Duplex pulsed Doppler sonography of hepatocellular carcinoma treated with transcatheter arterial embolization

Thirty-one patients with hepatocellular carcinoma underwent duplex scanning of their lesions with comparative angiography and serum alpha-fetoprotein determinations before and after transcatheter arterial embolization. Duplex ultrasound correctly identified 26 patients with patent tumor vessels after embolization. The Doppler signals became undetectable after embolization in the other five patients. Comparative angiography demonstrated good devascularization of their lesions. However, tiny tumor blush or small satellite nodules around the periphery of the devascularized masses were found. Therefore, the presence of signals after therapy indubitably needs further embolization. The timing of the second embolization for the patient with undetectable Doppler signals after the first embolization needs to be justified by further evaluations.

Comprehensive assessment of long-term postoperative continence in pediatric imperforate anus. Clinical, manometric and contrast studies

109 patients with imperforate anus were followed up postoperatively for 5 to 28 years. Postoperative continence was evaluated by anorectal manometry, barium enema and clinical symptoms. A comprehensive assessment system, combining the clinical and objective systems was designed which can reflect postoperative anal continence function completely and objectively. It is useful for determining the causes of incontinence and its treatment.

The single cysteine residue on an alpha family chick liver glutathione S-transferase CL 3-3 is not functionally important

Chick liver glutathione S-transferase CL 3-3, expressed using a baculovirus system in Spodoptera frugiperda (SF9) cells, contains a single cysteine residue per subunit. This enzyme was modified with iodoacetamide. Amino acid analysis indicates that 0.85 +/- 0.10 cysteine residue was modified per enzyme subunit. GST CL 3-3 modified with iodo[14C]acetamide was further digested with trypsin and the isotope-labelled fragments were isolated. The fragment containing the cysteine residue accounts for 53% of the total labels. The S-carbaminomethylated protein retains the glutathione conjugating activity. Therefore, the cysteine residue is not essential for the enzymatic activity of CL 3-3.

Regulation of kainate receptors by cAMP-dependent protein kinase and phosphatases

In the mammalian central nervous system, receptors for excitatory amino acid neurotransmitters such as the alpha-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid (AMPA)-kainate receptor mediate a large fraction of excitatory transmission. Currents induced by activation of the AMPA-kainate receptor were potentiated by agents that specifically stimulate adenosine 3',5'-monophosphate (cAMP)-dependent protein kinase A (PKA) activity or were supported by intracellular application of the catalytic subunit of PKA by itself or in combination with cAMP. Furthermore, depression of these currents by a competitive inhibitor of PKA indicates that AMPA-kainate receptors are regulated by endogenous PKA. Endogenous protein phosphatases also regulate these receptors because an inhibitor of cellular phosphates enhanced kainate currents. Modulation of PKA and phosphatases may regulate the function of these receptors and thus contribute to synaptic plasticity in hippocampal neurons.

State-dependent spike detection: concepts and preliminary results

In traditional methods of spike detection, spikes are defined in absolute terms (duration, amplitude) or relative to a few seconds of background. These methods result in many false positive detections during long-term epilepsy monitoring because of numerous artefacts and non-epileptic transients. To reduce significantly false detection, we propose to render spike detection sensitive to the state of the EEG. We thus defined 5 states (active wakefulness, quiet wakefulness, desynchronized EEG, phasic EEG and slow EEG) and designed a method for automatic state classification. We then designed procedures for identification of non-epileptic transients (eye blinks, EMG, alpha, spindles, vertex sharp waves). These procedures are to be applied only in the state in which they are likely to occur (e.g., eye blinks in wakefulness). We present preliminary results from 14 recordings each lasting 100 min, which indicate a state classification reliability of 85-90%, reduction in false detection of 65-90% if state classification were perfect; true spikes lost as a result of these procedures were under 5%. These results are encouraging and validate the concept of a spike detection system which analyses a wide temporal and spatial context before deciding the significance of a wave form.

