Cellular immune function and liver damage in post-hepatitic cirrhosis

AIM: To study cellular immune function in patients with post-hepatitic cirrhosis (PHC) and its relationship with different types of liver damage.

METHODS: Fifty-one patients with PHC, including 20 cases of Child-Pugh class A, 18 of class B, 13 of class C and 22 normal subjects as controls were studied. After peripheral blood mononuclear cells were isolated by Ficoll-Hypaque gradient centrifugation, lymphocyte transformation (LT) test, IL-2 activity and NK cell activity were measured by the ³H-TdR incorporation technique.

RESULTS: Changes of LT stimulation index (SI), IL-2 activity (SI) and NK cell activity (%) in patients with PHC were significantly decreased compared with in the healthy controls (18.1 ± 13.0 vs 34.9 ± 21.7, P < 0.01; 8.1 ± 6.0 vs 13.6 ± 5.8, P < 0.01; 40.3 ± 21.7 vs 61.3 ± 20.5, P < 0.01; respectively). The defects of cellular immune function were closely related to Child-Pugh classification. The values in class C were much lower than those in B and A (P < 0.01) and those in B were lower than those in A (P < 0.05).

CONCLUSION: Defective cellular immune functions in patients with PHC are connected with the degree of liver damage.

Uptake of bacterial lipopolysaccharide and expression of tumor necrosis factor-α-mRNA in isolated rat intrahepatic bile duct epithelial cells

AIM

To study the uptake of bacterial lipopolysaccharides (LPS) and expression of tumor necrosis factor α-mRNA (TNF-α-mRNA) with cultured rat intrahepatic bile duct epithelial cells.

METHODS

By using fluorescent, immunohistochemical and in situ hybridization techniques, the uptake of Escherichia coli LPS and expression of TNF-α-mRNA with isolated rat intrahepatic bile duct epithelial cells were observed with confocal laser scanning microscopy.

RESULTS

Positive reactions to LPS were found in the cytoplasm of isolated intrahepatic bile duct epithelial cells after incubation with LPS for 15 min and the FITC fluorescent intensity against LPS was significantly higher than that of the controls (121.45 μFI/μm(2) ± 15.62 μFI/μm(2) vs 32.12 μFI/μm(2) ± 9.64 μFI/μm(2), P < 0.01). After incubation with LPS for 3 h, fluorescein isocyanate (FITC) fluorescent intensities of the expression of TNF-α-mRNA with fluorescent in situ hybridization in the cytoplasm and nuclei of the cultured bile duct epithelial cells were significantly higher than those of the controls (189.15 μFI/μm(2) ± 21.33 μFI/μm(2) vs 10.00 μFI/μm(2) ± 8.99 μFI/μm(2), 64.85 μFI/μm(2) ± 14.99 μFI/μm(2) vs 21.20 μFI/μm(2) ± 2.04 μFI/μm(2), respectively (P < 0.01)). The increase of FITC fluorescent intensity of TNF-α-mRNA expression in the cytoplasm peaked at 6 h after incubation (221.38 μFI/μm(2) ± 22.99 μFI/μm(2)). At various time points after incubation with LPS, the increase of fluorescent intensities of TNF-α-mRNA in the cytoplasm were much higher than those in the nuclei (P < 0.01).

CONCLUSION

LPS can act on and enter into isolated intrahepatic bile duct epithelial cells and stimulate the expression of TNF-α-mRNA.

Construction of retroviral vector carrying HSV-tk gene under control of human AFP enhancer core sequence and human pgk promotor

AIM: To construct retroviral vector bringing HSV-tk gene under control of human AFP enhancer core sequence and human pgk promoter.

