Characteristics and risk factors of acetaminophen-induced hepatitis in Taiwan

BACKGROUND

Overdose of acetaminophen may cause hepatic injury and fatal fulminant hepatic failure. Acetaminophen is the most common form of drug-induced hepatic injury in Western countries. However, there is no formal report of this important issue in Taiwan. To assess the clinical characteristics and risk factors of acetaminophen-induced hepatitis in Taiwan, we conducted this study.

METHODS

A total of 71 patients who were intoxicated or overdosed with acetaminophen at Veterans General Hospital-Taipei between February, 1991 and June, 1997 were enrolled in this study. Acetaminophen-induced hepatitis was defined according to the Paris international consensus criteria.

RESULTS

Suicide attempt was the major cause (67/71) of acetaminophen overdose. Sixty-two of the patients were female. The mean patient age was 24.5 +/- 9.7 years (+/- standard deviation, SD). Nineteen of 71 patients had acetaminophen-induced hepatitis. The peak serum alanine aminotransferase, aspartate aminotransferase and total bilirubin concentrations were 4,181.0 +/- 931.4 IU/l (mean +/- SD), 4,148.0 +/- 1,147.5 IU/l and 2.6 +/- 0.4 mg/dl, respectively. The hepatitis group had higher ingested acetaminophen doses and serum peak acetaminophen levels than did those of the nonhepatitis group (24.9 g vs 12.9 g, p = 0.004; 132.0 mg/l vs 61.7 mg/l, p = 0.013). A higher percentage of alcohol consumption was also noted in the hepatitis group than in the nonhepatitis group (32% vs 12%, p = 0.05). After logistic regression for multivariate analysis, alcohol consumption was the most important risk factor for acetaminophen-induced hepatitis (odds ratio = 8.14, p = 0.018), followed by ingested acetaminophen dose (odds ratio = 1.21, p = 0.001). Most patients received acetylcysteine treatment in time. Two of the 19 patients with hepatitis died.

CONCLUSIONS

The majority of acetaminophen-induced hepatitis in Taiwan occurs in young females who attempt suicide. Alcohol consumption and the dose of acetaminophen ingested were the significant risk factors for acetaminophen-induced hepatitis. Alcohol should not be concomitantly used with acetaminophen. Early diagnosis and administration of the antidote are crucial to decrease mortality.

Serum levels of cytokines in hepatitis C-related liver disease: a longitudinal study

BACKGROUND

Elevated serum cytokine levels are found in patients with acute and chronic hepatitis B. However, little is known about the development and progression of cytokines in hepatitis C infection. We conducted this study to evaluate the change and clinical significance of cytokines in the different stages of hepatitis C infection.

METHODS

Circulating interleukin-1 beta (IL-1 beta), interleukin-2 receptor (IL-2r), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured by enzyme-linked immunosorbent assay in 29 patients with acute hepatitis C (AHC), 43 patients with chronic hepatitis C (CHC), 40 patients with liver cirrhosis (LC) and positive serum anti-hepatitis C antibody (anti-HCV), 36 patients with hepatocellular carcinoma (HCC) and positive anti-HCV and 30 normal controls. A cohort of patients with chronic hepatitis C was monitored for a median of seven years.

RESULTS

Serum IL-1 beta, IL-2r, IL-6 and TNF-alpha levels were significantly elevated in all patient groups compared with controls (p < 0.05). The serum IL-1 beta, IL-2r and TNF-alpha levels in patients with LC or HCC were higher than that in patients with AHC or CHC (p < 0.05). In the longitudinal follow-up, 12 patients with chronic hepatitis at enrollment in the study developed liver cirrhosis. For these patients, serum levels of IL-1 alpha, IL-2r and TNF-alpha were higher in liver cirrhosis than in chronic hepatitis (p < 0.05). In addition, the serum concentrations of these cytokines correlated better with indices of hepatic dysfunction (prothrombin time and indocyanine green retention ratio) than with parameters of hepatic inflammation (alanine aminotransferase and aspartate aminotransferase).

CONCLUSIONS

Serum IL-1 beta, IL-2r, IL-6 and TNF-alpha levels are elevated in patients with hepatitis C-related liver diseases, especially in LC and HCC patients. These levels reflect hepatic dysfunction better than liver inflammation parameters, which might explain the higher serum concentrations of cytokines in LC patients.

Treatment of ethylether in air stream by a biotrickling filter packed with slags

This paper reports results of studies using a biotrickling filter with blast-furnace slag packings (sizes = 2-4 cm and specific surface area = 120 m2/m3) for treatment of ethylether in air stream. Effects of volumetric loading, superficial gas velocity, empty bed gas retention time, recirculation liquid flow rate, and biofilm renewal on the ethylether removal efficiency and elimination capacity were tested. Results indicate that ethylether removal efficieincies of more than 95% were obtained with an empty bed retention time (EBRT) of 113 sec and loadings of lower than 70 g/m3/hr. At an EBRT of 57 sec, removal efficiencies of more than 90% could only be obtained with loadings of lower than 35 g/m3/hr. The maximum elimination capacities were 71 and 45 g/m3/hr for EBRT = 113 and 57 sec, respectively. The maximum ethylether elimination capacities were 71 and 96 g/m3/hr, respectively, before and after the renewal at EBRT = 113 sec. With an EBRT of 113 sec and a loading of lower than 38 g/m3/hr, the removal efficiency was nearly independent of the superficial liquid recirculation velocity in the range of 3.6 to 9.6 m3/m2/hr. From data regression, simplified masstransfer limited, and reaction- and mass-transfer limited models correlating the contaminant concentration and the packing height were proposed and verified. The former model is applicable for cases of low influent contaminant concentrations or loadings, and the latter is applicable for cases of higher ones. Finally, CO2 conversion efficiencies of approximately 90% for the influent ethylether were obtained. The value is comparable to data reported from other related studies.

Down-regulation of rat mitochondrial branched-chain 2-oxoacid dehydrogenase kinase gene expression by glucocorticoids

The mammalian mitochondrial branched-chain 2-oxoacid dehydrogenase (BCOD) complex is regulated by a reversible phosphorylation (inactivation)/dephosphorylation (activation) cycle. In the present study, the effects of glucocorticoids on the level of BCOD kinase mRNA were investigated in rat hepatoma cell lines (H4IIE and FTO-2B), as well as in the rat. In H4IIE cells, dexamethasone was found to significantly reduce steady-state concentrations of BCOD kinase mRNA after a 48 h culture, and this was correlated with a 2-fold increase in the dephosphorylated form of the BCOD complex. The half-life of the kinase mRNA in H4IIE cells was not affected by dexamethasone treatment. Therefore, the decrease in the steady-state kinase mRNA level resulting from dexamethasone treatment was not caused by changes in mRNA stability, which raised the possibility of regulation at the level of gene transcription. To identify the negative glucocorticoid-responsive element in the kinase promoter, nested deletion constucts in the 3.0 kb promoter region were examined in H4IIE cells cultured in the presence or absence of dexamethasone. No significant differences in promoter activity were observed on either transient or stable transfection. The data showed that the glucocorticoid-responsive element was located outside the 3. 0 kb promoter region. At the physiological level, hepatic BCOD kinase mRNA levels were reduced in rats injected intraperitoneally with dexamethasone. This effect was liver-specific, and was not detected in other tissues. These results suggest that the down-regulation of kinase gene expression by glucocorticoids is mediated through a liver-specific or -enriched transcription factor(s).

