[A study of the clinical curative effect of nucleos(t)ide analogues treated to pegylated interferon-α add-on therapy in patients with chronic hepatitis B]

Objective: To investigate the hepatitis B surface antigen (HBsAg) clearance condition and its predictive factors after treatment with nucleos(t)ide analogues to pegylated interferon-α add-on therapy in patients with chronic hepatitis B. Methods: Patients with chronic hepatitis B who visited the First Affiliated Hospital of Zhengzhou University from 2018~2019 were prospectively enrolled. HBsAg≤ 1500 IU/mL, hepatitis B e antigen-negative, HBV DNA undetectable, received antiviral treatment with nucleos(t)ide analogues for at least one year, and pegylated interferon-α add-on therapy for 48 weeks were included. The primary endpoint of study was to determine the proportion of HBsAg clearance at 72 weeks. Concurrently, the predictive factors for HBsAg clearance were analyzed. Quantitative and qualitative data were analyzed using a t-test or non-parametric test and a Fisher's exact test. Results: A total of 38 cases were included in this study, of which 13 cases obtained HBsAg clearance at 48 weeks of therapy and another six cases obtained HBsAg clearance throughout the extended treatment period of 72 weeks, accounting for 50.00% of all enrolled patients. There was a significant difference in HBsAg dynamics between the HBsAg clearance group and the non-clearance group (P < 0.05). Univariate logistic regression analysis showed that patients' age, baseline, 12-and 24-week HBsAg levels, and early HBsAg reduction were predictive factors for HBsAg clearance at 72 weeks of treatment. Multivariate logistic regression analysis showed that age (OR = 1.311; P = 0.016; 95% confidence interval: 1.051~1.635) and HBsAg levels at 24 weeks of treatment (OR = 4.481; P = 0.004; 95% confidence interval: 1.634~12.290) were independent predictors for HBsAg clearance. Conclusion: Hepatitis B e antigen-negative, nucleos(t)ide analogue treated, HBsAg ≤ 1500 IU/mL, and HBV DNA undetectable, peg-IFNα add-on treatment for 48 weeks could promote HBsAg clearance in patients with chronic hepatitis B. Six of the sixteen cases (37.50%) who did not obtain HBsAg clearance at week 48 did so with the course of therapy extended to week 72. Hence, the optimal individualized treatment strategy should be customized according to the predictors rather than the fixed 48-week course. Age (≤ 38), baseline HBsAg level (≤2.86 log(10)IU/ml), HBsAg level at 24 weeks (≤ 0.92 log(10)IU/ml), and 12-week HBsAg decrease from baseline (≥ 0.67 log(10)IU/ml) indicate that patients are highly likely to obtain HBsAg clearance at the 72 weeks of combination therapy, in which the combined indicator based on HBsAg level ≤0.92 log(10)IU/ml at 24 weeks will identify 85.0% to 100.0% of patients with HBsAg clearance.

Systemic Inflammation Response Index Predicts Clinical Outcomes in Patients With Acute Ischemic Stroke (AIS) After the Treatment of Intravenous Thrombolysis

BACKGROUND

Intravenous thrombolysis (IVT) is one of the most important means of therapy for patients with acute ischemic stroke (AIS). After cerebral infarction, the inflammatory response fulfills an essential role in the pathobiology of stroke, affecting the process of recanalization. Hence, we evaluated the usefulness of the systemic inflammatory response index (SIRI) for the prognosis of patients with AIS.

METHODS

A total of 161 patients suffering from AIS were retrospectively analyzed. SIRI was introduced and calculated using the absolute neutrophil, monocyte, and lymphocyte numbers from the admission blood work. The study outcomes were determined using a modified Rankin Scale (mRS) at the 3-month timepoint, and a favorable clinical outcome was calculated in the mRS score range of 0 to 2. The analysis of receiver operating characteristic (ROC) curves was performed to determine the values of the optimal cutoff of SIRI for the prediction of clinical outcomes. In addition, multivariate analyses were performed to investigate the association between clinical outcomes and SIRI.

