Gastric adenocarcinoma coexisting with a reddish semipedunculated polyp arising from Helicobacter pylori-negative normal gastric mucosa: a report of two cases.

We experienced two cases of adenocarcinoma coexisting with a hyperplastic polyp arising from Helicobacter pylori-negative normal gastric mucosa. The first case was of a 59-year-old man. Esophagogastroduodenoscopy revealed a protruding lesion measuring 4 mm in diameter on the greater curvature of the middle gastric body. The second case was of a 47-year-old man. Esophagogastroduodenoscopy showed a protruding lesion measuring 5 mm located at the greater curvature of the upper gastric body. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically in both cases. Multiple H. pylori tests were all negative. Endoscopically, these protruding lesions appeared as reddish, semipedunculated polyps. Hyperplastic polyps were suspected based on white light endoscopic findings. Magnified endoscopy with narrow band imaging could not predict the coexistence of cancer. However, histopathological examination of the resected specimen revealed focal cancer at the surface of the gastric hyperplastic polyps. Considering the possibility that cancer may be coexisting in polyps, when reddish polyps are detected in H. pylori-negative normal gastric mucosa, it is important to perform a biopsy, or a careful follow-up endoscopy.

Intestinal Anisakiasis Treated Successfully with Prednisolone and Olopatadine Hydrochloride.

The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a case of intestinal anisakiasis. A 43-year-old woman presented with symptoms of intermittent abdominal pain 2 days after eating raw fish. Her brother had eaten the same food and had been suffering from gastric anisakiasis. Abdominal ultrasonography in this patient showed localized jejunal wall thickening with dilated lumen of proximal jejunum and ascites. According to the clinical course and examinations, she was diagnosed with intestinal anisakiasis. Administration of prednisolone 5 mg/day and olopatadine hydrochloride 10 mg/day improved her symptoms quickly without hospitalization. Prednisolone was administered for 10 days, and olopatadine hydrochloride was administered for a total of 6 weeks according to ultrasonographic findings. Six months after the treatment, the abdominal ultrasonography demonstrated normal findings. This case demonstrates that ultrasonography was quite useful for the diagnosis and surveillance of intestinal anisakiasis. Furthermore, treatment with corticosteroid and an antiallergic agent could be an option for patients with intestinal anisakiasis.

[A factor analysis method for contingency table data with unlimited multiple choice questions].

The purpose of this study is to propose a method of factor analysis for analyzing contingency tables developed from the data of unlimited multiple-choice questions. This method assumes that the element of each cell of the contingency table has a binominal distribution and a factor analysis model is applied to the logit of the selection probability. Scree plot and WAIC are used to decide the number of factors, and the standardized residual, the standardized difference between the sample, and the proportion ratio, is used to select items. The proposed method was applied to real product impression research data on advertised chips and energy drinks. Since the results of the analysis showed that this method could be used in conjunction with conventional factor analysis model, and extracted factors were fully interpretable, and suggests the usefulness of the proposed method in the study of psychology using unlimited multiple-choice questions.

[Effect sizes, statistical power and sample sizes in "the Japanese Journal of Psychology"].

This study analyzed the statistical power of research studies published in the "Japanese Journal of Psychology" in 2008 and 2009. Sample effect sizes and sample statistical powers were calculated for each statistical test and analyzed with respect to the analytical methods and the fields of the studies. The results show that in the fields like perception, cognition or learning, the effect sizes were relatively large, although the sample sizes were small. At the same time, because of the small sample sizes, some meaningful effects could not be detected. In the other fields, because of the large sample sizes, meaningless effects could be detected. This implies that researchers who could not get large enough effect sizes would use larger samples to obtain significant results.

Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors.

