Cytoreduction and sequential resection for surgically verified unresectable hepatocellular carcinoma: evaluation with analysis of 72 patients

The poor prognosis of hepatocellular carcinoma (HCC) was partly a result of the majority of unresectable HCCs in clinical patients. Fortunately, with the progress of regional cancer therapies and multimodality treatment, some of the localized unresectable HCCs were converted to resectable ones. During the period 1960-1994, 72 of the 663 patients with surgically verified unresectable HCCs have been converted to resectable. Successful cytoreduction with median diameter reduced from 10 cm to 5 cm was mainly a result of the triple or double combination treatment with hepatic artery ligation, hepatic artery cannulation with infusion, radioimmunotherapy, and fractionated regional radiotherapy. The interval between the first operation and the sequential resection was 5 months. The operative mortality was 1.4% for sequential resection, and the 5-year survival was 62.1%. Analysis of factor influencing sequential resection rate revealed HCCs that were single nodule, well encapsulated, situated at right lobe or hepatic hilum, associated with micronodular cirrhosis, and treated with triple or double combination modalities had higher sequential resection rate as compared to their counterparts. Analysis of factors influencing survival after sequential resection revealed that HCCs with a solitary tumor confined in one lobe, without tumor embolus, and without residual cancer in specimen of sequential resection, had longer survival. It is suggested that localized unresectable, solitary, well encapsulated, right lobe or hilar HCC, associated with micronodular cirrhosis, will be good candidates for cytoreduction and sequential resection; and HCCs with unilateral involvement, without tumor embolus, and with complete necrosis of tumor after multimodality treatment favored better prognosis.

QSAR of 3-methylfentanyl derivatives studied with neural networks method

AIM

To use neural networks, which simulate the functions of living nervous systems, in QSAR studies;

METHODS

Using the back-propagation neural networks program devised by us, combining with partial least squares (PLS) method, we studied the relationships of quantum chemical indices and analgesic activities of 25 3-methylfentanyl derivatives;

RESULTS

Through learning process, a good QSAR model was established, and the activities of these compounds were predicted; the correlation between the activities and quantum chemical indices: the net charge of the atom N1, the net charge of the atom O16, the torsional angle of atoms C10-C9-N8-C4, the interatomic distance between atom C7 and the center of phenyl plane C9-14 (PhA), is quite well-matched. Based on these results, an interactive pattern between 3-methylfentanyl derivatives and opioid receptors was suggested;

CONCLUSION

Not only are the results of neural networks superior to those of PLS method but they also provide accurate predictions of the activity of the compounds and also combine the PLS method with neural networks.

3D-QSAR study on ether and ester analogs of artemisinin with comparative molecular field analysis

Comparative molecular field analysis (CoMFA), a three-dimensional quantitative structure-activity relationship (3D-QSAR) paradigm, was used to study the correlations between the physicochemical properties and the in vitro activities of a series of ether and ester analogs of artemisinin. Four alignment models were used in the CoMFA investigation. The correlations derived from CoMFA analysis with the four alignments proved all to have good predictive values. The steric field predictive model of alignment B is accordant with the experimental results of Avery M A, et al: J Med Chem 1993; 36: 4264-75. The electrostatic field predictive results of alignments A, B, and C are consistent with our previous result of quantum chemical calculation. The highest rcross2 of alignment D, indicated that the side chain of -C6-O2-O1-C10-O3-C7-O4-C12-O5- and atom C16 are important groups of artemisinin analogs for antimalarial activity.

Packaging of hepatitis delta virus RNA via the RNA-binding domain of hepatitis delta antigens: different roles for the small and large delta antigens

Hepatitis delta virus (HDV) is composed of four specific components. The first component is envelope protein which contains hepatitis B surface antigens. The second and third components are nucleocapsid proteins, referred to as small and large hepatitis delta antigens (HDAgs). The final component is a single-stranded circular RNA molecule known as the viral genome. In order to study the mechanism of HDV RNA packaging, a four-plasmid cotransfection system in which each viral component was provided by a separate plasmid was employed. Virus-like particles released from Huh-7 cells receiving such a cotransfection were found to contain HDV RNA along with three proteins. Therefore, the four-plasmid cotransfection system could lead to successful HDV RNA packaging in vitro. The system was then used to show that the large HDAg alone was able to achieve a low level of HDV RNA packaging. Analysis of a variety of large HDAg mutants revealed that the RNA-binding domain was essential for viral RNA packaging. By increasing the incorporation of small HDAg into virus-like particles, we found a three- to fourfold enhancement of HDV RNA packaging. This effect was probably through a direct binding of HDV RNA, independent from that of large HDAg, with the small HDAg. The subsequent RNA-protein complex was packaged into particles. The results provided insight into the roles and functional domains of small and large HDAgs in HDV RNA packaging.