Water maze performance is unaffected in artificially reared rats fed diets supplemented with arachidonic acid and docosahexaenoic acid

Four groups of male Long-Evans rats were reared artificially from postnatal d 5 to 18 by being fed through a gastrostomy tube with rat milk substitutes containing oils providing 10% linoleic acid and 1% alpha-linolenic acid (g/100 g fat); with the use of a 2 x 2 design, they were fed one of two levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) (0.0 and 2.5 g/100 g of fatty acids). A fifth artificially reared group was fed a diet high in saturated fat, and a sixth group was reared by dams fed a standard AIN-93M diet. The pups were weaned onto modified AIN-93G diets, with a fat composition similar to that fed during the artificial rearing period. Behavioral testing was conducted between 6 and 9 wk of age; brain lipid composition was then assessed. Relative to the unsupplemented group (0.0 g/100 g AA and DHA), dietary supplementation resulted in a wide range of AA (84-103%) and particularly DHA (86-119%) levels in forebrain membrane phospholipids. AA supplementation increased AA levels and decreased DHA levels, and DHA supplementation increased DHA levels and decreased AA levels, with the magnitude of these effects dependent on the level of the other fatty acid. DHA levels were very low in the saturated fat group. The groups did not differ on the place or cued version of the Morris water-maze, but on a test of working memory, the saturated fat group was impaired relative to the suckled control group. Further correlational analyses in the artificially reared animals did not support a relationship between the wide range of DHA and AA levels in the forebrain and working-memory performance.

Mechanisms for GroEL/GroES-mediated folding of a large 86-kDa fusion polypeptide in vitro

Our understanding of mechanisms for GroEL/GroES-assisted protein folding to date has been derived mostly from studies with small proteins. Little is known concerning the interaction of these chaperonins with large multidomain polypeptides during folding. In the present study, we investigated chaperonin-dependent folding of a large 86-kDa fusion polypeptide, in which the mature maltose-binding protein (MBP) sequence was linked to the N terminus of the alpha subunit of the decarboxylase (E1) component of the human mitochondrial branched-chain alpha-ketoacid dehydrogenase complex. The fusion polypeptide, MBP-alpha, when co-expressed with the beta subunit of E1, produced a chimeric protein MBP-E1 with an (MBP-alpha)2beta2 structure, similar to the alpha2 beta2 structure in native E1. Reactivation of MBP-E1 denatured in 8 M urea was absolutely dependent on GroEL/GroES and Mg2+-ATP, and exhibited strikingly slow kinetics with a rate constant of 376 M-1 s-1, analogous to denatured untagged E1. Chaperonin-mediated refolding of the MBP-alpha fusion polypeptide showed that the folding of the MBP moiety was about 7-fold faster than that of the alpha moiety on the same chain with rate constants of 1.9 x 10(-3) s-1 and 2.95 x 10(-4) s-1, respectively. This explained the occurrence of an MBP-alpha. GroEL binary complex that was isolated with amylose resin from the refolding mixture and transformed Escherichia coli lysates. The data support the thesis that distinct functional sequences in a large polypeptide exhibit different folding characteristics on the same GroEL scaffold. Moreover, we show that when the alpha.GroEL complex (molar ratio 1:1) was incubated with GroES, the latter was capable of capping either the very ring that harbored the 48-kDa (His)6-alpha polypeptide (in cis) or the opposite unoccupied cavity (in trans). In contrast, the MBP-alpha.GroEL (1:1) complex was capped by GroES exclusively in the trans configuration. These findings suggest that the productive folding of a large multidomain polypeptide can only occur in the GroEL cavity that is not sequestered by GroES.

Cortisol selectively stimulates pituitary gonadotropin beta-subunit in a primitive teleost, Anguilla anguilla

It has been suggested that in mammals, glucocorticoids, beside their stress-related inhibitory effects on reproductive function, may also play a stimulatory role at the onset of puberty. Using the juvenile female eel as a model, we investigated the potential stimulatory role of cortisol (F) on pituitary gonadotropin (GtH-II). GtH-II levels were measured by RIA, and messenger RNA (mRNA) levels for alpha- and GtH-II beta-subunits were determined by dot blot using homologous probes. F treatment increased eel pituitary GtH-II content in vivo and in vitro. Using a long term, serum-free primary culture of pituitary cells, we studied the direct effect of F on GtH-II production. F increased the GtH-II cellular content in vitro in a dose- and time-dependent manner. The relative potencies of various corticosteroids on GtH-II were: triamcinolone acetonide > dexamethasone > F >> cortisone and aldosterone, indicating a glucocorticoid-specific receptor (GR). F stimulated GtH-II production through a selective increase in mRNA levels for GtH-II beta-subunit; no significant effect was observed on alpha-subunit mRNA levels. This stimulatory effect of F on GtH-II beta, played out directly at the pituitary cell level, recalls that of F on FSHbeta in the rat. The present study, performed in a primitive teleost at the juvenile stage, suggests that the role of F in the positive regulation of gonadotropins at puberty may have arisen early in vertebrate evolution.

Pathogenesis of early cardiac myocyte damage after severe burns

BACKGROUND

The importance of early cardiac myocyte damage during postburn trauma has been emphasized in recent years. However, its pathogenesis, prevention, and treatment have not been fully clarified. The aim of this study is to define its pathogenesis.

METHODS

Rats with 30% third-degree burns were used. Cardiac biochemical markers reflecting cardiac myocyte damage including troponin T, cardiac myosin light chain 1, creatinine kinase and its cardiac-specific isoenzyme compound, as well as inflammatory mediators such as tumor necrosis factor, endothelin/nitric oxide ratio, malondialdehyde, and superoxide dismutase, were determined.

RESULTS

Cardiac biochemical markers reflecting cardiac myocyte damage, including troponin T, cardiac myosin light chain 1, cardiac-specific isoenzyme compound, were all significantly elevated between 3 hours and 24 hours after burn. Changes in tumor necrosis factor, endothelin/nitric oxide ratio, and malondialdehyde were similar to those of cardiac biochemical markers. In contrast, levels of superoxide dismutase declined markedly after burn.

CONCLUSION

The findings of this study showed that considerable amounts of myocardial constructive protein degradation and release due to destruction of cardiac myocytes occurred early after severe burns. The inflammatory mediators released after burn injury may be involved in the pathogenesis of myocardial destruction.

Improvement of early postburn cardiac function by use of Panax notoginseng and immediate total eschar excision in one operation

Cardiac dysfunction development in the early stage postburn has been an important problem in burn treatment. However, no effective therapies are available for use in clinical practice. In this study, we sought to determine whether early total eschar excision (EEE) in one operation and the traditional Chinese herb Panax notoginseng (PNS) would be helpful in improving early postburn cardiac function. 160 Wistar rats were randomly divided into burn (burn group, n = 50), burn treated with EEE (EEE group, n = 50), burn treated with PNS (PNS group, n = 50) groups and normal controls (n = 10). All rats except the normal control were given a 30% TBSA full skin thickness burn and resuscitated with Ringer's lactate. EEE was performed immediately after the burn group received the first intraperitoneal injection of Ringer's lactate. The wound was covered with homoskin from normal rats. In the PNS group, two doses of PNS (200 mg/kg for each dose) were given intraperitoneally immediately and 4 h postburn. Cardiac contractile function and cardiac troponin T (TnT) were determined at 1, 3, 6, 12 and 24 h postburn. Results showed that cardiac contractile parameters including AOSP, AODP, LVSP and +dp/dt(max) all declined and were still significantly lower than the control values at 24 h postburn. Cardiac TnT was elevated markedly and reached a level 25 times higher than control at 12 h postburn. In EEE and PNS groups, the reduction of cardiac contractile function was limited as compared with that in the burn group. Levels of TnT in both EEE and PNS groups were significantly lower than in the burn group 6 h postburn later. The findings of this study demonstrated that both EEE and PNS were effective in improving early postburn cardiac function.

Expression of transposon LINE-1 is relatively human-specific and function of the transcripts may be proliferation-essential

A new 1.7-kb LINE (L1) transcript has been discovered from the cDNA library of human small-cell lung cancer. The nucleotide sequence of 1.7-kb L1 transcript is 98.4% similar to that of open reading frame 2 (ORF2) found in consensus complete 6.5-kb L1. Although L1 DNA segments could be detected from both genomic DNAs of human and rodent cells by PCR, these L1 transcripts were not detectable from cellular RNA of rodent cells by RT-PCR and northern hybridization, implying that the expression of L1 was relatively human-specific. The functions of L1 transcripts in cells are not yet clear. This paper shows that L1 transcripts are essential for cell proliferation when determined by antisense oligonucleotides. Alternately, L1 transcripts exhibit in all human cells we have examined so far, and they map to all the human chromosomes. A sequence-similarity search in the GenBank database indicates that the major sequence of 1.7-kb L1 is integrated in human retinoblastoma (Rb), IL-2, and factor VIII genes. Since Rb and factor VIII genes have displayed high frequency of chromosomal deletions in various cancers and haemophilia A, the universal integration of long and homologous L1 segments in the genes and all chromosomes may be liable to promote abnormal DNA rearrangement.