BACKGROUND AND AIM: Various techniques of endoscopy have been developed to treat rectal carcinoids. This retrospective study aimed to evaluate the feasibility and efficacy of endoscopic submucosal dissection for the treatment of rectal carcinoids smaller than 10 mm in diameter. PATIENTS AND METHODS: A total of 18 consecutive patients were enrolled with 20 carcinoid tumors that had the following characteristics: the diagnosis of a rectal carcinoid smaller than 10 mm, no endoscopic evidence of muscularis propria invasion, and no evidence of lymph node or distant metastasis (11 men and seven women; median age, 69 years; median tumor size, 4 mm). Tumors were resected by endoscopic submucosal dissection with a needle knife and a hook knife. After marking, a one-third to one-half circumferential mucosal incision was made, and subsequently, the submucosa under the lesion was exfoliated. After the submucosa under the tumor was exfoliated, the residual mucosa was incised and the tumor was removed. Complete resection, complication rates, and operation time were evaluated. RESULTS: Complete resection was achieved in all cases (100%) without complications. The mean operation time was 34.2 min, which was acceptable in clinical practice. CONCLUSION: Endoscopic submucosal dissection with the strategy described above is feasible and efficacious for selected patients with a rectal carcinoid smaller than 10 mm.

Magnifying endoscopy for diagnosis of residual/local recurrent gastric neoplasms after previous endoscopic treatment.

BACKGROUND: Incomplete resection of gastric neoplasms by endoscopic treatment could lead to residual/local recurrence, which may be difficult to identify. This study aimed to evaluate the usefulness of magnifying endoscopy for identifying and demarcating residual/local recurrent gastric neoplasms after endoscopic treatment. METHODS: Between December 2004 and November 2010, magnifying endoscopy was performed in 15 patients with residual/local recurrent gastric neoplasms. All patients underwent conventional magnifying endoscopy (CME) and enhanced-magnification endoscopy with acetic acid instillation (EME) after conventional endoscopy (CE). Eleven patients additionally underwent magnifying endoscopy using narrow-band imaging (NBI-ME) and a combination of narrow-band imaging and acetic acid instillation (NBI-EME). For each procedure, it was recorded whether the location and circumferential demarcation of the lesions were identified. All lesions were resected by endoscopic submucosal dissection. RESULTS: Eleven lesions were identified using CE. However, two and four additional lesions were identified using CME and EME, respectively. In 11 cases, NBI-ME and NBI-EME were performed and all lesions were identified. Three lesions, which were identified by CME, were not demarcated circumferentially. All 15 lesions were well demarcated by EME and 11 by NBI-ME and NBI-EME. Of the resected specimens, histopathology indicated that ten lesions were differentiated tubular adenocarcinomas and five lesions were adenomas. The histopathological diagnosis of the location and demarcation of all neoplasms corresponded to endoscopic findings. CONCLUSIONS: Magnifying endoscopy techniques (CME, EME, NBI-ME, and NBI-EME) may be useful for identifying and demarcating residual/local recurrent gastric neoplasms after previous endoscopic treatment.

Effect of the misoprostol-rebamipide combination on iron deficiency anemia in patients under long-term cyclooxygenase-2 selective inhibitor treatment for small bowel ulcers.

The use of cyclooxygenase-2 (COX-2) selective inhibitors has been recommended to reduce the risk of upper and lower gastrointestinal adverse events. However, it is not clear whether the long-term use of COX-2 inhibitors reduces the risk of gastrointestinal injury. We report the case of a 60-year-old woman with rheumatoid arthritis who had ongoing anemia and intermittent tarry stools after the long-term use of meloxicam, a COX-2 selective inhibitor. Although gastrointestinal injuries were suspected, the findings of gastroduodenoscopy and ileocolonoscopy were normal. However, capsule endoscopy revealed multiple circumferential ulcers with bleeding in the small bowel. With the patient requiring continued meloxicam use, misoprostol, a prostaglandin (PG) analog and rebamipide, an endothelial PG inducer and cytoprotective agents were prescribed for the ulcers. After treatment, her anemia improved promptly, but it relapsed after she stopped regular use of these drugs. However, the anemia improved again after resumption of treatment. In conclusion, the long-term use of a COX-2 selective inhibitor may induce small intestinal injuries and multiple circumferential ulcers. Combination therapy with misoprostol and rebamipide may be useful for treating COX-2 selective inhibitor-induced anemia and small intestinal injuries.

[New assessment scale based on the type of person desired by an employer].

In many cases, aptitude tests used in the hiring process fail to connect the measurement scale with the emotional type of the person desired by an employer. This experimental study introduced a new measuring method, in which the measurement scale could be adjusted according to the type of person an employer is seeking. Then the effectiveness of this method was verified by comparing the results of an aptitude test utilizing the method and the results of the typical hiring process carried out by the new method in hiring.

