Comparative study of different interventional therapies for primary liver cancer

AIM: To compare the therapeutic effect of three types of inter-ventional management for primary liver cancer.

METHODS: A total of 468 patients with primary liver cancer were randomly allocated to the following three groups: 138 cases treated with chemotherapy alone using mitomycin C, adriamycin and 5-FU (group A); 158 cases treated with chemoembolization using lipiodol (group B); and 172 cases with chemoembolization using lipiodol and gelfoam (group C). All patients were angiographically and sonographically followed-up.

RESULTS: In group C, 67.5% patients had AFP value decreased by > 50%, which was much higher than the 43.3% in group B and 32.2% in group A. Tumor size reduction by ≥ 50% occurred in 20.3% of patients in group A, 41.2% of patients in group B and 44.8% of patients in group C. The intergroup differences between group A and group B or C were significant (P < 0.01). The 1-year and 3-year survival rates were 20.5% ± 3.6% and 1.9% ± 2.4% for group A, 51.3% ± 4.4% and 10.1% ± 4.9% for group B, and 63.0% ± 2.4% and 13.9% ± 5.0% for group C, respectively. The differences between all three groups were significant (P < 0.05). The mean survival time for patients in groups A, B and C were 9.6 mo, 16.1 mo and 17.9 mo, respectively.

CONCLUSION: Chemoembolization with lipiodol and gelfoam was the most effective therapy for primary liver cancer in this study. The position of the embolization should be far and middle sections of the hepatic artery, and the proximal section should be reserved as the route of the next intra-arterial chemoembolization.

Comparative study of biliary trace elements and clinical phenotypes in Wilson’s disease

AIM: To further explore the etiological mechanism of Wilson’s disease (WD) by comparing the changes of biliary trace elements and its clinical phenotype.

METHODS: WD patients with different types and conditions (n = 20), non-WD patients with chronic liver damage (n = 22), and healthy volunteers (n = 10; used as controls) were studied. Biliary samples were taken by duodenal drainage. Atom absorption spectrophotometer was used to assay the copper and zinc content of each sample.

RESULTS: In WD, the copper content and copper/zinc ratio of biliary juice were evidently lower than those of non-WD patients with chronic liver damage and of healthy controls (F = 14.76, 25.4; 14.92, 26.2 respectively; P < 0.01), while the biliary zinc level had no significant difference from the two non-WD control groups (P > 0.05). There were significant differences in biliary copper excretion among patients with different types and conditions (F = 3.75, P < 0.05; F = 6.20, P < 0.01).

CONCLUSION: Copper excretion by liver and the biliary system decreases obviously in WD, which plays a key role in the phenotypic copper retention, and the biliary copper retention is closely related with the severity of hepatic injury and illness.

Clinical significance of CD44v mRNA detection by PCR in peripheral blood of patients with hepatocellular carcinoma

AIM: To study the clinical significance of detecting the expression of CD44v mRNA in the blood of patients with hepatocellular carcinoma (HCC).

METHODS: The expression of CD44v mRNA was detected in blood with RT and diploid PCR, and the clinical significance was discussed based on the result of pathological examination and follow-up.

RESULTS: CD44v mRNA was detected in the blood of 10/15 patients, giving a positive rate of 66.67%. In the 13 patients who showed response in the follow up period, the CD44v mRNA expression was positive in 9 and negative in 4. Recurrence rate was higher in the patients with positive CD44v mRNA expression than in those with negative CD44v mRNA expression, and the clinical pathological indices were also higher in the former than in the latter.

CONCLUSION: Detection of the expression level of CD44v mRNA in blood of the patients with HCC can be used as an adjuvant means for differential diagnosis, prediction and monitoring of HCC recurrence.

Pharmacokinetics of four 5-FU preparations administered rectally to rats and rabbits

AIM: To compare the pharmacokinetic characteristics of four preparations of fluorouracil (5-FU) administered rectally using a rat model.

METHODS: Concentrations of 5-FU were measured in plasma, the rectal wall and mesentery lymph tissues of rats and rabbits by high performance liquid chromatography. Differences between the main pharmacokinetic parameters were compared by statistical analysis.

RESULTS: The 5-FU concentrations in the rectal wall and mesenteric lymph tissues were significantly higher than the concentration in blood following rectal administration for all four of the preparations (P < 0.01). The drug level in the rectal wall was higher in the animals received delivery of an emulsion, compared to those who received delivery as a suppository (P < 0.05). Moreover, the animals who received a lipophil-based suppository had lower plasma level of drug than those who received a hydrophil-based suppository, and the animals who received the simple (o/w) emulsion had lower plasma level than those who received the complex (w/o/w) emulsion. The differences found in the rat model were confirmed in rabbits (P < 0.01).

CONCLUSION: The lipophil-based suppository and the simple emulsion of 5-FU might be more suitable for rectal administration for treatment of rectal cancers.

Comparative study of changing patterns of concanavalin A-binding proteins in early stage of cholesterol gallstone formation

AIM: To elucidate the importance and the changing patterns of biliary concanavalin A-binding proteins (CPs) in the early stage of cholesterol gallstone formation.

METHODS: CP concentration and nucleation activity were measured by lectin affinity chromatography in bile samples of patients with cholesterol gallstones, pigment gallstones, gallbladder cholesterosis and non-biliary diseases.

RESULTS: The concentrations of CPs were much higher in patients with cholesterol gallstones (0.39 ± 0.11 g/L, n = 36, P < 0.01) or gallbladder cholesterosis (0.40 ± 0.09 g/L, n = 9, P < 0.01) than in those with pigment gallstones (0.2 ± 0.12 g/L, n = 7) and/or non-biliary diseases (0.27 ± 0.09 g/L, n = 10). Pronucleating activities were much stronger in patients with cholesterol gallstones (nucleation time ratio: 0.57 ± 0.21, n = 5, P < 0.01 vs pigment gallstones and/or non biliary diseases) and gallbladder cholesterosis (nucleation time ratio: 0.44 ± 0.23, n = 5, P < 0.01 vs pigment gallstones or non-biliary diseases). The binding percentages of CPs to model biliary vesicles were also higher for patients with cholesterol gallstones (n = 6) than those with pigment gallstones (n = 6) (2.4% ± 0.9% vs 0.9% ± 0.5%, P < 0.01).

CONCLUSION: Hypersecretion of CPs, especially those in vesicular phase, may be an important change in the early stage of cholesterol gallstone formation.

Gastric emptying and plasma levels of gastrointestinal hormones in patients with peptic ulcer

AIM: To study the plasma level of gastrointestinal hormones and the time of gastric emptying in patients with peptic ulcer.

METHODS: Thirty patients with gastric ulcer (GU), 29 patients with duodenal ulcer (DU), and 12 healthy controls were studied. Plasma levels of somatostatin (SS), vasoactive intestinal peptide (VIP) and substance P (SP) were measured by radioimmunoassay. Gastric emptying half-time (GET_1/2) was measured by the TC-99^m resin/solid meal method.

RESULTS: GET_1/2 was significantly longer in the GU patients than that in the healthy controls (65.9 ± 14.8 min vs 53.3 ± 4.3 min, P < 0.01) and plasma VIP levels were significantly higher (37.5 ± 10.7 ng/L vs 18.4 ± 5.9 ng/L, P < 0.05).There was a significant positive correlation between GET_1/2 and plasma VIP levels (r = 0.55, P < 0.01). No significant differences were found in SS and SP levels when GU patients were compared with healthy controls (P > 0.05). GET_1/2 was markedly shorter in the DU patients than in the healthy controls (41.7 ± 10.2 min vs 53.3 ± 4.3 min, P < 0.01) and plasma SS levels were significantly lower (6.4 ± 2.5 ng/L vs 11.9 ± 3.4 ng/L, P < 0.01). There was a significant positive correlation between GET_1/2 and SS levels (r = 0.56, P < 0.01). Plasma SP levels in the DU patients were significantly higher than those in the healthy controls (54.4 ± 12.7 ng/L vs 41.6 ± 5.8 ng/L, P < 0.01). There was a significant negative correlation between GET_1/2 and SP levels (r = -0.68, P < 0.01). No significant differences were found in the plasma VIP levels when DU patient were compared to healthy controls (P > 0.05).