Serial experimental and clinical studies on the pathogenesis of multiple organ dysfunction syndrome (MODS) in severe burns

These serial clinical and experimental studies were designed to clarify the pathogenesis of postburn MODS. Both animal and clinical studies were performed. In animal experiments, 46 male cross-bred dogs were cannulated with Swan-Ganz catheters and 39 of them were inflicted with 50% TBSA third degree burns (7 were used as controls). The burned dogs were randomly divided into 4 groups: immediate infusion, delayed infusion, delayed fast infusion and delayed fast infusion combined with ginsenosides. All dogs were kept under constant barbiturate sedation during the whole study period. Hemodynamics, visceral MDA, mitochondrial respiratory control rate (RCR) and ADP/O ratio, ATP, succinic dehydrogenase (SDH), organ water content as well as light and electron microscopy of visceral tissues were determined. In the clinical study, 61 patients with extensive deep burns were chosen, of which 16 sustained MODS. Plasma TXB2/6-keto-PGF1alpha ratio, TNF, SOD, MDA, circulatory platelet aggregate ratio (CPAR), PGE2, interleukin-1, total organ water content and pathological observations of visceral tissues from patients who died of MODS were carried out. Results demonstrated that ischemic-reperfusion damage due to severe shock, sepsis and inhalation injury are three main causes of postburn death. All inflammatory mediators increased markedly in both animals and patients who sustained organ damage or MODS. SDH, RCR, ADP/O and ATP decreased significantly. These findings suggested that ischemic damage and systemic inflammatory response syndrome (SIRS) initiated by mediators or cytokines might be important in the pathogenesis of postburn MODS.

Long-chain polyunsaturated fatty acid levels in formulae influence deposition of docosahexaenoic acid and arachidonic acid in brain and red blood cells of artificially reared neonatal rats

We studied the effects of dietary long-chain polyunsaturated fatty acids (PUFA) on the fatty acid composition of the brain and red blood cells in gastrostomized rat pups reared artificially from postnatal Days 5-18. These pups were fed rat milk substitutes in which the fat comprised 10% linoleic acid and 1% alpha-linolenic acid and, using a 3 x 3 factorial design, one of three levels of both arachidonic acid (AA) and docosahexaenoic acid (DHA) supplied as single cell microbial oils (0.0, 0.4 and 2.4% fatty acids). A tenth group was reared by nursing dams. The fatty acid composition of the phosphatidylethanolamine (PE) and phosphatidylserine/phosphatidylinositol (PS/PI) phospholipids in the brain and red blood cells on Day 18 reflected the dietary composition in that pups receiving long-chain supplementation of each had higher levels of the supplemented PUFA, but lower levels of the other, relative to unsupplemented groups. In contrast to these results, there were few changes in the brain in phosphatidylcholine (PC) phospholipids whereas, in the red blood cells, changes in PC were similar to those in PE and PS/PI. Regression analyses showed that DHA levels in the brain correlated more closely with those of the red blood cells than did AA levels. The results of this study indicate that, although supplementation of formula with AA or DHA during the period of rapid brain development in rats increases deposition of the long-chain PUFA in the developing tissues, each also affects the levels of the other.

Identification of Delta5-desaturase from Mortierella alpina by heterologous expression in Bakers' yeast and canola

A DNA fragment with homology to Delta6-desaturases from borage and cyanobacteria was isolated after polymerase chain reaction amplification of Mortierella alpina cDNA with oligonucleotide primers corresponding to the conserved regions of known Delta6-desaturase genes. This fragment was used as a probe to isolate a cDNA clone with an open reading frame encoding 446 amino acids from a M. alpina library. Expression of this open reading frame from an inducible promoter in Saccharomyces cerevisiae in the presence of various substrates revealed that the recombinant product had Delta5-desaturase activity. The effects of growth and induction conditions as well as host strain on activity of the recombinant Delta5-desaturase in S. cerevisiae were evaluated. Expression of the M. alpina Delta5-desaturase cDNA in transgenic canola seeds resulted in the production of taxoleic acid (Delta5,9-18:2) and pinolenic acid (Delta5,9,12-18:3), which are the Delta5-desaturation products of oleic and linoleic acids, respectively.

Serum vitamin A level in breast cancer patients

Vitamin A or its synthetic analogues are potent in controlling cell differentiation and in preventing epithelial cancer in experimental animals. Although some community-based studies have found that high serum retinol levels in prediagnostic sera were associated with reduced risk for cancer, other reports in humans have not confirmed this finding. This study is to evaluate the preoperative serum vitamin A level in breast cancer patients in Taiwan. The serum specimens were collected from 106 female cases of breast cancer (aged 30 to 70 years), 32 female cases of benign breast disease (aged 29 to 57 years), and 40 healthy females (aged 22 to 52 years). The serum vitamin A levels were measured by colorimetic analysis. The results showed the mean value of the vitamin A level was 140.4 +/- 65.7 micrograms/dl in the breast cancer group comparing to 145.2 +/- 44.2 micrograms/dl in the benign breast disease group, 144.0 +/- 30.0 micrograms/dl in the control group (P > 0.05). The characteristics of the breast cancer group were analyzed and they revealed that serum vitamin A levels did not bear statistically significant differences in age, duration, steroid receptor, tumor size and menopausal state. (P > 0.05) In conclusion, the serum vitamin A levels were not decreased in early breast cancer patients. The serum vitamin A levels were significantly decreased in the metastatic breast cancer group, especially in liver metastatic women. (P < 0.05). Postoperative vitamin A supplement may have potential benefit to metastatic breast cancer patients.

Flutamide-induced liver injury: a case report

Flutamide is a nonsteroidal antiandrogen agent. Since it was marketed in February of 1989 in the USA for treatment of prostate cancer, its potential for hepatotoxicity has been reported in Western countries. Here we report the case of a 72-year-old patient who suffered from general malaise, poor appetite, nausea and jaundice after six months of flutamide therapy for the treatment of prostate cancer. He had no past history of liver disease and was not receiving other medications. Liver biochemistries revealed elevated serum alanine aminotransferase and aspartate aminotransferase concentrations of up to 1,035 U/l and 745 U/l, respectively. Serum total bilirubin concentration was elevated to 7.0 mg/dl. Serologic markers for acute viral hepatitis were all negative. Serum antinuclear antibody, antimitochondrial antibody and antismooth-muscle antibody were also negative. Percutaneous liver biopsy revealed pericentral zonal necrosis with bridging hepatic necrosis. The patient's clinical symptoms and signs began to improve after discontinuation of flutamide, and his liver function had returned to normal three months later. Roussel Uclaf causality assessment for adverse drug reaction confirmed the diagnosis of drug-induced liver injury. This case reminds us that patients who are receiving flutamide should be regularly monitored for liver function. If drug-induced liver injury is suspected, flutamide must be discontinued promptly to avoid progression of liver injury.

Radiotherapy in the treatment of duodenal bleeding due to hepatocellular carcinoma invasion

Haemorrhage from an hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) tract is uncommon. A 58-year-old man was admitted with upper gastrointestinal (UGI) bleeding and panendoscopy on examination revealed a large duodenal ulcerative bleeding mass. The mass was eventually diagnosed as HCC by pathological examination. The bleeding failed to respond to conventional management of haemostasis, but resolved with an external beam of radiotherapy with a total dose of 6000 cGy over a 5 week period. This unusual presentation of UGI bleeding, due to HCC invading the duodenum and treated by radiotherapy, has not been previously reported.

