An increased dose of insulin detemir improves glycaemic control and reduces body weight of Japanese patients with diabetes.

AIMS: The aim of study was to evaluate the safety and efficacy of insulin detemir as a basal insulin switching from neutral protamine Hagedorn insulin (NPH) and insulin glargine in patients with diabetes on an intensive insulin therapy regimen. METHODS: This 6-month multicentre, prospective, treat-to-target [glycosylated haemoglobin (HbA(1c) ) less than 6.5%] trial included 92 people with diabetes (61 type 1, 29 type 2 and two unknown diabetes types). Detemir was administered first with fixed dose and injection times and then adapted to optimal dose after 3 months. RESULTS: Mean HbA(1c) (%) of all the subjects at months 4 to 6 of the study was improved compared with month 0 (7.34 ± 0.87, 7.28 ± 0.88, 7.25 ± 0.93 vs. 7.55 ± 1.18; p < 0.05 paired t-test). However, significant improvement was seen only among the patients who had previously used NPH as a basal insulin. Twice-daily injection of basal insulin increased among people in the type 1 previously injected insulin glargine. Total insulin dose increased in the type 1 glargine group. The mean body weight change in the highest quartile body mass index (BMI) group was from 70.7 to 69.3 kg over the 6 months. Quality of life (QoL) relating to the patients' glycaemic control tended to improve without a change in frequency of hypoglycaemia. CONCLUSIONS: The results suggest that insulin detemir has a greater effect on glycaemic control in subjects with poor glycaemic control using NPH; can reduce or maintain body weight in obese patients; and obtains perceptive stability for patients with unstable glycaemic control.

A study of the incidence of implantation cyst at anastomotic sites after low anterior resection of the rectum with the double stapling technique.

BACKGROUND: The incidence of implantation cyst occurring at sites of anastomosis after low anterior resection of the rectum were studied in two different periods depending on the type of surgical devices used to close the rectal stump. SUBJECTS: The study included 361 patients undergoing the surgery during the first 8-year period between 1996 and 2003 and 87 patients undergoing the surgery during the second 3-year period between 2004 and 2006. RESULTS: Implantation cysts were found in nine (2.5%) of the patients undergoing the surgery during the first period and one of them also had local recurrence. Implantation cysts occurred 9 to 31 months postoperatively (mean, 17.1 +/- 6.9 months). Clinical symptoms were noted in one patient and treatment of the cysts, including local recurrence, was given to two patients. Anastomosis of the distal rectum was performed with the Roticulator or the Access 55 in all patients. Although implantation cysts were found in any patient undergoing surgery during the second period, no statistically significant difference was recognized (p = 0.217). Anastomosis of the distal rectum was performed with the TX30 in all patients. CONCLUSION: The pathogenesis of implantation cysts may be explained by the production of mucus when the mucosal epithelium of the colon is caught under the submucosa, forming a cyst after closure of the rectal stump, and the difference in the incidence rates of implantation cyst was presumably due to the characteristics of the device used and progress of the operative procedure.

The valine anticodon and valylatability of Peanut clump virus RNAs are not essential but provide a modest competitive advantage in plants.

The role of valine aminoacylation of the two genomic RNAs of Peanut clump virus (PCV) was studied by comparing the amplification in vivo of RNAs with GAC, GDeltaC, or CCA anticodons in the tRNA-like structure (TLS) present at the 3' end of each viral RNA. The PCV RNA1 TLS of isolate PCV2 possesses a GAC anticodon and is capable of highly efficient valylation, whereas the RNA2 TLS has a GDeltaC anticodon that does not support valylation. The presence in RNA1 of GDeltaC or CCA anticodons that conferred nonvalylatability resulted in about 2- to 4-fold and a 14- to 24-fold reduction, respectively, in RNA accumulations in tobacco BY-2 protoplasts inoculated with the RNA1 variants together with wild-type RNA2(GDeltaC). No differences in RNA levels were observed among protoplasts inoculated with the three variant RNA2s in the presence of wild-type RNA1(GAC). All combinations of valylatable and nonvalylatable RNAs 1 and 2 were similarly infectious in Nicotiana benthamiana plants, and viral RNAs accumulated to similar levels; all input TLS sequences were present unchanged in apical leaves. In direct competition experiments in N. benthamiana plants, however, both RNA1 and RNA2 with GAC valylatable anticodons outcompeted the nonvalylatable variants. We conclude that valylation provides a small but significant replicational advantage to both PCV RNAs. Sequence analysis of the TLS from RNA2 of a second PCV isolate, PO2A, revealed the presence of an intact GAC valine anticodon, suggesting that the differential valylation of the genomic RNAs of isolate PCV2 is not a general characteristic of PCV.