Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia with or without the hybrid technique

AIM

The main aim of this study was to compare the long-term outcome of a conventional colorectal endoscopic submucosal dissection (ESD) in which submucosal dissection was continued throughout until the completion of resection (ESD-T) to hybrid endoscopic submucosal dissection (ESD-H) in the colorectum.

METHOD

Medical records of 836 colorectal neoplasia patients treated by ESD-T or ESD-H were reviewed. ESD-H was defined as colorectal ESD with additional snaring in the final stage of the procedure. Primary outcomes were the overall and metastatic recurrence rates. Secondary outcomes were short-term outcomes such as the en bloc resection rate, procedure time and adverse events.

RESULTS

The overall recurrence rate was higher in the ESD-H than in the ESD-T group (5.7% vs 0.7%, P = 0.001). The metastatic recurrence rate showed no significant difference between these groups (1.4% vs 1.4%, P = 1.000). Multivariate analysis revealed that a failed en bloc resection (hazard ratio 24.097; 95% CI 5.446-106.237; P < 0.001) and larger tumour size (hazard ratio 1.042; 95% CI 1.014-1.070; P = 0.003) were independently associated with overall recurrence. The ESD-H group showed a lower en bloc resection rate (56.8% vs 96.5%, P < 0.001), shorter procedure time (45.6 vs 54.3 min, P < 0.001) and higher perforation rate (10.3% vs 6.0%, P = 0.029).

CONCLUSION

Although long-term outcomes in terms of overall recurrence are inferior following ESD-H, a failed en bloc resection and large tumour size are the only independent risk factors for recurrence. Further investigations are warranted to improve the long-term outcomes of ESD-H.

[Study of the genes correlated with cyst calcification in patients with cystic echinococcosis]

OBJECTIVE

To explore the genes (biomarkers) correlated with cyst calcification in patients with cystic echinococcosis (CE), and to provide the evidence for the judgment on the patients' prognosis at molecular level.

METHODS

The liver tissues from 32 patients with liver CE (10 cases for mRNA microarray and 22 cases for real-time PCR analysis) and 11 patients with hepatic cystadenoma were collected from three hospitals in Ningxia from June, 2013 to December, 2014. A comparison of the different gene-expressions between five patients with calcified lesions and five cases with no calcification was carried out using Significant Analysis of Microarrays (SAM) to select a subset of differentially expressed genes (DEGs) . Fold-change analysis was used to assess the changes of the expression quantity in the same genes between two groups. The verification was conducted among the liver tissues from 22 patients with liver CE (11 in the group of calcified or 11 in that of non-calcified) by real-time quantitative PCR (RT-qPCR). With GAPDH as a reference-gene and the liver tissues from 11 cases with hepatic cystadenoma as standardized control groups, the relative expressions of galecitin-4 (LGALS4) and acid ceramidase (ASAH1) in patients with calcified and non-calcified were calculated, respectively. The differences between two groups were compared using t'-test.

RESULTS

Five screened genes presented siginificantly different expressions all had showed the low-regulated expressions in the calcified group, with the most distinct low-regulation of LGALS4 and ASAH1 whose fold changes were 0.008 8, and 0.020 3, respectively. The verification by RT-qPCR illustrated that the relative expression of LGALS4 was showed at level of 0.49±0.27 amongst patients with calcified, and at level of 2.70±2.61 amongst non-calcified individuals,,indicating significant differences between two groups (t=-2.59, P=0.026); while the ASAH1 was relatively expressed at levels of 1.36±0.33 and of 1.68±0.67 amongst patients with calcified and non-calcified, respectively, showing insignificant changes statistically (t=-1.44, P=0.167). In the non-calcified group, both LGALS4 and ASAH1 genes expression quantities had a small fluctuation range, but with positively correlated trend (r=0.91, P=0.001), which indicated that a patient with the low LGALS4 expression quantity also had a relative low level of ASAH1 expression quantity.

CONCLUSIONS

Low expression quantity of LGALS4 and ASAH1 genes in patients with CE in the calcification might be potential biomarker for an indication of the disease self-healing.

Thorium(IV) removal from aqueous medium by citric acid treated mangrove endophytic fungus Fusarium sp. #ZZF51

Thorium(IV) biosorption is investigated by citric acid treated mangrove endophytic fungus Fussarium sp. #ZZF51 (CA-ZZF51) from South China Sea. The biosorption process was optimized at pH 4.5, equilibrium time 90 min, initial thorium(IV) concentration 50 mg L(-1) and adsorbent dose 0.6 g L(-1) with 90.87% of removal efficiency and 75.47 mg g(-1) of adsorption capacity, which is obviously greater than that (11.35 mg g(-1)) of the untreated fungus Fussarium sp. #ZZF51 for thorium(IV) biosorption under the condition of optimization. The experimental data are analyzed by using isotherm and kinetic models. Kinetic data follow the pseudo-second-order model and equilibrium data agree very well with the Langmuir model. In addition, FTIR analysis indicates that hydroxyl, amino, and carbonyl groups act as the important roles in the adsorption process.

Long term follow-up of appendiceal and distal right-sided colonic inflammation

The aim of this study was to investigate the possibility of appendiceal orifice inflammation (AOI) as a preceding lesion in the development of ulcerative colitis. A total of 20 patients were identified (mean age 41.2 years; 11 males) who had ulcerative colitis-like inflammatory lesions at the appendiceal orifice without concomitant typical features of ulcerative colitis, such as rectal involvement. A total of 19 patients were followed up endoscopically for a mean duration of 18.4 months (range 2 - 84 months). Typical ulcerative colitis developed in five patients (25 %; four proctitis, one pancolitis) in a mean time of 18.4 months (range 2 - 36 months). Negative conversion of all inflammatory lesions occurred in seven patients (35 %) after a mean follow-up of 20 months (range 3 - 84 months). In the remaining seven patients (35 %), initial lesions did not progress to ulcerative colitis and did not go into remission during a mean follow-up of 16.9 months (range 2 - 42 months). These results suggest that, at least in some cases, AOI precedes development of ulcerative colitis.

Hospital and community surveys reveal the severe public health problem and socio-economic impact of human echinococcosis in Ningxia Hui Autonomous Region, China

A comprehensive study of human echinococcosis (caused by Echinococcus granulosus or E. multilocularis), including assessment of hospital records, community surveys and patient follow-up, was conducted in Ningxia Hui Autonomous Region (NHAR), China. In contrast to hospital records that showed 96% of echinococcosis cases were caused by cystic echinococcosis (CE), 56% of cases detected in active community surveys were caused by alveolar echinococcosis (AE). The AE and CE cases co-existed frequently in the same village, even occurring in the same patient. A serious public health problem caused by echinococcosis was evident in southern NHAR, typified by: a long diagnostic history for both AE and CE (7.5 years) compared with a shorter treatment history (4.7 years); a significant mortality rate (39%) caused by AE in one surveyed village, where patients had no previous access to treatment; family aggregation of CE and AE cases; a high proportion of both AE (62.5%) and CE (58%) in females; a high rate of recurrent surgery (30%) for CE demonstrated by surgical records; and frequent symptomatic recurrences (51%) because of discontinuous or sporadic access to chemotherapy for AE. The disease burden for both human AE and CE is thus very severe among these rural communities in NHAR, and this study provides the first attempt to determine the costs of morbidity and surgical intervention of human CE and AE cases both at the hospital and community level in this setting. This information may be useful for assessing the cost effectiveness of designing effective public health programs to control echinococcosis in this and other endemic areas in China and elsewhere.