Transverse modes of an apertured laser

Modes of a diaphragmed laser are expressed as linear combinations of Laguerre-Gauss functions and computed from the resonance condition. Hard and soft apertures are considered. Explicit results are given in both cases for the phase and amplitude distributions inside and outside a plano-concave cavity and for the three modes having the lowest losses. Deformations of modes with the diameter of the diaphragm are also given, showing the evolution of lateral lobes.

Duplex pulsed Doppler sonography of portal vein thrombosis in hepatocellular carcinoma

Sixteen patients with hepatocellular carcinoma had duplex pulsed Doppler scanning of the portal thrombus and comparative angiography. Fifteen patients demonstrated detectable Doppler signals from the thrombus. The Doppler signals were corroborated by the "thread-and-streaks" sign on angiography in eight patients. This suggests that signals come from tumor vessels within the thrombus. Therefore, the presence of Doppler signals in the thrombotic portal venous system is not only due to partial obstruction of the lumen. Tumor thrombus from hepatocellular carcinoma must be considered, especially when the detectable signals are pulsatile waves.

[Estrogen and progesterone receptors in esophageal carcinoma cells]

Distribution of estrogen and progesterone receptors (ER and PR) was studied in esophageal tissue (48 patients with esophageal carcinoma, 20 normal subjects and 12 fetuses) and Eca 109 cell line using enzyme-linking affinity immunohistochemistry method. In the meantime, plasma estradiol and progesterone levels were determined in 8 patients with esophageal carcinoma using radioimmunoassay method. The results showed that the positive rates of ER and PR in esophageal carcinoma were 43.75% (21/48) and 39.58% (19/48). Both ER and PR were positive in Eca 109 cell line whereas they were negative in the control groups. Sex and grade of cancer were the factors influencing the positive rates of ER and PR. It is indicated that carcinogenesis of esophageal carcinoma might be related to sex hormone metabolism. The measurement of ER and PR may be useful in clinical practice.

Abdominal sonographic screening in a single community

A health survey, on adults aged 30 years or more, was carried out at 3 villages on the southwest coast of Taiwan. A total of 923 cases (42.6%) of the 2,166 population participated in the survey. The estimated total population prevalence rates were as follows: no gross lesion (60.5%), fatty liver (25.2%), biliary stone (5.2%), gall bladder polyp (1.9%), hepatic hemangioma (1.4%), liver cyst (0.9%) and renal cyst (2.9%). The prevalence rates of gall bladder polyp and renal cyst were higher in men, while that of fatty liver was higher in women. There was an increase in the prevalence with age for fatty liver in females. The results might be a reference about the above findings among Chinese in Taiwan.

The cellular electropharmacology of mexiletine combined with sotalol in porcine papillary muscle and Purkinje fibre. I. Alteration of mexiletine-induced Vmax depression

Using standard microelectrode techniques, the authors compared the effects of 15 to 125 microM concentrations of mexiletine, 31 to 500 microM concentrations of sotalol and 15 to 125 microM of mexiletine combined with 125 microM sotalol, on the beat-to-beat maximum rate of depolarization of phase 0 of the action potential (Vmax) of porcine papillary muscles and Purkinje fibres stimulated by 30 beat trains at a frequency of 1 Hz. Sotalol alone had no effect on Vmax. Mexiletine caused both tonic and use-dependent depression of Vmax in papillary muscle. In the presence of sotalol, tonic Vmax depression was exaggerated, while use-dependent depression was attenuated. In Purkinje fibres, mexiletine exposure resulted in tonic Vmax depression, but no use-dependence could be demonstrated at this frequency. These results are best explained in the context of the modulated receptor hypothesis with the added consideration of two receptors--one within and one external to the sodium channel.

