Gastroesophageal reflux: the features in elderly patients

AIM: To compare the features of gastroesophageal reflux disease between elderly and younger patients.

METHODS: Twenty-four hour pH-monitoring and endoscopy were per formed for the 66 elderly patients with typical gastroesophageal reflux symptoms, and the results were compared with 112 symptomatic younger patients.

RESULTS: The results of 24-h pH-monitoring and endoscopy showe d that the elderly patients had pathological reflux and reflux esophagitis more frequently than the younger patients. Percentage time with pH < 4 in elderly patients with reflux esophagitis was 32.5% in 24 h, as compared with 12.9% in the younger patients with reflux esophagitis (P < 0.05). The elderly patients with reflux esophagitis have longer periods of acid reflux in both upright and supine positions than the younger patients. Endoscopy showed that 20.8% of elderly patients had grade III/IV esophagitis, whereas only 3.4% of younger patients had grade III/IV esophagitis (P < 0.002). Percentages of grades I/II esophagitis in the two groups were 12.5% and 26.5%, respectively (P < 0.002).

CONCLUSION: Elderly patients, as compared with younger patients, have more severe gastroesophageal reflux and esophageal lesions. The incompetence of lower esophageal sphincter and the presence of hiatal hernia may be important factors leading to the difference in incidence and severity of reflux esophagitis between elderly and younger patients.

Regulatory effect and mechanism of gastrin and its antagonists on colorectal carcinoma

AIM: To explore the effect and mechanism of gastrin and its an tagonists proglumide and somatostatin on colorectal carcinoma and their clinical significance.

METHODS: A model of transplanted human colonic carcinoma was established from SW480 cell line in gymnomouse body. The volume and weight of transplanted carcinoma was observed under the effect of pentagatrin (PG), proglumide (PGL) and octapeptide somotostatin (SMS201-995, SMS). The cAMP content of carcinoma cell was determined by radioimmunoassay and the DNA, protein content and cell cycle were determined by flow-cytometry. The amount of viable cells was determined by MTT colorimetric analysis, IP₃ content was determined by radioimmuno assay, Ca²⁺ concentration in cell by fluorometry and PKC activity by isotopic enzymolysis. The expression of gastrin, c-myc, c-fos and rasP21 in 48 case s of colorectal carcinoma tissue was detected by the immuno-cytochemistry SP method. Argyrophilia nucleolar organizer regions was determined with argyrophilia stain.

RESULTS: The volume, weight, cAMP, DNA and protein content in carcinoma cell, cell amount and proliferation index of S and G₂M phase in PG group were all significantly higher than those of control group. When PG was at the concentration of 25 mg/L, the amount of viable cells, IP₃ content and Ca²⁺ concentration in cell and membrane PKC activity in PG group were significantly higher than those in control group; when PGL was at a concentration of 32 mg/L, they dropped to the lowest level in PG (25 mg/L) + PGL group, but without significant difference from the control group. The positive expression rate of gastrin, c-myc, c-fos and rasP21 in carcinoma tissue was 39.6%, 54.2%, 47.9% and 54.2% respectively and significantly higher than that in mucosa 3 cm and 6 cm adjacent to carcinoma tissue and normal colorectal mucosa. The positive expression rate of gastrin of highly-differentiated adenocarcinoma group was significantly higher than that of poorly-differentiated and mucinous adenoc arcinoma groups. The AgNORs count of carcinoma tissue was significantly higher than that in mucosa 3 cm and 6 cm adjacent to carcinoma tissue and norm al colorectal mucosa; and the positive expression of c-myc and c-fos and the A gNORs count in gastrin-positive group was significantly higher than those in gastrin-negative group.