Diagnostic yield of advanced colorectal neoplasia at colonoscopy, according to indications: an investigation from the Korean Association for the Study of Intestinal Diseases (KASID)

BACKGROUND AND STUDY AIMS

The factors that more accurately predict the detection of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm (CRN), including colorectal cancer, in a group of patients undergoing colonoscopy.

PATIENTS AND METHODS

The 17 468 patients were enrolled in this study between July 2003 and March 2004, from 11 tertiary medical centers in Korea. They were recruited according to 11 itemized colonoscopic indications. The term "advanced adenoma" refers here to tubular adenomas of diameter of 11 mm or more, or to tubulovillous, villous, or severely dysplastic adenomas, irrespective of their size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced CRN was defined as advanced adenoma or invasive cancer.

RESULTS

Advanced CRN was found in 1227/17 307 patients (1176 advanced adenomas plus 51 carcinomas, 7.1 %). According to univariate and multivariate analysis, the factors associated with advanced CRN included age >60 years (odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.8 - 2.4, P < 0.0001), male gender (OR 2.1, 95 %CI 1.7 - 2.7, P < 0.0001), referral for colonoscopy from primary care physician (OR 3.1, 95 %CI 2.5 - 3.7, P < 0.0001), and several other indications (OR 1.8, 95 %CI 1.5 - 2.3, P < 0.001). The yield of colonoscopy for advanced CRN was lower (2.2 %) than expected in patients with iron-deficiency anemia (OR 0.5, 95 %CI 0.2 - 0.9, P = 0.03).

CONCLUSIONS

Age, gender, and referral for colonoscopy from primary care physician constituted important independent predictors of advanced CRN in patients undergoing colonoscopy.

Primary colon lymphoma in Korea: a KASID (Korean Association for the Study of Intestinal Diseases) Study

Although almost all primary colorectal lymphomas are of B-cell lineage in Western countries, primary colorectal T-cell lymphomas are not uncommon in the East. The aim of this study was to review the clinical characteristics and treatment outcomes of primary colorectal lymphomas, with special emphasis on the differences between T-cell and B-cell lymphomas. Ninety-five cases of primary colorectal lymphomas that satisfied Dawson's criteria were identified from the clinical databases of 13 university hospitals in Korea. The mean age at the time of presentation was 51.1 years and the male:female ratio was 64:31. The clinical information, including endoscopic and histological characteristics, was retrospectively analyzed. Of the primary colorectal lymphomas, 78 cases (82.1%) were of B-lineage and 17 cases (17.9%) were of T-cell lineage. Patients with T-cell lymphomas presented at a younger age than patients with B-cell lymphomas (42.8 vs 52.9 years, respectively; P = 0.016). The most common presenting symptom was abdominal pain (87.1%) for B-cell lymphomas, whereas hematochezia or night fever was more common for T-cell lymphomas (52.9% and 35.3%, respectively). The most common endoscopic type was fungating mass (54.0%) for B-cell lymphomas and ulcerative/ulcero-infiltrative lesions (80.0%) for T-cell lymphomas. Intussusception was more common in B-cell lymphomas than in T-cell lymphomas (30.8% vs 5.9%, respectively; P = 0.035), but perforation was more common in T-cell lymphomas than in B-cell lymphomas (23.5% vs 3.8%, respectively; P = 0.005). The prognosis was significantly worse for T-cell lymphomas than for B-cell lymphomas (P = 0.002). Primary colorectal T-cell lymphomas are characterized by multifocal ulcerative lesions in relatively young patients, a high rate of hematochezia, fever, or perforation, and a poor prognosis even for cases of localized disease.

Carbon monoxide and nitric oxide protect against tumor necrosis factor-alpha-induced apoptosis in osteoblasts: HO-1 is necessary to mediate the protection

BACKGROUND

Carbon monoxide (CO) and nitric oxide (NO) each have unique roles for various inflammatory states, including inflammatory bone resorption. Although it is known that NO can induce the expression of the cytoprotective enzyme HO-1, there is no information as to whether the protective effect of CO requires NO production or whether CO must induce the expression of HO-1 to exert its functional effects.

METHODS

Murine osteoblast cells, MC3T3E1 osteoblasts, were cultured for CO and NO-associated HO-1 experiments and were transfected with pcDNA 3, pcDNA 3-HO-1, control siRNA or HO-1 siRNA using Nucleofector. For cell death measurement, MTT and annexin V assays were used. We performed Western blotting to check the expressions of HO-1 and iNOs and measured the HO-1 enzyme activity. We also measured the amounts of nitrite and nitrate using Griess reagents.

RESULTS

The increased expression of HO-1 is required for the protective effect of NO and a single treatment of CO can increase the expression of HO-1, and this is also important for the protective effect of CO in MC3T3E1 osteoblasts. CO as well as NO attenuates the TNF-alpha-induced apoptosis in osteoblasts. The anti-apoptotic effect of CO or NO is not mediated by cGMP, and CO has no effect on the release of NO. The inhibition of HO-1 with using the HO-1 inhibitor ZnPP or HO-1 siRNA resulted in a striking increase of apoptosis in the CO/TNF-alpha-treated cells. Furthermore, HO-1 overexpression showed resistance against the TNF-alpha-induced cytotoxicity in the MC3T3E1 osteoblasts.

CONCLUSIONS

There is a need for HO-1 expression to mediate the protection provided by exogenous CO or NO in osteoblasts.

The antioxidant effect of rebamipide on oxygen free radical production by H. pylori-activated human neutrophils: in comparison with N-acetylcysteine, ascorbic acid and glutathione

Helicobacter pylori(H. pylori)-activated neutrophils produce the oxygen-derived free radicals (OFRs) which play an important role in gastric mucosal cell damage. Rebamipide (2-(4-chlorobenzoylamino)-3-[2-(1H)-quinolinon-4-yl] propionic acid) is an antiulcer compound, which protects gastric mucosa against OFR-mediated injury. In order to investigate the effects of rebamipide on OFR production and to compare the antioxidant activity of rebamipide with those of three known antioxidants, N-acetylcysteine (AC), ascorbic acid (Vit C) and glutathione (GSH), the antioxidant activities were determined by luminol-dependent chemiluminescence (ChL) assay and pyrogallol autoxidation assay. The ChL value was markedly elevated immediately after the addition of H. pylori into the medium containing neutrophils. The antioxidant activity of 1.0 mM rebamipide was greater than that of 0.1 mM rebamipide in the luminol-dependent ChL assay, while in the pyrogallol autoxidation assay, the antioxidant activity of 1.0 mM rebamipide was similar to that of 0.1 mM rebamipide. Rebamipide inhibited OFR generation in the pyrogallol autoxidation assay, with the potency being in the order of GSH > Vit C > rebamipide > AC. In the luminol-dependent ChL assay, the antioxidant activity of rebamipide was the greatest among them. These results indicate that rebamipide is a potent antioxidant and scavenges OFRs produced by H. pylori effectively in luminol-dependent ChL assays.