Insulin-like growth factor-I stimulates gonadotrophin production from eel pituitary cells: a possible metabolic signal for induction of puberty

Insulin-like growth factor (IGF)-I has been suggested as a potential signal linking growth and puberty in mammals. Using the juvenile European eel as a model, we employed a long-term, serum-free primary culture of pituitary cells to study the direct effect of IGF-I on gonadotrophin (GtH-II=LH) production. IGF-I increased both cell content and release of GtH-II in a time- and dose-dependent manner. IGF-I and IGF-II had similar potencies but insulin was 100-fold less effective, suggesting the implication of an IGF type 1 receptor. Other growth and metabolic factors, such as basic fibroblast growth factor and thyroid hormones, had no effect on GtH-II production. IGF-I did not significantly increase the number of GtH-II immunoreactive cells, indicating that its stimulatory effect on GtH-II production does not result from gonadotroph proliferation. Comparison of IGF-I and somatostatin (SRIH-14) effects showed that both factors inhibited growth hormone (GH) release but only IGF-I stimulated GtH-II production by eel pituitary cells. This indicates that the effect of IGF-I on gonadotrophs is not mediated by the reduction of GH released by somatotrophs into the culture medium. This study demonstrates a specific stimulatory effect of IGF-I on eel GtH-II production, played out directly at the pituitary level. These data obtained in a primitive teleost suggest that the role of IGF-I as a link between body growth and puberty may have been established early in the evolution of vertebrates.

Mechanism for basal expression of rat mitochondrial branched-chain-2-oxo-acid dehydrogenase kinase [corrected]

The rat branched-chain-2-oxo-acid dehydrogenase (BCOD) kinase mRNA is transcribed from a TATA-less promoter that has GC-rich sequences and two putative Sp1 binding sites near the transcription start site. We demonstrated previously that the 5' region of the kinase gene, base pairs -128 to +264, contained promoter activity when assayed using luciferase as a reporter (Huang and Chuang (1996) Biochem. J. 313, 603-609). To define DNA elements required for efficient expression of the kinase gene, nested deletion constructs of the above promoter region fused with a luciferase reporter gene were transfected into cultured H4IIE (hepatoma) and NRK-52E (kidney) cells. The results showed that the region between nucleotides -58 and +21 was indispensable for the kinase basal promoter activity. Methylation-interference and mutagenesis-promoter assays identified nucleotides -50 to -40 (ACAACTCCCA) as cis-acting DNA sequences that are required for nuclear protein binding and efficient promoter activity. Gel-supershift analysis with anti-Sp1 antibody suggested that the nuclear protein capable of binding to the -58 oligonucleotide (bp -58 to -34) was immunologically related to the Sp1 protein. The -58 oligonucleotide formed a DNA-protein complex with recombinant Sp1 protein with an affinity approximately ten-fold lower than that of the consensus Sp1 oligonucleotide. Co-transfection of the Sp1 expression plasmid and the -58 promoter construct into Drosophila Schneider cells revealed that Sp1 contributed to the kinase basal promoter activity by binding to the non-consensus site in the -58 region. Deletion of two consensus Sp1 binding sites (bases -150 to -140 and bases +29 to +38) in the kinase gene did not affect the basal promoter activity. Therefore binding of Sp1 or Sp1-like proteins to the above single non-consensus Sp1 sequence in the -58 region plays a major role of transactivating basal expression of the BCOD kinase.

Endoscopic ultrasonography for preoperative locoregional staging and assessment of resectability in gastric cancer

We performed a prospective study from November 1989 to December 1996 to assess the accuracy of endoscopic ultrasonography (EUS) in the locoregional staging and resectability of patients with gastric carcinoma. One hundred and nineteen patients with gastric cancer who received preoperative assessment by EUS underwent subsequent surgery. The endosonographic tumor-node-metastasis (TNM) classification was used for comparison with the histopathologic findings of the resected specimens. The ability of EUS to accurately predict the T stage (depth of tumor invasion) and N stage (involvement of lymph node) was 70% and 65%, respectively. EUS displayed a tendency to overestimate T stage and underestimate N state. The differentiation of early gastric cancer from advanced gastric cancer showed a concordance rate of 89% and underestimation rate of 8% and underestimation rate of 3%. The accuracy of EUS in predicting the stage T1 to T3, which correspond to D0 resectability (no macroscopic or microscopic tumor remains), was 91%. In conclusion, these results revealed EUS as a valuable tool for evaluating the local staging and resectability of gastric cancer. We suggest that EUS should be introduced in the preoperative assessment of patients with gastric cancer.

Characterization and localization of two forms of gonadotropin-releasing hormone (GnRH) in the spinal cord of the frog Rana ridibunda

Two molecular variants of gonadotropin-releasing hormone (GnRH) have been previously characterized in the brain of amphibians, i.e., mammalian GnRH (mGnRH) and chicken GnRH-II (cGnRH-II). The aim of the present study was to identify the molecular forms of gonadotropin-releasing hormone and to localize gonadotropin-releasing hormone-containing elements in the spinal cord of the frog Rana ridibunda using highly specific antisera against mGnRH and cGnRH-II. High-performance liquid chromatography (HPLC) analysis combined with radioimmunoassay (RIA) detection revealed that frog spinal cord extracts contained both mGnRH and cGnRH-II. Immunohistochemical labeling revealed that the frog spinal cord was devoid of GnRH-containing cell bodies. In contrast, numerous GnRH-immunoreactive fibers were observed throughout the entire length of the cord. mGnRH immunoreactivity was only detected in the rostral region of the cord and consisted of varicose processes located in the vicinity of the central canal. cGnRH-II-positive fibers were found throughout the spinal cord, the density of immunoreactive processes decreasing gradually toward the caudal region. Two main cGnRH-II-positive fiber tracts with a rostrocaudal orientation were observed: a relatively dense fiber bundle surrounding the central canal, and a more diffuse plexus in the white matter. In addition, short, varicose cGnRH-II-positive processes with a radial orientation were present throughout the gray matter. These fibers were particularly abundant ventromedially and formed a diffuse network that ramified laterally to end in the vicinity of motoneurons. Taken together, these data indicate that the frog spinal cord, like the frog brain, contains two forms of GnRH. The presence of numerous cGnRH-II-immunoreactive fibers in the ventral horn suggests that cGnRH-II may influence the activity of a subpopulation of motoneurons.

Phase II and pharmacokinetic study of paclitaxel therapy for unresectable hepatocellular carcinoma patients

Hepatocellular carcinoma (HCC) is a common lethal disease in Asia and there is no effective chemotherapy. Identification of new effective drugs in the treatment of inoperable HCC is urgently need. This is a phase II clinical study to investigate the efficacy, toxicity and pharmacokinetics of paclitaxel in HCC patients. Twenty patients with measurable, unresectable HCC, normal serum bilirubin, normal bone marrow and renal functions were studied. Paclitaxel 175 mg m(-2) was given intravenously over 3 h every 3 weeks. No complete or partial responses were observed. Five patients had stable disease. Major treatment toxicities (grade 3-4) were neutropenia (25%), thrombocytopenia (15%), infection (10%) and allergy (10%). Treatment-related deaths occurred in two patients. The median survival was 12 weeks (range 1-36). Paclitaxel is metabolized by the liver and the pharmacokinetics of paclitaxel in cancer patients with liver involvement or impairment may be important clinically. Pharmacokinetic study was completed in 13 HCC patients. The paclitaxel area under the curve was significantly increased (P < 0.02), clearance decreased (P < 0.02) and treatment-related deaths increased (P = 0.03) in patients with hepatic impairment. In conclusion, paclitaxel in this dose and schedule has no significant anti-cancer effect in HCC patients. Paclitaxel should be used with caution in cancer patients with liver impairment.

Age is one of the risk factors in developing gallstone disease in Taiwan

OBJECTIVES

To assess the prevalence and risk factors of gallstone disease (GSD) in Taiwan.

DESIGN

Descriptive and cross-sectional.

METHODS

A prospective ultrasonographic study of GSD was conducted in 3647 Chinese subjects who received a paid hospital physical check-up. Their demographic characteristics and biochemical parameters were recorded and compared. Ultrasonographic diagnosis revealed 2946 (M/F: 1838/1108) with normal gallbladder, 286 (M/F: 196/90) with gallbladder stones, 100 (M/F: 56/44) with previous cholecystectomy for gallstones, 243 (M/F: 174/69) with gallbladder polyps, 17 (M/F: 10/7) with mixed gallbladder stones/polyps and 35 as 'miscellaneous'. We enrolled subjects showing either gallbladder stones or cholecystectomy for gallstones in the GSD group.