CONCLUSION: Pentagastrin has a promoting effect on the growth of transplanted human colonic carcinoma from SW480 cell line. PGL has no obvious effect on the growth of human colonic carcinoma SW480 cell line, but could inhibit the growth promoting effect of PG on transplanted carcinoma. Somatostatin can not only inhibit the growth of transplanted human colonic carcinoma from SW480 cell line directly but also depress the growth-promoting effect of gastrin on the transplanted carcinoma. Some colorectal carcinoma cells can produce and secrete gastrin through autocrine, highly-differentiated adenocarcinoma express the highest level gastrin. Endogenous gastrin can stimulate the cell division and proliferation of carcinoma cell and promote the growth of colorectal carcinoma regulating the expression of oncogene c-myc, c-fos. Our study has provided experimental basis for the adjuvant treatment using gastrin antagonist such as PGL, so matostatin of patients with colorectal carcinoma.

Inhibitory activity of polysaccharide extracts from three kinds of edible fungi on proliferation of human hepatoma SMMC-7721 cell and mouse implanted S180 tumor

AIM:To determine the activities of polysaccharide extracts from Flammulina velutipes (Curt. ex Fr.) Sing (FV), Lentinus edodes (LE)and Agaricus bispo-rus Sing (AB) on the proliferation of human hepatoma SMMC-7721 cells in vitro and on mouse implanted S-180 tumors in vivo.METHODS:The polysaccharide extracts were isolated from the fruit bodies of FV, LE and AB by the methods of hot-water extraction,Sevag's removal of proteins, ethanol precipitation, trypsin digestion and ethanol fractional precipitation. Human hepatoma SMMC-7721 cells were treated with 50mg/L polysaccharide extracts, and the mitosis index, mitochondria activity and cell proliferation were detected at different times in both control and experimental groups. The mice with S-180 implanted tumors were injected with the polysaccharide extracts at 24mg/kg body weight for 9d and the tumor weight was measured on the 15th day.RESULTS:The mitosis index of hepatoma cells in vitro could be significantly decreased by treatment with the polysaccharide extracts from the three kinds of edible fungi (P< 0.005). The cell numbers and mitochondria activity of SMMC-7721 cells treated with polysaccharide extracts were lower than those in control groups (P<0.005). The inhibition rates of polysaccharide extracts against implanted S-180 tumors in mice were 52.8%, 56.6% and 51.9% respectively compared with that in control groups.CONCLUSION:The polysaccharide extracts from the three kinds of edible fungi could inhibit not only the cultured malignant cells in vitro but also implanted S-180 tumor in vivo.

Effects of a bioartificial liver support system on acetaminophen induced acute liver failure canines

AIM: To evaluate the safety and efficacy of the bioartificial liver support system in canines with acute liver failure (ALF).

METHODS: Nine canines with acute liver failure by acetaminophen -induced received TECA- I bioartificial liver support system (BALSS) from Hong Kong TECA LTD Co. Blood was perfused through a hollow fiber tube containing (1.2) × 10¹⁰ the porcine hepatocytes. In contrast, another 10 canines with a cute liver failure by Acetaminophen received drugs. Each treatment lasted 6 h.

RESULTS: BALSS treatment resulted in beneficial effects for acetaminophen-induced ALF canines with survival and with the recovery of the live r functions and tissues, and plasma ammonia decreased from 135.9 μmol/L ± 17.5 μmol/L to 65.7 μmol/L ± 22.0 μmol/L, 32.5 μmol/L ± 8.8 μmol/L, GPT from 97.8 U/L ± 8.7 U/L to 64.8 U/L ± 11.9 U/L, 19.0 U/L ± 6.3 U/L, GOT from 103.0 U/L ± 16.7 U/L to 75.7 U/L ± 19.6 U/L, 26.5 U/L ± 5.0 U/L, and AKP from 158.3 U/L ± 12.1 U/L to 114.5 U/L ± 19.8 U/L, 43.8 U/L ± 5.6 U/L during and after the treatment. In contrast, 10 ALF canines in both the drug and control groups died 1 or 2 d after treatment.

CONCLUSION: TECA-1 artificial liver support system is safe and efficacious for canines with acute liver failure.

