mesopharyngeal carcinoma with short Tpot, tumor was microscopically residual even though it showed good radioresponsiveness during radiotherapeutic course. Meanwhile, all patients treated with brachytherapy showed complete response in spite of various Tpot. Tpot seems significant in the selection of fractionation to control head and neck carcinoma with external radiotherapy.

[Angiography in arteriosclerosis]

Advances in angiography of arteriosclerosis have been made possible by improvement of angiographic techniques, materials, such as narrow catheters and gliding guidewires, x-ray apparatus and equipments, including digital subtraction angiography (DSA), computed radiography and magnetic resonance angiography and contrast media. Improved, narrow and yet wide lumen catheters have made it possible to insert the catheter via the axillary or brachial artery. The matrix of DSA was increased to 1024 x 1024 from 512 x 512, and resolution of DSA has been greatly improved. Intravenous DSA has made examination of aneurysm or arterial stenosis or occlusion, easier without much harmful invasion. Ionic or non-ionic low osmolar contrast media has greatly reduced the irritation to the vessels.

[Percutaneous transluminal laser angioplasty]

Percutaneous transluminal laser angioplasty (PTLA) has been carried out on 63 peripheral arterial occlusive lesions in 43 patients. Most patients complained of intermittent claudication. The sites of lesions are the iliac artery (28 lesions or 44.4%), the femoropopliteal artery (30 lesions or 47.6%), and the below knee artery (5 lesions or 8.0%). There are 54 lesions (85.7%) that showed over 70% stenosis, with 19 of them complete occlusions (30.2%). Out of 63 lesions, 16 lesions or 25.4% had occlusions of over 10 cm. A Nd:YAG laser (1.06 microns, continuous wave) was used for the vaporization of atheromatous plaque and old thrombus. The laser was irradiated by increments of 1 to 2 seconds at 80W using the non-contact method, at 10-25W using the contact method with a ceramic tip and at 10-15W with a bare laser fiber. Balloon dilatation was then utilized. The initial success rate was 85.7%. The 5 year cumulative patency rate after PTLA is 88.4% in total cases, 88.7% in the iliac artery, 86.1% in the femoropopliteal artery, and 100% in the below knee artery. The 5 year cumulative patency rate for stenosis of the iliac artery is 91.0%, and it is 92% for stenosis of the femoropopliteal artery, and 81% for occlusion of the femoropopliteal artery. PTLA seems to have improved the cumulative patency rate when compared with that of conventional PTA.

Proteases involved in generation of beta- and alpha-amylases from a large amylase precursor in Bacillus polymyxa

The genes for extracellular neutral protease (Npr) and intracellular serine protease (Isp) were cloned from Bacillus polymyxa in order to elucidate the process involved in the generation of multiple beta-amylases and an alpha-amylase from a large amylase precursor. The npr gene was composed of 1,770 bp and 570 amino acids, while the isp gene was composed of 978 bp and 326 amino acids. Both proteases produced by E. coli cleaved the amylase precursor to generate beta- and alpha-amylases. Furthermore, several other proteases produced the same products from the precursor. A 130-kDa amylase precursor has two large domain structures responsible for the generation of beta- and alpha-amylases. The junction region of approximately 200 amino acids may be exposed on the surface of the molecule and susceptible to proteolytic enzymes, which results in the formation of multiple amylases.