CONCLUSION: Elevation in VIP may contribute to occurrence of GU and its associated delay in GET_1/2. Increased SP and reduced SS may play important roles in GET_1/2 acceleration and in the pathogensis of DU.

Multicenter randomized study on Me-CCNU, 5-FU and ADM vs ACNU, 5-FU and ADM for treatment of advanced gastric cancer

AIM: To compare the efficacy of a combined chemotherapy regimen of 5-fluouracil (5-FU) and adriamycin (ADM) with nimustine hydrochloride (ACNU; brand name Nidran), a new nitrosourea agent, or with methyl-CCNU for advanced gastric cancer.

METHODS: One-hundred-and-three cases of advanced gastric cancer were randomly allocated into Group A (Me-CCNU, 5-FU and ADM combination) and Group B (ACNU, 5-FU and ADM combination). The quality of life (QOL) questionnaire, composed of 11 ordinal categorical items, was used to collect data from these patients.

RESULTS: Group A had no case of complete remission (CR) or partial remission (PR), while Group B had no CR but 8 PR (8/46 cases), for a response rate of 0% in Group A and 17.4% in Group B. The median survival time in Group A was 108 d and in Group B was 112 d. Both groups tolerated the treatment well and there were no serious adverse effects. QOL evaluations showed better psychological and physical feelings of tiredness for Group B than for Group A, and scores based on facial scaling showed a more pleasant inclination for the former.

CONCLUSION: ACNU combination is superior to the Me-CCNU combination for advanced gastric cancer patients.

Comparative study on proliferation activity in small hepatocellular carcinoma related to hepatitis virus B and C

AIM: To compare the proliferation activity of small hepatocellular carcinoma (HCC) related to hepatitis B virus (HBV) and hepatitis C virus (HCV).

METHODS: Sixty liver biopsy specimens were obtained from patients with small HCC (≤3 cm in diameter) and examined immunohistochemically using anti-proliferating cell nuclear antigen monoclonal antibody. Of the 60 specimens, 30 were HBV-related and 30 were HCV-related. The 60 patients providing the samples for study were matched by sex and morphologic features of the HCC specimens.

RESULTS: The labeling index of proliferating cell nuclear antigen was 7.9% in the HBV-related HCC specimens and 12.5% in the HCV-related HCC specimens. There was no statistically significant difference between the two groups (P > 0.05).

CONCLUSION: In the early phase, or small stage, of HCC, HBV-related HCC shows similar proliferating activity to that of HCV-related HCC; this finding suggests that in the early phase, HBV-related HCC has similar malignancy to HCV-related HCC.

Effect of garlic on micronuclei frequency in peripheral blood lymphocytes of rats with N-methyl-N’nitro-N-nitrosoguanidine-induced gastric carcinoma and precancerous lesions

AIM: To investigate the effects of garlic on micronuclei frequency (MNF) in peripheral blood lymphocytes (PBLs) of Wistar rats with N-methyl-N’nitro-N-nitrosoguanidine (MNNG)-induced gastric carcinoma (GC) and precancerous lesions (PLs).

METHODS: Wistar rats were exposed to MNNG at 1.25 mg/5 mL per day for 10 mo to induce GC and PLs (MNNG group, n = 30); rats not exposed to MNNG served as unmodeled controls (control group, n = 16). The MNNG rats were randomly divided into a prevention treatment group (n = 30; receiving 10 mL of a 10% garlic solution per day) and an untreated model control group (n = 20; receiving tap water). MNF in PBLs were detected at experiment months 10 and 16 mo by the microculture technique.

RESULTS: The MNNG group had similar MNF levels at months 10 and 16. Compared to the control group, the MNNG, prevention and untreated model control groups had remarkably higher MNF levels (P < 0.01). The level of PLs was significantly lower in the prevention treatment group than in the untreated model control group (P < 0.01). The prevention group showed significantly lower MNF than the MNNG group (P < 0.01), and the MNF level was reduced in month 16 compared to month 10 (P < 0.01). However, the difference in MNF levels in groups given prevention or treatment was not significant.

CONCLUSION: MNNG exposure exerted continuous mutagenicity and carcinogenicity properties on PBLs, and garlic exerted a remarkable anti-mutagenic and anti-carcinogenic effect. MNF in PBL may be a novel marker of early-stage GC.

Altered expression of tumor suppressors p16 and Rb in gastric carcinogenesis

AIM: To determine whether expression of the tumor suppressors p16 and Rb is altered in gastric carcinoma.

METHODS: Mucosal biopsies were endoscopically obtained from patients with superficial gastritis (n = 12), atrophic gastritis (n = 15), atypical hyperplasia (n = 20) and gastric cancer (n = 40). Upon obtainment, all samples were immediately fixed with 10% buffered formalin, embedded in paraffin, and sectioned serially. Protein expression of p16 and Rb was detected by immunohistochemistry (ABC method).

RESULTS: The gastric epithelium samples showed various degrees of nuclear immunostaining for p16 and Rb according to the different stage of lesion. Progressive pathology of the lesions was associated with a decreasing trend in positive immunostaining for p16 protein (83.3% > 73.3% > 30.0% > 27.5%) but an increasing trend for Rb protein (25.0% > 46.7% > 60.0% > 67.5%). A negative correlation was found between these two parameters and gastric cancer. Correlation analysis of the 40 cases of gastric cancer identified a negative correlation for 20 of the cases. When positive (n = 9) and negative tissues (n = 11) were compared, a statistically significant difference was found (50.0%, 22.5%, 27.5%) (P < 0.05).

CONCLUSION: Abnormal expression of p16 and Rb may play an important role in gastric carcinogenesis.

Effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats

AIM: To investigate the effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats.

METHODS: Twenty-eight male Sprague-Dawley rats were equally divided into a intrahepatic portal hypertension (IHPH) model group (n = 14, established by injection of CCl₄) and a prehepatic portal hypertension (PHPH) model group (n = 14, established by stenosis of the portal vein). Animals in each group were subdivided into an octreotide treatment (injection) group and a control (normal saline injection) group. Seven age-matched unmodeled/untreated normal rats served as controls. The mean systemic arterial pressure (MSAP) and free portal venous pressure (FPP) were measured. The splanchnic blood flow was detected by injection of toad blood red cell labelled with ⁵¹Cr and ¹²⁵I·T₃. The concentration of plasma glucagon was determined by radioimmunoassay.

RESULTS: All rats with portal hypertension showed significantly decreased splanchnic blood flow and FPP in response to octreotide treatment, as well as markedly increased splanchnic vascular and portal venous resistance. The octreotide treatment did not appear to significantly lower the plasma glucagon levels in either the peripheral or the portal veins.

CONCLUSION: Octreotide induces a decrease in splanchnic blood flow in rats with portal hypertension, and this effect results primarily from direct vasoconstriction and to a lesser extent from decreased plasma glucagon level.

Clinical significance of CA19-9 in diagnosis of digestive tract tumors

AIM: To evaluate the clinical value of CA19-9 in diagnosing and differentiating gastrointestinal tumors and in monitoring patients treated surgically.

METHODS: Patients with gastric cancer (n = 70), colorectal cancer (n = 90), pancreatic cancer (n = 7), esophageal cancer (n = 10) and benign disorders (n = 30), and normal adults (n = 111; used as healthy controls), were studied. Fasting blood samples were obtained from each study participant. The serum CA19-9 concentration was measured with radioimmunoassay.