RESULTS

The ROC curve analysis revealed that the ideal SIRI cutoff was at 2.54 [area under the curve, 78.85%; 95% CI, 71.70% to 86.00%; sensitivity, 70.89%; and specificity, 84.14%]. Multivariate analysis indicated that SIRI ≤2.54 (odds ratio, 1.557, 95% CI, 1.269 to 1.840; P =0.021) was an independent predictor of favorable clinical outcomes in patients suffering from AIS after treatment with IVT.

CONCLUSIONS

We preliminary speculate that SIRI may serve as an independent predictor of clinical outcomes with AIS following IVT.

[Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction]

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO₂ before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO₂ value was higher (χ²=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ²=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ²=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ²=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.

[Discussion on teaching reform of oral histopathology in multiple classes]

In the information age, teaching methods are undergoing tremendous changes, and the traditional teaching methods are difficult to draw students' attention. As the core course of stomatology, oral histopathology is an important foundation for oral students. Along with the rapid development of medical science, it is imperative to deepen the reform of teaching. This article discussed the diversified teaching methods conducted in oral histopathology course in Zhejiang University School of Stomatology in the past 10 years with the core teaching theory of "learning before teaching" including the exploration design course, case based learning, journal club, etc. Diversified teaching methods activated students' subjective initiative, which laid a foundation for the next stage of clinical study, and provided a guiding framework for the future teaching reforms.

Comparison of size-resolved hygroscopic growth factors of urban aerosol by different methods in Tianjin during a haze episode

Size-resolved hygroscopic growth factors of urban aerosol during a haze episode were measured using a Humidified Tandem Differential Mobility Analyzer (HTDMA) (g_m(RH)). These factors were also derived from size-resolved particulate chemical composition combined with the κ-Köhler theory (g_κ(RH)) and the thermodynamic model ISORROPIA-II running in forward mode (g_iso-f(RH)) and reverse mode (g_iso-r(RH)), respectively. In terms of agreement among these hygroscopic growth factors, g_κ(RH) matched g_m(RH) best, followed by g_iso-r(RH). In contrast, g_iso-f(RH) demonstrated a poorer agreement with g_m(RH). The good consistency among g_m(RH), g_κ(RH), and g_iso-r(RH) was because they only focus on the physical hygroscopic process, whereas g_iso-f(RH) contains not only the direct influence of relative humidity (RH) on particle size but also the influence of gaseous precursor on the particle chemical composition, which indirectly affects the hygroscopicity of the particles. In this sense, size-resolved g_κ(RH) and g_iso-r(RH) in a wide size range are more adequate to investigate the impact of RH on light scattering and aerosol radiative forcing. At RH = 80%, g_κ(RH) for accumulation mode particles was 1.30-1.45 on polluted days and higher than that on clean days (1.2-1.3). Whereas on both polluted and clean days, g_κ(RH) of ultrafine and coarse mode particles were generally lower than 1.25. The strong hygroscopicity of accumulation mode particles observed on polluted days can deteriorate visibility due to their high extinction efficiency.

[Clinical features of 20 patients with phytosterolemia causing hematologic abnormalities]

