Changes of serum copper and zinc levels in patients with nasopharyngeal carcinoma by radiotherapy

Serum copper levels (SCL) and serum zinc levels (SZL) were evaluated in 128 patients with nasopharyngeal carcinoma (NPC) of varying stages before, during, and after radiotherapy, and then compared with normal age-matched subjects. Among these patients, there were 119 undifferentiated squamous cell carcinoma, 5 differentiated squamous cell carcinoma, and 4 moderately differentiated squamous cell carcinoma, respectively. Before radiotherapy, SCLs were significantly higher in NPC patients than in normal subjects, but the difference of SZLs was not significant. The ratio of Cu/Zn also showed a significant difference between normal subjects and NPC patients preradiotherapy. Moreover, except stage II, patients with more advanced stages of the disease had more elevated Cu/Zn ratios. During and after the period of radiotherapy, the SCL decreased as compared with the level of preradiotherapy. The Cu/Zn ratio also decreased after radiotherapy but not significant. However, Cu/Zn ratio of expired patients at least 2 yr after radiotherapy did not show the significant decrease in contrast to the alive ones.

Response to supplementary vaccination with recombinant or plasma hepatitis B vaccine in healthy non-responding children

Fifty-three children who failed to respond to four doses of plasma hepatitis B (HB) vaccine (anti-HBs titre < 10 IU l-1) were divided into two groups and received revaccination with either three doses of recombinant HB vaccine (10 micrograms/dose, by 0, 1, 6 month schedule; group A) or two additional doses of plasma HB vaccine (5 micrograms/dose, by 0, 1 month schedule; group B) respectively. Thirty-two vaccinees in group A had a response rate (with anti-HBs > 10 IU l-1) of 53.1% (17/32), 87.5% (28/32), and 100% (32/32) after first, second and third doses of the vaccine respectively. Twenty-one vaccinees in group B had a response rate of 61.9% (13/21) after two additional doses of plasma vaccine. High anti-HBs titres (> 1000 IU l-1) were noted in 50% of the vaccinees in group A after three doses of vaccine. Comparing anti-HBs response between group A and group B after two additional doses of HB vaccine, group A had a higher anti-HBs titre (geometric mean titre 104.7 IU l-1 versus 75.9 IU l-1) along with a better seroconversion rate (87.5 versus 61.9%). However, the differences in vaccine dose between the two groups may also be a contributory factor. Our findings indicate that three doses of recombinant HB vaccine were invariably effective in eliciting a good immune response in previous non-responders to the four doses of plasma HB vaccine. Therefore, it is speculated that these young vaccinees who did not respond to four doses of plasma HB vaccine may not be real non-responders, but hyporesponders.

Age-specific prevalence of hepatitis B surface and e antigenemia in pregnant women in Taiwan

To investigate the age-specific prevalence of hepatitis B surface and e antigens (HBsAg and HBeAg) in pregnant women, we studied all the parturients encountered in National Taiwan University Hospital between 1985 and 1990. Serum HBsAg and HBeAg were checked by radioimmunoassay. The prevalence rate of HBsAg in pregnant women was 13.2%, 12.7%, 11.4%, 11.7%, 12.9% and 14.2%, respectively for each year. The figures seemed stable. The positive rate of HBeAg in HBsAg-positive pregnant women was 32.8%, 39.9%, 42.6%, 30.8%, 32.0% and 31.7%, respectively during the past 6 years. We also analyzed the results in different age-grouped pregnant women. The positive rate of HBsAg was 12.8%, 13.1%, 11.6% and 11.5% respectively in 21-25 year-old, 26-30 year-old, 31-35 year-old and 36-40 year-old groups. The positive rate of HBeAg in HBsAg-positive pregnant women was 49.4%, 36.5%, 31.5% and 20.0% respectively in these 4 age groups, with a prevalence declining with the advanced age. We conclude that HBsAg-positive rate was 11-14% in the pregnant women who visited our hospital, and their HBeAg-positive rate was 31-43%. No decrease of HBsAg carriage or HBeAg prevalence was seen in the past 6 years.