[An improved method using k-means to determine the optimal number of clusters, considering the relations between several variables].

In this article, we propose a non-hierarchical clustering method that can consider the relations between several variables and determine the optimal number of clusters. By utilizing the Mahalanobis distance instead of the Euclidean distance, which is calculated in k-means, we could consider the relations between several variables and obtain better groupings. Assuming that the data are samples from a mixture normal distribution, we could also calculate Akaike's information criterion (AIC) and the Bayesian information criterion (BIC) to determine the number of clusters. We used simulation and real data examples to confirm the usefulness of the proposed method. This method allows determination of the optimal number of clusters, considering the relations between several variables.

Using non-normal SEM to resolve the ACDE model in the classical twin design.

One of the biggest problems in classical twin studies is that it cannot estimate additive genetic (A), non-additive genetic (D), shared environmental (C), and non-shared environmental (E) effects, simultaneously, because the model, referred to as the ACDE model, has negative degrees of freedom when using Structural Equation Modeling (SEM). Therefore, instead of the ACDE model, the ACE model or the ADE model is actually used. However, using the ACE or ADE models almost always leads to biased estimates. In the present paper, the univariate ACDE model is developed using non-normal Structural Equation Modeling (nnSEM). In SEM, (1st- and) 2nd-order moments, namely, (means and) covariances are used as information. However, nnSEM uses higher-order moments as well as (1st- and) 2nd-order moments. nnSEM has a number of advantages over SEM. One of which is that nnSEM can specify models that cannot be specified using SEM because of the negative degrees of freedom. Simulation studies have shown that the proposed method can decrease the biases. There are other factors that have possible effects on phenotypes, such as higher-order epistasis. Since the proposed method cannot estimate these effects, further research on developing a more exhaustive model is needed.

[Scheffé-type paired comparison models for examining correlations between individual preferences for alternatives].

It is difficult to estimate and examine correlations between individual preferences for alternatives using the present Scheffé-type paired comparison models. In this paper, we propose two models that address individual preferences for alternatives. One is a simple model that makes it possible to estimate correlations between individual preferences. The other is an improved model that makes it possible to extract independent components from those correlations. Paired comparison data were collected in a survey about preferences for several new product names. Analysis of this data shows that the proposed models enabled the estimation not only of average preferences for alternatives, but also correlations between individual preferences and loading matrices for independent components. The effectiveness of the proposed methods was confirmed by the interpretations of those estimates.

Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods.

BACKGROUND AND AIM: Various techniques using magnifying endoscopy (ME) have been developed to enhance images of early gastric cancer (EGC) demarcations, which are often obscure. We investigated four ME methods to determine which is most effective in enhancing the recognition of EGC demarcations: conventional ME (CME), ME with narrow band imaging (NBI-ME), enhanced-magnification endoscopy with acetic acid (EME), and ME with NBI and acetic acid (NBI-EME). METHODS: Thirty-seven successive patients having a total of 40 EGCs participated in the investigation. The endoscope was fixed and magnification images of EGC demarcations in each patient were recorded using four different ME methods (CME, NBI-ME, EME and NBI-EME). Eight experts and eight non-experts scored each of the four images of each lesion for ease of recognition of demarcation (1 to 4, with 4 being easiest). RESULTS: The mean scores of expert and non-expert judges, respectively, for images acquired using each technique were: CME 1.23, 1.24; NBI-ME 2.61, 2.95; EME 2.62, 2.32 and NBI-EME 3.54, 3.50. There were significant differences between the mean scores for the four techniques (P < 0.0001) using one-way repeated-measures anova. In a Bonferroni's multiple comparison, the average scores (expert and non-expert) of images acquired using NBI-EME were significantly higher than those acquired using other methods; images acquired by NBI-ME or EME also scored significantly higher than those by CME. Non-experts also scored NBI-ME images significantly higher than CME and EME images. CONCLUSIONS: Early gastric cancer demarcations were recognized most easily using NBI-EME, and more easily using EME or NBI-ME than CME.

Antibody responses against NY-ESO-1 and HER2 antigens in patients vaccinated with combinations of cholesteryl pullulan (CHP)-NY-ESO-1 and CHP-HER2 with OK-432.