Objective: To investigate the clinical and laboratory features of Phytosterolemia with hematological abnormalities. Methods: A retrospective study was performed on 20 patients with phytosterolemia admitted to the hematology department of the First Affiliated Hospital of Suzhou University during 2004-2017. History of patients was collected and the platelet counts, lipidomic analysis of plasma and osmotic fragility of erythrocytes were carried out. The erythrocyte and platelet morphology was examined by light microscope. Phytosterol levels in serum were measured by high performance liquid chromatography method. All of ABCG5/8 exons and intron-exon boundaries were amplified by PCR and directly sequenced to identify mutations. Results: All patients had been misdiagnosed as immune thrombocytopenia (ITP), or Evans syndrome with a mean delay of 21 years between symptom onset and accuracy diagnosis. The clinical manifestations of the patients were variable, but most of them presented with thrombocytopenia, anemia, splenomegaly from early ages, and xanthomas. Other major features were also observed, such as impaired liver functions (9 cases), premature atherosclerosis (5 cases) and/or arthritis (4 cases). Interestingly, all patients displayed an increased osmotic fragility of red cells and unique blood film features: large unequal platelets surrounded by a circle of vacuoles and various abnormal erythrocyte shapes, especially stomatocyte. Serum levels of the sitosterol and stigmasterol in the patients were remarkably elevated up to 331.05(276.00, 670.20)mg/L and 244.60(193.78,399.40)mg/L, about 10 and 24 times higher than those of normal subjects. There were 14 mutations in ABCG5/8 genes found in the patients. Among them, 2/3 of the mutations were in ABCG5 gene, including p.(E22X), p.(R446X),g.ISV7+3G>A, p.(R446X), p.(R419H), g.ISV7+3G>A, p.(G90E), p.(R389H) and g.7+2G>A), and 1/3 in ABCG8 gene involving p.(M614-K628del), p.(E25X), p.(L86P fs X185), p.(R263Q), p.(E500D fs X604) and p.(G674R) mutation. The ABCG5 p.(R446X) mutation was found in 3 separate families. Conclusions: The phenomena of thrombocytopenia/ stomatocyte/splenomegaly represents a special clinical manifestations of phytosterolemia, and distinct changes of blood cell morphology are the typical characters. Plasma plant sterols and ABCG5/ABCG8 genes should be analyzed when such hematologic abnormalities are unexplained.

[Studies on the role of chromobox protein homolog 2 in the inhibition of progression of hepatoma]

Objective: To explore chromobox protein homolog 2 (CBX2) expressions in relation to clinical features of patients and elucidate its role in the progression of hepatocellular carcinoma. Methods: Using the Cancer Genome Atlas (TCGA) database, R language was used to analyze the distribution of differentially expressed mRNA in hepatocellular carcinoma. The different expression of CBX2 in HCC and adjacent tissues and its relationship with survival and clinical characteristics of patients were further analyzed. The expression of CBX2 in liver tissues, liver cancer tissue, and L02, HepG2 and SMMC-7721 cell lines was detected by real time-PCR and western blot. The expression of CBX2 was interfered by siRNA in hepatoma cell line. MTT, colony formation, transwell assays, and flow cytometry were used to identify the proliferation, apoptosis, invasion and clone-formation ability of HepG2 and SMMC-7721 cells after CBX2 down-regulation. According to the different data, t-test, ANOVA, chi-square test, and COX regression model were used for statistical analysis. Survival curve was plotted through Kaplan-Meier method. Results: TCGA public database analysis showed that the expression of CBX2 mRNA in hepatocellular carcinoma tissues (7.296 ± 1.6115) was significantly higher than normal liver tissues (4.706 ± 0.940) (P = 0.000). In addition, the overall survival time of patients with low CBX2 mRNA expression was significantly longer than that of patients with high CBX2 mRNA expression [(5.971 ± 0.411) years vs. (4.650 ± 0.503) years, P = 0.001]. The expression level of CBX2 mRNA was correlated with the pathological TNM stage (P = 0.025) and differentiation degree (P < 0.001) of liver cancer. COX regression analysis showed that CBX2 mRNA expression was an independent predictor of patient survival (P = 0.013). siRNA was transfected and compared with the blank control group. The transgenic ability of HepG2 and SMMC-77221 cells decreased significantly at 72h (P < 0.05) and 96h (P < 0.05), and the apoptosis rate (11.430% ± 0.215%) was higher than blank control group (6.6 00% ± 0.170%) (P = 0.003). The number of invasive cells ((both P < 0.05) and relative colony forming cells ((both P < 0.001) were significantly decreased. In 20 cases of tissue samples, the expression of CBX2 protein (relative expression level 3.020 ± 0.269) in liver cancer was higher than that in adjacent tissues (relative expression level 0.886±0.065) (P < 0.001). The overall survival time of patients with low CBX2 expression in liver cancer was longer than that of patients with high expression [(3.670 + 0.576) years vs. (0.834 + 0.153) years, P = 0.004]. Conclusion: An evident high expression of CBX2 is an independent poor prognostic factor in hepatoma. Down-regulation of CBX2 expression can inhibit the progression of liver cancer. Therefore, CBX2 may be a prognostic biomarker and a new target for HCC treatment.