RESULTS

Excluding those subjects with mixed gallbladder stones/polyps, the overall prevalence of GSD in the studied group was 10.7%. The studied factors manifesting an increase in risk for the development of GSD were age (P<0.05), high body mass index (P< 0.05), diabetes mellitus (adjusted odds ratio: 1.998; P< 0.05) and glucose intolerance (adjusted odds ratio: 2.056; P<0.05) by multivariate analysis. Other demographic characteristics and biochemical parameters, such as body height, ABO blood type, cigarette smoking, alcohol consumption, blood pressure, lipid profiles, hepatitis B virus infection, liver function and multiparity did not show any correlation to GSD.

CONCLUSIONS

Age, high body mass index, diabetes mellitus and glucose intolerance are the risk factors for developing GSD in Taiwan.

Variations in gene expression and genomic stability of human hepatoma cells integrated with hepatitis B virus DNA

The association of hepatitis B virus (HBV) infection with human hepatoma is well established. However, no consensus regarding the etiology of hepatocellular carcinoma was elucidated. In this paper, the genomic stability and gene expression of HBV DNA-integrated and non-integrated hepatoma cells by Transcript Profile (TP)-PCR and RT-PCR are characterized. The additional DNA bands generated from TP-PCR of HBV integrated genomes were not correlated with the sequence of HBV, suggesting that the variations may result from genomic instability of the host cells. Moreover, differential genes expressed in HBV DNA-integrated cells were sequenced. A cDNA generated from the integrated cells exhibited 99.3% homology with the sequences of ATP synthase 6 and cytochrome C oxidase III, but the sequences were abnormally linked together. Since HBV infection may alter the energy metabolism of the cell, the results suggest that the integration may cause mitochondriae defects in the ATP synthase 6 and cytochrome C oxidase III genes.

Long-term inhibitory effects of somatostatin and insulin-like growth factor 1 on growth hormone release by serum-free primary culture of pituitary cells from European eel (Anguilla anguilla)

To investigate the ability of hypothalamic and peripheral factors to directly regulate growth hormone (GH) release in a primitive teleost, the European eel (Anguilla anguilla L.), we used primary cultures of dispersed pituitary cells. When cultured for 12 days in a serum-free medium, pituitary cells continuously released large amounts of GH, which exceeded the initial cellular content. Somatotropin-release inhibiting hormone (SRIH-14) dose-dependently inhibited GH release (EC50 0.75 nM) up to a maximal inhibitory effect of 95%. No desensitization of somatotropes to SRIH was observed over the 12 days of culture. Use of receptor subtype-selective SRIH agonists suggests the existence on eel somatotropes of SRIH receptor(s) related to the mammalian sst2/sst3/sst5 class rather than to the sst1/sst4 class. Insulin-like growth factor 1 (IGF1) dose-dependently inhibited GH release (EC50 0.03 nM) up to a maximal inhibitory effect of 85%, without desensitization. IGF1 and IGF2 were equipotent in inhibiting GH release, whereas insulin was 1,000 times less active, suggesting the implication of a receptor related to the mammalian IGF type 1 receptor. These results indicate that eel somatotropes are active in vitro without any specific additional factors, and suggest the existence of a dominant inhibitory control of GH release in vivo. Two potential candidates for this chronic negative regulation are a neurohormone, SRIH and a circulating factor, IGF1. These data underline the early evolutionary origin of the molecular and functional SRIH-GH-IGF1 neuroendocrine axis in vertebrates.

The experiences of rectosigmoid pouch as a continent urinary diversion after radical cystectomy

Thirty-five patients receiving cystectomy underwent rectosigmoid pouch. The technique of ureteral submucous implantation was described. The follow-up results were analyzed. The relationship of postoperative voiding frequency and preoperative anal closure pressure was assessed. The day and night time continence rate is 97% (34/35). There were no hydronephrosis, no ureterocolonic stricture or reflux. The complications are not unique to rectosigmoid pouch and not high when compared with other forms of urinary diversion. When the preoperative anal closure pressure reaches nearly 100 cmH2O a postoperative outcome with good quality of life will be predicted. With the advantages of high continence rate and simplicity of performance the rectosigmoid pouch will become one of the alternative forms of continent urinary diversion. For obtaining the favorable results a patient with normal renal function, good hepatic function and anal closure pressure more than 50 cmH2O is required.

Evaluation of galactography for nipple discharge

Galactography is useful in the evaluation of spontaneous discharge from the nipple of a nonlactating breast. Without galactography, surgeons have relied on either masectomy or excision of the major duct system responsible for the discharge. From January 1989 to May 1996, 106 galactograms were performed with monofilament polypropylene suture guiding for duct cannulation in 105 cases. The discharge duct was identified by pre-operative galactography, followed by a selective excision of ductal-lobular unit. In all tissue specimens, the cause of the pathologic secretion was found histologically; most often, it was intraductal papilloma (42.6%). In 35.6% of the specimens, findings with a prospective significance (papillomatosis, hyperplasia, carcinoma) were discovered and further operative treatment was initiated. The color of the discharge allowed no prediction of the histological findings. The accuracy of galactography was 88.4%, 84.6%, and 77.4% in papilloma, cancer, and other benign lesions, respectively. It is better than physical examination and other tests. Galactography represents a useful test in the diagnostic workup of secretory breasts.

Gastric duplication cyst: report of a case

Gastric duplication cyst is a rare disease entity, especially in the adult population. We report a case of 33-year-old female patient who presented with epigastric pain, postprandial fullness and nausea for the past several months. Gastroendoscopy showed a submucosal mass with normal overlying gastric mucosa. Upper gastrointestinal series confirmed a extrinsic compression of mass in the fundus of the stomach. Endoscopic ultrasonography and computerized tomography demonstrated the lesion to be a cyst in nature. The surgical procedure consisted of total excision without violation of the gastric lumen. Gastric mucosa was found by the histologic study of the excised cyst.

Adrenic acid delta4 desaturation and fatty acid composition in the liver of marine-oil fed streptozotocin diabetic rats

The aim of the present study was to assess the effect of streptozotocin diabetes and insulin treatment on adrenic acid delta4 desaturation and fatty acid composition of liver microsomes in Wistar rats fed a fat free semi-synthetic basal diet supplemented with 10% EPA-rich marine oil. Results showed that, in liver microsomes of hyperglycemic rats, the 22:6n-3/22:5n-3 ratio in total lipids was elevated and desaturation of adrenic acid to n-6 docosapentaenoic acid was enhanced. Insulin treatment with 2.0 I.U./100 g body weight-1 twice a day for 3 days resulted in hypoglycemia and suppressed both the increased delta4 n-6 desaturation and 22:6n-3/22:5n-3 ratio. It is concluded that the delta4 desaturation enzyme system, which is activated by experimental diabetes, is regulated by mechanisms different from those regulating delta6 and delta5 desaturations.

Androgens stimulate gonadotropin-II beta-subunit in eel pituitary cells in vitro

Primary cultures of juvenile eel (Anguilla anguilla) pituitary cells were used to study the direct effects of sex steroids on gonadotropin (GtH-II) cell content and release (radioimmunoassay) as well as on mRNAs levels for alpha and GtH-II beta-subunits (dot-blot). Testosterone stimulated GtH-II production in a dose- and time-dependent manner by selectively increasing mRNAs for GtH-II beta-subunit but not alpha-subunit. This positive effect was also induced by non-aromatizable androgens (androstanediol and dihydrotestosterone) but not by estradiol, indicating an androgen-specific effect in the eel. The androgen-specific stimulation of eel GtH-II beta appears closer to the regulation of mammalian follicle stimulating hormone-beta (FSHbeta) than that of salmonid GtH-II beta or mammalian luteinizing hormone-beta (LHbeta)-subunits. Comparison with previous in vivo experiments suggests multiple sites of action of sex steroids on the brain-pituitary gonadotropic axis for the positive feedback on GtH-II synthesis in this juvenile fish.