RESULTS: The mean CA19-9 level was significantly higher in patients with gastric cancer (170.69 ± 91.45 kU/L) and patients with colorectal cancer (87.21 ± 39.55 kU/L) than in the healthy controls (11.254 ± 6.00 kU/L). Compared with the healthy controls, the CA19-9 level was also much higher in patients with pancreatic cancer (1266.58 ± 521.31 kU/L) (P < 0.01). However, the CA19-9 concentrations in patients with non-recurrent gastric cancer (12.63 ± 3.62 kU/L), colorectal cancer (14.14 ± 3.26 kU/L) and benign disorders (14.23 ± 2.60 kU/L) were statistically similar to those in the healthy controls (P > 0.05). The demarcation value of CA19-9 between negative and positive was < 31.0 kU/L. The sensitivity of CA19-9 for gastric, colorectal, pancreatic and esophageal cancers and for gastrointestinal benign disorders was 47.3%, 50.0%, 83.3%, 20.0% and 0%, respectively. The specificity of CA19-9 for digestive system malignant diseases was 100% for all.

Analysis of two constitutive forms of microsomal heme oxygenase in different rat tissues

AIM: To isolate and purify the heme oxygenase (HO) isoform in microsomal fractions of Sprague-Dawley rat liver and brain in order to understand the characteristics of the two constitutive forms and the mechanism of the occurrence of hyperbilirubinemia.

METHODS: After induction by hematin and phenylhydrazine, the rat liver and brain microsomal fractions were isolated and purified by DEAE-Sephacel and hydroxyapatite. Activity and the apparent molecular weight of the two isoforms [heme oxygenase 1 (HO-1) and heme oxygenase-2 (HO-2)] were measured. Kunming mice were used to prepare antiserum against purified liver HO-2. Rat liver HO-1 and brain HO-2 preparations were analyzed by the western immunoblotting technique.

RESULTS: Two isoforms were purified and identified in the treated rat liver, and HO-1 was the predominant form with a ratio of 2:1. In the native state, HO-2 activity was detectable but HO-1 activity was increased in response to hematin and phenylhydrazine, while HO-2 activity was fully refractory to these agents. The apparent molecular weights of HO-1 and HO-2 were about Mr 30000 and Mr 36000 under reducing conditions, respectively. In the untreated liver and treated brain, only one peak of HO activity exhibiting an elution profile similar to that of HO-2 of the treated liver was detected. The presence of an activity peak was not found in the elution profile at the region where the inducible isoform of HO (HO-1) was expected. The apparent molecular weight in treated brain preparation was identical to that of the purified liver HO-2. Cross-reactivity of HO-2 in the brain microsomal preparation was established, but a reactivity of HO-1 in the liver was not observed by western immunoblotting analysis when antiserum to liver HO-2 was applied.

CONCLUSION: Two constitutive forms of HO, designated as HO-1 and HO-2, exist in the treated rat liver. HO-1 is an inducible enzyme. In the treated rat brain only HO-2 exists and is a molecular entity similar to that found in liver. The two constitutive forms were different in molecular weight and in inducibility and immunochemical properties.

AgNOR and rasp21 expression in gastric mucosal lesions caused by Helicobacter pylori infection

AIM: To investigate AgNOR and rasp21 expression levels in gastric mucosal lesions caused by Helicobacter pylori (Hp) infection in order to gain insight into the related biological processes (i.e. tumor-like behavior) and possible underlying mechanism supporting Hp pathogenesis.

METHODS: Hp infection was diagnosed in using the standard Campylobacter-like organism test along with Wathin-Starry staining. The expression of AgNOR was detected by the silver colloid staining technique. The expression of rasp21 was detected by monoclonal antibody and immunohistochemical staining using the ABC method. The study included a total of 278 patients with endoscopically- and pathologically-confirmed gastric mucosal lesions, representing chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG), intestinal metaplasia, dysplasia, and gastric cancer. Among these, 146 of the patients were Hp-positive and 132 were Hp-negative.

RESULTS: The Hp-positive group of patients showed significantly greater AgNOR in the gastric mucosal lesions than the Hp-negative group, with the exception of the CSG sub-group (P < 0.05 or P < 0.01). The positive rate of rasp21 expression in gastric mucosal lesions in the Hp-positive group was also significantly higher than that in the Hp-negative group, with the exception of the CSG and CAG sub-groups (P < 0.05).

CONCLUSION: Hp-positive gastric mucosal lesions show biological behaviour of tumors. Hp may act as a promoter to activate the ras gene and to stimulate cell over-proliferation.

Clinical and experimental studies on stomach carcinoma treated with Yangwei Kangliu granules

AIM: To study the anti-cancer mechanism of Yangwei Kangliu (YWKL) granules from the view point of red blood cell (RBC) immunity and to investigate the relationship between RBC immunity and T lymphocyte immunity.

METHODS: Fifty patients with advanced gastric carcinoma were treated with a combination of YWKL granules and chemotherapy. Venous blood samples were obtained before treatment and after one course of treatment. The rosette rate of c-3b-receptor (RBC-C-3bRR), tumor and red cell (RRTR) and RBC immune complex (RBC-ICR) were measured under microscopy by counting the rosettes formed by sensitized or unsensitized yeast adherence. The T lymphocyte subset was observed by the method of APAAP. Control patients were treated with chemotherapy alone (n = 20). In addition, mouse tumor studies were performed to investigate the dynamic changes of RBC-C-3bRR, RRTR and RBC-ICR in response to treatment with YWKL granules (n = 30). Mice treated with chemotherapy alone (n = 30) or water alone (n = 30) were used as controls.

RESULTS: The clinical therapeutic effect of combination treatment with YWKL granules and chemotherapy (i.e. the treatment group) was markedly superior to that of chemotherapy alone (i.e. the control group) (P < 0.01). In the treatment group, the rosette rates of RBC-C-3bRR and of RRTR were significantly increased (P < 0.01) after treatment, the rate of RBC-ICR was markedly decreased (P < 0.01), and the ratio of CD4 to CD8 was obviously elevated (P < 0.01). Moreover, CD8 was much lower (P < 0.01) and the ratio of CD4 to CD8 was much higher (P < 0.01) than that in the control group. The RRTR rate was positively correlated with the ratio of CD4 to CD8. In mice, on day 9 of bearing cancer, the tumor weight in the group treated with YWKL granules alone was much lower than that of the tumors in the control mice groups; in addition, the YWKL treated mice showed higher RBC immune function than the mice of the two control groups. On day 13 of bearing cancer, however, the differences in both tumor weight and RBC immune function had disappeared.

CONCLUSION: The anti-cancer mechanism of YWKL granules may involve enhancement of RBC immunity and of T lymphocyte immune function, which is supported by the finding of RBC immune function being correlated with T lymphocyte immune function.

Clinicopathogenic studies of acute diarrhea in children

AIM: To identify etiologic pathogens of acute diarrhea in children and to determine the diagnostic value of stool pH.

METHODS: From May 1988 to April 1992, 368 children with acute diarrhea were studied. Fresh stools were routinely examined, and stool pH was tested with pH paper. Samples were placed in Cary-Blair culture medium and were sent to the lab for bacterial isolation and identification. Rotavirus was identified in the supernatant by ELISA.

RESULTS: Thirty-one pathogens and 385 bacterial strains were found in the 368 samples, with a detection rate of 67.7%, including 37.8% of mixed infections. Among the bacteria families, vibrionaceae was the most common (39.7%), and among bacteria genera, aeromonas was the most common (26.8%). In bacterial diarrhea, stool pH tended to be basic, while in viral diarrhea it tended to be acidic.

CONCLUSION: There are 31 pathogens for children’s acute diarrhea in this area. It is quite difficult to make an etiologic diagnosis only by clinical signs. However, stool pH is of some value for early disease diagnosis.

Double-bullet radioimmunotargeting therapy in 31 primary liver cancer patients

AIM: To observe the effect of double bullet immunotargeting therapy with chemotherapy and internal radiotherapy on primary liver cancer.

METHODS: The polyclonal horse antibody against human AFP (anti-AFPAb) and the monoclonal murine antibody against human AFP (anti-AFPMcAb) were used as carriers, and ¹³¹I and mitomycin C (MMC) were used as warheads to form double bullet, i.e. ¹³¹I anti-AFPMcAb-MMC (double bullet 1) and ¹³¹I anti-AFPAb-MMC (double bullet 2) prepared using the modified chloramine T method. Double bullet targeting therapy was administered by intravenous drip once a month in 31 patients (treatment group) with unresectable primary liver cancer. Among them, 4, 17 and 10 patients were administered 1, 2 and 3 times, and the median radiation dose (MBq/case) was 193.5 ± 37.74; 651.9 ± 232.4, and 992.0 ± 230.5 respectively.