Posttransfusion hepatitis C virus infection in children

Hepatitis C virus (HCV) infection was investigated retrospectively and prospectively in children who had open heart surgery. The retrospective study included 196 patients who had open heart surgery 2 to 6 years before enrollment and were regularly followed. Antibody to HCV was detected in eight cases, and seven of these eight patients had viremia caused by HCV infection. The other patient's anti-HCV titer gradually decreased and HCV ribonucleic acid was absent throughout the course. Four of these eight had persistent viral replication without clinical evidence of hepatitis; the other three had viremia and chronic hepatitis. The HCV infection rate in the retrospective study group was about 4%. The HCV was of genotype 2 in five cases and of genotype 3 in two cases. The clinical outcome was not related to sex, age, amount of transfusion, or HCV genotype. For the prospective study, we enrolled 94 patients. Of the 56 enrolled after the initiation of anti-HCV screening in the blood bank, none was infected by HCV. Of the 94 patients, 38 were enrolled before screening; 4 had abnormal liver function 1 to 3 months after operation, and 2 were infected with HCV. One patient had an acute but resolving course; the other had persistent anti-HCV and HCV viremia, although the liver function test results returned to the normal range. The HCV in both cases belonged to genotype 2. We conclude that in Taiwan the seroconversion rate of HCV in children who underwent open heart surgery was 4% to 5%. Anti-HCV screening in donor blood significantly decreased the incidence of posttransfusion hepatitis C.

Temporal profile of hepatitis C virus antibody and genome in infants born to mothers infected with hepatitis C virus but without human immunodeficiency virus coinfection

To investigate mother-to-infant transmission of hepatitis C virus, serial follow-up of anti-HCV and hepatitis C virus RNA was undertaken in 11 infants born to hepatitis C virus-infected mothers who had been screened from 11,688 pregnant women. None of the hepatitis C virus-infected mothers was infected by human immunodeficiency virus. Anti-HCV was checked by the second-generation enzyme immunoassay kit, and hepatitis C virus RNA was examined by reverse transcriptase-nested polymerase chain reaction. Hepatitis C virus RNA was found in more than two serum samples in two of these 11 infants; those two infants were regarded as hepatitis C virus-infected. One of the two had hepatitis C virus RNA at the age of 1, 3, and 6 months, but not later. The course of hepatitis C virus RNA and anti-HCV in this baby may reflect fluctuating viral replication in chronic infectious disease or viral clearance in acute infection. The other infant had hepatitis C virus RNA detectable at the age of 3 months and at 15, 18 and 24 months. In the other nine non-hepatitis C virus-infected infants, maternally acquired anti-HCV gradually disappeared by the age of 6 months. The liver function profile fell to the normal range in all the infants, including the two hepatitis C virus-infected infants. This may indicate the subclinical nature of hepatitis C virus infection in infancy. Seven fathers and four siblings of these 11 infants were checked for anti-HCV and liver function tests; none had evidence of hepatitis C virus infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Basic fibroblast growth factor-induced low density lipoprotein receptor transcription and surface expression. Signal transduction pathways mediated by the bFGF receptor tyrosine kinase

Basic fibroblast growth factor (bFGF) has been implicated in the regulation of cell proliferation and cholesterol metabolism. In studies reported herein, we show bFGF increases low density lipoprotein (LDL) binding, uptake, and degradation in arterial smooth muscle cells in a dose-dependent manner. This increase was paralleled by an increase in LDL receptor mRNA steady state levels. To determine if bFGF activated transcription of the LDL receptor gene, we transiently transfected smooth muscle cells with a gene construct consisting of the 5'-upstream promoter region of the DNA from the human LDL receptor gene ligated to a plasmid containing the luciferase gene. We found that bFGF and a protein kinase C (PKC) activator, phorbol 12-myristate 13-acetate, significantly induced luciferase activity driven by the LDL receptor promoter, whereas 25-hydroxycholesterol reduced the luciferase activity in bFGF-stimulated cells. These findings show that bFGF and PKC are inducing LDL receptor gene transcription. We also evaluated potential signal transduction pathways induced by bFGF to establish the mechanism(s) leading to the activation of the LDL receptor gene. Activation of the activity of FGF receptor tyrosine kinase in smooth muscle cells by ligand binding resulted in tyrosine phosphorylation of one of the FGF receptors and a 90-kDa-protein as well as increased tyrosine phosphorylation of phospholipase C-gamma. Parallel observations were made in that increased PKC and protein kinase A activities occurred with bFGF as compared with control cells. Inhibitors of receptor tyrosine kinase and other protein kinases significantly reduced transcription and surface expression of LDL receptor. Finally, several key enzymes that are central to the regulation of LDL-cholesteryl ester metabolism were also studied in bFGF-stimulated cells. An increase in acyl-CoA:cholesterol acyltransferase activity and cholesterol esterification was observed with bFGF stimulation, but there was no effect on the lysosomal or cytoplasmic cholesteryl ester hydrolase activities. Our findings suggest potential signal transduction pathways activated by bFGF which play a role in regulating transcription and surface expression of the LDL receptor.