[Treatment of gastric cancer patients with peritoneal metastasis by continuous hyperthermic peritoneal infusion with mitomycin C and cisplatin]

Following the resection of its primary lesion, continuous hyperthermic peritoneal perfusion (CHPP) with anticancer drug (mitomycin C, cisplatin) containing warmed physiological saline was performed on gastric cancer having peritoneal dissemination, and the effect of CHPP was examined by second look operation (SLO). The subjects were 41 cases of gastric cancer with peritoneal dissemination but without hepatic metastasis, which we have experienced in the past 7 years. The prognosis of these CHPP-treated cases was such that 50% survival period, 3 year survival rate and 5 year survival rate were 398 days, 28.5 and 12%, respectively. Comparison of the effects of CHPP by SLO revealed remarkable diminution of the peritoneal dissemination in 7 (44%) of 16 cases and disappearance of the ascites with a single course of CHPP in 7 of ascitic cases. Long-term survival (greater than 3 years) was noted in 4 of the CHPP-treated cases. Side effects were renal insufficiency, leukopenia and small intestinal perforation in 2(5), 2(5) and 1 cases (2%), respectively. The above results suggested the effectiveness of CHPP for the treatment of gastric cancer having peritoneal dissemination.

[Effect of PMUE therapy (CDDP, MMC, UFT, etoposide) in terminal gastric cancer]

CDDP, MMC, UFT and Etoposide (PMUE)-combined therapy was applied to 60 cases of terminal gastric cancer to examine its effectiveness. PMUE therapy consists of i.v. injection of CDDP 75 mg/body and MMC 10 mg/body on day 1, i.v. injection of Etoposide 50 mg/body on days 3, 4 and 5 and consecutive daily administration of UFT 400 mg/body, with 3 weeks as one course. Of 42 cases having estimable lesions, 23 (53.8%) showed high rate of effectiveness (PR). Especially, of 23 cases receiving no previous treatment, 15 (65.2%) benefitted by the therapy (PR) and 9 (69.2%) of 13 non-resected cases, to a wonderful extent. Five non-resected cases showed such a reduction in tumor size as made gastrectomy possible. As for the prognosis, one year-survival rate was 34.3, 49.0 and 16.0% for all 42 cases, 23 effective cases and 19 ineffective cases, respectively, with significant (p less than 0.001) prognostic prolongation for effective cases compared with ineffective ones. Side effects were digestive symptoms (85.7%), epilation (81.0%) and myelopathy (73.8%), which were all transitory and recovered. The present PMUE therapy was regarded as one of the best combined chemotherapies for terminal gastric cancer.

[Metastasis of uterine cervical cancer to the biceps muscle of right upper arm; report of a case]

A hematogenic metastasis to the biceps muscle of right upper arm was reported in a 48-year-old women with recurrent uterine cervical cancer who had undergone radiotherapy. Cancer metastasis to the limb skeletal muscle is very rare. We have not known the similar case report in uterine cervical cancer.

[CT findings of pseudomyxoma peritonei]

Four patients with pseudomyxoma peritonei were studied by computed tomography. CT images in all cases showed low density area simulating ascites in the peritoneal cavity. The low density area was due to gelatinous masses, which were proved by surgery or autopsy. The CT number of gelatinous masses was almost equal to that of water. Scalloping of liver and separated intestinal loops in the low density area were seen. One case had scattered calcifications in the low density area. The calcification in the low density area is a specific finding in pseudomyxoma peritonei.

[A case of hepatocellular carcinoma effectively treated by intraarterial infusion of CDDP and other agents]

It is very common for intraarterial infusion therapy of some anticancer agent to be effective against hepatocellular carcinoma. In this case, the patient was a 74-year-old man who suffered from very advanced hepatocellular carcinoma with tumor thrombus of the intrahepatic portal vein and IVC. He was treated with intraarterial infusion of CDDP, Etoposide, 5-FU, through a catheter placed in the proper hepatic artery. CDDP (30 mg/day) and Etoposide (60 mg/day) were given once every 5 days, and then 5-FU(250 mg/day) was infused daily for 26 days. The patient underwent this protocol study twice in 3 months. After the intraarterial infusion, transarterial embolization using CDDP (100 mg) powder added to lipiodol and aluminum stearate as suspension was done a month later. The tumor regression rate was 84% after intraarterial infusion of CDDP, Etoposide and 5-FU. The tumor thrombus in the intrahepatic portal vein and IVC had completely disappeared. We could not find lipiodol accumulated in the tumor after TAE. Thus, we assumed that the remaining tumor was a necrotic scar and that a complete response was obtained in the patient. There were some side effects, such as nausea, vomiting, pancytopenia and gastritis but no severe complication occurred.