METHODS: Tumor shrinkage, decrease in AFP, and 1 and 2 -year survival rates were significantly higher than the control groups who received transarterial infusion (TAI) or transarterial chemoembolization (TACE) at the same time (50.0%, 15/30 vs 30.0%, 9/30, P < 0.05; 66.7%, 18/27 vs 28.0%, 7/25, P < 0.01 and 50.0%, 34.0% vs 33.0%, 3.3%, P < 0.01, respectively). Furthermore, the tumor progression rate (10%) in the treatment group was significantly lower than that of the control group (40.0%, P < 0.01).

CONCLUSION: Double bullet target therapy is more effective than traditional therapies due to the synergistic effects of the antibody, radioisotope, and anticancer agents, which together, enhance tumor killing.

Loss of heterozygosity and mRNA expression at deleted in colorectal cancer gene locus in gastric cancer

AIM: To assess the effects of the deleted in colorectal cancer (DCC) gene changes on the development and progression of gastric cancer.

METHODS: The loss of heterozygosity (LOH) and mRNA expression DCC gastric cancer using a PCR-based detection method.

RESULTS: LOH was found in 35.3% (18/51) of the specimens, and the LOH was more frequently detected in tumors from patients with stage III or IV cancer (50.5%) than those in stages I or II (14.3%) (P < 0.05). The occurrence of LOH was not found to correlate with the histological type, tumor size, invasion depth and lymph node metastasis of gastric cancer. The mRNA expression of the DCC gene was studied in 26 of the 51 cases, of which LOE was found in 30.8% (8/26). LOE was not significantly correlated to LOH or other clinicopathological parameters.

CONCLUSION: LOH and LOE of DCC gene are frequently encountered in gastric cancer, and the LOH of DCC gene is a late event associated with progression of gastric cancer.

Immunohistochemical study on endocrine-like tumor cells in colorectal carcinomas

AIM: To evaluate the clinical significance of endocrine-like tumor cells in human colorectal carcinomas.

METHODS: The immunohistochemistry method (ABC) using a rabbit polyclonal antibody against human chromogranin A (CGA) was employed to determine changes in endocrine-like tumor cells from the surgically resected colorectal carcinoma tissues of patients (35 males and 27 females, aged from 19 to 78 years, with a mean age of 50.3 years). Of the 62 specimens, 44 were from rectal carcinomas, 18 from colonic carcinomas, 14 from lymph nodes and 48 from non-involvement. Dukes classification revealed 19 of the cases were in stage A, 29 cases were in stage B and 14 cases were in stage C. All of the specimens were fixed with 10% formalin, embedded with paraffin and cut into 5 μm sections. Additionally, the correlations among CGA-positive tumor cells, as well as the clinicopathologic data, age and sex of the patients, were also investigated.

RESULTS: CGA-positive tumor cells were found in 35.5% of the patients with colorectal cancers, representing 20.0% (5 of 25) and 45.9% (17 of 37) of the aged and non-aged, respectively. These differences were significant (χ² test, P < 0.05). Nevertheless, no significant correlations were found between the CGA-positive tumor cells and the sex, Dukes stages, tumor location, degree of histological differentiation or presence of lymph node metastasis.

CONCLUSION: The low incidence of endocrine-like tumor cells found in the aged patients may be a new pathological feature for colorectal carcinomas, which could explain why the aged patients usually had a better prognosis. The exact significance of these findings requires further characterization.

Effects of electro-acupuncture on 5-HT, NOS and the gastric mucosa of stress rats

AIM: To study the effects of electro-acupuncture (EA) on 5-hydroxytryptophan (5-HT) levels, nitrous oxide (NOS) levels, nitric oxide (NO) levels, and the gastric mucosa in stress rats.

METHODS: The changes of 5-HT and NOS were measured in the gastric mucosa, and NO and 5-HT were measured in the serum by biochemical methods. The gastric mucosa was examined pathohistologically in the stress rats with gastric mucosa damage after EA. The changes before and after stress by EA were compared.

RESULTS: EA decreased the gastric mucosa damage index in the stress rats (2.71 ± 0.40 to 1.86 ± 0.69, P < 0.01). EA normalized NOS level in gastric mucosa to the control group. The changes before stress by EA was more obvious than that after stress. EA lowered the 5-HT levels in the gastric mucosa (μg/g wet weight, 6.91 ± 3.08 to 4.51 ± 1.62, P < 0.01). EA recovered the NO level in serum of the stress rats (μmol/L, 5.78 ± 1.49 to 7.91 ± 1.11, P < 0.05), and increased the levels of 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) in serum continuously.

CONCLUSION: EA stimulation normalizes the NOS and NO levels in the gastric mucosa of stress rats. EA also lowers the high 5-HT levels and induces NO release.

Survival and malignant phenotype changes of human hepatoma SMMC-7721 cell line induced by cryopreservation at -50 °C

AIM: To investigate the effect of cryopreservation at -50 °C on the human hepatoma SMMC-7721 cell line.

METHODS: With 15% DMSO as a cryoprotectant, the SMMC-7721 cells were cryopreserved at -50 °C, then thawed and recultured. The survival rate, mitotic index and LDH isoenzymes were compared between pre- and post-cryopreservation.

RESULTS: Thirteen hours after the thaw, the mitotic index of cryopreserved SMMC-7721 cells decreased by 1.09%. The mode scope of chromosome number (46-53) after cryopreservation tended to transfer to that of normal human cells, and the percentage of metaphases containing 46 chromosomes changed from 0% to 16%. LDH isoenzymes changed from H-like model (LDH3(29.3%) > LDH4 (26.8%) > LDH2 (25.3%) > LDH5 (14.9%) > LDH1 (3.6%) to M-like model (LDH4 (48.3%) > LDH5 (28.3%) > LDH3 (18.9%) > LDH2 (4.4%) > LDH1 (0%)). This suggests that the survival rate could reach over 95%.

CONCLUSION: Cryopreservation at -50 °C can be a convenient method for the cryopreservation of cell lines. However, cryopreservation at -50 °C is likely involved in the changes of the malignant phenotypes of the human hepatoma SMMC-7721 cell line, and may induce the differentiation of malignant cells.

Source of blood supply and embolization treatment in cavernous hemangioma and sclerosis of the liver

AIM: To investigate the source of the blood supply in carvenous hemangioma of liver (CHL), and provide a feasible treatment for CHL via thehepatic artery.

METHODS: (1) Portovenography, hepatic arteriography and portal vein staining were performed in 5 patients to determine the origin of the blood supply. Two casts of hepatic blood vessels from resected specimens were observed. (2) Clinical data from 75 patients (30 males, 45 females, aged 25-57 years, mean of 37.4) were obtained. Of these, 56 were of solitary type (44 on the right lobe, 12 on the left, with 4 having intraparenchyma), and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty-two patients were treated with sclerosis, 50 by embolization via hepatic artery, and 3 were excised.

RESULTS: In the 5 cases where portography was used, the contrast medium did not enter the tumor, and the tumor appeared as low density area, with the intrahepatic branches of the portal vein pushed aside. In the 5 cases with where portal vein staining was used, the normal liver parenchyma stained a deep blue; however, the tumor was not stained. The tumor area appeared as a round vacant cavity in the 2 specimen casts. For the 72 patients treated with sclerosis or embolization via hepatic artery or through interventional method, the tumors diminished by 10%-30% in diameter, and no tumors grew larger.

CONCLUSION: The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and embolization decreased in size or got fibrotic.

Alterations of erythrocyte ATPase activity and oxygen consumption in patients with liver-blood deficiency syndrome

AIM: To investigate the pathophysiology of erythrocyte energy metabolic changes of patients with the traditional Chinese Medicine (TCM) liver-blood deficiency syndrome (LBDS).