Establishment and characterization of four human hepatocellular carcinoma cell lines containing hepatitis B virus DNA

AIM: To investigate the characteristics of newly established f our hepatocellular carcinoma cell lines (SNU-739, SNU-761, SNU-878 and SNU-886) from Korean hepatocellular cancer patients.

METHODS: Morphologic and genetic studies were done.

RESULTS: All four lines grew as a monolayer with an adherent pat tern, and their doubling times ranged from 20 to 29 h. The viability rate was relatively high (88%-94%). Neither mycoplasmal nor bacterial contamination was present. The lines showed different patterns in fingerprinting analysis. The hepatitis B virus (HBV) DNA was integrated in the genomes of all four lines, and in all of them HBx, HBc and HBs transcripts were detected by reverse transcriptase-PCR methods. Among the three cell lines used as control (Hep 3B, SK Hep1 and Hep G2), only Hep 3B showed HBx expression, and this line was used as a HBV integrated control. The RNA of albumin was detected in three lines (SNU-761, SNU- 878 and SNU-886), that of transferrin in two lines (SNU-878, SNU-886), and that of IGF- II was detected in none of the cell lines.

CONCLUSION: These well characterized cell lines may be very useful for studying the biology of hepatocellular carcinoma in association with the hepatitis B virus.

A study of the ameliorating effects of carnitine on hepatic steatosis induced by total parenteral nutrition in rats

AIM: To investigate the effects of carnitine on ameliorating hepatic steatosis induced by total parenteral nutrition (TPN) in animal model.

METHODS: Eighteen normal Wistar rats and 19 cirrhotic Wistar rats induced by carbon tetrachloride were randomly divided into three groups, i.e., free access to food and drink (group A), TPN (group B) and TPN + carnitine (group C) for one week, respectively. Hepatic function, histology and its fat content were determined on the 7^th day.

RESULTS: Hepatic triglyceride (TG) and cholesterol (CHO) contents were significantly higher in groups B and C than in group A, and significantly lower in group C than in group B in both normal and cirrhotic rats (all P < 0.05). Histopathological examinations revealed that hepatic steatosis was more severe in group B than in group C in both normal and cirrhotic rats.

CONCLUSION: Carnitine can ameliorate hepatic steatosis associated with TPN in both non-cirrhotic and cirrhotic rats.

Clinical implication of VEGF serum levels in cirrhotic patients with or without portal hypertension

AIM: To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein.

METHODS: Fifty-three patients (mean age 56 ± 2 years) with HCV (n = 26), HBV (n = 13), and cryptogenic liver cirrhosis (n = 14) (Child-Pugh-s class A: 24, B: 19 and C: 12) and normal renal function constitute the patient population, who were all diagnosed by clinical, histological and radiological findings. Six healthy people and six patients with acute hepatitis served as controls. Severity of liver disease was evaluated by the CP score. Serum levels of IGF-1 and VEGF were measured by radioimmunoassay and ELISA, respectively. Portal hypertension was assessed using pulsed Doppler ultrasound.

RESULTS: The mean serum VEGF levels in all cirrhotic patients (73 ± 58) were significantly lower than those of healthy controls (360 ± 217, P < 0.01) and acute hepatitis (1123 ± 1261, P < 0.01) respectively. No significant difference in median serum VEGF levels were noted among the different Child-Pugh-s classes (class A: median, 49.4 ng/L, range, 21-260 ng/L, Class B: median 59.9 ng/L; range 21-92, and Class C: median 69; range 20-247 ng/L). A significant correlation was noted between serum VEGF and two accurate parameters of portal hypertension: portal blood flow velocity (r = 06) and spleen size (r = 0.55). No correlation was found between VEGF serum levels and serum albumin, IGF-1, platelets count and aminotrasnferases (r = 0.2, r = 0.1, r = 0.2 and r = 0.2, respectively).

CONCLUSION: Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of chronic liver disease but rather, they may reflect increased portal hypertension or decreased hepatic regenerative activity or the combination of both.