[A case report of hepatoma with a giant splenic aneurysm both treated by TAE therapy]

A case of a 49-year-old woman who was found to have a giant splenic aneurysm during the course of TAE therapy for hepatoma and who was given TAE therapy using 47 steel coils is reported. The splenic arterial embolization therapy using steel coils proved effective for preventing the rupture of an aneurysm and for inhibiting hypersplenism. In addition, no serious adverse effect was observed.

[New technique of intra-arterial catheterization via the branch of left axillary artery for continuous infusion chemotherapy]

A new technique of intra-arterial catheterization via the branch of left axillary artery is described. This provides relatively swift and safe insertion and long-term placement of an infusion catheter through the left thoracoacrominal artery without exposure of the left axillary artery, that was required by conventional methods. With our technique, the tip of the catheter tends to enter the distal axillary artery because of oblique angulation of the trunk of the thoracoacrominal artery. Therefore, the tip of the catheter in the axillary artery must be deflected using a deflecting guidewire, so that it will advance into the subclavian artery and then down to the descending aorta. The deflection guidewire can also be of help when the catheter tip migrates into either celiac or SMA. The selective catheterization has been successful in all twenty seven patients without preliminary selective left subclavian arteriography.

Combination chemoembolization therapy for hepatocellular carcinoma: mainly, using cisplatin (CDDP)

Chemoembolization therapy, using the arterial injection of mixtures of various anticancer agents and lipiodol along with gelfoam particles, was carried out on 77 cases of hepatocellular carcinoma between January 1985 and March 1987, and an assessment was made on the anticancer effects of this treatment method. For the patients receiving lipiodol, the value of the longitudinal dimension multiplied by the vertical length of the tumor was calculated using a computerized tomograph before and after chemoembolization to determine the rate of tumor regression. (a) Of the 30 patients receiving chemoembolization therapy using a simple mixture of 100 mg cisplatin (CDDP) and lipiodol, the tumor regression rate was 50% or more in 10 cases (31%). (b) Of the 14 patients receiving chemoembolization therapy with a suspension of 100 mg of cisplatin, adriamycin (10-30 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (29%). (c) Of the 31 cases receiving chemoembolization therapy using a suspension of adriamycin (10-40 mg), mitomycin C (10-20 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (13%). (d) From these results, it can be concluded that the antitumor effect of chemoembolization using cisplatin is more significant than with other drugs.

A single gene directs synthesis of a precursor protein with beta- and alpha-amylase activities in Bacillus polymyxa

The Bacillus polymyxa amylase gene comprises 3,588 nucleotides. The mature amylase comprises 1,161 amino acids with a molecular weight of 127,314. The gene appeared to be divided into two portions by the direct-repeat sequence located at almost the middle of the gene. The 5' region upstream of the direct-repeat sequence was shown to be responsible for the synthesis of beta-amylase. The 3' region downstream of the direct-repeat sequence contained four sequences homologous with those in other alpha-amylases, such as Taka-amylase A. The 48-kilodalton (kDa) amylase isolated from B. polymyxa was proven to have alpha-amylase activity. The amino acid sequences of the peptides generated from the 48-kDa amylase showed complete agreement with the predicted amino acid sequence of the C-terminal portion. The B. polymyxa amylase gene was therefore concluded to contain in-phase beta- and alpha-amylase-coding sequences in the 5' and 3' regions, respectively. A precursor protein, a 130-kDa amylase, directed by a plasmid, pYN520, carrying the entire amylase gene, had both beta- and alpha-amylase activities. This represents the first report of a single protein precursor in procaryotes that gives rise to two enzymes.