Clinical evaluation of primary biliary cirrhosis in Chinese patients without serum anti-mitochondrial antibody

BACKGROUND

Primary biliary cirrhosis (PBC), a chronic, progressive, cholestatic liver disease characterized by frequent presence of the anti-mitochondrial antibody (AMA), is rarely seen in the Asian population. Whether or not the presence of AMA alters the clinical, serological and histological features of the disease remains unclear.

METHODS

During the 25-year period from 1972 to 1996, 71 Chinese patients with PBC who were diagnosed clinically and/or histologically were reviewed. Seventeen (24%) of them repeatedly tested negative for serum AMA. Clinical, biochemical, immunological, histological data and treatment response to ursodeoxycholic acid were compared between PBC patients with positive and negative serum AMA.

RESULTS

Mean serum immunoglobulin M (IgM) level was significantly lower in AMA-negative PBC patients when compared with AMA-positive PBC patients (422 +/- 163 vs. 651 +/- 412 mg/dL, p = 0.042). Serum anti-nuclear antibodies (ANA) were positive in 93% of the AMA-negative PBC patients, a significantly higher percentage when compared with the 66% of AMA-positive patients (p = 0.048). There were no significant differences with regard to age, sex, clinical manifestations, liver biochemistries, histological findings, survival and response to 1-year ursodeoxycholic acid treatment between the AMA-negative and AMA-positive patients. Univariate logistic regression analysis showed relatively lower serum IgM levels, positive serum ANA and anti-centromere type ANA were significant predictive factors to negative serum AMA in PBC patients (p = 0.035, 0.044 and 0.029, respectively). Multi-variate analysis revealed relatively lower serum IgM levels were the only independent significant predictor to negative serum AMA in PBC patients (p = 0.015).

CONCLUSIONS

Twenty-four percent of Chinese patients with PBC were negative for serum AMA. AMA-negative PBC patients were characterized by relatively lower serum IgM levels and a higher rate of positive serum ANA.

The hierarchical diffusion of AIDS and violent crime among U.S. metropolitan regions: inner-city decay, stochastic resonance and reversal of the mortality transition

Census data on migration within and between the 25 largest U.S. metropolitan areas-containing more than 113 million people-permit construction of a probability-of-contact matrix corresponding to a particular Markov process dominated by the nation's largest cities, a hierarchical structure. Regression models based on vectors associated with that process find the large-scale diffusion of AIDS in the U.S.A. depends strongly on national patterns of contact with the original AIDS outbreaks in New York City and San Francisco as modulated by the violent crime rate, a local index of social disintegration resulting from the marginalization of minority ethnic urban communities. Violent crime is itself undergoing a recognizably similar hierarchical diffusion from the largest U.S. cities into smaller metropolitan regions. Further analysis suggests that continuation of public policies of "benign neglect" and "planned shrinkage" directed against marginalized urban populations may trigger a strong stochastic resonance which can significantly degrade public health and public order for much of the three-quarters of the U.S. population living in or near cities, in effect reversing the mortality transition of the last century.

Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients

Fifty-seven patients treated by radical gastric resections were retrospectively studied to understand the clinicopathologic characteristics of advanced gastric cancer without serosal invasion (the depth of tumor invasion limited to the muscularis propria or subserosal layer) in young and old age persons. There were 36 patients in the old age group (age > 60 years) and 21 in the young age group (age < or = 40 years). The clinical and pathologic parameters for this study included sex, gross type, location, maximum tumor size, depth of invasion, lymph node metastasis, tumor stage, histologic type, and rate of curative resection. The old patients had a higher percentage of small tumors, subserosal invasion and lymph node metastasis, but these parameters were not significantly different from those of the young patients, nor did the sex ratio, gross type, location, and rate of curative resection show significant differences. The histologic feature was the only statistically significant parameter, determined by univariate and multivariate analyses. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were detected in 10 (47.6%) and 4 (19.0%) of the 21 younger patients, respectively, while there were 4 (11.1%) and 2 (5.6%) in the old age group. Although the gastric cancer in young patients had more aggressive histologic characteristics than it did in elderly patients, survival rates between the two groups did not differ to any great degree. Our findings indicate that the prognosis for younger patients with advanced gastric cancer without serosal invasion was favorable when curative resection was performed.

Chronic intermittent salt loading enhances functional recovery from polydipsia and survival of vasopressinergic cells in the hypothalamic supraoptic nucleus following transection of the hypophysial stalk

Hypophysial stalk-transected (ST) and sham-operated animals were subjected to a chronic intermittent salt loading regimen (CISL) for 14 days beginning 1 day post surgery (dps). Animals were sacrificed at 15 and 36 dps. Three days after the termination of CISL, water consumption in ST + CISL animals decreased to the same level as that of sham-operated animals, while that of ST + water animals was maintained at a significantly higher level. The number of the surviving vasopressinergic neurons in the supraoptic nuclei of the ST + CISL group was significantly higher than that of ST + water group. CISL induced vasopressinergic axonal sprouting into the external zone of the median eminence, and formation of subependymal perivascular plexus. While CISL also enhanced regeneration of oxytocinergic axons into the external zone, it did not, however, have any effect on the number of oxytocinergic neurons surviving axotomy.

Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients

Fifty-seven patients treated by radical gastric resections were retrospectively studied to understand the clinicopathologic characteristics of advanced gastric cancer without serosal invasion (the depth of tumor invasion limited to the muscularis propria or subserosal layer) in young and old age persons. There were 36 patients in the old age group (age > 60 years) and 21 in the young age group (age < or = 40 years). The clinical and pathologic parameters for this study included sex, gross type, location, maximum tumor size, depth of invasion, lymph node metastasis, tumor stage, histologic type, and rate of curative resection. The old patients had a higher percentage of small tumors, subserosal invasion and lymph node metastasis, but these parameters were not significantly different from those of the young patients, nor did the sex ratio, gross type, location, and rate of curative resection show significant differences. The histologic feature was the only statistically significant parameter, determined by univariate and multivariate analyses. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were detected in 10 (47.6%) and 4 (19.0%) of the 21 younger patients, respectively, while there were 4 (11.1%) and 2 (5.6%) in the old age group. Although the gastric cancer in young patients had more aggressive histologic characteristics than it did in elderly patients, survival rates between the two groups did not differ to any great degree. Our findings indicate that the prognosis for younger patients with advanced gastric cancer without serosal invasion was favorable when curative resection was performed.

Expression of P53 protein and it's prognostic significance in breast cancer patients

Nuclear accumulation of p53 protein is associated with a poor clinical outcome in breast cancer patients. This study was designed to determine the frequency of p53 protein immunoreactivity in primary breast cancer to correlate the presence of p53 protein with established risk factors including the estrogen receptor and progesterone receptor status, and to evaluate the prognostic significance of p53 protein immunoreactivity regarding patient survival in Taiwan. To assess the p53 protein immunoreactivity, 104 patients with breast cancer were examined using immunohistochemical methods. P53 protein was detected in 40 (38.5%) of these primary breast cancer specimens. Highly significant associations were found between p53 protein expression and negative steroid receptors, histologic grade III. There were no statistically significant references in p53 protein expression with respect to age, tumor size, lymph node status, or clinical stage. Patients with p53 positive tumor showed poorer survival but this did not achieve significance. However, there were more patients with poor survival in the axillary node-positive group (p < 0.05) than in node-negative group. This suggests that the p53 protein expression is marginal as a prognostic indicator in breast cancer with axillary-node metastasis.

Utility of lentil lectin affinity of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma

AIMS/METHODS

Frozen sera obtained from 70 patients (35 with hepatocellular carcinoma and 35 with benign chronic liver disease) with serum alpha-fetoprotein > 20 ng/ml were studied to evaluate the diagnostic indices of lentil lectin affinity of alpha-fetoprotein in detecting hepatocellular carcinoma.