Analysis of mRNA Expression Patterns in Peripheral Blood Cells of 3 Patients With Cancer After the First Fraction of 2 Gy Irradiation: An Integrated Case Report and Systematic Review

Background

Radiation therapy induces acute and chronic radiological toxicity, in particular hematological toxicity (HT). This study aimed to explore the mechanistic clue and potential predictors at the messenger RNA (mRNA) level.

Materials and Methods

Peripheral blood was collected from 3 patients with cervical cancer (CC), nasopharynx cancer (NC), and tongue cancer (TC) after the first 2 Gy fraction of radiotherapy (RT). High-throughput sequencing was used to assess mRNA profiles.

Results

Eleven genes, such as ALAS2(5-aminolevulinate synthase), SLC4A1(solute carrier family 4 member 1), HBG2(hemoglobin subunit gamma 2), TNFAIP3 (TNF α-induced protein 3), PER1 (period circadian clock 1), CCDC136 (coiled-coil domain containing 136), C9orf84 (chromosome 9 open reading frame 84), IL1B (interleukin 1β), FOSB (FosB protooncogene), NR4A2 (nuclear receptor subfamily 4), PARP15 (polymerase family member 15), had overlapping expression changes in all 3 cancers of which 3 (ALAS2, FOSB, and HBG2) are suggested as potential predictors for the early diagnosis of HT after RT.

Conclusions

ALAS2, FOSB, and HBG2 may be useful predictors of HT in patients after RT. Eleven overlapping expression mRNAs among 3 cancers might be potential predictors for early diagnosis of radiation toxicity in patients.

Down-regulation of telomerase reverse transcriptase-related anti-apoptotic function in a rat model of acrylamide induced neurobehavioral deficits

Although the precise mechanism is unknown, neuron apoptosis is believed to participate in neuropathy caused by acrylamide (ACR). Telomerase reverse transcriptase (TERT) exhibits an anti-apoptotic function, but its contribution to the pathogenesis of ACR neurotoxicity is unclear. We investigated adult male rats that were given 30, 40 and 50 mg/kg ACR three times/week for 4 weeks. We found that ACR treatment caused significant deficits in sensory/motor function as measured by gait score, landing foot spread distance, movement initiation test and tail immersion test. Histological examination showed that the cerebral cortex in all ACR treated animals exhibited fewer neurons and more condensed nuclei than normal cortex. A significant increase in apoptosis was found in the cerebral cortex of rat brains subjected to ACR treatment in a dose-dependent manner. The expression of TERT in the brain was significantly reduced by ACR treatment. The pro-apoptotic cleaved caspase-3 protein level was increased, while the anti-apoptotic Bcl-2 protein level was decreased by 30 - 50 mg/kg ACR. Our findings indicate that TERT and its downstream regulators of neuron apoptosis, including Bcl-2 and cleaved caspase-3, were involved in ACR neurotoxicity.

Seasonal dynamics of the tick Haemaphysalis tibetensis in the Tibetan Plateau, China