Epidemiology of inflammatory bowel disease in Asia

Studies of Asians in Asia show relatively low incidence rates for ulcerative colitis and Crohn's disease compared with North America and Europe. The prevalence of ulcerative colitis in migrant South Asians in Europe is similar to Europeans, whereas the prevalence of Crohn's disease for migrant South Asians in Europe is decreased compared with Europeans. The prevalence for both ulcerative colitis and Crohn's disease in Japan and Korea is relatively low. There are no obvious differences in age or sex distribution or rates of familial aggregation, and there are no significant differences in the clinical characteristics and natural history of ulcerative colitis and Crohn's disease in Asians compared with other racial groups with inflammatory bowel disease.

Radiologic findings of Behçet syndrome involving the gastrointestinal tract

Behçet syndrome is characterized by the histopathologic finding of nonspecific vasculitis in multiple organs. The diagnosis is usually made on the basis of the combination of clinical signs and symptoms. This disease involves the gastrointestinal tract in 10%-50% of patients, and the terminal ileum and cecum are chiefly affected. Barium study is useful in demonstrating the characteristic radiographic features of Behçet syndrome involving the gastrointestinal tract. The presence of deep, penetrating ulcers results in a high rate of complications, such as perforation, fistula, hemorrhage, and peritonitis. Furthermore, recurrence of disease adjacent to or at the surgical anastomosis is common. Computed tomography is useful in determining the extent of the lesions and in identifying cases in which complications are likely to occur. Familiarity with the various radiologic findings of Behçet syndrome involving the gastrointestinal tract helps in making an early diagnosis, as well as in establishing an appropriate treatment strategy.

CT differentiation of mesenteric ischemia due to vasculitis and thromboembolic disease

PURPOSE

The purpose of this work was to differentiate CT findings of acute mesenteric ischemia due to vasculitis (MV) or thromboembolism (MTE).

METHOD

CT scans of 69 patients with mesenteric ischemia caused by MV (n = 37) or MTE (n = 32) were analyzed. After dividing the patients into groups with and without MV, we compared them with regard to gastrointestinal tract involvement patterns, mesenteric changes, and presence or absence of vascular thrombosis, atherosclerosis, other organ changes, and ascites.

RESULTS

Duodenum was involved only in the MV group (30%). The MV group had preferential involvement of the small intestine (89%) to large intestine (51%), whereas the MTE group showed even distribution. Multisegmental bowel involvement was more common in the MV group (86%) than in the MTE group (44%), especially in both jejunum and ileum and both small and large intestine. The MV group showed prominent involvement of the superior mesenteric vessel territory, although the MTE group showed even distribution. Splenomegaly and hydronephrosis were more frequently seen in the MV group and vascular thrombosis and atherosclerosis in the MTE group.

CONCLUSION

Although considerable overlap was noted, CT is useful in differentiating MV from MTE.

CT features of primary colorectal signet-ring cell carcinoma

PURPOSE

The purpose of this work was to evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas.

METHOD

We retrospectively reviewed the CT scans of 15 patients (mean age 44 years) with pathologically proved colorectal signet-ring cell carcinoma. On CT, we evaluated the site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs.

RESULTS

The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. The tumor length ranged from 4.0 to 10.0 cm (mean 6.1 cm) with mean thickness of 2.1 cm. CT showed concentric bowel wall thickening in all patients ("even" in 8 and "uneven" in 7), target appearance was noted in 4, perirectal or pericolic infiltrations were moderate to severe in 12, and colorectal obstruction was seen in 6. In the tumor spread patterns, lymphadenopathy was noted in 13, invasion to adjacent pelvic organs in 5, peritoneal carcinomatosis in 4, liver metastasis in 2, and periureteric metastasis in 1.

CONCLUSION

Primary signet-ring cell colorectal carcinoma should be included for differential consideration when CT shows a long length of concentric bowel wall thickening and target sign, especially when such findings occur in the rectum and in young patients.

CT of patients with right-sided colon cancer and distal ileal thickening

OBJECTIVE

The purpose of this study was to analyze the incidence and primary causes of distal ileal wall thickening in 131 patients with right-sided colon cancer.

SUBJECTS AND METHODS

During a 2-year period, 131 patients underwent surgical resection for right-sided colon cancer. Of these patients, we analyzed 13 who had distal ileal wall thickening on CT before surgery and also had the cause determined at pathology. CT findings were analyzed with regard to the morphologic features of colonic tumors, bowel wall involvement patterns of the distal ileum, and changes in the pericolic space.

RESULTS

Distal ileal wall thickening occurred in 13 (10%) of the 131 patients who had right-sided colon cancer. Three patients had polypoid colon cancer, whereas the other 10 had infiltrative colon cancer. The mean thickness of the involved colonic segments was 1.6 cm (range, 1.0-2.2 cm) with a mean length of 5.2 cm (range, 2.5-10.0 cm). Pericolic infiltration was mild in six patients and moderate in four patients. The mean length and thickness of the affected ileal segments were 3.2 cm (range, 1.5-6.0 cm) and 1.1 cm (range, 0.7-2.0 cm), respectively. On histopathologic examination, neoplastic processes involved the distal ileum in nine (69%) of the 13 patients. This involvement was caused by either direct tumor invasion in seven patients or lymphatic spread in two. In four patients (31%), nonneoplastic processes with edema and congestion involved the distal ileum.

CONCLUSION

The distal ileum may be abnormally thickened in about 10% of patients with right-sided colon cancer; this thickening results from tumor extension (69%) or a nontumorous process (31%).

Duplication of genes encoding non-clathrin coat protein gamma-COP in vertebrate, insect and plant evolution

Coatomer is a major component of COPI vesicles and consists of seven subunits. The gamma-COP subunit of the coatomer is believed to mediate the binding to the cytoplasmic dilysine motifs of membrane proteins. We characterized cDNAs for Copg genes encoding gamma-COP from mouse, zebrafish, Drosophila melanogaster and Bombyx mori. Two copies of Copg genes are present in vertebrates and in B. mori. Phylogenetic analysis revealed that two paralogous genes had been derived from a single ancestral gene by duplication independently in vertebrates and in B. mori. Mouse Copg1 showed ubiquitous expression with the highest level in testis. Zebrafish copg2 was biallelically expressed in hybrid larvae in contrast to its mammalian ortholog expressed in a parent-of-origin-specific manner. A phylogenetic analysis with partial plant cDNA sequences suggested that copg gene was also duplicated in the grass family (Poaceae).

Incidence and prevalence of ulcerative colitis in the Songpa-Kangdong District, Seoul, Korea, 1986-1997

BACKGROUND AND AIMS

Ulcerative colitis (UC) is regarded as a rare disease in developing countries, but accurate data are generally lacking. We performed the present study to evaluate the incidence and prevalence of UC in Korea.

METHODS

A retrospective study was performed from 1986 to 1997 in the Songpa-Kangdong district of Seoul, Korea. To recruit UC patients as completely as possible, multiple information sources including all medical facilities in the study area and three referral centres located nearby, but outside the study area were used. The incidence and prevalence rates were adjusted using the 1997 Korean population statistics.