RESULTS

The proportion of alpha-fetoprotein-L3 was significantly higher in patients with hepatocellular carcinoma than in those with benign chronic liver disease (41.0 +/- 33.6% vs. 16.4 +/- 15.3%, p < 0.001). This difference led to a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 57, 89, 83, 67 and 73%, respectively, in detecting hepatocellular carcinoma using the proportion of alpha-fetoprotein-L3 > 35% as a parameter. Within a 1-year period, 1500 high-risk persons were collaborating, leading to 22 cases with serum total alpha-fetoprotein > 20 ng/ml. These 22 cases included six pregnant women. The parameter, alpha-fetoprotein-L3 > 35% was used along with sonography to detect hepatocellular carcinoma for the remaining 16 cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 75, 83, 60, 91 and 81%, respectively, by the proportion of alpha-fetoprotein-L3 > 35%; and 100, 92, 80, 100 and 94%, respectively, by sonography.

CONCLUSIONS

Lentil lectin affinity of alpha-fetoprotein provides a moderately high sensitivity and a high specificity in the detection of hepatocellular carcinoma for persons with high alpha-fetoprotein levels. It may be a useful adjuvant tool of sonography and total alpha-fetoprotein level in a mass survey of hepatocellular carcinoma for a high-risk population.

Expression of catalytically active human multifunctional glycogen-debranching enzyme and lysosomal acid alpha-glucosidase in insect cells

Glycogen debranching enzyme and acid alpha-glucosdase are responsible for glycogen degradation in human. The formal enzyme is a multifunctional enzyme with two independent catalytic activities occurring on a single polypeptide, while the latter is a lysosomal enzyme which matures through extensive glycosylation and phosphorylation and proteolytic processing. Deficiency of glycogen debranching enzyme and acid alpha-glucosidase cause glycogen storage disease type III and II, respectively. Baculovirus/insect expression system was used to produce both GDE and GAA. Both enzymes were found to be catalytically and antigenically active. The majority of recombinant GDE is present in the medium (70%). Uptake experiment indicated that GAA produced in the insect cells could not be absorbed into the GSD type II patient fibroblasts through mannose-6-phosphate receptor mediated endocytosis. Uptake experiment combined with immunoblot analysis indicated there are differences in the posttranslational modification and processing between insect cells and mammalian cells.

Phase II study of flutamide in the treatment of hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is a male predominant disease and may be an androgen-dependent or androgen-responsive tumor. This Phase 11 study was designed to investigate the clinical activity and toxicity of flutamide in the treatment of patients with advanced HCC.

METHODS

Thirty-two patients with measurable advanced HCC were studied. Flutamide, 750 mg per day, was administered orally for 8 weeks. Ten patients died before repeat tumor measurements could be performed.

RESULTS

Twenty-two patients were evaluable for response and toxicities. There were no complete responses nor partial responses. Nine of 22 patients (41%) had stable disease and 13 patients (59%) had progressive disease. Serum alpha-fetoprotein was reduced in three patients. The median survival was 10 weeks (range, one to 35 weeks). Toxicities were minimal and tolerable.

CONCLUSIONS

Flutamide is not effective in the treatment of advanced HCC. Clinically, HCC may not be an androgen-responsive tumor. Other new methods of treatment of HCC warrants future clinical investigations.

Autoimmune hepatitis in an area endemic for hepatitis B virus infection: a report of three cases

The role of autoimmune hepatitis (AIH) in the pathogenesis of chronic hepatitis is usually neglected, and its prevalence in Taiwan is uncertain. This report described three cases of AIH among consecutive patients with abnormal liver function tests encountered during the past six years. The minimal follow-up period was three years. Two of them were elderly males and one was associated with spontaneous clearance of hepatitis B surface antigen before being recognized as AIH. Though multiple relapses were encountered in two patients, good response to low-dose corticosteroid therapy was evidenced clinically and histologically. The possibility of AIH as the underlying etiology should be considered when other causes of chronic hepatitis are excluded. Prompt recognition and management prevent untoward outcome.

Serum levels of interleukin-8 in alcoholic liver disease: relationship with disease stage, biochemical parameters and survival

BACKGROUND/AIMS

Interleukin-8 (IL-8), a cytokine produced by a host of cells, including monocytes, macrophages, Kupffer cells and hepatocytes, can activate neutrophils. Peripheral neutrophilia and liver neutrophil infiltration are frequently noted in patients with alcoholic liver disease. However, the relationship between IL-8 and different stages of alcoholic liver disease is uncertain. The aim of this study is to determine if a correlation exists between circulating IL-8 levels and biochemical and histological parameters and survival in alcoholic liver disease.

METHODS

Serum levels of IL-8 were determined with an enzyme-linked immunosorbent assay in 166 subjects, consisting of 30 healthy controls, 26 patients with non-alcoholic fatty liver, 15 with alcoholic fatty liver, 32 with alcoholic hepatitis, 30 with alcoholic cirrhosis, 28 with chronic hepatitis B and 5 with chronic hepatitis C.

RESULTS

Serum IL-8 levels were markedly elevated in patients with alcoholic hepatitis (437 +/- 51 pg/ml) when compared with all other groups (p < 0.05). Levels of IL-8 in patients with alcoholic fatty liver, alcoholic cirrhosis and viral hepatitis were higher than those in controls and in patients with non-alcoholic fatty liver. In addition, IL-8 levels were higher in patients who died (p = 0.007), and correlated with biochemical and histological parameters, and severity of liver injury: serum aspartate aminotransferase, alanine aminotransferase, total bilirubin, prothrombin time, indocyanine green retention ratio, tumor necrosis factor-alpha and peripheral neutrophil count in patients with alcoholic hepatitis. After a 2-year follow up, patients with IL-8 above 479 pg/ml had a higher mortality rate in the alcoholic hepatitis group (p = 0.033).

CONCLUSIONS

These findings suggest that IL-8 is activated in alcoholic liver disease, especially in alcoholic hepatitis, and is closely correlated with liver injury. IL-8 levels can reflect the stage and severity of alcoholic liver disease, and may serve as a predictor of survival in patients with alcoholic hepatitis.

Effects of dietary gamma-linolenic acid and prenatal ethanol on mouse brain and behavior

Pregnant B6D2F mice were treated with ethanol (25% Kcal) from days 5-17 of gestation. The diet was supplemented with either 18 : 2n-6 [linoleic acid (LA)] or 18 : 3n-6 [gamma-linolenic acid (GLA)] throughout the study. Ethanol reduced 20 and 22 carbon n-6 and n-3 fatty acids in the brains of adult offspring. Feeding of GLA, compared with LA, increased levels of 20 : 3n-6 and 22 : 4n-6, but reduced 22 : 6n-3, particularly in the offspring of dams administered ethanol during gestation; adult brain weight was also lower in this group. Ethanol reduced the number of viable litters and adult body weight, and GLA reduced birth weight. Neither prenatal ethanol nor GLA affected open-field activity in adult males, nor did either treatment have an effect on the duration of immobility in the forced swimming test. However, GLA did affect circadian activity by increasing running wheel activity during the dark cycle, and decreasing it slightly during the light cycle. These results do not support a beneficial effect of GLA in preventing the developmental effects of ethanol; we suggest caution in the administration of high doses of GLA with ethanol during pregnancy.

Comparison of serum CA15-3 and CEA in breast cancer

The monoclonal antibodies CA15-3 were developed against the two antigens 115D8 of the human milk fat globule membrane and DF3 of breast cancer. CA15-3 was assayed radioimmunologically and CEA was analysed using the enzyme immunoassay. Normal control was achieved in 32 healthy women, the mean values for CA15-3 were 11.5 +/- 3.0 u/ml, range from 7.9 to 16.9 u/ml. We compared serum levels of CA15-3 and CEA in 121 patients with histologically proved breast carcinoma. CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. 31 of 121 patients studied had elevated CA15-3 levels (sensitivity: 25.6%) and 21 of 121 patients had positive CEA levels (sensitivity 17.4%). 92 of the breast cancer patients (76%) did not have metastatic disease. In this group CA15-3 sensitivity was 7.6%, while CEA sensitivity was 6.5%. Mean values were 15.1 +/- 6.6 u/ml for CA15-3 and 1.78 +/- 2.47 ng/ml for CEA. 29 patients (24%) had metastatic disease. In this group, CA15-3 sensitivity was 82.8% and CEA sensitivity was 51.7% (P < 0.05). Mean values for CA15-3 were 147.5 +/- 175.9 u/ml and 16.9 +/- 24.0 ng/ml of CEA. With regard to the correlation of two tumor markers with clinical course patients had significantly higher levels of CA15-3 than of CEA in metastatic breast cancer. This result suggests CA15-3 to be the more sensitive and more specific of the two for metastatic breast cancer detection and monitoring.