Possible role of high-titer maternal viremia in perinatal transmission of hepatitis C virus

To study perinatal transmission of hepatitis C virus (HCV), 15 anti-HCV-positive carrier mothers without human immunodeficiency virus coinfection were recruited. At delivery, maternal blood was taken and anti-HCV titer was determined and HCV RNA measured in each serum sample by reverse transcription polymerase chain reaction (PCR). A competitive PCR was used in selected samples to quantitate HCV concentration. The 15 neonates were followed regularly for 1 year and their sera were also assayed for anti-HCV and for HCV RNA by reverse transcription PCR. All the mothers were positive for HCV RNA. Only one normal spontaneously delivered neonate of a mother with extremely high titer of anti-HCV (1:20,000) and HCV concentration (10(10) copies/mL) had both anti-HCV and HCV RNA in serum for up to 6 months of age. In contrast, none of the remaining 14 neonates born to mothers with low- to high-titer anti-HCV (1:4-1:1000) and moderate amounts of HCV RNA (10(5)-10(6) copies/mL) contracted HCV infection. The results imply that high-titer maternal viremia and normal spontaneous delivery may allow more HCV to infect the neonate intrapartum, therefore establishing perinatal transmission.

Hepatitis C virus infection in pregnant women: detection by different anti-HCV immunoassays and serum HCV-RNA

To assess the seroepidemiology of hepatitis C virus (HCV) infection in pregnant women and explore the correlation between different anti-HCV immunoassays, we investigated 2 independent groups in Taipei: 1,687 pregnant women without screening for serum alanine aminotransferase (ALT) (group A) and 260 pregnant women with elevated ALT activity (> 45 IU/l) screened from 15,978 cases (group B). In group A, 11 women (0.65%) were found to be anti-HCV-positive by first-generation tests and 21 (1.24%) by second-generation tests, while 7 (2.69%) and 15 (5.77%) of the group B subjects were positive, respectively. The results of the second-generation assays, based either on recombinant proteins or synthetic peptides, were identical. Among the 36 second-generation anti-HCV-positive cases, 18 (86%) of the 21 cases in group A and 13 (87%) of the 15 cases in group B contained serum HCV-RNA by RT-PCR. We conclude that the prevalence of anti-HCV in pregnant Taiwanese women is 1.24%, and the prevalence is 5.77% among those with an elevated ALT level. HCV-RNA is present in 86% of the cases positive for anti-HCV. The discrepancy between positive anti-HCV and negative HCV-RNA in some pregnant women suggests that anti-HCV positivity in such cases may merely represent a past HCV infection or a fluctuating viremia.

