Expression of vascular endothelial growth factor and its prognostic significance in gastric carcinoma

AIM: The aim was to investigate the clinical significance of vascular endothelial growth factor (VEGF) expression in gastric carcinoma.

METHODS: The expression of VEGF in 128 gastric carcinomas was investigated by immunohistochemical staining with an anti-VEGF polyclonal antibody. Correlations between VEGF expression and various clinicopathological factors and prognosis were studied.

RESULTS: The overall VEGF-rich expression rate was 64.1% in gastric carcinoma tissue, and was significantly higher in patients with stage III and IV disease than in those with stage I disease (P < 0.05). Significant differences in expression rate were related to growth pattern, serosal invasion, and lymph node metastasis. VEGF-rich expression was much higher in tumors with an expanding growth pattern (71.8%) or serosal invasion (73.5%) than in those with an infiltrative growth pattern (52.0%) or nonserosal invasion (53.3%) (P < 0.025, respectively). Expression was also significantly higher in patients with lymph node metastases (75.0%) than in those without such metastases (50.0%, P < 0.05). A postoperative survey of 86 patients who had been followed for at least 5 years found that the 5-year survival rate of patients with VEGF-rich tumors was significantly lower than that of patients with VEGF-poor tumors (P < 0.05).

CONCLUSION: VEGF expression may be associated with invasion and metastasis and may also be a useful indicator of gastric carcinoma prognosis.

Effect of interferon in combination with ribavirin on the plus and minus strands of HCV RNA in patients with chronic hepatitis C

AIM: To probe the effect of interferon in combination with ribavirin on the plus and minus strands of hepatitis C virus RNA (HCV RNA).

METHODS: Twenty-three cases diagnosed as chronic hepatitis C (CHC), according to positive HCV RNA/anti-HCV, fluctuating levels of aminotransferase activities (< 1 year), and absence of other hepatitis virus marker, were studied. Among them, 13 patients received combined antiviral therapy (subcutaneous injection of 3 MU of interferon-α three times per week for 3 months and intravenous drip of 1 g of ribavirin per day during the first month of treatment with interferon), and 10 patients received single interferon therapy, as described above, as control. The plus and minus strands of HCV RNA in sera and peripheral blood mononuclear cells (PBMCs) of these patients were tested by nested reverse transcription-polymerase chain reaction (nested RT-PCR).

RESULTS: At the end of therapy, the abnormal alanine amino-transferase (ALT) levels decreased to normal range in nine (69.23%) cases in the combined antiviral group. Of them, five (55.56%) experienced post-therapy relapse, and four (44.44%) were complete responders. In the interferon group, ALT decreased to normal in six (60%) cases, of which, four (66.67%) had post-therapy relapse and two (33.33%) were complete responders. The differences between the two groups were not significant (P < 0.05). At the end of therapy, the positive rate of the plus strand in sera decreased from 92.30% to 38.46% (P < 0.05) and that of the minus strand in PBMCs from 76.92% to 38.46% (P < 0.05) in the combined antiviral group. In the interferon only group, the former decreased from 100% to 50% (P < 0.05) and the latter, from 90% to 40% (P < 0.05). Again, no significant differences were found between groups (P < 0.05). Relapse occurred in patients whose plus strand HCV RNA in PBMCs remained after treatment.

CONCLUSION: Ribavirin did not enhance the antiviral effect of interferon when the plus and minus strands of HCV RNA were measured. The absence of HCV RNA in serum does not mean complete clearance of HCV, and its value for evaluating antiviral effects and prognosis is limited. Therefore, it is essential to measure the plus and minus strands of HCV RNA in sera and PBMCs simultaneously.

Assessment of natural and interleukin-2-induced production of interferon-gamma in patients with liver diseases

AIM: To determine whether the production of lower interferon gamma (IFNl) by lymphocytes in patients with liver diseases is due to defects of the lymphocytes themselves or to other cofactors, such as interleukin-2 (IL-2).

METHODS: Peripheral blood mononuclear cells (PBMCs) from patients with various liver diseases were cultured with or without phytohemagglutinin (PHA) and IL-2. The cells were harvested and counted, and the supernatants were tested for IFNl by a sensitive and quantitative ABC-enzyme-linked immunosorbent assay (ELISA).

RESULTS: IFNl was not found in serum samples from patients or normal individuals. However, IFNl was detectable in supernatants of non-induced and induced PBMCs by ABC-ELISA. In non-induced PBMCs (group 1), the content of IFNl in supernatants from control, chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and hepatocellular carcinoma (HCC) was 8.72/L, 5.03/L, 6.02/L, and 4.91/L, respectively. The production of IFNl in liver disease was significantly decreased compared to control. In PBMCs stimulated with PHA (group 2), the content of IFNl was 22.71/L, 17.12/L, 14.54/L, and 17.63/L, respectively. In PBMCs induced by IL-2 (group 3), the amount of IFNl in supernatant from control (60.67/L) was much larger than those from CAH (21.70/L), CPH (24.00/L), and HCC (19.15/L) (p < 0.01). When comparing the amount of IFNl in group 3 with that in group 1, we found that IFNl production was enhanced by nearly 4-folds in liver diseases and by over 7-fold in control. In contrast, the number of PBMCs, whether from liver diseases or from control, was increased by only approximately 3-fold.