RESULTS

During the study period, a total of 94 incident cases were identified, for an adjusted mean annual incidence rate of 0.68 per 100,000 inhabitants. On 31 December 1997, 91 patients with UC lived in the study area, giving an adjusted prevalence rate of 7.57 per 100,000 inhabitants. By using the Poisson regression analysis, the annual incidence rate increased significantly from 0.20 per 100,000 inhabitants in 1986-1988 to 1.23 per 100,000 inhabitants in 1995-1997 (P < 0.005). Patient age at diagnosis, the interval from onset of symptoms to diagnosis, and the disease extent at diagnosis were fairly constant throughout the study period.

CONCLUSIONS

The incidence and prevalence of UC in our study area are still low compared with those of Western countries, but the incidence rate is steadily increasing.

[Study on gallic acid preparation by using immobilized tannase from Aspergillus niger]

Immobilized tannase which had higher ability of transforming tannin from Chinese gallotannin into GA was prepared by embedding tannase with calcium alginate carrier. The immobilization conditions and some properties of the immobilized tannase were studied. The results showed that: The optimal immobilized parametres were 90 mg sodium alginate, 546 u(182 u/mL) tannase and 1%-2% CaCl2. The optimum temperature and pH value of immobilized tannase were 45 degrees C and 6.5, respectively. It was stable in the temperature range of 10-50 degrees C and between pH5-7. Based on the optimum program, the laboratory gramme-grade preparation experiments of GA were done. The average yield of GA product in three preparations was upto 61%, and was about equivalent to the yield of acidic hydrolytic method which is used to produce GA industrially now. Thus, the research results possessed potential applied value.

De novo methylation at intronic CpG islands of Igf2r is associated with decreased expression of antisense RNA in aged mice

Changes in cytosine methylation status of several genes have been implicated in the aging process. We have examined methylation status of differentially methylated regions of insulin-like growth factor II receptor gene during mouse senescence. Bisulfite-aided genomic sequencing revealed that methylated CpG residues were extended beyond the 3' boundary of de novo methylation sequence of DMR2 in aged mice. Furthermore, the de novo methylation of DMR2 in aged mice was associated with decreased expression of antisense transcript which recruits DMR2 as a promoter. On the contrary, methylation status of DMR1 was well-maintained during senescence. Accordingly, no significant changes in expression levels of sense transcripts were observed during the course of mouse aging.

Germline mutations of the dpc4 gene in Korean juvenile polyposis patients

Juvenile polyposis is an uncommon condition characterized by the development of multiple (usually more than 5) juvenile polyps in the gastrointestinal tract, especially in the colon. This disease usually occurs during childhood, and is inherited in an autosomal dominant fashion. It has been suggested that the dpc4 (deleted in pancreatic carcinoma, locus 4) gene, which is located on chromosome 18q21.1, might cause juvenile polyposis. The dpc4 (smad4) gene is a candidate tumor-suppressor gene and may play a role in the TGF-beta-signaling pathway. To confirm the idea that alterations of the dpc4 gene may result in juvenile polyposis, we screened 5 Korean juvenile-polyposis patients by PCR-SSCP (single-strand conformation polymorphism) analysis and bi-directional sequencing. There were germline mutations of the dpc4 gene in 3 out of the 5 patients: 2 had a genetic alteration in exon 9 and the third had a mutation in exon 8. These germline mutations occurred in the C-terminus of the dpc4 gene, similar to most published mutations. One patient exhibited a non-sense mutation (codon 388), which changed a glutamine codon (CAG) to a stop codon (TAG). The second patient harbored a mis-sense mutation (codon 390), causing a non-conservative amino-acid change <glutamate (GAA) to lysine (AAA)>. The third patient had a mis-sense mutation in exon 8 (codon 361), which altered an arginine codon (CGC) into a histidine codon (CAC).

Decreased trabecular bone mineral density in newly diagnosed inflammatory bowel disease patients in Korea

BACKGROUND

Decreased bone mineral density (BMD) is common in Western patients with inflammatory bowel disease (IBD). However, BMD has never been studied in Asia where the demographic and socio-economic status are different from the West. The aim of this study was to investigate the prevalence and mechanisms of osteopenia in newly diagnosed Korean patients with IBD.

METHODS

We studied 14 patients with Crohn's disease (CD) and 25 patients with ulcerative colitis (UC), all of whom had never been treated with corticosteroids. Bone mineral density was measured in the lumbar spine and the femoral neck by dual energy X-ray absorptiometry. Biochemical parameters including serum osteocalcin, parathyroid hormone, plasma inactive and active vitamin D, and urinary deoxypyridinoline were measured.

RESULTS

The BMD Z score at the lumbar spine was lower both in CD and in UC patients, but there was no significant difference between the two groups. There was no significant difference in nutritional status or biochemical parameters of bone metabolism between patients with a normal BMD and those with a decreased BMD.

CONCLUSIONS

Low BMD at the lumbar spine is common in newly diagnosed Korean patients with IBD, a result which is similar to Western studies. The mechanism for low bone mass remains undetermined; however, nutritional status and hormonal parameters of bone metabolism, and ethnic differences are not likely to be an important factor in the pathogenesis of this bone loss.

Somatic mutations of the first 14 exons of APC in hamartomatous polyps of the colon

Although hamartomatous or hyperplastic polyps are rarely accompanied by adenomatous or carcinomatous foci, the role of APC (MIM# 175100) mutations in these polyps is not clear. The neoplastic potential of these polyps was assessed with regard to somatic mutation of the first 14 exons of APC. DNA from 14 hamartomatous polyps (12 patients with juvenile polyp, JP; two patients with Peutz-Jeghers syndrome, PJS) and 27 hyperplastic polyps was used. Exons 1-14 of APC were amplified using verified oligonucleotide primers, and PCR-SSCP analysis was performed. Translation-terminating mutation in exon 15 was also screened using the protein truncation test. All mutations found were transitions or transversions with heterozygous alleles of both wild-type and mutant APC in exons 2, 9, 10, and 11. Four hamartomatous polyps (three from JP and one from PJS) showed seven, new mutations and one common APC variant (codon 486), whereas no hyperplastic polyps demonstrated mutation. APC mutation was not correlated with previous history of colorectal carcinoma or number of polyps. Since all mutations were missense or silent mutations occurred in exons not previously known to have functionally relevant area, their phenotypic implication appeared to be limited.

Appendiceal orifice inflammation as a skip lesion in ulcerative colitis: an analysis in relation to medical therapy and disease extent

BACKGROUND

Although several reports have claimed that the appendix can be involved as a skip lesion in ulcerative colitis, they do not exclude the possibility that this skip lesion occurs as a result of medical therapy. Also, little is known about the relation between the presence of appendiceal orifice inflammation and the extent of the disease.

METHODS

The presence of appendiceal orifice inflammation was prospectively assessed both endoscopically and histologically in 94 patients with active ulcerative colitis, the extent of whose disease had not been beyond the hepatic flexure. To evaluate the effect of prior medical therapy on the prevalence of appendiceal orifice inflammation, all cases were divided into two groups. Group A consisted of 66 patients who had been treated before inclusion; group B was composed of 28 patients newly diagnosed at inclusion.