Association of HLA-DR14-DR52 with low responsiveness to hepatitis B vaccine in Chinese residents in Taiwan

To determine the HLA-linked immune response gene that controls low responsiveness to hepatitis B surface antigen (HBsAg), HLA typing was performed in 33 initial non-responders (male:female = 23:10, age 1.5-46 years) who had poor antibody response (anti-HBs < 10 mIU ml-1) after four doses of plasma-derived hepatitis B vaccine. Of 33 initial non-responders, 26 received two additional doses of either the same vaccine (n = 18) or recombinant hepatitis B vaccine (n = 8) and returned for anti-HBs measurement. At 1 month after the sixth dose, anti-HBs was still < 10 mIU ml-1 in 20 cases and 10-20 mIU ml-1 in three cases. Analysis of HLA antigen frequencies in these 23 ultimate low responders revealed that nine (39%) were positive for DR14, a statistically significant association of low responsiveness to hepatitis B vaccine with HLA-DR14. In addition, 26% of the ultimate low-responders were positive for DQ3, a frequency significantly lower than the expected rate in the general population. Among the nine ultimate low-responders with DR14, seven were heterozygous for this allele, while the other two cases had a single isolated DR14; and all nine were in association with DR52. These results suggest that a DR14-DR52 association, probably dominantly expressed, may be involved in the low immune responsiveness to hepatitis B vaccine of the Chinese population in Taiwan.

Hepatitis B virus in the colostra of HBeAg-positive carrier mothers

To investigate the amount of hepatitis B virus (HBV) in colostra of hepatitis B e antigen (HBeAg)-positive carrier mothers and the relationship of HBV amount between colostrum and maternal blood, 50 HBeAg-positive carrier mothers were recruited and studied for hepatitis B surface antigen (HBsAg) titer, HBeAg titer, and HBV-DNA concentration in their sera and colostra. According to the presence or absence of seral HBV-DNA determined by dot hybridization, these 50 HBeAg-positive carrier mothers could be divided into two groups: group 1 (n = 28, HBV-DNA < 0.04 ng/ml), and group 2 (n = 22, HBV-DNA > or = 0.04 ng/ml). The colostral HBsAg and HBeAg titers were both significantly higher in group 2 than in group 1. In addition, both colostral HBsAg and HBeAg titers had positive correlation with each corresponding maternal blood. Although the colostral HBV-DNA was undetectable by dot hybridization, all were positive by polymerase chain reaction with Southern blot hybridization. Because HBV-DNA can be detected in all HBeAg-positive carrier mother's milk, it reinforces the necessity of hepatitis B vaccination for the neonates born to these carrier mothers, particularly in countries with a high carrier rate.

Absence or delayed appearance of hepatitis B core antibody in chronic hepatitis B surface antigen carrier children

An absence of the hepatitis B core antibody (anti-HBc) in hepatitis B surface antigen (HBsAg) carrier children has been reported before, but whether anti-HBc will ultimately appear is unknown. In a group of 420 HBsAg carrier children who were followed longitudinally, 10 (2.4%) had an absence or delayed appearance of serum anti-HBc. These 10 children were persistently seropositive for HBsAg, hepatitis B e-antigen, and hepatitis B virus DNA (HBV-DNA). Anti-HBc never appeared in 4, one of whom was a case of hepatitis B vaccine failure and became an HBsAg carrier. Three of the 4 were born to HBsAg carrier mothers. Liver biopsy in one revealed non-specific reactive hepatitis (NSRH). All 4 were asymptomatic during follow-up. Mothers of the other 6 children who had delayed appearance of anti-HBc were also HBsAg carriers. The children seroconverted to anti-HBc positivity between 2 and 8 years of age, and the titer of serum anti-HBc at the first appearance varied. There were no significant changes in liver function tests, HBV-DNA levels, or associated symptoms and signs before and after seroconversion. Liver biopsies were performed before anti-HBc seroconversion in 2 children and showed NSRH. All 10 children had a moderate to high replication of HBV as shown by the high titer of HBsAg and HBV-DNA. The absence of anti-HBc occurred almost exclusively in children who were infected perinatally.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary study on the anti-radiation effect of jen-sheng-yang-yung-tang

Six to seven week old male mice of ICR strain were exposed to different doses of x-rays to determine if jen-sheng-yang-yung-tang could be a modifier in the elimination of radiation damage. Colony forming units of bone marrow cells in the spleen (CFUs) were measured before and after x-ray irradiation with intraperitoneal injection of 10 mg/20 g or 20 mg/20 g body weight of jen-sheng-yang-yung-tang, once a day for seven consecutive days. The recovery of CFUs and hemocytes counts by 4 Gy irradiation with jen-sheng-yang-yung-tang administration was faster for a concentration of 20 mg/20 g than 10 mg/20 g. The measurement of 10-day CFUs showed an increase of radiotolerance in the treatment of 20 mg/20 g administration before x-ray irradiation. The injection of jen-sheng-yang-yung-tang accelerated the recovery of hemocyte counts in mice irradiated with 4 Gy x-ray; the effect was especially profound for leukocytes with 20 mg/20 g jen-sheng-yang-yung-tang administration after irradiation.