The tick Haemaphysalis tibetensis (Acari: Ixodidae) Hoogstraal is an important arthropod vector widespread in the Qinghai-Tibet Plateau, and knowledge of its seasonal dynamics is still poor. The current study investigated the seasonal dynamics of the parasitic and non-parasitic H. tibetensis over a 2-year period from March 2014 to February 2016 in the Tibetan Plateau, China. During this timeframe, non-parasitic ticks were collected weekly by flag-dragging in grassland and shrubland areas, and parasitic ticks were removed weekly from selected sheep. Plateau pikas were captured using traps and examined for immature ticks between May to September 2014. Results suggest that non-parasitic H. tibetensis were mainly distributed in the grassland, and the parasitic adults and nymphs were found mostly on sheep. Larvae were usually found on Plateau pikas and the prevalence of infestation and mean parasitic intensity were 72.1 and 1.81%, respectively. Adults were observed from March to July with the major peak occurring in mid-April. Nymphs were found from March to August and reached a peak in late June. Larvae were collected from April to September, and their numbers peaked in late May. In the parasitic and non-parasitic period, the overall sex ratio of males to females was 1.62 and 1.30, respectively. Results show that H. tibetensis can complete one generation per year, with a population overlap between stages over the spring-summer months. These findings provide additional information on the biology and ecology of H. tibetensis as well as insights on its control in the environment and on sheep.

Stabilization of 4E-BP1 by PI3K kinase and its involvement in CHK2 phosphorylation in the cellular response to radiation

Objectives: 4E-BP1 is a family member of eIF4E binding proteins (4E-BPs) which act as the suppressors of cap-dependent translation of RNA via competitively associating with cap-bound eIF4E. RNA translation regulation is an important manner to control the cellular responses to a series of stress conditions such as ionizing radiation (IR)-induced DNA damage response and cell cycle controlling. This study aimed to determine the mechanism of 4E-BP1 stabilization and its potential downstream target(s) in the response to IR. Methods: PI3Ks kinase inhibitors were used to determine the signaling control of 4E-BP1 phosphorylation and protein stability. shRNA strategy was employed to silence the expression of 4E-BP1 in HeLa and HepG2 cells, and determine its effect on the irradiation-induced CHK2 phosphorylation. The protein degradation/stability was investigated by western blotting on the condition of blocking novel protein synthesis by cycloheximide (CHX). Results: The phosphorylation of 4E-BP1 at Thr37/46 was significantly increased in both HepG2 and HeLa cells by ionizing radiation. Depression of 4E-BP1 by shRNA strategy resulted in an incomplete G2 arrest at the early stage of 2 hours post-irradiation, as well as a higher accumulation of mitotic cells at 10 and 12 hours post-irradiation as compared to the control cells. Consistently, the CHK2 phosphorylation at Thr68 induced by IR was also attenuated by silencing 4E-BP1 expression. Both PI3K and DNA-PKcs kinase inhibitors significantly decreased the protein level of 4E-BP1, which was associated with the accelerated degradation mediated by ubiquitination-proteasome pathway. Conclusion: PI3K kinase activity is necessary for maintaining 4E-BP1 stability. Our results also suggest 4E-BP1 a novel biological role of regulating cell cycle G2 checkpoint in responding to IR stress in association with controlling CHK2 phosphorylation.

[Acquired von Willebrand syndrome in three patients and literature review]

OBJECTIVE

To deepen the understanding of acquired von Willebrand syndrome (AVWS).

METHODS

The clinical data of 3 patients were analyzed and related literature were reviewed.

RESULTS

① Case 1, a 70- year- old male, diagnosed as Waldenstrom macroglobulinemia and AVWS, was presented with spontaneous epitaxis and bruising. The VWF∶Ag level was 16%. Treatment was initiated with VWF concentrates. Two cycles of chemotherapy with Bortezomib, thalidomide and Dexamethasone were followed. Partial remission was achieved. Half- year' follow- up showed no sign of spontaneous hemorrhage. ② Case 2, a 48- year- old female, diagnosed as monoclonal gammopathy of undetermined significance and AVWS, was presented with repeated epitaxis. The VWF∶Ag level was 7%. Because the bleeding was slight and self-relieved, no specific treatment was addressed. She was followed up for one and a half year. ③ Case 3, a 50- year- old man, diagnosed as monoclonal gammopathy of undetermined significance and AVWS, was referred to our hospital for presentation with significant hematomas. VWF∶ Ag was reduced to 12%. VWF- containing cryoprecipitate, plasma, intravenous immunoglobulin and rituximab were used to control his bleeding symptom. During the follow-up, spontaneous hemorrhage still occurred occasionally.