METHODS: Internal SV40 promoter was deleted by SalI from retroviral vector pMNSM to construct pMNM. HSV-tk gene driven by pgk promoter was released by BamH I from an eukaryotic expression vector pBPGK-tk, and inserted into polylinker site of pMNM to construct pMNP-tk retroviral vector. Human α-fetoprotein gene enhancer core sequence was released by EcoR I from pGEM. 7Z-AFPe plasmid was inserted into the immediate upstream of pgk promoter of pMNP-tk vector. Construction of hepatoma specific retroviral vector pMNAP-tk was completed.

RESULTS: The structure of pMNP-tk and pMNAP-tk vector was confirmed by restriction analysis.

CONCLUSION: The vector is of great significance for hepatoma specific prodrug transformation gene therapy.

Study on content of serum epidermal growth factor, gastric acid secretion and serum gastrin in duodenitis

AIM: To study whether there is EGF secreting abnormality in duodenitis and its relationship with gastric acid output and serum gastrin, so as to further explore the pathogenesis of duodenitis.

METHODS: Twenty-five duodenitis patients were confirmed by electrogastroscopy and biopsy, with an average age of 35.9 ± 7.0 years (range, 24-52 years). The control group consisted of 20 healthy volunteers (10 females, 10 males), with an average age of 34.4 ± 7.6 years (range, 23-48 years). Twenty duodenal ulcer patients (10 females, 10 males), with an average age of 35.0 ± 7.6 years (range, 24-52 years), were also included. Serum EGF and gastrin were measured using radioimmunoassay. Intragastric acidity was determined by pentagastrin method. Statistical analysis was performed using Student’s t-test.

RESULTS: In comparison with those in the control group, the contents of serum EGF and serum gastrin in duodenitis patients were all significantly increased. In comparison with those in the duodenal ulcer group, serum EGF was significantly increased, basal acid output and peak acid output were decreased, and serum gastrin was increased significantly in duodenitis patients. Serum EGF was negatively correlated with gastric acid output and positively correlated with serum gastrin.

CONCLUSION: In duodenitis, serum EGF concentration was increased, which was positively correlated with serum gastrin content, but was negatively correlated with gastric acid output. This indicates that EGF plays a protective role in the pathogenesis of duodenitis, which provides a new clue to pathogenesis study of duodenitis.

Therapeutic effects of rhubarb on gastrointestinal failure

AIM: To investigate the effects of rhubarb on gastrointestinal failure and the underlying pharmaceutical mechanism.

METHODS: Ninety-seven patients in intensive care unit were divided into a treatment group (76 critically ill patients complicated with gastrointestinal failure) and a control group (21 recovered patients). The effects of rhubarb on stress ulcer and toxic paralytic ileus in the patients were observed. The rectal and gastric intramural pH values, cardiac index, oxygen delivery, and oxygen consumption were measured.

RESULTS: Treatment with rhubarb achieved a significant curative effect in 30 of the 36 cases of stress ulcer complicated with gastrointestinal hemorrhage. Ha-2-receptor blocking agent had a poor effect on them (P < 0.05). Among the 49 cases of toxic paralytic ileus treated with rhubarb, peristalsis was recovered in 41, and gastrointestinal nutrition could be tolerated in 24, while other medicine had no effect on them. According to gastric and rectal intramural pH, rhubarb could improve gut mucosa perfusion. Among the 23 cases of multiple organ dysfunction syndrome who received treatment with rhubarb, 9 survived.

CONCLUSION: This study suggests that rhubarb has a good curative effect on gastrointestinal failure.

Correlation between Hepatitis delta virus infection and heptitis B virus serum markers

AIM: To analyse the correlation between HDV infection and HBV serum markers.

METHODS: Patients who were positive for HBV serum markers were selected and HDV infection was examined in them. Blood donors were used as a control group. Both HDV infection and HBV serum markers were tested by enzyme-linked immunosorbent assay.