The cellular electropharmacology of mexiletine combined with sotalol in porcine papillary muscle and Purkinje fibre. II. Effects on action potential duration and refractoriness

Using standard microelectrode techniques, the authors compared the effects of 15 to 125 microM concentrations of mexiletine, 31 to 500 microM concentrations of sotalol and 15 to 125 microM of mexiletine combined with 125 microM sotalol, on the beat-to-beat action potential duration and refractoriness of porcine papillary muscles and Purkinje fibres stimulated by 30 beat trains at a frequency of 1 Hz. Sotalol alone prolonged action potential duration and effective refractory period without altering their ratio. Mexiletine shortened action potential duration while prolonging refractoriness. When the two drugs were combined, action potential duration was shortened to the same extent as with mexiletine alone, but refractoriness, particularly in papillary muscle, was further prolonged. These changes suggest additive inhibition of the sodium window current by both drugs. Purkinje action potential duration was longest in the first beat of the train, while in papillary muscle, this beat was shortest. Exposure to either or both drugs eliminated the prolongation of duration of the first beat of the train in Purkinje fibre. Thus, the phenomenon of restitution, which prolongs the duration of the first beat after a long diastolic interval, appears also to be related to the sodium window current.

Cardiovascular effect and stimulus-dependent inhibition of superoxide generation from human neutrophils by tibenelast, 5,6-diethoxybenzo(b)thiophene-2-carboxylic acid, sodium salt (LY186655)

Tibenelast (LY186655), 5,6,-diethoxybenzo(b)thiophene-2-carboxylic acid, sodium salt, is an orally active anti-anaphylactic compound in guinea pigs, and has been shown to prevent bronchospasm in moderately severe asthmatic patients. Pharmacological studies with tibenelast demonstrated that it is a selective phosphodiesterase (PDE) inhibitor in that it is moderately active against the lung and stomach enzyme while being a very weak inhibitor of the heart enzyme. The compound was without cardiovascular effects at anti-anaphylactic doses. In contrast to theophylline, tibenelast did not have a direct inotropic effect in the cat papillary muscle system. The concentration that inhibited 50% of the enzymatic activity (IC50) for tibenelast was 20- to 30-fold lower for neutrophil PDE than for PDE of other tissues. It was 100 times more potent than aminophylline in inhibiting superoxide generation from platelet-activating factor (PAF)-primed polymorphonuclear leukocytes (PMNL) challenged with chemotactic factor, N-formyl-methionyl-leucyl-phenylalanine. However, tibenelast was less effective in the tumor necrosis factor-primed system, and did not inhibit superoxide generation during phagocytosis or when other soluble stimuli, such as phorbo-12-myristate-13-acetate or the calcium ionophore A23187, were used. Furthermore, tibenelast did not inhibit enzymes involved in arachidonic acid metabolism. These results suggest that tibenelast probably inhibits superoxide release from PMNL via a selective inhibition on PDE.

The effect of pitressin and glypressin in variceal bleeding--a preliminary clinical trial

Effects of hemostatic and various side effects were compared between glypressin and pitressin. Fifty-five episodes of esophageal variceal bleeding in 29 patients were studied. Although the glypressin group included more patients in Pugh's classification C than the pitressin group, the result of hemostasis was not influenced. The effect of hemostasis was evaluated in 24 episodes receiving either glypressin or pitressin. The hemostatic effects of glypressin and pitressin were 6/11, 54.5% and 7/13, 53.8% respectively. Eighteen episodes in six patients, with multiple episodes, were used to observe the effect of these two drugs in the same person. No difference was observed. The number of side effects in the glypressin group and the pitressin group were 5 and 10 respectively. Although the side effects of glypressin might be fewer than those of pitressin, chest pain was observed in patients receiving glypressin treatment. The use of glypressin in the patients with cardiac diseases should be studied further. Glypressin is more convenient in clinical use. However, pitressin doses is easily modified. Both drugs might be selected in the control of variceal bleeding.