RESULTS

Appendiceal orifice inflammation was diagnosed in 24 (26%) of 94 patients with active subtotal ulcerative colitis, with no statistical difference observed between group A (23%) and group B (32%). In all 94 patients, the frequency of appendiceal orifice inflammation decreased significantly as the extent of disease increased, i.e., 37% in proctitis (n = 49), 17% in left-sided colitis (n = 36), and 0% in extensive colitis (n = 9) (p < 0.05).

CONCLUSIONS

Appendiceal orifice inflammation as a skip lesion of ulcerative colitis is not rare, is more frequently observed in patients with less extensive disease, and is not the result of patchy improvement due to medical therapy.

Intestinal tuberculosis with abdominal complications: radiologic and pathologic features

BACKGROUND

To investigate radiologic and pathological features of intestinal tuberculosis with abdominal complications.

METHODS

Twenty-two patients with 23 surgically proven complications (nine intestinal obstructions, eight perforations, three fistulae, and three intestinal bleeds) were analyzed. Medical records, radiologic studies, and pathologic examinations were reviewed with special emphasis on searching for the common features in each group of complication.

RESULTS

The most important single feature in seven of the nine patients with intestinal obstruction was the presence of stricture. In the remaining two patients, bowel adhesion was a primary cause of obstruction. In eight patients with intestinal perforation, both obstruction and ulcerations in the dilated proximal loop were the important features in six, and multiple deep ulcerations without obstruction was a primary cause in the remaining two. The common features in three patients with fistulae were focal or multiple strictures, severe adhesions, and fibrotic bowel wall. Intestinal bleeding originated from diffuse mucosal ulcerations. The abdominal complications occurred during antituberculous therapy in 10 of the 22 patients.

CONCLUSION

Understanding the radiologic and pathologic features of intestinal tuberculosis with complications help in making an appropriate clinical decision for the treatment strategy. Close observation is necessary, especially in those patients who are acutely ill during antituberculous medical therapy. Enteritis-Intestines, diseases-Intestines, infection-Intestines, perforation-Intestines, stenosis or obstruction.

Zinc deficiency manifested by dermatitis and visual dysfunction in a patient with Crohn's disease

We report a case of Crohn's disease with low serum zinc concentration in a 26-year-old woman. She demonstrated acrodermatitis enteropathica and decreased visual acuity during total parenteral nutrition. Subsequent intravenous zinc supplementation resulted in alleviation of the skin lesions and improvement of visual acuity. This case supports the notion that depressed serum zinc in Crohn's disease may cause clinical manifestations, such as acrodermatitis enteropathica and retinal dysfunction, which may be correctable with zinc supplementation.

Intestinal Behçet syndrome: CT features of patients with and patients without complications

PURPOSE

To analyze the computed tomographic (CT) features of intestinal Behçet syndrome and to determine the usefulness of CT in detecting complications.

MATERIALS AND METHODS

The CT scans of 28 patients with intestinal Behçet syndrome were retrospectively reviewed. Five patients had bowel perforation, and two had peritonitis. Patterns of bowel involvement, patterns of contrast enhancement, and ancillary findings were compared in patients with complications (n = 7) and patients without complications (n = 21).

RESULTS

Ten patients had polypoid lesions, nine had a thickened bowel wall, and nine had both findings. Lesion enhancement was mild in eight patients (29%) and marked in 20 (71%). Polypoid lesions were more commonly seen in patients without complications (P = .020); a thickened bowel wall was more commonly seen in patients with complications (P = .030). Seventeen of 18 patients (94%) with minimal perienteric infiltration did not have complications (P = .0003), whereas all five patients with severe perienteric infiltration did have complications.

CONCLUSION

In patients with known intestinal Behçet syndrome, CT can be useful in determining the extent of the lesions and in identifying cases in which complications are likely to occur.

Antigenic diversity and serotypes of Helicobacter pylori associated with peptic ulcer diseases

OBJECTIVES

Clinical presentation of Helicobacter pylori (H. pylori) infection has marked variation mainly due to the strain diversity and host susceptibility. Although H. pylori is identified as a major risk factor for gastric and duodenal ulcers, the ulcerogenic or pathogenic strain has not been documented yet. The objective of this study was to investigate antigenic types of the ulcerogenic strain of H. pylori.

METHODS

The sera of 64 patients were tested by Western blot using Helicoblot 2.0 for six major anti-H. pylori antibodies, together with CLO test and histological examination of gastric biopsy tissues. Thirty-five, nine and 20 patients had duodenal ulcer, gastric ulcer and chronic active gastritis, respectively. The antigenic types of H. pylori were analyzed in 54 patients with positive H. pylori infection. In this study, H. pylori was divided into four serotypes according to the presence and absence of CagA and VagA: type I; CagA (+) and VacA(+), type Ia: CagA (+) and VacA(-), type Ib: CagA(-) and VacA(+), and type II: CagA(-) and VacA(-).

RESULTS

There was no difference in the number of bands for six antigens: 3.2 +/- 1.4, 3.0 +/- 1.2 and 3.1 +/- 1.4 in 35 duodenal ulcer, 7 gastric ulcer and 12 chronic gastritis, respectively. The band with 119 kDa was 90.7%, which was the most common band with the order of 35, 30, 26.5, 89 and 19.5 kDa. Type I, la and Ib were positive in 22.2, 42.6 and 27.8%, respectively, which were significantly higher than type II (p < 0.05). There was no difference in the positive rates of four urease subtypes between the four serotypes.

Inhibitory monoclonal antibody to human cytochrome P450 2B6

The human cytochrome P450 2B6 metabolizes, among numerous other substrates, diazepam, 7-ethoxycoumarin, testosterone, and phenanthrene. A recombinant baculovirus containing the human 2B6 cDNA was constructed and used to express 2B6 in Sf9 insect cells. The 2B6 was present at 1.8 +/- 0.4% of the total cellular protein and was purified to a specific content of 13.3 nmol/mg protein. Mice were immunized with the purified 2B6, and a total of 811 hybridomas were obtained from the fusion of NS-1 myeloma cells and spleen cells of the immunized mice. Monoclonal antibodies (MAbs) from 24 of the hybrids exhibited immunobinding to 2B6 as determined by ELISA. One of the MAbs, 49-10-20, showed a strong immunoblotting activity and was highly inhibitory to 2B6 enzyme activity. MAb 49-10-20 inhibited cDNA-expressed 2B6-catalyzed metabolism of diazepam, phenanthrene, 7-ethoxycoumarin, and testosterone by 90-91%. MAb 49-10-20 showed extremely high specificity for 2B6 and did not bind to 17 other human and rodent P450s or inhibit the metabolism of phenanthrene catalyzed by human 1A2, 2A6, 2C8, 2C9, 2D6, 2E1, 3A4, and 3A5. MAb 49-10-20 was used to determine the contribution of 2B6 to the metabolism of phenanthrene and diazepam in human liver. In ten liver samples, MAb 49-10-20 inhibited phenanthrene metabolism variably by a wide range of 8-42% and diazepam demethylation by 1-23%. The degree of inhibition by the 2B6 specific MAb 49-10-20 defines the contribution of 2B6 to phenanthrene and diazepam metabolism in each human liver. This technique using inhibitory MAb 49-10-20 determines the contribution of 2B6 to the metabolism of its substrates in a human tissue containing multiple P450s. This study is a prototype for the use of specific and highly inhibitory MAbs to determine individual P450 function.