Combination vaccines of the NY-ESO-1 protein complexed with cholesteryl pullulan (CHP), CHP-NY-ESO-1, and the truncated 146HER2 protein with CHP, CHP-HER2, were subcutaneously administered with the immuno-adjuvant OK-432 to eight esophageal cancer patients. Vaccination was well-tolerated. NY-ESO-1- and HER2-specific antibody responses were analyzed using the patients' sera and samples from previous single CHP-NY-ESO-1 or CHP-HER2 vaccine trial. The responses to NY-ESO-1 in the combination vaccine study were comparable to the single vaccine. For responses to HER2, there were fewer antibody responses in the combination vaccines. Although there were marked individual variations in the antibody responses to the NY-ESO-1 and HER2 antigens, the reaction patterns to these antigens were comparable within each patient. Antibodies to OK-432 were not augmented. Protein cancer vaccines targeting multiple antigens are feasible.

[A endoscopic treatment of penetration of the colon by an ingested fish bone].

An 81-year-old woman was admitted complaining of left lower abdominal pain. Computed tomography on admission revealed foreign a body penetrating descending colon and free air. We extracted the foreign body endoscopically. The foreign body was a sharp-edged fish bone. She was treated by conservative medication without complication.

Surface pattern classification by enhanced-magnification endoscopy for identifying early gastric cancers.

BACKGROUND: The correlation between fine surface patterns of gastric mucosal lesions and early gastric cancer is not sufficiently clear. OBJECTIVE: To evaluate the efficacy of surface pattern classification by enhanced-magnification endoscopy (EME) for identifying early gastric cancers. DESIGN: Observational study. SETTING: All procedures were performed at Mie University Hospital. PATIENTS: A total of 380 consecutive patients who underwent EGD by using magnification endoscopy. Among these subjects were found 250 newly detected lesions suspected of being gastric cancer. METHODS: Conventional magnification endoscopy (CME), magnification chromoendoscopy (MCE), and EME were performed, and surface patterns of lesions were classified into 5 types: type I, small round pits of uniform size and shape; type II, slit-like pits; type III, gyrus and villous patterns; type IV, irregular arrangement and size; and type V, destructive pattern. Biopsy specimens were obtained from all lesions. MAIN OUTCOME MEASUREMENTS: Correlation between surface pattern classification by EME and histopathologic findings of early gastric cancer. RESULTS: Surface patterns were evident by CME/MCE in only 66.4% (166/250) of lesions but in 100% (250/250) of lesions by EME. Classification by EME was as follows: type I, 52 lesions; type II, 12; type III, 146; type IV, 32; and type V, 8. By histopathologic examination, 16 early gastric cancers were detected between type IV or V lesions. Thus, classification of types IV-V strongly correlated with the presence of gastric cancer (sensitivity 100%, specificity 89.7%). LIMITATIONS: Single-center study. CONCLUSIONS: Surface pattern classification by EME may be useful for identifying early gastric cancers.

[Graphical modeling for constructs: an integrated solution for factor analysis and GM].

This research develops a new method for analyzing relation for factors which combines graphical modeling (GM) and factor analysis. In this method, estimation of the inverse of the variance-covariance matrix is done in the framework of factor analysis, and then the data-model fit is investigated using GM. The partial correlation coefficients of the estimated model are calculated, and the estimation of parameters is repeated until discovery of the worst fit index. In order to confirm the effectiveness of this method, three correlation matrices were analyzed as a real data study. In first and second case, intelligence models of Harman and Turstone were restructured using this method. In third case, EQ model was structured using it. The results show that this method can be apply GM for latent variables and a good assistant to set up path models for factors.

[The ranking model which estimates the factor scores of residual variables].

In this research, a new directions for utilizing the residual variable score in structural equation modeling was proposed. The residual variable score is created by removing the influence of the comprehensive index, which is strongly related to brand cognition from each trait factor. By using it as a new index, we tried to detect low cognition and high evaluation Brands which are not ranked high in the comprehensive index. It was shown that the ranking by the residual variable score on the same trait has very high correlation between years and same trait, and low correlation with the comprehensive index. Thus, the discriminant validity and stability of the new index were identified. Concerning the interpretation of the new index, it became clear that the brand which shows an increasing trend with the new index has the uniformly low degree of cognition as compared with the descending brand. It indicates that the new index has the capability of detecting brands with low cognition and high evaluation Brand.