Risk factors for gallstones among Chinese in Taiwan. A community sonographic survey

A health survey of adults aged 30 years or more was carried out in southwest Taiwan to determine the prevalence of gallstones and to study risk factors associated with gallstones. Blood samples were collected and abdominal sonographic examination and anthropometric measurements were performed on a total of 923 people. The 40 gallstone cases detected resulted in a prevalence of 4.3%. The risk factors explored included age, sex, hepatitis, obesity, hyperlipidemia, and diabetes mellitus (DM). Age and DM were the only significant factors associated with gallstones in our study. With a reference group of 30-39-year-olds as a comparison, multiple logistic regression analysis showed a trend effect with odds ratios of 1.73, 3.74, and 6.32 for age groups of 40-49, 50-59, and 60 or above, respectively. The odds ratio for DM was as high as 2.59. However, sex, body weight index, chronic hepatitis B, and hyperlipidemia were not significantly associated with gallstones.

Sequential changes of serum transaminase and abdominal sonography in patients with suspected dengue fever

Southern Taiwan experienced a dengue (type 1) outbreak in the autumn of 1988. One hundred and thirteen febrile patients suspected as having dengue infection were seen in the emergency room of the Kaohsiung Medical College Hospital. These patients were recruited for this study. Two hundred and eighty-six sequential serum aspartate transaminase (AST) and alanine transaminase (ALT) data from these patients were analyzed. Data analysis showed serum AST had increased daily and all data were out of normal range from day 6 of the illness. Compared to the AST level on the first day of the illness, the AST level was noted to elevate to an average of 9.25 folds on day 6. The sequential changes of AST were as follows: AST had elevated since the third ill-day in most cases and reached a peak on the 7th or 8th ill-day. It then declined gradually from the 8th ill-day and became normal about 3 weeks later. The changes of ALT level were about the same as AST but had later onset and lower peak. Abdominal sonographic examinations showed thickening of the gall bladder wall, splenomegaly and ascites in some patients during acute stage of the illness and recovered completely after patients recovered from the dengue attack. The sequential change of serum transaminase levels and sonographic findings were compatible. These findings may be used as a reference for the differential diagnosis among dengue fever, acute hepatitis and acute cholecystitis.

Sensory nerve endings in puborectalis and anal region: normal findings in the newborn and changes in anorectal anomalies

This study was carried out in five full-term newborn babies and 11 patients with anorectal anomalies (five of whom had high deformity, five had intermediate, and one had low), using the modified Bielschowsky method. The following four kinds of sensory nerve ending were found: muscle spindle in the puborectalis and the external anal sphincter, Pacinian corpuscle in the plane between the internal anal sphincter and the external anal sphincter and in the presacral space, globular ending in the presacral space, and free nerve ending in the epithelium of the anal canal and in the perianal skin. It was found that there were significantly fewer muscle spindles in the puborectalis and many fewer Pacinian corpuscles and globular endings in the presacral space of high and intermediate deformities than normal. No spindle was found in the external sphincteric muscles of the deformities. On the other hand, the Pacinian corpuscles and the globular endings of high and intermediate deformities lagged behind normal in development. The densities of the nerve bundles in the subepidermis and the nerve fibers in the dermis of perineal region in high and intermediate deformities were much lower than normal, and the decrease in density corresponded to the levels of the rectal pouch. The observation showed that the agenesis of sensory nerve endings in the puborectalis and the anal region was one of the most significant pathological features in high and intermediate types of anorectal anomalies, and might be responsible for the abnormalities of the reflex of the anal sphincter and the anal sensation in such patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of fatty liver from serum triglyceride levels and body weight indexes

Fatty liver is a common disease in Taiwan. In this study, we tried to evaluate the validity of predicting the presence of fatty liver from clinical data instead of liver biopsy or sonography. From a community survey in Putai, a total of 873 adults older than 30 years and quantified as to triglyceride level, body height, body weight, and the results of the oral glucose tolerance test and upper abdominal sonography were recruited for analysis. Using a receiver operating characteristic (ROC) curve, the best 'cutoff values' for determination of fatty liver were predicted from body weight index and serum triglyceride level in 8 clusters grouped by sex, age and presence or absence of diabetes mellitus. The best cutoff values of triglyceride in the 8 clusters varied from 100 to 170 mg/dl with worse validity. Most of the values were 130 and 140 mg/dl. The cutoff values of body weight index were constant in all clusters and showed greater validity than those for triglyceride. They were 115% or 120%. Their accuracy for the prediction of fatty liver was positively correlated with its prevalence. However, their accuracy was lower than 70% in non-diabetic females. We conclude that body weight index is a good parameter for prediction of fatty liver especially in the high risk groups and we recommend that health-determining cutoff values of serum triglyceride and body weight index should be set at 130 mg/dl and 115%, respectively.