METHODS: Erythrocyte membrane ATPase activity and oxygen consumption rate (OCR) were determined in 66 patients with LBDS, including 35 patients with iron deficiency anemia and 31 patients with chronic aplastic anemia. Thirty healthy adults served as controls.

RESULTS: ATPase activity and OCR were decreased in patients with LBDS.

CONCLUSION: The decreased erythrocyte ATPase activity and OCR might cause the energy hypometabolism in LBDS patients.

Relation between bile acids and myocardial damage in obstructive jaundice

AIM: To investigate the morphologic changes of the myocardium and its relationship to serum bile acids in obstructive jaundice.

METHODS: Part 1: 35 rats were randomly assigned to three groups: Group I (BDL1, n = 11), the common bile duct (CBD) was ligated and severed and mice were then sacrificed after one week. Group I (BDL2, n = 11), the CBD was ligated and severed and mice were then killed after two weeks. Group I (SO, n = 13), the CBD was isolated. Hearts were collected for morphologic studies and blood was taken to determine the total serum bile acids (TAB). Part 2: 13 rats received gastric intubation of 10% 4 mL/kg sodium cholate. Their serum TBA and the heart’s morphologic changes were then examined.

RESULTS: One to two weeks after the CBD was ligated and severed, damage was evident in the mitochondria within the myocardium and the serum TBA was significantly increased. When rats were administered sodium cholate to make their peak blood concentration mimic the average blood concentration in BDL2, a similar degree of myocardial damage was observed.

CONCLUSION: An increase in endogenous bile acids is one causative factor of myocardial damage in obstructive jaundice.

Analysis of fibronectin, fibronectin receptor and interleukin-1 in patients with cirrhosis treated by the Yanggan Jieyu decoction

AIM: To investigate the effects of the Yanggan Jieyu (YGJY, nourishing the liver and alleviating mental depression) decoction on the plasma concentrations of fibronectin (FN), fibronectin receptor (FNR), tumor necrosis factor alpha (TNF-α), and the activity of interleukin-1 (IL-1) in patients with cirrhosis.

METHODS: Thirty-four cases of decompensated cirrhosis were divided into the YGJY decoction treatment group and the control group (patients received standard treatment). FN, FNR and TNF-α were measured by ELISA and expressed as mg/L (FN, FNR) and ng/L (TNF-α). IL-1 was measured by mice thymocyte proliferation using a β scintillation counter and was expressed as cpm.

RESULTS: In the YGJY decoction treatment group, FN and TNF-α levels increased significantly (P < 0.01 and P < 0.05, respectively), and FNR and IL-1 levels decreased significantly (P < 0.05 and P < 0.05, respectively). In the control group, FN, FNR, TNF-α, and IL-1 levels did not significantly change.

CONCLUSION: YGJY decoction could prevent hepatic fibrosis by adjusting the plasma levels of FN, FNR, TNF-α and IL-1, which could mediate cirrhosis formation. This data is of clinical significance.

Effects of tetrandrine on gastric mucosa and liver in portal hypertensive rats

AIM: To study the effects of tetrandrine on portal hypertensive gastric mucosal lesions.

METHODS: Portal hypertensive models were induced in Wistar rats by 60% CCl₄ 3 mL/kg body weight through subcutaneous injection, once every 4 d for 56 d. The animals were randomly divided into portal hypertension, tetrandrine and propranolol groups and subsequently, treated by normal saline, tetrandrine and propranolol respectively for 15 d. Some healthy rats were used as control group. Portal venous pressure (PVP), gastric mucosal prostaglandin E₂ (PGE₂) content, gastric mucosal blood flow (GMBF), gastric adherent mucus (GAM), ALT, ALP and serum total bilirubin (STB), were measured and liver tissues were observed histologically.

RESULTS: In tetrandrine group and propranolol group, PVP was significantly lower (1.43 ± 0.13, 1.45 ± 0.12 vs 1.89 ± 0.18 kPa; P < 0.01) and gastric mucosal PGE₂ content (138.59 ± 12.68, 129.98 ± 14.31 vs 104.65 ± 12.97 pg/mg; P < 0.01), GMBF (11.80 ± 3.47, 10.54 ± 3.63 vs 6.61 ± 2.82 mL·h·kg; P < 0.05) and GAM (3.01 ± 0.15, 2.98 ± 0.21 vs 2.24 mg ± 0.26 mg; P < 0.01) was significantly higher than that in portal hypertension control group. In tetrandrine group intrahepatic proliferative fibrous tissues were reduced and serum ALT (47.67 ± 25.90 vs 189.33 ± 41.21 King U; P < 0.01), ALP (0.22 ± 0.04 vs 0.31 ± 0.06 μmol·s^-1/L; P < 0.01) and STB (4.75 ± 0.76 vs 11.12 ± 2.93 μmol/L; P < 0.01) were lowered as compared with those in portal hypertension control group. ALT (209.34 ± 36.91 vs 189.33 ± 41.21 King U; P > 0.05) and STB (11.63 ± 3.01 vs 11.12 ± 2.93 μmol/L; P > 0.05) in propranolol group were not different from that in portal hypertension control group, but it showed more marked hepatocellular degeneration and necrosis and elevation of ALP (0.46 ± 0.05 vs 0.31 ± 0.06 μmol·s^-1/L; P < 0.01).

CONCLUSION: Tetrandrine can improve the functions of gastric mucosa and liver, and facilitate the absorption of intrahepatic proliferative fibrous tissues. Propranolol can aggravate hepatosis though it may improve portal hypertensive gastric mucosal lesions.

Difference between periportal and pericentral Kupffer cells in lipopolysaccharide uptake in rats

AIM: To reveal the difference in the ability of Kupffer cells in the periportal and pericentral regions of the liver to uptake lipopolysaccharides (LPS) injected into the portal vein.

METHODS: Male Wistar rats were divided into two groups: normal control group (n = 6) and GdCl₃-treated group (n = 8). Sixteen hours before the experiment, rats in the GdCl₃-treated group were injected with GdCl₃via the tail vein to eliminate Kupffer cell function specifically in the periportal region. LPS at a dose of 20 μg/100 g body weight was injected into rats of both groups via the portal vein. Zero, 2, 5, 10, 30, and 60 min after LPS injection, liver samples were obtained and the distribution of LPS in Kupffer cells was observed by immunofluorescence imaging of monoclonal antibody-specific LPS staining using a confocal laser scanning microscope.

RESULTS: In the normal control group, positive reactions to LPS were found in Kupffer cells in the periportal region with the peak at two minutes after LPS injection. Kupffer cells in the pericentral region showed the peak at five minutes after LPS injection, but its fluorescent intensity to LPS at the peak time in the cytoplasm was significantly lower than that of Kupffer cells in the pericentral region. In the GdCl₃-treated group, Kupffer cells in the pericentral region showed the peak at two minutes following LPS injection, and the LPS fluorescent intensity showed no significant difference from that of the normal control rats at the peak point. No significant changes of LPS fluorescent intensities were found in Kupffer cells in the periportal region at various time points following LPS injection in GdCl₃-treated rats.

CONCLUSION: Kupffer cells in the periportal and pericentral regions showed differences in LPS uptake via the portal vein.

Effects of metoclopramide on gastrointestinal myoelectric activity in rats

AIM: To investigate the effects of metoclopramide (MCP) action on myoelectric activity in the antrum and small intestine.

METHODS: Ten healthy male Wistar rats, weighing 250-350 g, were anesthetized with ketamine hydrochloride (100 mg/kg, intramuscularly). Four pairs of bipolar stainless steel electrodes 3 mm apart were implanted on the serosal surface of the antrum at one, 10 and 20 cm distal to the pylorus. Five to ten days following the operation, the gastrointestinal myoelectric activity of fasted rats after intramuscular injection of 2.5, six and 12 mg/kg MCP was recorded using a 8-channel EEG machine, and these values were quantitatively compared with the myoelectric activity after saline injection.