Role of cDNA-expressed human cytochromes P450 in the metabolism of diazepam

The metabolic conversion of diazepam (DZ) to temazepam (TMZ, a C3-hydroxylation product of DZ) and N-desmethyldiazepam (NDZ, an N1-demethylation product of DZ) was studied using cDNA-expressed human cytochrome P450 (CYP) isozymes 1A2, 2B6, 2C8, 2C9, 2C9R144C, 2E1, 3A4, and 3A5 and human liver microsomes from five organ donors. Of the CYPs examined, 3A5, 3A4, and 2B6 exhibited the highest enzymatic activities with turnovers ranging from 7.5 to 12.5 nmol of product formed/min/nmol for the total metabolism of DZ, while 2C8, 2C9, and 2C9R144C showed lesser and moderate activities. 1A2 and 2E1 produced insignificant amounts of metabolites of DZ. The regioselectivity of CYPs was determined, and 2B6 was found to catalyze exclusively and 2C8, 2C9, and 2C9R144C preferentially the N1-demethylation of DZ to form NDZ. 3A4 and 3A5 catalyzed primarily the C3-hydroxylation of DZ, which was more extensive than the N1-demethylation. The ratios of TMZ to NDZ formed in the metabolism of DZ by 3A4 and 3A5 were approximately 4:1. Enzyme kinetic studies indicated that 2B6- and 2C9-catalyzed DZ metabolism followed Michaelis-Menten kinetics, whereas 3A4 and 3A5 displayed atypical and non-linear curves in Lineweaver-Burk plots. Human liver microsomes converted DZ to both TMZ and NDZ at a ratio of 2:1. Our results suggest that hepatic CYP3A, 2C, and 2B6 enzymes have an important role in the metabolism of DZ by human liver.

Differential and regulated expression of C-X-C, C-C, and C-chemokines by human colon epithelial cells

BACKGROUND & AIMS

Intestinal epithelial cells constitute a barrier between host and external milieu and can play a role in signaling the influx of leukocytes during the acute mucosal inflammatory response. To further explore this role, the regulated expression of twelve C-X-C, C-C, and C-chemokines by human colon epithelial cells was characterized.

METHODS

Chemokine production was assessed in HT-29 and Caco-2 human colon epithelial cells that were infected with Salmonella dublin or stimulated with interleukin 1 alpha or tumor necrosis factor alpha and in freshly isolated human colon epithelial cells by quantitative reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay.

RESULTS

Expression of the neutrophil chemoattractants GRO-alpha, GRO-gamma, and interleukin 8 increased rapidly (2-3 hours) but transiently after infection or proinflammatory agonist stimulator. In contrast, expression of another neutrophil chemoattractant, epithelial cell-derived neutrophil activator 78, was delayed for 6-10 hours, and secretion continued to increase for 24 hours after infection. Among C-C chemokines known to chemoattract different leukocyte populations, monocyte chemotactic peptide 1 was rapidly expressed, whereas RANTES was up-regulated with delayed kinetics. Freshly isolated colon epithelial cells produced an array of chemokines similar to the cell lines, as well as macrophage inflammatory proteins 1 alpha and 1 beta.

CONCLUSIONS

These data suggest that regulated chemokine production by epithelial cells results in temporal and spatial mucosal chemokine gradients that are important in both early and later phases of the mucosal inflammatory response.

Antitumor activity of DA-125, a novel anthracycline, in human gastric and pulmonary adenocarcinoma cells resistant to adriamycin and cisplatin

The study was undertaken to investigate the antitumor activity of DA-125, a promising new analogue of adriamycin (ADM) containing fluorine, against human gastric and pulmonary adenocarcinoma cell lines and their sublines resistant to ADM and cisplatin (CDDP) by MTT assay. The cells used were MKN-45, human gastric adenocarcinoma, PC-14, human pulmonary adenocarcinoma, and their sublines resistant to ADM, MKN/ADM and PC/ADM, and CDDP, MKN/DDP and PC/DDP. MKN/ADM and PC/ADM were 12.6- and 13.9-fold resistant to ADM, respectively, compared to the respective parental cell lines in terms of IC50. The survival was less in cells treated with DA-125 than that treated with ADM in all lines tested. The antitumor activity of DA-125 was compared with that of ADM using IC50 values and relative resistance (RR). RR was defined as the ratio of the IC50 value of the resistant subline to that of the parent line. In all lines tested, the mean IC50 values for both DA-125 and ADM were lowest in the parent cells, followed by CDDP-resistant cells and ADM-resistant cells. The IC50 values for DA-125 were lower than those for ADM in all six lines tested, although statistical significance was observed in four lines. ADM-resistant sublines were highly resistant to DA-125 (RRs for ADM and DA-125; 12.6 and 7.6 MKN/ADM and 13.9 and 10.3 in PC/ADM, respectively). On the other hand, CDDP-resistant sublines were also resistant to ADM and DA-125 when compared with the respective parent cell lines (RRs for ADM and DA-125; 2.3 and 2.0 in MKN/DDP and 4.8 and 6.0 in PC/DDP, respectively). Although DA-125 showed cross-resistance to ADM and CDDP, we recommended DA-125 to be a good candidate for further development because DA-125 exhibited remarkable antitumor activity against the parent cell lines.

Human hepatocytes express an array of proinflammatory cytokines after agonist stimulation or bacterial invasion

Inflammatory cells infiltrate the liver in response to microbial infection or hepatic injury. To assess the potential role hepatocytes may play in initiating or amplifying the acute inflammatory response in the liver, we used three human hepatocyte cell lines and primary human hepatocyte cultures to characterize the repertoire of cytokines that can be expressed and regulated in hepatocytes in response to agonist stimulation or bacterial infection. As reported herein, a proinflammatory cytokine gene program that includes C-X-C and C-C chemokines [interleukin-8(IL-8), growth related (GRO)-alpha, GRO-beta, GRO-gamma, epithelial neutrophil activating peptide-78 (ENA-78), and RANTES] and the cytokines tumor necrosis factor-alpha (TNF-alpha) and macrophage colony stimulating factor was upregulated in human hepatocytes after stimulation with IL-1 alpha or TNF-alpha or bacterial invasion. In contrast, expression of hematopoietic/ lymphoid growth factors by the same cells was either down-regulated (erythropoietin and stem cell factor) or unchanged (IL-7 and IL-15) in response to the identical stimuli. Hepatocytes did not express cytokines that often are associated with the regulation of antigen-specific immune responses (IL-2, IL-4, IL-5, IL-10, IL-12p40, IL-13, and interferon-gamma) or genes for several other proinflammatory cytokines [IL-1 alpha, IL-6, monocyte chemotactic protein-1 (MCP-1), and MCP-3] or hematopoietic growth factors (granulocyte colony stimulating factor, granulocyte macrophage colony stimulating factor, IL-3, and IL-11). Together, these studies suggest that hepatocytes can both initiate and amplify acute inflammatory responses in the liver through the regulated expression and secretion of a specific array of proinflammatory cytokines.