[Effect of Rhodiola kirilowii (Regel.) Maxim on preventing high altitude reactions. A comparison of cardiopulmonary function in villagers at various altitudes]

The highland villagers are subject to abnormalities in their cardiopulmonary function as they move from 2500m altitude to 4475m altitude areas. Rhodiola kirilowii can efficiently protect the villagers from the above said mountain reaction.

Two subsets of cloned T helper cells exhibit different activation requirements and characteristics

An anti-clonotypic monoclonal antibody (mAb 211G7H) was generated against a T helper cell clone which specifically recognized type II collagen. Besides inhibiting the proliferative response of the immunizing T cell clone to type II collagen, mAb 211G7H (soluble form) also suppressed the antigen-induced proliferation of several other T cell clones which shared similar specificity for antigen and major histocompatibility complex with the immunizing T cell clone. On the other hand, mAb 211G7H did not inhibit the responses of clones exhibiting different antigenic specificities from the clonotype-positive T cell clones. It was also demonstrated that these clonotype-positive T cell clones responded differently to mAb 211G7H when it was immobilized. Based upon their proliferative responses to immobilized anti-clonotype 211G7H mAb, two subpopulations of T cell clones were defined. Collagen-specific T cell clones of the first group proliferated poorly when stimulated with immobilized anti-clonotype mAb, by contrast, T cell clones belonging to the second group proliferated well to immobilized mAb. Furthermore, upon stimulation with immobilized 211G7H mAb, the second subpopulation of cloned T cells produced both interleukin (IL) 2 and IL4, while the first group secreted IL2 but not IL4. The cloned T cells from the group which responded weakly to immobilized anti-clonotype mAb also mediated reduced proliferative responses to IL2 in the presence of immobilized 211G7H mAb. Finally, these two subsets of T cell clones were found to respond differently to other non-antigen stimuli such as IL4 and phorbol 12-myristate 13-acetate. Thus, from a panel of collagen-specific T cell helper clones which had similar receptor fine specificities, we have isolated two subsets of cloned T helper cells that displayed different activation requirements and lymphokine production.

Factor analysis for the presence of serum HBV DNA in chronic hepatitis B virus infection

To elucidate the role of HBeAg and other influential factors for the presence of serum HBV DNA and their interactions, serum HBV DNA was examined in 68 patients with chronic HBV infections and 23 HBsAg negative persons by molecular hybridization. Based on the univariate analysis, the positive rate of HBV DNA was higher in patients with HBeAg (31/43, 72.1%) than in patients with anti-HBe (5/22, 22.7%) with an odd ratio of 8.78. The positive rates of HBV DNA between men and women were not significantly different, and the positive rates of HBV DNA were not related to the SGPT levels. The mean age of patients without HBV DNA was higher than that of patients with HBV DNA (p value less than 0.025), and the positive rate and concentration of HBV DNA were decreased with increasing age (p value less than 0.005). The positive rates of serum HBV DNA among different histological changes were not statistically different. However, the discordance of HBV DNA and HBeAg/anti-HBe was increased when the liver parenchymal damage became severe (p less than 0.05). Only 5 patients were anti-D positive and 3 of them had serum HBV DNA. To exclude interactions of the influential factors, multivariate analysis was also performed. HBeAg was the only significant factor for the presence of serum HBV DNA when logistic regression was used (p less than 0.001). The age was an important factor when the concentration of serum HBV DNA was considered.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dynamic changes in depolarization of action potentials by high frequency stimulation in guinea pig papillary muscles]