CONCLUSIONS

Acquired von Willebrand syndrome presented with heterogeneous symptoms. The level of VWF∶Ag and VWF∶Rco for patients with bleeding disorder should be performed. Abnormal bleeding symptoms in elderly patients without personal or family history of bleeding should prompt consideration of the underlying disorders. Treatment included controlling acute bleeding, curing the underlying diseases and preventing bleeding in high- risk situations. The prognosis of acquired von Willebrand syndrome is mainly related to the underlying diseases.

Characterization of the Microbial Communities in the Ant Lion Euroleon coreanus (Okamoto) (Neuroptera: Myrmeleontidae)

Euroleon coreanus (Okamoto) is widely distributed in China, and the larval stage can be treated as traditional Chinese medicine. However, the host-bacterium relationship remains unexplored, as there is a lack of knowledge on the microbial community of ant lions. Hence, in the current study, we explored the microbial community of the larval ant lion E. coreanus using Illumina MiSeq sequencing. Results indicated that a total of 10 phyla, 126 genera, and 145 species were characterized from the second instars of E. coreanus, and most of the microbes were classified in the phylum Proteobacteria. Cronobacter muytjensii was the most abundant species characterized in the whole body and gut of E. coreanus, and the unclassified species in the genera Brevundimonas and Lactobacillus were relatively more abundant in the head and carcass. In addition, no Wolbachia-like bacteria were detected, whereas bacteria like Francisella tularensis subsp. Holarctica OSU18 and unclassified Rickettsiella were first identified in ant lion E. coreanus.

EVALUATION OF ANTIVIRAL THERAPY TREATMENT FOR LIVER CIRRHOSIS CAUSED BY CHRONIC HEPATITIS C AND HEPATITIS C BY 31P-MRS, BASED ON METABOLITE DETECTION

This study discusses the application of magnetic resonance spectrum (MRS) to evaluate the efficacy of antiviral therapy in the treatment of liver cirrhosis caused by chronic hepatitis C and hepatitis C, based on metabolite detection. A total of 54 patients with liver cirrhosis caused by chronic hepatitis C and hepatitis C were selected and divided into treatment group and control group. 31P-MRS imaging was carried out on patients in the two groups both before receiving antiviral treatment and 6 months after treatment to compare the change of metabolite ratio (PE+PC)/(GPE+GPC). It was revealed that no statistically significant difference was found in the comparison of (PC+PE)/(GPC+GPE) ratio in the two groups before treatment, but the difference was found 6 months after treatment; ratio of (PC+PE)/ (GPC+GPE) in the treatment group distinctly decreased 6 months after treatment compared to before treatment, with a statistically significant difference, while the control group had no remarkable change or statistical significance. Moreover, 32 patients were found with sustained virus response to antiviral therapy. Of these, 25 patients possessed a decreased ratio of (PC+PE)/ (GPC+GPE), 4 remained without change and 3 had a slightly increased ratio after antiviral treatment. Of 12 patients with no response, 1 had a decreased ratio of (PC+PE)/ (GPC+GPE), 2 remained without change and 9 had a slightly increased ratio. The differences were all statistically significant in comparison of the two groups. 31P-MRS is thought to be effective for evaluating the efficacy of antiviral therapy through non-invasive detection of liver energy metabolism.

Morphological characteristics and developmental changes of the ovary in the tick Haemaphysalis longicornis Neumann

Haemaphysalis longicornis (Ixodida: Ixodidae) is an important vector of transovarially transmitted parasites of the genus Babesia (Piroplasmida: Babesiidae). In the present study, we investigated the morphological characteristics and developmental changes of the ovary of H. longicornis. We show that the ovary of H. longicornis has a single tubular structure and is surrounded by a tunica propria. There is a longitudinal groove along one side of the ovary. During feeding and after engorgement, great changes can be observed in the ovary of H. longicornis and two rapid growth phases can be detected. The number of major protein bands of the ovary is significantly increased from day 3 of feeding and reaches a maximum on the day of engorgement. Therefore, the great diversity of proteins in the ovaries of H. longicornis can facilitate the identification of new targets for vaccine development.