Usefulness of CT in patients with ischemic colitis proximal to colonic cancer

OBJECTIVE

The purpose of this study was to assess the usefulness of CT scans for distinguishing ischemic from tumoral segments in patients with colonic carcinoma complicated by proximal bowel ischemia.

MATERIALS AND METHODS

CT scans of 20 patients with ischemic colitis proximal to obstructing colonic carcinoma were reviewed retrospectively. The concomitant presence of ischemia was proven on pathologic examinations in 12 patients and on barium enema studies in the remaining eight patients. CT scans were analyzed for the involved site and length, bowel wall thickness, enhancing pattern of both tumoral and ischemic segments, and changes in the pericolic space. The results of tumor staging on CT scans were compared with those of pathologic findings.

RESULTS

Distinction of ischemic from tumoral segments could be made on CT in 15 (75%) of the 20 patients. Of the 20 patients, 18 had ischemic segments contiguously proximal to the tumoral segment, and the remaining two patients had a skipped zone with intervening normal mucosa. Tumoral segments were irregularly thickened in most patients. Maximum thickness ranged from 0.8 to 4.5 cm (mean, 2.0 cm). Most often the ischemic segment was concentrically and smoothly thickened, ranging from 0.6 to 1.5 cm (mean, 1.0 cm). The tumoral segments enhanced heterogeneously in 12 patients and enhanced homogeneously in the remaining eight, whereas ischemic segments enhanced homogeneously in 14 (70%) patients and heterogeneously in six. On CT scans, we saw the target or double halo sign in four (20%) patients. Pericolic vascular engorgement was 19 patients, two of whom were overstaged because pericolic vascular engorgement was interpreted as tumor infiltration.

CONCLUSION

Although CT findings are not specific for certain groups of patients, they are often helpful in distinguishing tumoral from ischemic segments in patients with ischemic colitis proximal to colonic carcinoma. An understanding of this pathologic entity may increase the accuracy of CT for staging colonic carcinoma.

Mutations of Ros differentially effecting signal transduction pathways leading to cell growth versus transformation

The signaling functions of the oncogenic protein-tyrosine kinase v-Ros were studied by systematically mutating the tyrosine residues in its cytoplasmic domain. The carboxyl mutation of Tyr-564 produces the most pronounced inhibitory effect on v-Ros autophosphorylation and interaction with phospholipase Cgamma. A cluster of 3 tyrosine residues, Tyr-414, Tyr-418, and Tyr-419, within the PTK domain of v-Ros plays an important role in modulating its kinase activity. The mutant F419 and the mutant DI, deleting 6-amino acids near the catalytic loop, retain wild type protein tyrosine kinase and mitogenic activities, but have dramatically reduced oncogenicity. Both mutant proteins are able to phosphorylate or activate components in the Ras/microtubule-associated protein kinase signaling pathway. However, F419 mutant protein is unable to phosphorylate insulin receptor substrate 1 (IRS-1) or promote association of IRS-1 with phosphatidylinositol 3-kinase. This tyrosine residue in the context of the NDYY motif may define a novel recognition site for IRS-1. Both F419 and DI mutants display impaired ability to induce tyrosine phosphorylation of a series of cytoskeletal and cell-cell interacting proteins. Thus the F419 and DI mutations define v-Ros sequences important for cytoskeleton signaling, the impairment of which correlates with the reduced cell transforming ability.

2-(methylamino)-5-chlorobenzophenone imine: a novel product formed in base-catalyzed hydrolysis of diazepam

Diazepam (1), a hypnotic and anxiolytic drug in worldwide use, formed an intermediate product in a mixture of ethanol and sodium hydroxide ([NaOH] > or = 1 M). The intermediate product slowly decomposed to form 2-(methylamino)-5-chlorobenzophenone imine (2) and 2-(methylamino)-5-chlorobenzophenone (3). The amount of 2 formed, relative to that of 3, increased with increasing NaOH concentration. Compound 2, a heretofore unknown derivative of 1, was characterized by high-performance liquid chromatography, ultraviolet-visible absorption, mass, and proton nuclear magnetic resonance spectral analyses.

3-Hydroxymethylcholanthrene: metabolic formation from 3-methylcholanthrene and stereoselective metabolism by rat liver microsomes

3-Hydroxymethylcholanthrene (3-OHMC) was identified as one of the three initial hydroxylation products formed in the metabolism at the aliphatic carbons of 3-methylcholanthrene (3MC) by rat liver microsomes. The 3-OHMC formed in 3MC metabolism by liver microsomes prepared from untreated (control) rats, and rats treated with phenobarbital, 3MC, and polychlorinated biphenyls (Aroclor 1254) was determined by HPLC analysis and the effect of enzyme inducers on its formation was phenobarbital > polychlorinated biphenyls > 3MC > control. Incubation of 3-OHMC with rat liver microsomes produced the following identifiable products: 1-hydroxy-3-hydroxymethylcholanthrene (enriched in 1S-enantiomer, enantiomer excess 14-50%), 2-hydroxy-3-hydroxymethylcholanthrene (enriched in 2S-enantiomer, enantiomer excess 30-92%), 3-hydroxymethylcholanthrene-1-one, 3-hydroxymethylcholanthrene-2-one, 8-hydroxy-3-hydroxymethylcholanthrene, 3-hydroxymethylcholanthrene trans-9,10-dihydrodiol (enriched in 9R,10R-enantiomer, enantiomer excess 64-86%), 3-hydroxymethylcholanthrene trans-7,8-dihydrodiol (enriched in 7R,8R-enantiomer), and 3-hydroxymethylcholanthrene trans-11,12-dihydrodiol (enriched in 11R,12R-enantiomer). The enantiomer compositions were determined by circular dichroism spectral analysis and/or chiral stationary phase HPLC analysis.

Clinical features of ulcerative colitis in Korea

OBJECTIVES

This study was conducted to investigate the clinical features of ulcerative colitis in Korea and to evaluate the clinical course after medical therapy.

METHODS

Symptoms, signs and results of the treatment were retrospectively analyzed in 66 patients (male 32, female 34) diagnosed to have ulcerative colitis at the Asan Medical Center.