RESULTS: HDV infection was detected in 40 of 289 patients who were positive for HBV serum markers. The overall positive rate of HDV infection was 13.8%. The positive rates of HDV infection in HBsAg(+) group, HBcAb(+) group and HBeAb(+) group were 17.6%, 18.8% and 25.2%, respectively, which were higher than that in HBeAg(+) group (10.9%), and none was detected in HBsAb(+) group. HDV infection appeared in HBsAg(+)HBcAb(+)HBeAb(+) patients with a positive rate of 26.2%, which was much higher than that in HBsAg(+)HBcAb(+)HBeAg(+) patients (10.9%).

CONCLUSION: HDV coinfection is more frequent in HBsAg(+) HBcAb(+)HBeAb(+) patients than in BsAg(+)HBcAb(+)HBeAg(+) patients. HDV infection is not completely related with the speed and amount of HBV replication.

Expression of metastasis suppressor gene nm23 in human hepatocellular carcinoma

AIM: To investigate the relationship between the expression of nm23-Hi mRNA and the metastatic potential of hepatocellular carcinoma (HCC).

METHODS: The expression of nm23-H1 mRNA was detected in 24 cases of HCC by in situ hybridization using digoxigenin-labeled nm23-H1 antisense cRNA probe. Twenty-four HCC specimens were divided into two groups according to the following criteria: (1) metastasis in portal lymph nodes; (2) the number of tumors in the liver; (3) cancerous emboli in the portal vein; and (4) the existence of satellite lesions. We named those meeting criteria (1) or (2) and (3), or (3) and (4) high metastatic potential (n = 6); and the others formed the low metastatic potential group (n = 18).

RESULTS: Positive results of in situ hybridization showed granules or masses in the cytoplasm. In the low metastatic potential group strong staining was obtained in ten specimens, while in the high metastatic potential group there was none. Three negative results were found in the high metastatic potential group, and one in the low metastatic potential group (P < 0.05). The expression of nm23-H1 mRNA was not correlated with some clinical factors, such as tumor size or the background liver disease.

CONCLUSION: The expression of nm23-H1 mRNA is inversely correlated with HCC metastatic potential, and can be considered as an index which indicates the metastatic potential of HCC.

Scanning electron microscopic study of lymphatic corrosion casts in the rabbit appendix

AIM: To study the three-dimensional structure and distribution of the lymphatics in the rabbit appendix, and to reveal the correlation between the perifollicular lymphatic sinus (PLS) and lymphatics.

METHODS: Freeze-fractured tissues and lymphatic corrosion cast with the Mercox were used for scanning electron microscopy (SEM), and histologic and semithin sections were used for light microscopy. The Mercox was diluted and injected intraparenchymally into the appendix wall. The injected appendixes were cut and put in a concentrated NaOH solution until the tissues were corroded away.

RESULTS: The lymphatic capillary networks were found in the superficial layer of the mucosa and the lymphatic capillary plexuses were observed in the deep layer of the mucosa. From the plexuses, the short grove-like lymphatic capillaries were connected with the PLS. The luminal side of the sinus looked like a flower basket. Short lymphatic capillaries arising from the bottom of the PLS were continuous with the lymphatics of the submucosa. The lymphatics of the submucosa were connected with the lymphatics running in the muscular layer, then they were led into the serosal lymphatics and drained into the lymphatics in the mesoappendix.

CONCLUSION: The PLS and rich lymphatics in the rabbit appendix may play an important role in the drainage of lymph and the immune function.

Changes of neurotensin and endotoxin in rats with intestinal ischemia

AIM: To investigate the changes of neurotensin (NT) and endotoxin in rats with segmental intestinal ischemia.

METHODS: The distal ileal mesenteric arteries in rats were ligated to make segmental intestinal ischemia models. At the 2^nd, 6^th and 12^th hours after intestinal ischemia, endotoxin levels in portal blood were tested by limulus lysate test and NT levels in plasma from the heart and in intestine tissues (ischemia and peri-ischemia areas) were assayed by radioimmunoassay. Histological changes of the mucosa were examined under light and electron microscopes.