CONCLUSION: The decreased production of IFNl in liver diseases, including HCC, is mainly due to endogenous defects of lymphocytes but may also involve a decrease in stimulating cofactors, such as IL-2.

Relation between viremia level and liver disease in patients with chronic HCV infection

AIM: To explore the relation between level of hepatitis C virus (HCV) viremia and HCV-related chronic liver disease.

METHODS: Serum HCV RNA was measured by competitive reverse transcription polymerase chain reaction (CRT-PCR) in 27 patients with chronic HCV infection.

RESULTS: Levels of serum HCV RNA were low (10²-10⁶ copies/50 μL serum) in patients with chronic HCV infection. Patients with chronic active hepatitis (10^{5.739 ± 0.25} copies/50 μL serum) and with cirrhosis (10^{5.803 ± 0.76} copies/50 μL serum) had higher levels of serum HCV RNA than patients with chronic persistent hepatitis (10^{5.068 ± 1.04} copies/50 μL serum) (P < 0.05). There was a positive relation between levels of serum HCV RNA and alanine aminotransferase.

CONCLUSION: All of these results suggest that viremia level is low in chronic HCV infection. HCV itself plays an important role in progress of chronic liver disease, and HCV replication is related to liver damage.

Significance of microvessel count in gastric carcinoma

AIM: To investigate the correlation between microvessel count and various clinicopathologic factors and prognosis of gastric carcinoma using immunohistochemical staining with anti-factor-VIII-related antigen (F-RAg) antibody.

METHODS: A total of 128 specimens resected from patients with gastric carcinoma were investigated by immunohistochemical staining with a monoclonal antibody against F-RAg. Correlations between the microvessel count (the mean number of microvessel in the five areas of highest vascular density at 200 × magnification) and various clinicopathologic factors and prognosis were studied for 86 cases with complete follow-up data.

RESULTS: The mean microvessel count of all patients was 16.5 ± 8.5; the microvessel count increased with histological stage and was significantly higher in patients with lymph node metastasis than those without such metastasis (18.3 ± 8.7 vs 13.8 ± 7.4, P < 0.01). In addition, the prognosis of 86 patients who were followed up for at least 5 years after surgery was significantly worse for patients who had a tumor with a high microvessel count (≥ 16) than for those with a low microvessel count (< 16), and the 5-year survival rates were 42.5% and 58.7% respectively (P < 0.05).

CONCLUSION: Microvessel count may be a useful prognostic indicator in patients with gastric carcinoma.

Biological significance of serum soluble tumor necrosis factor receptor I in hepatoma patients

AIM: In order to elucidate the biological significance of soluble tumor necrosis factor receptor (sTNF-R) in hepatomas, we observed the differential profiles of serum sTNF-R levels in 83 hepatoma patients and 61 healthy controls.

METHODS: The serum levels of soluble sTNF-R were measured with sandwich enzyme immunoassay.

RESULTS: The mean serum sTNF-R levels were significantly higher in the hepatoma patients than in the controls (2.69 ± 0.79 μg/L vs 0.93 ± 0.29 μg/L, P < 0.001). The increment correlated well with the stage of the disease, i.e. the serum levels of soluble sTNF-RI in the patients with stages III-IV were greater than in those with stages I-II (2.97 ± 0.43 μg/L vs 1.74 ± 0.41 μg/L, P < 0.001). Additionally, we found that increased sTNF-R level correlated positively with serum alkaline phosphatase (r = 0.59), white cell count (r = 0.43) and serum globulin (r = 0.32), and correlated negatively with serum albumin (r = -0.71). Among the hepatoma patients, the frequency of increased serum sTNF-RI level (89.16%) greatly exceeded that of serum AFP (54.22%). Moreover, comparison of 25 patients before and after chemotherapy indicated that patients with a rise in sTNF-R over the therapy course had decreased clinical response (3.39 ± 0.43 μg/L vs 2.67 ± 0.34 μg/L, P < 0.001).

CONCLUSION: In patients with hepatoma, serum soluble sTNF-R levels correlate well with disease stage and response to chemotherapy. It is reasonable to postulate that this determination can serve as an aid for the detection of these cancers, for follow-up studies, and for assessments of prognosis.

Measurements of cell proliferation in esophageal and gastric cardia epithelia of subjects in a high incidence area for esophageal cancer

AIM: To determine the proliferation patterns of normal and different precancerous lesions of esophageal and gastric cardia epithelia by measuring levels of proliferating cell nuclear antigen (PCNA), Ki-67 and bromodeoxyuridine (BudR) incorporation.

METHODS: One-hundred-and-seventy-five esophageal biopsies and 45 gastric cardia biopsies were collected from symptom-free subjects in Huixian. Of these, 24 esophageal biopsies were incubated with BudR. The avidin-biotin-peroxidase complex (ABC) method was used to detect PCNA, Ki-67 and BudR. Quantitative data of the immunostaining results were recorded as the number of positive cells per mm² of the biopsied epithelium.