Sympathetic innervation of the eustachian tube in rats

The glyoxylic catecholaminergic histofluorescence method was employed on the mucosa of the rat's eustachian tube (ET) in order to study the sympathetic innervation present. One percent neutral red was used as counterstain. Many noradrenergic fibers were demonstrable around blood vessels, glands and submucosa of the ET, but not in the epithelium. In a group of rats following neurectomy, the superior cervical ganglia (SCG) were removed unilaterally or bilaterally. Changes in sympathetic innervation of the ET were examined 14 days after SCG ganglionectomy. In those animals after unilateral SCG ganglionectomy, no noradrenergic histofluorescence was found in the ipsilateral ET, although some scant fluorescence could be detected in the tube's nasopharyngeal (NP) orifice. However, no noradrenergic histofluorescence could be observed in animals bilateral SCG ganglionectomies. Our results indicate that sympathetic innervation of the ET in the rat originates in the SCG, with some cross-innervation of sympathetic fibers occurring in the tube's NP orifice.

Noradrenergic innervation of juvenile nasopharyngeal angiofibroma

The glyoxylic catecholaminergic histofluorescence method was employed on tissues from five cases of juvenile nasopharyngeal angiofibroma in order to study the sympathetic innervation present. There was no sympathetic innervation identified in tumor parenchyma while some scant noradrenergic fibers were found in the tumor border. These findings indicate that keeping a dissection surface out of tumor during planned excisions may be very important, as vessels there have more sympathetic innervation which will then result in good vessel contraction in controlling bleeding. Non-diseased nasal mucosa from each patient was used as control tissue, with its submucosa seen to be filled with noradrenergic innervation. Some noradrenergic fibers were also found to innervate the muscle layers of arterioles or venules adjacent to the sphenopalatine foramen.

The structure-activity relationships of flavonoids as inhibitors of cytochrome P-450 enzymes in rat liver microsomes and the mutagenicity of 2-amino-3-methyl-imidazo[4,5-f]quinoline

The antimutagenicity of 19 naturally occurring flavonoids and their derivatives including flavones, flavonols, flavanones, isoflavones and flavanols were determined using Salmonella typhimurium TA98 against 2-amino-3-methylimidazo[4,5-f] quinoline (IQ) in the presence of Aroclor 1254-induced rat hepatic S9. In general, a relationship between the chemical structure of flavonoids and their antimutagenicity was found for compounds containing one or more of the following features: (i) C4 keto group, (ii) aglycone, (iii) double bond at positions C2 and C3, (iv) phenyl group at position C2, and (v) three hydroxy substituents at positions C4', C5 and C7. The inhibitory effects of flavonoids on activities of 7-ethoxycoumarin deethylase (ECD) and 7-ethoxyresorufin deethylase (ESD) of Aroclor 1254-induced hepatic microsomes were also examined. In addition, we studied the effects of flavonoids on the metabolism of IQ by Aroclor 1254-induced microsomes using high-performance liquid chromatography. The antimutagenicity correlated with the inhibition of cytochrome P-450IA1-linked ESD and P-450IA2-linked ECD activity in hepatic microsomes, and with an inhibition of N-hydroxy-IQ formation from IQ metabolism by hepatic microsomes. These results indicated that flavones or flavonols that contain C5, C7 and C4' hydroxyl groups are potent inhibitors of P-450 enzyme activities induced by Aroclor 1254 (P-450IA1 and P-450IA2), and may potentially be useful as chemopreventive agents against heterocyclic amine-induced mutagenesis or carcinogenesis.