RESULTS: NT levels decreased significantly in intestinal ischemia and peri-ischemia areas (34.07 ± 5.93 vs 40.14 ± 5.38, P < 0.05; 7.47 ± 1.38 vs 40.14 ± 5.38, P < 0.01), especially lower in ischemia area (34.07 ± 5.93 vs 7.47 ± 1.38, P < 0.05. However, NT level increased obviously in plasma (0.76 ± 0.16 vs 0.47 ± 0.10, P < 0.05). Levels of endotoxin elevated obviously in portal blood (389.0 ± 105.0 vs 55.1 ± 6.7, P < 0.01), and the mucosa was injured both in ischemia and peri-ischemia areas.

CONCLUSION: Intestinal ischemia injures intestinal mucosa and leads to decrease of intestinal NT level, which is accelerated by endotoxemia and increase of blood NT level.

Structure-activity relationship of pituitary adenylate cyclase activating polypeptide

AIM: To investigate the structure-activity relationship of pituitary adenylate cyclase activating polypeptide (PACAP) in guinea pig gallbladder using a synthetic PACAP/vasoactive intestinal peptide (VIP) hybrid.

METHODS: We synthesized PACAP-VIP hybrid peptides using the Fmoc strategy and a simultaneous multiple solid-phase peptide synthesizer. The peptides were tested in isolated guinea pig gallbladders using an improved horizontal type organ bath.

RESULTS: VIP induced relaxation of gallbladder smooth muscle strips, while PACAP27 contracted them. Amino acids at positions 4, 5, 9, and 24-26 were replaced without significant loss of activity. [Leu¹³]-PACAP27, a substitution in the α-helix domain, also had no significant loss in activity (P < 0.05). It was more potent than [Gly⁸]- and [DAsp⁸]-PACAP27 and could substitute peptides at position 21. Des-[His¹] and [Ala⁶]-PACAP27 had no activity at 10^-7 mol/L. [Gly⁸]-, [DAsp⁸]-, [Phe²¹]- and [Pro²¹]-PACAP27 at 10^-7 mol/L had about 25% of the activity of PACAP27 at 10^-7 mol/L (P < 0.05).

CONCLUSION: The N-terminal disordered region is more important than other regions for determining the physiological activity of PACAP in the guinea pig gallbladder.

Mucosal permeability to lipopolysaccharides in the colon in chronic alcoholic rats

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

METHODS: Escherichia coli lipopolysaccharide (LPS, 20 μg/mL) was injected into the colon of chronic alcoholic rats (n = 10) and the rats were supplied with Lieber diets every other day for 6 weeks. Before LPS injection and 5, 10, 20, 30 min after injection, blood samples from the portal vein were obtained and contents of LPS in the blood were measured. The distribution of LPS in the colon tissues was observed with a confocal laser scanning microscope by immunofluorescent technique using a monoclonal antibody specific to the lipid A region of LPS. Normal rats were used as controls (n = 6).

RESULTS: Before LPS injection into the colon, LPS levels in the blood of portal vein of chronic alcoholic rats were significantly higher than those of normal controls (3.56 ± 0.67 pg/mLaa, vs 2.45 ± 0.15 pg/mLaa, P < 0.01). At 5, 10, 20, 30 min after injection of LPS, LPS contents were significantly higher than those before LPS injection (173.56 ± 23.45 pg/mLaa, 154.78 ± 20.57 pg/mLaa, 43.89 pg/mLaa ± 8.67 pg/mLaa, 45.38 ± 7.89 pg/mLaa vs 3.56 ± 0.67 pg/mLaa, P < 0.01 respectively). Most mucosal cells showed strong positive reactions to LPS in the rats of chronic alcohol abuse, but no significant changes of LPS contents in blood from the portal vein and fluorescentreactions to LPS in mucosal cells of normal rats were found after LPS injection.

CONCLUSION: Chronic alcohol abuse resulted in a significant increase of permeability to LPS in colon mucosal cells in rats.

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.