Fifty-five patients with high-grade advanced gastric cancer in whom the presence of stage IV was confirmed by preoperative diagnostic imaging were treated with PMUE therapy by a combined use of cisplatin (CDDP) 75 mg/m2, mitomycin C (MMC) 10 mg/body, etoposide 150 mg/body, and UFT (a combination of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1:4) 400 mg/day. CDDP and MMC was administered intravenously on the first day, followed by etoposide 50 mg/day on the 3rd, 4th, and 5th days. All the patients had measurable lesions that were evaluated by computed tomography scanning before and after the treatments. These patients were allocated randomly to two groups. Of these cases, 29 belonged to the neoadjuvant chemotherapy (NAC) group to whom PMUE therapy was given preoperatively; the remaining 26 patients underwent operation first and received PMUE thereafter (control group). Background factors did not differ significantly between the two groups. The response rate was higher in the NAC group than in the control group (62% in the former versus 35% in the latter). The resectability rates were 79% and 88% in the NAC and control groups, respectively. However, the rate of potentially curable cases was higher in the NAC group than in the control group (38% in the former versus 15% in the latter). Among the nonresection cases, the prognosis was highly unfavorable in both groups. In the resection cases, however, the survival rate was significantly better in the NAC group than in the control group. These results may indicate that in patients with high-grade, advanced gastric cancer initial chemotherapy (neoadjuvant chemotherapy) and then surgery should be considered.

Continuous hyperthermic peritoneal perfusion (CHPP) with a solution which contains 30 mg mitomycin C and 300 mg cisplatin has been introduced as a prophylactic treatment for peritoneal recurrence after curative resection of 79 advanced gastric cancers. The control group consisted of 81 patients with advanced gastric cancer who underwent curative surgery during the same period. CHPP was performed for 60 minutes by perfusing MMC- and CDDP-containing saline solutions warmed at 43.5 degrees C by a special CHPP device. In patients with pathologically confirmed serosal invasion-positive tumors, the survival rate of the CHPP group was significantly higher than that of the control group. A survival advantage for stage IV patients was also obtained by CHPP. However, there was no survival advantage between the CHPP group and the control group with serosal invasion-negative tumors. Adverse effects were observed in four patients who underwent CHPP: One developed severe bone marrow suppression, and transient hyperazotemia was observed in the other three. There was no difference in the incidence of mortality and morbidity between the two groups. These results indicate that CHPP is a safe, readily available prophylactic therapy for peritoneal recurrence after gastric cancer surgery.

Background: Effects of endurance training on adipose insulin sensitivity in association with body composition, circulating adipokines, and markers of inflammation have been studied less in young Asian subjects.Methods: Adipose insulin sensitivity/resistance was compared between 170 female Japanese collegiate athletes and 311 nonathletes (18–24 years), who underwent measurements of serum adipokines, markers of insulin sensitivity, inflammation, and dual-energy X-ray absorptiometry. Two separate subsamples of two groups of women underwent either a 75-gram oral glucose tolerance test or a standardized meal test, but not both.Results: As compared with nonathletes, athletes, characterized by higher skeletal muscle mass and lower percentage of body fat (both P < 0.001), had lower adipose insulin resistance (IR) (a product of fasting insulin and nonesterified fatty acid (NEFA) and lower leptin/adiponectin ratio (both P < 0.001). Although athletes had lower postmeal/postglucose insulinemia (P = 0.009 and 0.01, respectively), the two groups did not differ in postmeal percentage NEFA suppression and postmeal/postglucose glycemia, suggesting increased insulin sensitivity in adipose tissue and skeletal muscle, respectively. Serum leptin (P < 0.001) and tumor necrosis factor-α (P = 0.01) were lower in athletes, whereas adiponectin and homeostasis model assessment IR did not differ.Conclusions: Endurance training was associated with increased insulin sensitivity in adipose tissue as well as skeletal muscle without changes in circulating adiponectin even in young, normal-weight Japanese women.

Background and Objective: Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the vascular endothelium. The purpose of this study was to elucidate the pathophysiological role of ET-1 in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD). Method: We measured plasma ET-1 levels during right heart catheterization both at rest and during exercise on room air and while breathing oxygen in patients with COPD. In addition, we simultaneously measured plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). Results: Plasma ET-1 levels at rest were significantly higher in 21 patients with COPD than in 16 control subjects (p < 0.001). For COPD patients, there was no correlation between the plasma ET-1 level and pulmonary arterial pressure or pulmonary vascular resistance at rest. On the other hand, there was a significant negative correlation between plasma ET-1 level and mixed venous oxygen tension (r = –0.503, p < 0.05). Also, the plasma ET-1 level was positively correlated with those of ANP (r = 0.540, p < 0.05) and BNP (r = 0.533, p < 0.05) at baseline. Oxygen administration significantly decreased plasma ET-1 levels at rest (p < 0.05). Plasma ET-1 levels did not change significantly with exercise despite the progression of pulmonary hypertension and hypoxemia. In contrast, plasma ANP and BNP levels both increased markedly with exercise (p < 0.01). Conclusion: We conclude that in patients with COPD, the plasma ET-1 level is not affected by acute progression of pulmonary hypertension and hypoxemia during exercise, and persistent hypoxemia may be associated with an increase in the plasma ET-1 level. In addition, our findings suggest that ANP and BNP may modulate the pulmonary vascular tone by interacting with ET-1 in these patients.

This study was performed to clarify the relationship between isocapnic buffering and maximal aerobic capacity (VO2max) in athletes. A group of 15 trained athletes aged 21.1 (SD 2.6) years was studied. Incremental treadmill exercise was performed using a modified version of Bruce's protocol for determination of the anaerobic threshold (AT) and the respiratory compensation point (RC). Ventilatory and gas exchange responses were measured with an aeromonitor and expressed per unit of body mass. Heart rate and ratings of perceived exertion were recorded continuously during exercise. The mean VO2max, oxygen uptake (VO2) at AT and RC were 58.2 (SD 5.8) ml x kg(-1) x min(-1), 28.0 (SD 3.3) ml x kg(-1) x min(-1) and 52.4 (SD 6.7) ml x kg(-1) x min(-1), respectively. The mean values of AT and RC, expressed as percentages of VO2max, were 48.3 (SD 4.2)% and 90.0 (SD 5.2)%, respectively. The mean range of isocapnic buffering defined as VO2 between AT and RC was 24.4 (SD 4.5) ml x kg(-1) x min(-1), and the mean range of hypocapnic hyperventilation (HHV) defined as VO2 between RC and the end of exercise was 5.8 (SD 3.0) ml x kg(-1) x min(-1). The VO2max per unit mass was significantly correlated with AT (r = 0.683, P < 0.01). In addition, VO2max/mass was closely correlated with both the range of isocapnic buffering (r = 0.803, P < 0.001) and RC (r = 0.878, P < 0.001). However, no correlation was found between VO2max per unit mass and the range of HHV (r = 0.011, NS.). These findings would suggest that the prominence of isocapnic buffering, in addition to the anaerobic threshold, may have been related to VO2max of the athletes. The precise mechanisms underlying this proposed relationship remain to be elucidated.