RESULTS

The median age of the beginning of symptoms was 36 years (range, 14-72). Diarrhea and rectal bleeding were observed in 95.1 and 91.4%, respectively, at the time of diagnosis, while extra-colonic manifestations were observed in 24.1%. In 41 patients (62.1%), colitis developed in the rectum and sigmoid colon, while left colitis and extensive colitis developed in 11 (16.7%) and 14 patients (21.2%), respectively. The severity of disease was determined according to the clinical criteria, resulting in 22 (33.3%) mild, 21 (31.8%) moderate and 23 (34.8%) severe diseases. The seventy was also classified as 1, 2 and 3 by sigmoidocolonoscopic findings: 1;17 patients(25.8%), 2;27(40.9%) and 22(33.3%). Among 23 patients with severe disease, 5 patients (7.6%) received total colectomy due to toxic megacolon, intractability to medical therapy, ileocolic fistula and intestinal stenosis. The severity determined by colonoscopic findings was well correlated with that determined clinically and was closely related to the severity of symptoms, levels of albumin, hemoglobin and the count of leukocyte. The median duration of symptoms before treatment was 4 weeks (range, 11-300). All patients were treated with sulfasalazine and prednisolone. All patients with medical therapy, except 2 patients (96.7%), obtained clinical remission. The median days required for remission was 14 (range, 3-70). Relapse rates at 6 months, 1 year and 2 years after the initiation of treatment were 19.7, 34.1 and 49.3%, respectively. The median disease-free interval from the time of remission was 10 months (range, 2-60). After remission, the subsequent relapse rate increased in severe disease, while no difference was observed between the disease extents.

CONCLUSIONS

The general characteristics of clinical manifestations and clinical course, after the medical treatment of ulcerative colitis in Korean patients, are not considerably different from those in Western countries.

Stereoselective nucleophilic substitution of oxazepam and racemization in acidic methanol and ethanol

Enantiomeric and racemic oxazepam (OX), 3-O-methyloxazepam (MeOX), and 3-O-ethyloxazepam (EtOX) were used to study racemization, heteronucleophilic, and homonucleophilic substitution reactions in anhydrous acidic methanol and ethanol. Kinetics of racemization and nucleophilic substitution reactions in nondeuterated and deuterated solvents were determined by circular dichroism spectropolarimetry, chiral stationary phase high-performance liquid chromatography (HPLC), reversed-phase HPLC, and mass spectrometry. Several reactions occurred when (S)-OX, for example, was dissolved in acidic methanol: (1) (S)-OX itself underwent spontaneous racemization, (2) the 3-hydroxyl group of (S)-OX was stereoselectively substituted by the methoxy group of methanol to form MeOX enriched in (S)-MeOX, and (3) the 3-methoxy group of (R)-MeOX was stereoselectively substituted by the methoxy group of methanol to form MeOX enriched in (S)-MeOX, and (4) the 3-methoxy group of (R)-MeOX was stereoselectively substituted by the methoxy group of methanol to form MeOX enriched in (R)-MeOX. Repetitive reactions 3 and 4 eventually resulted in a racemic MeOX. Similar reactions occurred for an enantiomeric OX in acidic ethanol.

Highly stereoselective acid-catalyzed homonucleophilic substitution reactions

Enantiomeric 3-O-methyltemazepam and 3-O-ethyltemazepam were highly stereoselectively substituted by the 3-methoxy group of methanol in acidic anhydrous methanol and by the 3-ethoxy group of ethanol in acidic anhydrous ethanol, respectively. The stereoselectivity of the homonucleophilic substitution reactions was determined by circular dichroism spectropolarimetry and gas chromatography-mass spectrometry. In anhydrous solutions containing 0.5 M D2SO4 at 50 degrees C, for example, the stereoselectivity was approximately 63:1 for enantiomeric 3-O-methyltemazepam in CD3OD and approximately 94:1 for enantiomeric 3-O-ethyltemazepam in C2D5OD. The high stereoselectivity at C3 position was primarily due to the presence of a methyl group at N1 position.

Inhibitory and non-inhibitory monoclonal antibodies to human cytochrome P450 3A3/4

Cytochromes P450 3A3/4 are inordinately important P450 enzymes catalyzing the metabolism of a large variety of clinically useful drugs, steroids, and carcinogens. Two monoclonal antibodies, MAb 3-29-9 and MAb 275-1-2, were prepared to human P450 3A4 from mice immunized with baculovirus-expressed human P450 3A4. MAb 3-29-9 was a powerful inhibitor of the enzymatic activity of P450 3A3/4/5. MAb 3-29-9 inhibited the P450 3A3, 3A4, and 3A5 catalyzed metabolism of substrates of divergent molecular weights, e.g., p-nitroanisole, phenanthrene, diazepam, testosterone, taxol, and cyclosporin. However, MAb 3-29-9 did not give a western blot with P450 3A3 or 3A4. MAb 275-1-2 was non-inhibitory but yielded a strong western blot with P450 3A3 and 3A4 but not with 3A5, and thus distinguished between 3A3/4 and 3A5. The two MAbs did not cross-react with human 2E1, 1A2, 2B6, 2C8, and 2C9; rat 2A1, 3A1/2, 4A1, 4A3, and 2B1; and mouse 1A1 and 1A2. MAb 3-29-9 has been used successfully to measure the quantitative contribution of P450 3A3 and 3A4 to the metabolism of the above-designated substrates in human adult liver. MAb 3-29-9 and MAb 275-1-2 are precise and sensitive reagents for P450 3A studies.

Elevation of serum type IV collagen in liver cancer as well as liver cirrhosis

Studies on the level of serum type IV collagen (IV C) have usually been focused on the disease with diffuse hepatic fibrosis. To investigate whether serum level of IV C was predictive for the development of liver cancer as well as liver cirrhosis, serum IV C level was measured by a one-step sandwich enzyme immunoassay. The mean level of serum IV C was 73.3 +/- 31.3 ng/ml in 48 controls. The levels (ng/ml) of IV C were 396.4 +/- 254.9, 429.6 +/- 320.7, 420.6 +/- 322.8, and 362.9 +/- 247.4 respectively in 11 patients with chronic hepatitis, 11 with liver cirrhosis, 16 with hepatocellular carcinoma (HCC) with cirrhosis, 10 with HCC without cirrhosis, and 10 with metasatic liver cancer, which were significantly higher than that in controls (p < 0.05). Serum IV C levels were also evaluated using a cut-off value which was determined as the mean plus two standard deviations in the controls, 136 ng/ml. The elevations above the cut-off value were observed in 91, 100, 80, and 90% respectively of 11 patients with cirrhosis, 16 with HCC with cirrhosis, 10 with HCC without cirrhosis, and 10 with metastatic liver cancer, while only one (9%) of 11 chronic hepatitis patients and none (0%) of 48 controls had elevated levels. The levels of serum IV C were analysed with regard to age, sex, serum levels of albumin, globulin, transaminases, alpha-fetoprotein, and diameter of liver mass, a significant difference being observed only between the diameter of HCC and serum level of IV C (p < 0.01). These results indicate that the measurement of serum IV C is a useful for the determination of primary and metastatic liver cancer as well as liver cirrhosis.

Acid-base equilibria of 1,4-benzodiazepine 4-oxides by spectrophotometry

Chlordiazepoxide (a 1,4-benzodiazepine 4-oxide) is an anxiolytic/hypnotic drug in clinical use. It was reported to be predominantly protonated at the N-oxide oxygen in acidic aqueous solutions at pH << 4.6 (pKa). We have studied the acid-base equilibria of three 1,4-benzodiazepine 4-oxides (chlordiazepoxide, diazepam 4-oxide, and nordiazepam 4-oxide) by ultraviolet-visible spectrophotometry. The results indicate that chlordiazepoxide is not protonated at the N-oxide oxygen, but rather at the nitrogen of an imine bond between C2 carbon and its nitrogen substituent in acidic media.