RESULTS: In fasted rats, 2.5 mg/kg MCP increased the amplitude of spike activity (402.0 ± 138.4 μV, vs 345 ± 163.4 μV, P < 0.05) and the percentage of the slow wave-containing spike bursts (60.4% ± 22.0% vs 47.4% ± 22.5%, P < 0.01) of small intestine (1 cm distal to the pylorus), but did not affect the myoelectric activity of the antrum. Six and 12 mg/kg MCP increased the amplitude of both the slow wave (332.8 ± 200.1 μV vs 191.2 ± 143.9 μV, P < 0.01; 330.0 ± 197.1 μV vs 191.2 ± 143.9 μV, P < 0.05) and the spike activity of the antrum (180.5 ± 69.7 μV vs 121.8 ± 63.3 μV, P < 0.05; 174.5 ± 71.7 μV vs 123.8 ± 63.3 μV, P < 0.05), while in small intestine (1 cm distal to the pylorus) only the amplitude of spike activity (407.3 ± 179.0 μV vs 345.0 ± 163.4 μV, P < 0.05; 456.0 ± 145.4 μV vs 345.0 ± 163.4 μV, P < 0.05) and the percentage of the slow wave containing spike bursts (61.7% ± 26.5% vs 47.4% ± 22.5%, P < 0.01; 59.1% ± 17.3% vs 47.4% ± 22.5%, P < 0.01) was increased and the latent period significantly prolonged (2.5 ± 0.35 min vs 0.77 ± 0.18 min, P < 0.01).

CONCLUSION: Different mechanisms may be involved in enhancing the myoelectric activity of the antrum and small intestine following MCP administration.

Clinicopathological risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

AIM: To analyze the clinicopathological risk factors in hepatocellular carcinoma recurrence after surgery.

METHODS: We used significance testing (χ² and Student’s t-test) of single and multiple factors, and Wilcoxon Cox tropic examination; a retrospective clinicopathological analysis was performed on 156 cases of hepatocellular carcinoma after hepatectomy.

RESULTS: Of the 156 cases, 68.4%, 57.3%, 46.7%, 31.5%, and 28.6% had one, two, three, four, and five postoperative tumor-free years, respectively; the total recurrence rate was 53.2% (83/156). In the 83 recurrent cases, 65 were intrahepatic subclinical, with a resection rate of 78.3% (65/83). The relevant factors involved in recurrence were: male gender, tumor number and size, capsule infiltration, and portal vein involvement. These factors were an obvious influence on the prognosis of the patients with postoperative hepatocellular carcinoma (P < 0.05). In the recurrent liver carcinomas, 63.1% of tumor nodes (41/65) were at the ipsilateral segment of the primary tumor nodes.

CONCLUSION: Male gender, tumor number and size, capsule infiltration, and portal vein involvement are factors for postoperative hepatocellular carcinoma recurrence. Recurrence is mainly unicentral. The right front liver lobe is the segment with a high rate of recurrence.

P21 and CEA expression and AgNOR counts in dimethylhydrazine-induced colon carcinoma in rats

AIM: To study P21 and carcinoembryonic antigen (CEA) expression and to measure argyrophilic nucleolar organizer region (AgNOR) counts in various lesions of colonic mucosa and the mechanism of carcinogenesis.

METHODS: Thirty-eight male Wistar rats were injected with dimethylhydrazine (DMH) once a week for 25 wk. P21 and CEA expression was detected by immunohistochemical methods, and AgNOR was counted by silver staining paraffin sections from various colonic lesions.

RESULTS: The incidence of colonic carcinoma in DMH-treated rats was 71.05% (27/38), and lymph node metastasis occurred in six rats. Immunohistochemical studies showed that P21 was primarily expressed in dysplasia and carcinomas, while CEA was expressed in carcinomas and metastatic tumors. AgNOR counts were higher in dysplasia and carcinomas. There were significant differences in P21 and CEA expression between benign and malignant lesions (P < 0.05). The difference in AgNOR counts was also significant between normal and dysplastic tissues, and between dysplasia and malignant lesions (P < 0.05).

CONCLUSION: Dysplasia is a premalignant change of colonic carcinoma. The detection of P21 via immunohistochemistry and AgNOR counting may be an important clinical screening technique for colon carcinoma and premalignant lesions.

Effects of metoclopramide on gastrointestinal myoelectric activity in rats

AIM

To investigate the effects of metoclopramide (MCP) action on myoelectric activity in the antrum and small intestine.

METHODS

Ten healthy male Wistar rats, weighing 250-350 g, were anesthetized with ketamine hydrochloride (100 mg/kg, intramuscularly). Four pairs of bipolar stainless steel electrodes 3 mm apart were implanted on the serosal surface of the antrum at one, 10 and 20 cm distal to the pylorus. Five to ten days following the operation, the gastrointestinal myoelectric activity of fasted rats after intramuscular injection of 2.5, six and 12 mg/kg MCP was recorded using a 8-channel EEG machine, and these values were quantitatively compared with the myoelectric activity after saline injection.

RESULTS

In fasted rats, 2.5 mg/kg MCP increased the amplitude of spike activity (402.0 ± 138.4 μV, vs 345 ± 163.4 μV, P < 0.05) and the percentage of the slow wave-containing spike bursts (60.4% ± 22.0% vs 47.4% ± 22.5%, P < 0.01) of small intestine (1 cm distal to the pylorus), but did not affect the myoelectric activity of the antrum. Six and 12 mg/kg MCP increased the amplitude of both the slow wave (332.8 ± 200.1 μV vs 191.2 ± 143.9 μV, P < 0.01; 330.0 ± 197.1 μV vs 191.2 ± 143.9 μV, P < 0.05) and the spike activity of the antrum (180.5 ± 69.7 μV vs 121.8 ± 63.3 μV, P < 0.05; 174.5 ± 71.7 μV vs 123.8 ± 63.3 μV, P < 0.05), while in small intestine (1 cm distal to the pylorus) only the amplitude of spike activity (407.3 ± 179.0 μV vs 345.0 ± 163.4 μV, P < 0.05; 456.0 ± 145.4 μV vs 345.0 ± 163.4 μV, P < 0.05) and the percentage of the slow wave containing spike bursts (61.7% ± 26.5% vs 47.4% ± 22.5%, P < 0.01; 59.1% ± 17.3% vs 47.4% ± 22.5%, P < 0.01) was increased and the latent period significantly prolonged (2.5 ± 0.35 min vs 0.77 ± 0.18 min, P < 0.01).

CONCLUSION

Different mechanisms may be involved in enhancing the myoelectric activity of the antrum and small intestine following MCP administration.

Survival and malignant phenotype changes of human hepatoma SMMC-7721 cell line induced by cryopreservation at -50 °C

AIM: To investigate the effect of cryopreservation at -50 °C on the human hepatoma SMMC-7721 cell line.

METHODS: With 15% DMSO as a cryoprotectant, the SMMC-7721 cells were cryopreserved at -50 °C, then thawed and recultured. The survival rate, mitotic index and LDH isoenzymes were compared between pre- and post-cryopreservation.

RESULTS: Thirteen hours after the thaw, the mitotic index of cryopreserved SMMC-7721 cells decreased by 1.09%. The mode scope of chromosome number (46-53) after cryopreservation tended to transfer to that of normal human cells, and the percentage of metaphases containing 46 chromosomes changed from 0% to 16%. LDH isoenzymes changed from H-like model (LDH3(29.3%) > LDH4 (26.8%) > LDH2 (25.3%) > LDH5 (14.9%) > LDH1 (3.6%) to M-like model (LDH4 (48.3%) > LDH5 (28.3%) > LDH3 (18.9%) > LDH2 (4.4%) > LDH1 (0%)). This suggests that the survival rate could reach over 95%.

CONCLUSION: Cryopreservation at -50 °C can be a convenient method for the cryopreservation of cell lines. However, cryopreservation at -50 °C is likely involved in the changes of the malignant phenotypes of the human hepatoma SMMC-7721 cell line, and may induce the differentiation of malignant cells.

Changes in mucosal permeability to lipopolysaccharide in the colon of chronic alcoholic rats

AIM: To evaluate the effects of chronic alcohol abuse on mucosal permeability to lipopolysaccharide (LPS) in the colon of rats.