Effects of cocaine on human nasal mucosa

The effects of cocaine on the contractile response of isolated human nasal mucosal blood vessels to field stimulation and methoxamine were investigated. Results showed that cocaine antagonized methoxamine and inhibited field stimulation. The drug increased resting tension in human nasal mucosa in vitro through direct actions and potentiated mucosal contractions by norepinephrine and epinephrine. The study indicated that high concentrations of cocaine may actually antagonize alpha-adrenoceptors, but these concentrations are not necessary in eliciting desired degrees of vasoconstriction in nasal blood vessels while being applied as a local anesthetic.

Induction of olfactory receptor sensitivity in mice

Repeated exposure to olfactory ligands (odorants) increased peripheral olfactory sensitivity in mice. For two unrelated ligands, androstenone and isovaleric acid, induction of olfactory sensitivity was odorant-specific and occurred only in inbred strains that initially had low sensitivity to the exposure odorant. These data demonstrate stimulus-induced plasticity in a sensory receptor cell, suggesting a form of stimulus-controlled gene expression. Induction with two unrelated odorants implies that olfactory induction is a general phenomenon that may occur in a large fraction of the human population.

Genotoxicity of heated cooking oil vapors

Epidemiological studies of lung cancer in Chinese women indicated that factors other than cigarette smoking are related to lung cancer risk. A case-control study suggested that indoor air pollution, particularly from cooking oil emissions, may be involved. Condensates of volatile emissions from rapeseed and soybean cooking oils were prepared and found to be genotoxic in short-term tests including the Salmonella mutation assay, SV50 forward-mutation assay, and sister-chromatid exchange assay, as well as the micronucleus assay in mouse bone marrow. In contrast, condensates from rapeseed oil with butylated hydroxyanisole or hydrogenated rapeseed oil were not mutagenic, implicating oxidation products as the cause for mutagenicity. Peanut oil and lard condensates were not mutagenic in any assay. The association of exposure to Chinese rapeseed cooking-oil emissions and lung-cancer risk may be related to the mutagenic component of these condensates.

A histofluorescent study of sympathetic innervation of human palatine tonsils

The glyoxylic catecholaminergic histofluorescence method was employed on human palatine tonsil specimens in order to study the sympathetic innervation present. One percent neutral red was used as a counterstain. Abundant sympathetic fibers were demonstrable around the blood vessels of the medulla and capsule. However, few sympathetic fibers were found around the vessels of the subepithelial connective tissue and interfollicular septa. In the areas of the follicle and extrafollicle where B and T lymphocytes were located, sympathetic fibers were not found. These findings indicate that if sympathetic innervation can affect T and B cells, it will do so indirectly. Results also show that there is a higher norepinephrine content in focally infected tonsils that is not due to hyperactivity of the sympathetic nerve, but may be due to other mechanisms. Finally surgical dissection at the capsule during tonsillectomy will reduce bleeding, perhaps because vessels there have an abundant sympathetic innervation that leads to good vessel contraction.

Echocardiographic estimate of left atrial pressure in children

Echocardiographic estimates of left atrial pressure (LAP) using the Q-C/A2-E ratio were obtained from 40 patients and compared with directly recorded mean LAP and/or pulmonary wedge pressure (PWP). The best correlation was obtained between LAP and the Q-C/A2-E (gamma = 0.95, P < 0.01); a good one between PWP and the Q-C/A2-E in normal and moderate pulmonary hypertension (gamma = 0.82, P < 0.01), but a poor one in severe pulmonary hypertension (gamma = 0.61, P > 0.05). Consequently, echocardiography provides a useful noninvasive method for the estimation of the LAP and PWP, particularly appropriate for children Intensive Care Unit.

Pre- and post-synaptic alpha-2 adrenoceptors in the canine nasal mucosa

The alpha-2 adrenoceptor radioligand tritiated yohimbine was used to determine the location of pre- versus postsynaptic alpha-2 adrenoceptors in canine nasal mucosa. Using Scatchard analysis, the maximal binding capacity (Bmax) and an apparent equilibrium dissociation constant (Kd) of the alpha-2 adrenoceptor were measured in seven normal dogs and in seven dogs subjected to a unilateral superior cervical ganglionectomy. The results showed that most alpha-2 adrenoceptors in the canine nasal mucosa were located at postsynaptic membranes and very few were located at presynaptic membranes. After superior cervical ganglionectomy, there were no significant changes of the affinity (Kd) and number (Bmax) of the alpha-2 adrenoceptors in the mucosa. These results suggest that the postsynaptic alpha-2 receptors are located extrasynaptically.