The effect of high frequency stimulation on rate-dependent depression of depolarization of action potentials was studied with computer and standard microelectrode techniques in guinea pig papillary muscles. After increasing driving frequency from 0.5 to 6 Hz, decreases in Vmax, APA and OS were found. Changes of upstroke velocity during phase 0 between driving frequency 6 and 0.5 Hz could be described as a parabola. The rate-dependent depression of depolarization was exaggerated by tetrodotoxin (TTX), particularly during the accelerating period of phase 0. A progressive decline in Vmax, which could be fitted by a power function curve, was observed after changing driving frequency from 1 to 5 Hz. TTX significantly influenced the decline in Vmax and the regression coefficients in fitted equations.

Lymphocyte transformation in patients with HBsAg-positive chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma

To evaluate cellular immunity, mitogen-induced lymphocyte transformation was assessed in 146 patients with chronic hepatitis B virus (HBV) infection, including 63 patients with chronic hepatitis (CH), 34 with liver cirrhosis (LC), and 49 patients combined with liver cirrhosis and hepatocellular carcinoma (HCC). The PHA-induced transformation indices (TI) were lower in patients with chronic HBV infection, especially in the LC and the HCC groups. The Con A-induced TI were also diminished in patients with chronic HBV infection. The mitogen-induced TI in patients with CH showed no significant difference in regards to different histological patterns, HBeAg/anti-HBe statuses, sex groups, age distributions, and SGPT levels. However, the mitogen-induced TI were substantially higher in CH patients with elevated serum AFP levels, especially in the group with AFP levels over 100 ng/ml. From these data, we conclude that: (1) impaired PHA-induced TI in patients with LC may partly explain the high risk factor of LC in the occurrence of HCC; (2) the reduction in TI induced by optimal concentration of Con A reflects the defective suppressor cell activity in patients with chronic HBV infection, even in patients with HCC; (3) no significant difference among the control group and patients with chronic HBV infection in PWM-induced TI implies that the response of B cells may be normal in patients with chronic HBV infection; (4) elevated mitogen-induced TI in CH patients with high AFP levels indicate that the activation of lymphocyte may contribute to the severity of inflammation and tissue damage.

The effect of edible black tree fungus (Auricuaria auricula) on experimental atherosclerosis in rabbits

The effects of edible black tree fungus (BFF) compared with aspirin on serum lipid level and experimental atherosclerosis and thrombosis in rabbits were studied. The results showed that total serum cholesterol and B-lipoprotein of the BTF group were significantly decreased (P less than 0.01) than the aspirin group and the group with neither BTF nor aspirin. There were less aortic atherosclerotic plaque and intramyocardial arterial lumen stenosis in the BTF group. The development of thrombus and platelet aggregation and thromboxane TXB2 level were inhibited both in the BTF and aspirin group (P less than 0.01). These findings indicate BTF may be used as a healthy food in preventing atherosclerosis and coronary heart disease, but its mechanism requires further investigation.

Antibody response of adults to an aluminum hydroxide-adsorbed Neisseria meningitidis serotype 2b protein-group B polysaccharide vaccine

A group B Neisseria meningitidis serotype protein vaccine was studied clinically in adults. The vaccine comprised lipopolysaccharide-depleted outer membrane vesicles from a serotype 2b strain, 3006-M2, noncovalently complexed with group B meningococcal polysaccharide. Volunteers received 25 micrograms each of protein and polysaccharide administered intramuscularly either in 0.9% NaCl or adsorbed onto aluminum hydroxide on weeks 0 and 6. Most individuals experienced mild local reactions, but there were no systemic reactions. Both vaccine formulations stimulated antibodies to the outer membrane proteins of serotypes 2a:P1.2 and 2b:P1.2, but higher levels were achieved with the aluminum hydroxide-adsorbed vaccine after two immunizations. Vaccine-induced antibodies were primarily IgG and were bactericidal for both a serotype 2a and a serotype 2b strain. Induction of bactericidal antibodies has been shown to be a major predictor of protection against meningococcal disease.