Distribution of plasma phosphatidylcholine molecular species in rabbits fed fish oil is modulated by dietary n-6 fatty acids

The present study examined the distribution of plasma phosphatidylcholine (PC) molecular species in rabbits fed a chow diet supplemented with fish oil (FO) in combination with either hydrogenated coconut oil or the n-6 fatty acid-rich evening primrose oil (EPO) for 4 weeks. Significant proportions of plasma PC molecular species contained long-chain n-3 fatty acids. Addition of EPO to the FO supplemented diet increased the incorporation of n-6 fatty acids into plasma PC molecules; it also raised the proportions of 16:0-18:2, n-6, 18:1-18:2, n-6, 18:2, n-6-18:2, n-6, and 16:0-20:4, n-6. The increase of n-6 fatty acid-containing PC was at the expense of n-3 fatty acid containing PC species. However, feeding n-6 fatty acids did not affect the distribution of PC molecular species based on total carbon chain length. The most interesting observation was that dietary suplementation with EPO, raised the ratio of 22:6, n-3-containing to 20:5, n-3-containing molecular species, suggesting an enhanced conversion of 20:5, n-3 to 22:6, n-3.

Frozen section of diagnosis of breast lesions

Frozen section diagnosis rendered in 549 consecutive breast biopsies performed in 5 years in a single pathology laboratory was correlated with the final pathological diagnosis. There were no false positive reports among the 220 (40.1%) biopsies interpreted as benign lesions in paraffin sections. Among 329 (59.9%) malignant biopsies on paraffin sections, 3 cases were interpreted as benign lesions on frozen sections. Three false negatives included 2 ductal carcinoma in situ and one infiltrating ductal carcinoma associated with papillomatosis. The tumors were small and confined to the breast without any evidence of metastasis. There was a very good correspondence between the frozen section diagnosis and the paraffin section diagnosis (K = 0.98). The sensitivity of frozen section diagnosis was 99.1% and the clinical diagnostic specificity was 100%. Our results suggest that frozen section diagnosis is a highly reliable procedure, but small lesions (less than 1 cm in diameter, or non-palpable) should not be subjected to frozen section examination to avoid unnecessary loss of neoplastic tissue during the frozen section. The careful investigation of paraffin-embedded tissue is recommended for small breast lesions in breast conserving lumpectomy.

N-3 and n-6 fatty acid metabolism in undifferentiated and differentiated human intestine cell line (Caco-2)

Metabolism of n-6 and n-3 fatty acids in the undifferentiated and differentiated human adenocarcinoma colon cell line (Caco-2) was studied. In cells incubated with either 18:2n-6 or 18:3n-3, no significant amounts of long chain n-6 and n-3 metabolites were found. Incubation with either 18:3n-6 or 18:4n-3 raised significantly the levels of 20:3n-6 and 20:4n-3, respectively. In the undifferentiated cells, significant proportions of 20:3n-6 and 20:4n-3 were further delta 5-desaturated to form 20:4n-6 and 20:5n-3, respectively. Incubation with either 20:4n-6 or 20:5n-3 raised the levels of their direct elongation products, 22:4n-6 and 22:5n-3, respectively. Incubation with 22:4n-6 or 22:5n-3 increased the levels of 20:4n-6 and 20:5n-6. These results suggest that delta 6-desaturation in the Caco-2 cells is less active in comparison with elongation, delta 5-desaturation and retro-conversion. These enzymes were modulated by the state of differentiation, and appeared to be non-specific to n-3 and n-6 fatty acids. When cells were incubated with 18:3n-6 and 18:4n-3 concomitantly, the levels of incorporation of total n-6 fatty acids into cellular lipids were greater than those of the n-3 fatty acids, whereas the ratios of 20+22 carbon metabolites to 18-carbon precursor favored n-3 over n-6 fatty acids. These results suggest that n-3 and n-6 fatty acids were not metabolized identically in Caco-2 cells.

Expression and characterization of branched-chain alpha-ketoacid dehydrogenase kinase from the rat. Is it a histidine-protein kinase?

The recombinant rat branched-chain alpha-ketoacid dehydrogenase kinase has been amplified from rat kidney cDNA, based on the previously reported rat cDNA sequence (Popov, K. M., Zhao, Y., Shimomura, Y., Kuntz, M. J., and Harris, R. A. (1992) J. Biol. Chem. 267, 13127-13130). This kinase was expressed in Escherichia coli as a fusion protein with bacterial maltose-binding protein (MBP). Expression was improved by overexpression of chaperonins GroEL and GroES. The MBP-kinase, when reconstituted with lipoylated recombinant E2 (dihydrolipoyl transacylase), catalyzed phosphorylation of recombinant E1 (branched-chain alpha-ketoacid decarboxylase) with a kcat of 28.5 nmol of phosphate/min/nmol of MBP-kinase at 25 degrees C. Recombinant MBP-kinase alone demonstrated a slow rate of autophosphorylation with a kcat of 3.25 pmol of phosphate/min/nmol of kinase at 25 degrees C. Serine 22 of the kinase was identified as the possible site of autophosphorylation by Edman microsequencing analysis. Autophosphorylated kinase cannot transfer phosphate to E1, indicating that autophosphorylation of kinase is not an intermediate in ATP-dependent phosphorylation of E1. Therefore, despite the reported sequence similarity to prokaryotic histidine protein kinases, the mitochondrial rat branched-chain alpha-ketoacid dehydrogenase kinase apparently does not phosphorylate E1 via a histidine-mediated phosphotransfer reaction. Significant corrections to the published cDNA sequence of rat branched-chain alpha-ketoacid dehydrogenase kinase are included.

A simple method of duct cannulation and localization for galactography before excision in patients with nipple discharge

A monofilament polypropylene guiding suture was inserted into a secreting duct in 72 female patients (aged 15-78 years) with nipple discharge. Cannulation and injection of contrast material was successful in all patients before galactography and of methylene blue dye before excision. Patients did not report discomfort, no injuries ensued, and no duct was perforated. This technique should expedite excision of a discharging duct and any lobules.

Detection of antibody to M2 mitochondrial antigen in Chinese patients with primary biliary cirrhosis

BACKGROUND

Antimitochondrial antibodies (AMA) are present in more than 90% of patients with primary biliary cirrhosis (PBC). However, AMA are not specific for PBC; they can be observed in nonhepatic disease. It has been reported that antibody of M2 mitochondrial antigen (anti-M2) is specific for PBC. The aim of the present study is to clarify the role of anti-M2 in the diagnosis of PBC.

METHODS

Sera from 27 patients with PBC, 62 normal subjects, 18 patients with chronic hepatitis B and 30 patients with chronic hepatitis C were obtained for the detection of anti-M2 and AMA. The anti-M2 assay was performed by enzyme immunoassay (EIA) and the AMA test was performed by indirect immunofluorescent method.

RESULTS

Twenty-four (88.9%) of the serum specimens from the patients with PBC and one (0.9%) of the 110 serum specimens from the non-PBC groups were positive for AMA. In contrast, twenty-five (92.6%) of the 27 PBC sera and five (4.5%) of the 110 non-PBC sera were positive for anti-M2. Most of the PBC sera contained high titers of anti-M2 and all the false-negative specimens disclosed low titers of anti-M2.

CONCLUSIONS

Although the anti-M2 assay used in the present study seemed not superior to the conventional AMA test in the sense of specificity, it had the advantage of being able to provide quantitative results. Since the presence of high titer anti-M2 is very specific for PBC, this assay may have a role in the diagnosis of equivocal PBC.