Developmental studies of electrical properties in cultured rat brain neurons

The rat brain neurons isolated from 15--17-day embryos were grown in dissociated cell culture and maintained in vitro for 3 weeks. The developmental process of the neurons was observed from the early stage of development in terms of passive and active electrical parameters and their changes induced by perfusion of ionic channel blockers. The neurons' development could be morphologically divided into stages I (from seedling to 6 days), II (7-11 days), III (12-20 days) and IV (21-22 days). The relative values of resting membrane potentials (RMP) for stages I, II, III and IV were 1, 3.46, 4.07 and 6.54, respectively; the corresponding values of input resistance (Rin) were 1, 1.48, 2.53 and 4.56, respectively. The current-voltage relationship in stages II and III was exponential in the direction of depolarization and the Rin's change with time was nearly linear. Spontaneous activities increased with prolongation of culture and the amplitude of evoked action potentials reached the maximum during stages III and IV. The RMP and Rin were markedly decreased by perfusion of TEA while no change was seen in TTX perfusion group. The results indicate that potassium ionic channels develop slower in stages II and IV, faster in stages I and III and mature by the end of stage IV.

Effects of lidocaine and procaine on canine nasal blood vessels

The effects of lidocaine and procaine on contractile responses of isolated canine nasal mucosal blood vessels to field stimulation and methoxamine were investigated. Analysis of cumulative dose-response curves showed that the two local anesthetics antagonized methoxamine and inhibited the field-stimulation response. The latter effect was interpreted as due to the blockade of Na+ channels. This would inhibit nerve conduction induced by field stimulation. The former effect on methoxamine is probably caused by the effect of these anesthetics on the mobilization of Ca++ needed for smooth muscle contraction. Preincubation of the nasal mucosa with low doses of procaine or lidocaine shifts the methoxamine dose-response curve to the right. With higher doses, the maximal response is also reduced. The shift of the dose-response curve showed that procaine or lidocaine can change the alpha-adrenergic receptor affinity. Commercial 1% lidocaine with 1:100,000 epinephrine also inhibits field stimulation and antagonizes methoxamine contractions. Lidocaine can increase the basal tone of nasal mucosa, while procaine cannot. From these results, we conclude that procaine and lidocaine have common mechanisms in blocking Na+ channels but differ in their ability to modify Ca++ stores or channels.

Do cholinergic neurons directly innervate nasal blood vessels?

The main aim of this work was to provide additional evidence that cholinergic neurons can induce nasal vasodilation by inhibiting norepinephrine release, not by a direct action on nasal blood vessels. We induced a degeneration of the nasal sympathetic neurons in order to observe the effects of electrical stimulation of the cholinergic neurons on nasal blood vessels. Electrical stimulation had no measurable effect. One interpretation of this result is that cholinergic fibers control vasomotor tone by inhibiting the output of the sympathetic neurons, i.e., they have a presynaptic influence. However, it should be stressed that the data were obtained from in vitro experiments, which may not reflect the true in vivo processes. Additional evidence was obtained to demonstrate that electrical stimulation of the in vitro nasal tissue causes contraction by the release of norepinephrine from remnants of sympathetic nerve fibers remaining in the tissue. Also, there is no evidence of transganglionic degeneration in the cervical sympathetic nerve.

Distribution of noradrenergic nerve fibers in canine nasal mucosa following selective neurectomies