METHODS: Escherichia coli LPS (20 mg/L) was injected into the colon of chronic alcoholic rats (n = 10) that had been supplied with Lieber diet every other day for six weeks. Before and 5, 10, 20, and 30 min after LPS injection, portal vein blood samples were obtained and the LPS levels in the blood were measured. The distribution of LPS in the colon tissues was observed with confocal laser scanning microscopy by immunofluorescence technique using a monoclonal antibody specific to the lipid A region of LPS. Normal rats were used as the controls (n = 6).

RESULTS: Before LPS injection, LPS levels in the portal vein blood of chronic alcoholic rats were significantly higher than that of the normal controls (3.56 ± 0.67 ng/L vs 2.45 ± 0.15 ng/L, P < 0.01). At 5, 10, 20, and 30 min after LPS injection, LPS levels were significantly higher than that before LPS injection (173.56 ± 3.45 ng/L, 154.78 ± 0.57 ng/L, 43.89 ± 0.67 ng/L, 45.38 ± 0.89 ng/L vs 3.56 ± 0.67 ng/L, respectively, P < 0.01). Most mucosal cells in the chronic alcoholic rats showed strong positive reactions to LPS, but in the normal rats, there were no significant changes in portal vein blood LPS levels and in the fluorescence reactions to LPS in the mucosal cells after LPS injection.

CONCLUSION: Chronic alcohol abuse results in a significant increase in LPS permeability in the colon mucosa cells of rats.

Endoscopic monitoring in small bowel transplantation

AIM: To investigate the role of endoscopic monitoring in small bowel transplantation.

METHODS: This study was conducted in two parts—an initial experimental study followed by a clinical study. In the experimental study, segmental small bowel allotransplantation was performed on white outbred pigs. Stomas were created for exteriorization of the proximal and distal ends of the intestines (Thiry-Vella loop). The grafts were monitored by endoscopy via stomas, with or without immunosuppressive therapy. For the clinical study, the whole small-bowel allograft of a woman with short bowel syndrome was endoscopically monitored via distal stoma.

RESULTS: The most common endoscopic findings of graft rejection following small bowel allotransplantation were mucosal erythema, erosion, and ulceration. Diffuse ulceration with bleeding occurred in the late phase of rejection.

CONCLUSION: Endoscopic monitoring is essential to small bowel transplantation.

Characteristics of upper digestive tract diseases in Bohai Bay fishermen

AIM: To study the characteristics of upper digestive tract diseases (UDTDs) in fishermen who live in Bohai Bay.

METHODS: An investigation was carried out in 1488 fishermen with symptoms of UDTDs (aside from liver, biliary and pancreatic diseases) during the time period between December 1991 and February 1995. This investigation included medical history evaluations, physical, gastroscopic and pathological examinations, tests for Helicobacter pylori (H. pylori) infection, and analysis of the nitrate content in their drinking water.

RESULTS: Among the 1488 subjects investigated, 1467 suffered from one or more of the 14 UDTD diseases, most of which were chronic atrophic gastritis (CAG, 1103 cases), peptic ulcers (268 cases), and cancer of the upper digestive tract (25 cases).

CONCLUSION: The incidence rate of UDTDs tends to be high among fishermen due to their particular living habits, the high nitrate content of their drinking water, etc. In addition, the clinical manifestations of UDTDs in fishermen are significantly different from those of the inland residents.

Treatment of postoperative gastric cancer with the Fuzheng Huoxue anticancer prescription

AIM: To study effects of the Fuzheng Huoxue anticancer prescription (Traditional Chinese Medicine) in treatment of gastric cancer.

METHODS: Sixty-nine patients with histologically confirmed mid- or late-stage gastric cancer were assigned to two groups. The treatment group included 35 cases (26 males and 9 females; 2 patients aged 33-40 years, 18 patients aged 41-60 years, and 15 patients aged 61-75 years; mean group age = 58.4 years). The control group included 34 cases (23 males and 11 females; 4 patients aged 33-40 years, 16 patients aged 41-60 years, and 14 patients aged 61-75 years; mean group age = 56.8 years. The two groups were not significantly different in sex, age, their clinical and pathological stages of disease or operation mode. The two groups of patients were given similar treatments; however, patients in the treatment group were given the Fuzheng Huoxue anticancer prescription. In animal studies, SGC-7901 gastric cancers cells were inoculated into the backs of 30 nude mice under sterile conditions. After inoculation, the nude mice were randomly allocated to a control group, a traditional Chinese medicine group, and a chemotherapy group (n = 10 mice per group). The total weight of the 10 mice in each group was similar. Each nude mouse in the control group received 0.5 mL of saline solution each day. Mice in the traditional Chinese medicine group received 0.5 mL of the Fuzheng Huoxue anticancer prescription (containing 1.5 g crude drug) each day, while mice in the chemotherapy group were intraperitoneally injected with 1 mg of 5-Fu once a week for 8 wk.

RESULTS: Prior to treatment, the mean OKT8 percentage among gastric patients in the treatment group was 45.94% ± 8.45%, the mean OKT4/OKT8 ratio was 0.89 ± 0.19, the mean AT-III concentration was 29.9 ± 7.9 mg/dL, the mean Fa value was 50.4% ± 24.4%, and the mean β-TG concentration was 91.0 ± 25.9 ng/dL. Prior to treatment, the mean percentage of OKT8 cells among patients in the control group was 49.21% ± 6.60%, the OKT4/OKT8 ratio was 0.94 ± 0.20, the AT-III concentration was 32.3 ± 7.2 mg/dL, the mean Fa value was 57.3% ± 24.6%, and the mean β-TG concentration was 87.5 ± 34.2 ng/dL. After treatment, the mean OKT8 percentage among patients in the treatment group was 33.52% ± 7.80%, the mean OKT4/OKT8 ratio was 1.47 ± 0.51, the mean AT-III concentration was 38.8 ± 5.5 mg/dL, the mean Fa value was 102.6% ± 31.6%, and the mean β-TG concentration was 62.3 ± 15.1 ng/dL. After treatment, the mean OKT8 percentage among patients in the control group was 42.22% ± 7.07%, the mean OKT4/OKT8 ratio was 1.12 ± 0.24, the mean AT-III concentration was 30.9 ± 8.0 mg/dL, the mean Fa value was 64.6% ± 26.9%, and the mean β-TG concentration was 67.0 ± 42.1 ng/dL. These data indicate that after treatment, the immunologic function of the T lymphocytes of gastric cancer patients in the treatment group was significantly improved (P < 0.01). Additionally, the hypercoagulability in the treatment group was also improved (P < 0.001), and the mean OKT4/OKT8 ratio, antithrombin III (AT-III) concentration, and fibrinolytic activity, etc. had all beome normalized. The one-year (86%), 3-year (69%), and 5-year (40%) survival rates in the treatment group were all higher than those in the control group (P < 0.05). The mean tumor weights in the control, traditional medicine, and chemotherapy groups were 0.895 ± 0.289 g, 0.433 ± 0.177 g, and 0.357 ± 0.142 g, respectively. The tumor-inhibition rates in the traditional Chinese medicine group and chemotherapeutic group (51.6% and 60.1%, respectively) were significantly better than that in the control group (P < 0.001). The mean tumor weight in the traditional Chinese medicine group (24.68 ± 1.93 g) was significantly higher than that in both the treatment group (22.96 ± 1.87 g) and control group (22.47 ± 2.18 g).

CONCLUSION: The Fuzheng Huoxue anticancer prescription can not only replenish vital functions (Zhengqi), correct a hypercoagulatory state, improve immunologic function, and extend patient survival times, but may also directly inhibit gastric tumor growth without producing toxic side effects.

Ultrastructural observation of the gastric mucosa in chronic gastritis patients treated by traditional Chinese medicine

AIM

To demonstrate the relationship between the ultrastructural changes of the gastric mucosa and the syndrome differentiation in chronic gastritis.