Effects of jen-sheng-yang-yung-tang on cellular immunocompetence of gamma-irradiated mice

This study was conducted to determine the therapeutic effects of Jen-Sheng-Yang-Yung-Tang on mice irradiated by gamma-ray. A total of 160 male ICR strain mice, 6-7 weeks of age, were chosen to receive different treatment of radiation and Jen-Sheng-Yang-Yung-Tang. After the treatments, six to eight mice from each group were sacrificed on days 1, 5, 12, 19, 26 and 33. The body and splenic weights of mice by different treatments were measured and the splenic cells were separated under aseptic conditions, thereafter. The changes of cellular immunocompetence in mice following treatments were measured by 3H-thymidine incorporation in each experimental mouse. The results revealed that 4 Gy of gamma-ray irradiation inhibited the increases of body and splenic weights and exerted an obvious inhibitory effect on the blastogenic responses of the splenic lymphoid cells after being stimulated by mitogens such as PHA, Con A, PWM and LPS. Jen-Sheng-Yang-Yung-Tang administration seemed to help the recovery of cellular immunocompetence in the gamma-ray irradiated mice. Among these treatments, Jen-Sheng-Yang-Yung-Tang administered with the concentration of 20 mg/20 g body weight after irradiation enhanced the recovery of radiation damages and had the highest efficacy of any other kinds of treatments.

Patterns of hepatitis B virus DNA integration in liver tissue of children with chronic infections

Although an integration of hepatitis B virus (HBV) DNA in children with chronic HBV infection has been documented at early phases of the disease, the incidence of this process is not known. Therefore we examined nine liver DNA specimens from chronic HBV carriers ages 5-14 years and one sample from a neonate delivered of a carrier mother, in order to determine the HBV DNA patterns of these patients at different ages and phases of chronic infection. The integrated HBV DNA was detected by Southern blot hybridization and analyzed by molecular cloning. Southern blot showed a smear pattern of HBV DNA integration in four of six chronic hepatitis patients (ages 5-14), as well as in one asymptomatic carrier (age 12). Multiple and random integrations occurred during chronic infections in childhood. The neonate did not, however, show signs of any integrations, suggesting that integration starts after HBV multiplication. A band pattern that suggested clonal growth of integrated liver cells was found in a chronic active hepatitis patient (age 9) and in one of two hepatocellular carcinoma patients (age 11). Molecular cloning in two cases with chronic active hepatitis showed that the HBV genome structure was preserved in five of six HBV DNA inserts. Our findings confirm that HBV DNA integration can occur at early stages of chronic HBV infection. In Japanese children, the process of integration seems to be common regardless of HBeAg/anti-HBe status.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of kuei-pi-tang on cellular immunocompetence of gamma-irradiated mice

Kuei-Pi-Tang is a kind of traditional Chinese medicine which has been suggested to have therapeutic effects on hemato-deficient disease and radiation injuries. In order to further investigate its protection function, this study is focused on the efficacy of kuei-pi-tang on cellular immunocompetence of gamma-ray irradiated mice. ICR strain male mice were chosen and divided into several groups for their different treatments of 4 Gy gamma-ray whole body irradiation and kuei-pi-tang administration. After the treatments, six to eight mice from each group were sacrificed on days 1, 5, 12, 19, 26 and 33. The body and splenic weights of mice by different treatments were measured and the splenic cells separated thereafter. The changes of cellular immunocompetence in mice following treatments were measured by 3H-thymidine incorporation. The results revealed that 4 Gy of gamma-ray irradiation inhibits the increases of body and splenic weights and exerts a pronounced inhibitory effect on the incorporative rates of 3H-thymidine in the splenic lymphoid cells which have been stimulated by mitogens. kuei-pi-tang administration seems to increase the recovery of the cellular immunocompetence, especially for the treatment of kuei-pi-tang administered with the concentration of 20 mg/20 g body weight after gamma-ray irradiation.