RESULTS: Intense immunostaining for PCNA, Ki-67 and BudR was observed in the cell nuclei of normal tissues and of tissues with different severities of precancerous lesions. For esophageal biopsies, the numbers of both PCNA and Ki-67 increased significantly as the epithelia progressed from normal to basal cell hyperplasia (BCH) and to dysplasia (DYS). The number of PCNA- and Ki-67-positive cells was three times higher than that of BudR in the same category of BCH. For cardia biopsies, the number of Ki-67-positive cells was lower in normal tissues and increased significantly from chronic superficial gastritis (CSG) to chronic atrophic gastritis (CAG) and to DYS.

CONCLUSION: The staining patterns for PCNA and Ki-67 were correlated with the histopathology of the esophagus and gastric cardia. These methods may be useful for screening subjects at high risk for esophageal and gastric cardia cancers and for monitoring the effect of chemoprevention. PCNA is relatively easy to analyze and may prove to be very useful in studies on esophageal cancer.

Synergic effect of erythromycin and CoAA on gallbladder contraction in patients with cholelithiasis

AIM: To study the effect of combined use of compound amino acids (CoAA) and erythromycin in the promotion of gallbladder emptying and their mechanism of action.

METHODS: Sucralfate-NS, sucralfate-CoAA, proglumide-CoAA or erythromycin-CoAA was administered to 36 patients with cholelithiasis, and their gallbladder emptying rates (PGER) were compared by ultrasonographic measurement of gallbladder volume.

RESULTS: The PGER of the CoAA group was 40.52% ± 6.84%, which was significantly increased. The gallbladder contractive effect of CoAA could be blocked partially by the cholecystokinin (CCK) receptor blocker Proglumide. The PGER of combined erythromycin and CoAA was 54.17% ± 5.35%, being much higher than that in the group treated with CoAA alone (P < 0.05).

CONCLUSION: Rapid infusion of CoAA in patients with cholelithiasis can increase PGER, via a mechanism that is related to the release of CCK. When erythromycin is administrated at the same time, the PGER increases more significantly and the peak effect appears earlier. This finding suggests that combined use of the two has a synergic effect on gallbladder contraction, and that it is more effective than CoAA alone; thus, combined treatment might be useful in correcting gallbladder emptying impairment and preventing bile retention.

Histopathological study of hepatocellular carcinoma after transcatheter hepatic arterial embolization

AIM: To study the histopathological changes in hepatocellular carcinoma (HCC) after transcatheter arterial embolization (TAE).

METHODS: Histopathological analysis was made in 39 cases of liver neoplasms after TAE and 11 cases of liver neoplasms after digital selective angiography (DSA); data assessed included pathological type, histological grade, necrotic degree, encapsulation, times of treatment, vasculature injury and lymphocyte infiltration.

RESULTS: Following DSA, histological analysis identified 6 cases with 100% necrosis, 14 cases with 30%-95% necrosis, 19 cases with 0%-5% necrosis after TAE and 11 cases without necrosis. The presence of necrosis was related to the pathological type, encapsulation and vasculature injury, but not to the histological grade, times of treatment or lymphocyte infiltration of the liver neoplasms.

CONCLUSION: TAE is an effective therapy for late-stage HCC. Encapsulated HCC is a preferable indicator for TAE.

Current research and development of integrated traditional Chinese and Western Medicine in gastroenterology

Traditional Chinese medicine (TCM) is one of China’s scientific treasures. We are very fortunate to apply modern scientific knowledge and methodology towards reorganizing our inherited TCM and to then promote the integration of TCM and Western medicine (TCM-WM). Over the 45 years, many remarkable achievements have been made in this regard and we are looking forward to the next achievements in the coming century; however, many challenges remain to the establishment of TCM-WM as a trusted and oft used approach for improving human health.

Genesis and distribution of motilin in the human fetus

AIM: To investigate the pattern of distribution and ontogeny of motilin (MTL) in the human fetus.

METHODS: MTL concentrations were determined systematically, using radioimmunoassay, in the tissues of the central nervous system (CNS, six regions) and the digestive system (20 regions) in human fetuses.

RESULTS: The results showed a wide distribution of MTL in the tissues but at different concentrations. The MTL concentrations in the digestive system tended to be higher than those in the CNS, and the concentrations increased with the fetal age, especially in the digestive system. High concentrations of MTL were found in hypophysis (the earliest MTL generation region in the CNS), spinal cord and cerebellum; however, there were no significant differences among them. In the digestive system, MTL was detectable as early as 16^th week in jejunum, duodenum, ileum, stomach, transverse colon, sigmoid colon, and rectum, while in other regions MTL was not detec until after the 23^rd week. By the 24^th week, MTL showed an adult distribution pattern in all of the tissues. In the digestive system tissue of different fetal ages, the highest MTL concentration was found in jejunum, followed by duodenum and ileum, and MTL was positively correlated with the fetal age. The MTL concentration in ileum was about 6-7 times higher than in the CNS. In addition, we detected MTL at a considerable concentration in the appendix for the first time.

CONCLUSION: The findings might help reveal distribution and ontogeny of MTL in fetuses.