In this study, we have used noradrenergic histofluorescence and selective neurectomies of the vidian, ethmoid and caudal nasal nerves to evaluate the distribution of postganglionic sympathetic fibers in the canine nasal mucosa. In conjunction with the histochemical localization of the noradrenergic fibers in the nasal mucosa after vidian neurectomy, the norepinephrine content of the mucosa was also evaluated using high-performance liquid chromatography. Unilateral neurectomy of the superior cervical ganglion (SCG) resulted in the unilateral disappearance of all noradrenergic histofluorescence in the nasal mucosa, while no morphological changes in noradrenergic fibers could be identified after neurectomy of the cervical sympathetic trunk 1 cm below the SCG. Ethmoid neurectomy caused the disappearance of noradrenergic fibers of the upper third of the nasal mucosa, while vidian neurectomy resulted in a partial loss of noradrenergic fibers in the lower two-thirds of the nasal mucosa. The loss was chiefly in the area adjacent to venous sinusoids and was responsible for 50% of the norepinephrine content of this tissue. We concluded that all the postganglionic sympathetic fibers are from the ipsilateral SCG. Some of them travel via the ethmoid nerve and innervate the upper third of the nasal mucosa. The remaining fibers travel via the vidian nerve and perhaps the vessel walls of the supplying arteries and innervate the lower two-thirds of the nasal mucosa. The vidian nerve chiefly innervates the venous sinusoids of the lower two-thirds of the nasal mucosa.

Mutagenicity and carcinogenicity studies of homemade "rust-proof cutting fluid"

A homemade rust-proof cutting fluid (RPCF) used in China was tested for carcinogenicity by an in vivo chronic experiment and for mutagenicity by the Ames Salmonella microsomal assay. Undiluted and threefold water-diluted fluid were given as drinking water to groups of young adult Wistar rats for 2 years. The treatment induced 11/40 malignant tumors with 9/40 acinar adenocarcinomas of the pancreas in the high-dose group. Simultaneous administration of ascorbic acid dissolved in the undiluted fluid at 2 g acid per 1 g sodium nitrite resulted in 1/40 pancreatic carcinoma. The results of the Ames test showed that the technical RPCF was mutagenic to TA100 with or without metabolic activation. It was concluded that the homemade RPCF, which is comprised of sodium nitrite, triethanolamine, and polyethylene glycol, may form direct-acting mutagen(s) upon storage and form, in vivo, e.g., nitrosamines that caused acinar pancreatic carcinoma in Wistar rats. Simultaneous administration of ascorbic acid is suggested for the protection of workers exposed to the rust-proof cutting fluid.

Retrograde axonal transport of true blue dye by the peripheral autonomic nerves in canine nasal mucosa

In this study we employed retrograde axonal transport of (E)-2,2'-vinylendi-benzofuran-5-carboxamidin-diaceturate+ ++ or true blue (TB) to study the peripheral autonomic innervation of the canine nasal mucosa. After injection of TB into the nasal mucosa, labeled neurons were found in the ipsilateral sphenopalatine ganglion (SPG) and the superior cervical ganglion (SCG). There were no labeled neurons in the middle cervical or stellate ganglia. This indicated that the origin of the postganglionic sympathetic fibers of the nasal mucosa was only from the ipsilateral SCG. When TB was injected into the nasal mucosa of dogs following a caudal or ethmoidal neurectomy, labeled neurons could still be found in the SPG and SCG. When TB was injected into the nasal mucosa of dogs following ethmoidal and vidian neurectomies or with maxillary neurectomy added, some labeled neurons could still be found in both the ipsilateral SPG and SCG. These results support the concept that another pathway--perhaps perivascular--exists for postganglionic sympathetic fibers other than the vidian and ethmoidal nerves. Labeled neurons were still observed in SPG when TB was applied to the canine nasal mucosa following neurectomy of either the ethmoidal or the caudal nasal nerve. However, retrograde labeled neurons could not be found in SPG following simultaneous neurectomies of the ethmoidal and caudal nasal nerves. These results show that the postganglionic parasympathetic fibers originating in the SPG travel along the ethmoidal and caudal nasal nerves.

Investigation of cancer epidemiology and study of carcinogenic agents in the Shanghai Rubber Industry

Preliminary studies on crude cancer incidences among workers from 89 factories in Shanghai revealed excessive risk of cancer for workers in certain workshops of rubber tire factories. Chronic in situ animal exposures showed that compounding and Banbury mills for mastication and mixing were origins of carcinogenic contaminants. Various chronic experiments indicated the carcinogenicity of PBNA in rats and mice, especially with regard to the lungs. The high concentration of PBNA in the atmosphere of the work area seemed to be related to the excessive incidence of lung cancer among the workers. Epidemiological investigation showed that there was an excessive number of cases of lung cancer in the workshop of rubber tire factories where compounding, mixing, and milling took place.