Polymerase chain reaction to detect human cytomegalovirus in livers of infants with neonatal hepatitis

Neonatal hepatitis is closely related to human cytomegalovirus infection in Taiwan, a conclusion based on serological and urine culture studies. To obtain more direct evidence further relating cytomegalovirus to the pathogenesis of neonatal hepatitis, the cytomegalovirus genome was studied in the liver tissues of 50 infants with neonatal hepatitis using the polymerase chain reaction (PCR). Liver tissues from 26 infants with biliary atresia and another 30 infants and children with diagnoses other than neonatal hepatitis, cholestasis, or hepatitis were also studied for comparison. Sequences from the immediate early gene 1 and 2 regions were used as primers. The liver tissues from 23 (46%) of the 50 infants with neonatal hepatitis were positive for cytomegalovirus genome, whereas those of 2 of the 26 infants with biliary atresia and none of the liver tissues from 30 infants and children without neonatal hepatitis were positive for cytomegalovirus genome, by PCR. The results of PCR correlated well with that of serology and urine culture. This study provides further evidence of cytomegalovirus in the pathogenesis of neonatal hepatitis.

Correlation between ELISA and recombinant immunoblot assay in serum samples positive for anti-HCV

To determine the false-positivity of antibody to hepatitis C virus (HCV) (anti-C100-3), the correlation between ELISA optical density (OD), anti-HCV titer and recombinant immunoblot assay (RIBA) in 87 anti-HCV-positive sera was analyzed. The results showed that > 90% of the serum samples with an anti-HCV OD > 2.0 or with titers > 10 x were RIBA reactive. These findings are applicable in daily clinical practice.

Cellular immune response to HBcAg in mother-to-infant transmission of hepatitis B virus

Cellular immunity to HBcAg was studied in hepatitis B virus carrier children and neonates born to hepatitis B virus carrier mothers. A significant proliferative response of peripheral blood mononuclear cells to HBcAg was found in 5 of 10 children with elevated ALT levels but in none of the nine HBeAg-positive children with normal ALT levels. HBeAg but not HBsAg was detected in cord blood of 9 of 10 neonates born to HBeAg-positive carrier mothers, suggesting exposure of these neonates to HBeAg in utero. However, cord mononuclear cells from neonates born to HBeAg-positive carrier mothers did not show a significant change in the proportion of suppressor and helper T-cell subsets or proliferative response to HBcAg. Nor did they produce interleukin-2 receptor after being cocultured with HBcAg. The unresponsiveness of peripheral-blood mononuclear cells or cord mononuclear cells to HBcAg was not reversed by CD8+ cell depletion. Although cord blood mononuclear cells from neonates born to carrier mothers positive for antibody to HBeAg also did not respond to HBcAg, we encountered an infant, born to a carrier mother positive for antibody to HBeAg, who contracted acute hepatitis B at 2.5 mo of age. The baby's peripheral-blood mononuclear cells showed a significant proliferative response to HBcAg. These results support the view that transplacental maternal HBeAg probably induces a specific unresponsiveness of helper T cells to HBcAg and HBeAg in the neonates born to HBeAg-positive carrier mothers. This specific helper T cell tolerance could be maintained throughout the early replicative phase of carrier state but might break someday with the appearance of raised ALT level.