METHODS

Sixteen chronic gastritis patients with Piweixuhan (PXG, the cold of insufficiency syndrome of the spleen and the stomach) and fifteen chronic gastritis patients with Ganweibuhe (GBG, incoordination syndrome of the liver and the stomach) were treated with Jianpiwenwei decoction (JWD, invigorating the spleen and warming the stomach) or Shuganhewei decoction (SHD, dispersing the stagnated Liver Qi and regulating the stomach), respectively for three months. Before and after treatment, a gastroscopy was performed and the gastric mucosa was collected from the lesser curvature of the antrum of each patient. The ultrasections were observed and photographed under the JEM-100C X electron microscope.

RESULTS

The common ultrastructural anomalies of the two types of chronic gastritis were the plasmacyte infiltration and the lesions of the mucosal epithelial cells, chief cells and antral mucous cells. There were obvious differences between the two types. In PXG, the predominant lesion of the chief cells was swelling of the mitochondria, while in GBG the rough endoplasmic reticulum was enlarged in the chief cells and the plasmacytes. After treatment, most cases of the ultrastructural lesions reverted to normal or improved.

CONCLUSION

There was a close relationship between the ultrastructural changes of gastric mucosa and the syndrome differentiation of chronic gastritis. JWD and SHD could significantly improve the ultrastructural lesions of the gastric mucosa.

Ultrastructural observation of liver tissue ablation induced by high-intensity focused ultrasound

AIM: To observe the ultrastructural changes of liver tissues on normal rabbit ablated by high-intensity focused ultrasound (HIFU).

METHODS: A single shot of 1.1 MHz focused ultrasound at an intensity of 500 W/cm² with 20-s duration of continuous exposure was applied intraoperatively in normal rabbit livers. Ultrastructural changes of the sonoablated lesion, as viewed by light and electron microscopy, were observed.

RESULTS: Liver cells at the center of the sonoablated lesion showed irreversible degeneration immediately after HIFU treatment; electron microscopy showed that although the liver cells appeared normal histologically, irregularly shaped cavities of about 0.3-0.5 μm in diameter were present in the cytoplasm.

CONCLUSION: Thermal damages may be the main mechanism of HIFU-induced ablation of liver tissues besides cavitation effect.

Significance of monoclonal antibody SC3A expression in gastric carcinoma and precancerous lesion

AIM: To study the significance of monoclonal antibody SC3A expression in gastric carcinoma and precancerous lesions.

METHODS: Immunohistochemical staining and mucin histochemical staining were performed on paraffin-embedded sections from gastric benign and malignant lesions from 101 patients.

RESULTS: SC3A positive rate was 80.3% (57/71) in lesions of gastric carcinoma. The expression of SC3A was not related to the classification, differentiation, metastasis and or survival rates. The positive rate of SC3A in cancers secreting acid mucin (90.2%) or sulphomucin (91.3%) was higher than that in cancers without acid mucin (20.0%) or sulphomucin (60.0%) (P < 0.01). The positive rate of sulphomucin was higher in cases of intestinal metaplasia with cancer (88.9%) than that of cases of intestinal metaplasia with a benign lesion (35.3%) (P < 0.01). Additionally, the positive rate of SC3A with sulphomucin in intestinal metaplasia (60.9%) was higher than that without sulphomucin (31.3%) (P < 0.05).

CONCLUSION: SC3A monoclonal antibody might be helpful in the diagnosis of gastric cancer and the discernment of histogenesis.

Characteristics of saliva secreted by patients with TCM-Piyinxu

AIM: To investigate various characteristics of saliva secreted by patients with TCM-Piyinxu (Spleen-yin deficiency).

METHODS: Twenty-five individuals with Piyinxu (15 males and 10 females; age range 26-70 years, mean age = 45 years) diagnosed based on criteria used in traditional Chinese medicine, were compared with 20 individuals with Shenyinxu (Kidney-yin deficiency) (11 males, 9 females; age range 35-75 years, mean age = 50) and 30 normal individuals (17 males, 13 females; age range 35-65 years, mean age = 49 years). After acid stimulation, the saliva flow in each group was measured, and the levels of amylase and protein in saliva were determined using an automatic biochemical analyzer. The resultant data were analyzed using the Kruskal-Wallis test and one-way factorial ANOVA test.

RESULTS: The flow rates of saliva and amylase in Piyinxu patients (0.27 ± 0.016 mL/min and 2134.13 ± 343.51 IU/min, respectively) were lower than those in normal subjects (0.46 ± 0.027 mL/min and 3501.63 ± 1099.63 IU/min, respectively, P < 0.01), but higher than those in the Shenyinxu group (0.13 ± 0.051 mL/min and 951.62 ± 383.17 IU/min, respectively, P < 0.01). The three groups showed no significant difference in their level of total salivary protein (Piyinxu group, 3.07 ± 0.60 g/L; Shenyinxu group, 3.01 ± 0.90 g/L, and control group, 2.94 ± 1.13 g/L, P = 0.869), amount of amylase per saliva volume, or their ratio of amylase to protein in secreted saliva (P = 0.173 and P = 0.436, respectively).

CONCLUSION: Piyinxu patients showed altered rates of saliva and amylase secretion when compared with those parameters in patients with Shenyinxu and normal subjects.

Cost-effectiveness study on treatment of duodenal ulcer

AIM: To compare the efficiency of therapy with a 2-week regimen of amoxicillin plus metronidazole and six weeks of Tagamet (AMT group) vs the efficacy of therapy with 6 wk of omeprazole plus 2 wk of amoxicillin (OA group) for ulcer healing, Helicobacter pylori (Hp) eradication, and decreasing the recurrence of duodenal ulcers.

METHODS: This cost-effectiveness analysis was based on results shown in a randomized controlled trial conducted in 1995 in patients with a duodenal ulcer (OA group, 46 patients; AMT group, 43 patients) and treated at class grade III A hospitals in Shanghai, China.

RESULTS: The costs of treatment in the AMT group were less than those in the OA group for ulcer healing (￥546.25 vs ￥1296.76 per case, P < 0.01), Hp eradication (￥702.32 vs ￥1742.53 per case, P < 0.01), and decreasing ulcer recurrence (￥640.39 vs 1424.54 per case, P < 0.01). Direct costs comprised the major cost involved in treatment of duodenal ulcers. The difference in the cost of treating ulcers in the two groups was primarily due to the costs of the different drugs. There was no significant difference between the two groups regarding their direct non-medical costs and indirect costs.

CONCLUSION: When based on therapeutic effectiveness and financial costs, AMT therapy was more cost-efficient than OA therapy. AMT therapy is recommended for its low cost, acceptable ulcer healing rates, ability to cure of an Hp infection, and especially when treating patients with an ulcer < 1 cm in diameter.

Hepatitis G virus infection in patients with chronic non-A–E hepatitis

AIM: To elucidate the role of hepatitis G virus (HGV) infection in chronic non-A–E hepatitis and sequence the partial NS5 genome of HGV isolated from the serum of a Chinese patient with chronic non-A–E hepatitis

METHODS: Serum samples of patients with chronic non-A–E hepatitis were collected and total nucleic acids were extracted and subjected to reverse transcriptase-nested-polymerase chain reaction (RT-nested-PCR) using primers from the putative NS5 region of HGV genome. Then, 994bp cDNA was prepared from the positive serum, purified with electrophoresis of polyacrylamide gels, and directly sequenced using the dideoxy-mediated chain-termination method.

RESULTS: HGV-RNA was detected in 1 of the 35 patients with chronic non-A–E hepatitis. Compared with the 2 HGV isolates (PNF2161 and R10291) obtained from American patients, the HGV NS5 gene of this Beijing isolate (HG-G) showed homology of 88.0% and 89.2% respectively. On the other hand, in comparison with the West African isolate (GBV-C), the Beijing isolate showed homology of 93.5%. The patient showed persistent increase of alanine transaminase, but normal levels were achieved after interferon therapy with persistent positive HGV RNA.

CONCLUSION: HGV is one of the causes of chronic non-A–E hepatitis, but it may not be a very important cause. The nucleotide sequence of partial NS5 gene of HG-G was found to be highly homologous to the West Africa isolate.