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.