Spontaneous loss of HBsAg in children with chronic hepatitis B virus infection

Spontaneous loss of HBsAg is infrequent in adult HBV carriers. Little is known about this serological change in children. In a prospective study of 420 hepatitis B virus-carrier children who were observed for 1 to 12 yr (mean = 4.3 yr), spontaneous loss of HBsAg occurred in 10 patients, with an average incidence of 0.6%/yr. The HBsAg clearance rate was significantly higher in children who had anti-HBe; children who were at an older age on entry; children whose mothers were HBsAg-; or children with severe liver histological changes detected while they were HBeAg+. Children who seroconverted from HBeAg to anti-HBe before the age of 6 or who had a peak serum ALT level above 100 IU/L were more likely to clear HBsAg. In all 10 patients who became HBsAg-, serum hepatitis B virus DNA became undetectable by both spot hybridization and the polymerase chain reaction, suggesting a complete clearance of the virus from serum. After the loss of HBsAg, the anti-HBs levels were higher in the children born to carrier mothers than in those born to noncarrier mothers. These findings suggest that chronic hepatitis B virus-carrier children rarely lose HBsAg, especially if they have been infected during the perinatal period and have mild histological changes. The poor humoral immune response to HBsAg may be a contributing factor in the establishment of carrier status during horizontal infection but may not be primarily involved in the establishment of carrier status during perinatal infection.

Low prevalence of hepatitis C virus and infrequent perinatal or spouse infections in pregnant women in Taiwan

To assess the prevalence of hepatitis C virus (HCV) infection in the pregnant women in Taiwan, we investigated two groups of pregnant women, 944 women without serum alanine aminotransferase (ALT) screening (group A) and 197 women with abnormal ALT (greater than 45 IU/L) (group B). They were checked for anti-HCV (anti-C100-3) with HCV EIA kit (Abbott Lab., North Chicago, IL). The results showed that 21 (2.2%) in group A and 5 (2.5%) in group B were anti-HCV-positive. However, 15 out of 21 in group A had an optical density (O.D.) of anti-HCV less than 1.0, were negative by recombinant immunoblot assay (RIBA), and were regarded as false-positive. Nine infants delivered by those 11 cases were negative for anti-HCV at 6 months of age, while none of the 8 husbands were anti-HCV-positive. It is concluded that the prevalence of anti-HCV in pregnant women in Taiwan is low (6/944, 0.63%), even in the cases with abnormal ALT (5/197, 2.5%). There was no serologic evidence for perinatal transmission or spouse infection.

Hepatocellular carcinoma in childhood. Clinical manifestations and prognosis

From December 1964 to November 1989, 71 children from 3 to 17 years of age with the eventual diagnosis of hepatocellular carcinoma (HCC) presented at the National Taiwan University Hospital (Taipei, Taiwan, Republic of China). Forty-three of them had pathologic proof, whereas 28 were diagnosed on a clinical and laboratory basis. A male predominance (M:F = 3.2:1) was noticed. Most patients presented in a late, advanced stage. Abdominal pain and abdominal mass were the major symptoms and signs, followed by anorexia, fever, and internal bleeding. Hydrocele, purpura, and obstructive jaundice were rare presenting symptoms. Hepatosplenomegaly, superficial venous engorgement, and ascites were the main physical signs. The prognosis for such children with HCC was very poor. Only 10% of the patients survived longer than 1 year after the onset of the initial symptom. Among 49 patients who could be followed, only two had long-term survival of over 5 years. One patient had a small HCC with internal bleeding, whereas the other had a large HCC with abdominal distention. Both received surgical resection, and a resection was repeated for tumor recurrence in the patient with the large mass. The resectability of these 71 patients was low (9.8%). Resectability and nonicterus seemed to be the factors indicating favourable prognosis. Observation indicated that the prognosis for children with symptomatic HCC is grave but surgical resection, whenever possible, should be carried out.

Hepatocellular carcinoma in childhood. Clinical manifestations and prognosis

From December 1964 to November 1989, 71 children from 3 to 17 years of age with the eventual diagnosis of hepatocellular carcinoma (HCC) presented at the National Taiwan University Hospital (Taipei, Taiwan, Republic of China). Forty-three of them had pathologic proof, whereas 28 were diagnosed on a clinical and laboratory basis. A male predominance (M:F = 3.2:1) was noticed. Most patients presented in a late, advanced stage. Abdominal pain and abdominal mass were the major symptoms and signs, followed by anorexia, fever, and internal bleeding. Hydrocele, purpura, and obstructive jaundice were rare presenting symptoms. Hepatosplenomegaly, superficial venous engorgement, and ascites were the main physical signs. The prognosis for such children with HCC was very poor. Only 10% of the patients survived longer than 1 year after the onset of the initial symptom. Among 49 patients who could be followed, only two had long-term survival of over 5 years. One patient had a small HCC with internal bleeding, whereas the other had a large HCC with abdominal distention. Both received surgical resection, and a resection was repeated for tumor recurrence in the patient with the large mass. The resectability of these 71 patients was low (9.8%). Resectability and nonicterus seemed to be the factors indicating favourable prognosis. Observation indicated that the prognosis for children with symptomatic HCC is grave but surgical resection, whenever possible, should be carried out.

Seroprevalence of hepatitis B virus infection in children in Taipei, 1989: five years after a mass hepatitis B vaccination program

A nationwide hepatitis B vaccination program was launched in Taiwan in 1984. To study the impact of this ongoing program on hepatitis B virus (HBV) infection, a follow-up seroepidemiologic study was carried out in 1989 in a Taipei district where pre-vaccination seroepidemiology had been studied. HBV markers were studied in 1134 apparently healthy children (619 boys and 515 girls) under 13 years of age between March and July 1989. The prevalence of hepatitis B surface antigen (HBsAg) in children under 5 years of age decreased from 9.3% in 1984 to approximately 2% in 1989. A significant decrease in HBsAg prevalence and hepatitis B core antibody in 5- to 8-year-old children who were not immunized against HBV showed that horizontal infection among the older children had also decreased. Thus, this program not only protected vaccinated subjects; the reduction in numbers of highly infectious young HBV carriers also contributed to a lower prevalence of hepatitis B infection and carrier rates in some older children. This study demonstrates that hepatitis B vaccination is effective in protecting the majority of children in hyperendemic areas from HBV infection and from becoming chronic carriers.

Analysis of duodenal bile acids by high performance liquid chromatography in infants with cholestasis

Non-sulfated bile acid levels including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), lithocholic acid (LCA), ursodeoxycholic acid (UDCA), five taurine conjugates, and five glycine conjugates in duodenal juice were measured in 50 Chinese infants with cholestasis to test their diagnostic value. All 17 with biliary atresia (BA) cases, 11 out of 26 neonatal hepatitis (NH) cases and one case with paucity of the interlobular bile duct were without detectable bile acids. In those NH patients with detectable bile acids, the major components were conjugated forms of CA and CDCA, which was similar to all 6 cases of the comparison group with other diseases. The minor bile acid components identified in them were glycine conjugated UDCA, free CDCA, free CA, and free and conjugated DCA. Only one patient with NH had taurine conjugated LCA. The mean total duodenal bile acid level in 15 patients with NH was significantly lower than that in the 6 patients of the comparison group. Most patients with NH had a CDCA/CA ratio of less than one, indicating that cholic acid is the predominant form in their bile. Glycine conjugated bile acids were the predominant bile acids present in 11 out of 15 patients with NH and 4 out of 6 of the comparison group patients. The results suggest that the detection of duodenal bile acids by a sensitive HPLC method is of limited value in making a differential diagnosis between BA and NH.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies on the preparation and evaluation of Kijitsu, the immature citrus fruits. IV. Biological activities of immature fruits of different citrus species]

Biological activities of the 50% ethanolic extract of Kijitsu, dried immature Citrus fruits prepared from C. hassaku Hort. ex Tanaka (H), C. natsudaidai Hayata (N) or allied plants (T, A) were observed. Weak toxicities, weak intestine or uterine relaxant activities, beta-adrenergic activities were shown by in vitro experiments and antiasthmatic activity by intraperitoneal administration. These activities among each extract did not differ. The content of flavonoids (narirutin, naringin hesperidin, neohesperidin) or synephrine did not show much difference among the four dried immature Citrus fruits. These results suggest that H can be used for medicine as the substitute for N, T or A which has been commonly used as Kijitsu. This method is generally applicable to the proof of the biological equivalency of the crude drug and its substitutes.