Vector-mediated expression of interferon gamma inhibits replication of hepatitis B virus in vitro

Despite the existence of efficient vaccines against hepatitis B virus (HBV) infections, these still represent a serious threat to human health worldwide. Acute HBV infections often become chronic, marked by liver cirrhosis and hepatocellular carcinoma. Promising results with interferons alpha or gamma (IFN-α, γ) or nucleoside/nucleotide analogs in inhibiting HBV replication in vitro have led to therapeutic applications to chronic HBV patients, however, their results so far have not been satisfactory. The treatments were either not effective in all patients or had adverse effects. Certain progress was expected from expression of interferons targeted to liver by adenovirus vectors, however, this approach turned out to be limited by undesired expression of toxic viral genes and high production costs. Therefore, in this study, we attempted to inhibit HBV replication in HepG2.2.15 cells by human IFN-γ expressed through a non-viral vector, an eukaryotic plasmid. The results demonstrated that IFN-γ, targeted to HBV-replicating cells, significantly inhibited the virus growth without inducing apoptosis and indicated that local expression of this kind of cytokine may be a promising strategy of gene therapy.

RNAi-mediated knockdown of FANCF suppresses cell proliferation, migration, invasion, and drug resistance potential of breast cancer cells

Fanconi anemia complementation group F protein (FANCF) is a key factor, which maintains the function of FA/BRCA, a DNA damage response pathway. However, the functional role of FANCF in breast cancer has not been elucidated. We performed a specific FANCF-shRNA knockdown of endogenous FANCF in vitro. Cell viability was measured with a CCK-8 assay. DNA damage was assessed with an alkaline comet assay. Apoptosis, cell cycle, and drug accumulation were measured by flow cytometry. The expression levels of protein were determined by Western blot using specific antibodies. Based on these results, we used cell migration and invasion assays to demonstrate a crucial role for FANCF in those processes. FANCF shRNA effectively inhibited expression of FANCF. We found that proliferation of FANCF knockdown breast cancer cells (MCF-7 and MDA-MB-435S) was significantly inhibited, with cell cycle arrest in the S phase, induction of apoptosis, and DNA fragmentation. Inhibition of FANCF also resulted in decreased cell migration and invasion. In addition, FANCF knockdown enhanced sensitivity to doxorubicin in breast cancer cells. These results suggest that FANCF may be a potential target for molecular, therapeutic intervention in breast cancer.

An exploration of the extended lymph node dissection and skeletonization of the vasculature for pancreatic adenocarcinoma

About 50%-90% of patients with pancreas carcinoma are found to have metastatic tumors when diagnosis is confirmed. The metastasis routes include via circulation system, lymph-node, and invasion to solar nerve plexus which usually occurs in 70% of patients. Pancreatoduodenectomy (PD) is the routine operation performed for pancreas carcinoma. There is also operation plan suggesting the resection of the nerve plexus and soft tissue distributing along the artery vessels, and the nerve fiber bat around the pancreas. This operation is also named as skeletonization of the vasculature. There have been different point-views from different surgery groups, on whether the extended lymphadenectomy (ELND) can extend the survival length and improve life quality of patients or not. However, ELND is considered to be possible to prolong the survival time for the patients with positive nodal metastasis.

Microsurgical Reconstruction of the Amputated Hand

Fourteen successful results in 16 cases of microsurgical reconstruction of uni- and bilateral hand amputations are reported. Metacarpal reconstruction included the use of titanium alloy for artificial metacarpi, autogenous metatarsals, and autogenous iliac bone grafts. Uni- and bilateral single and multiple donor toes were used in various combinations. Basic hand function and functional sensibility were restored in 14 of 16 cases. There was minimal donor site functional impairment.

Reconstruction of the Thumb by Free Skin Flap of the Big Toe

Experience with 12 cases of thumb reconstruction is reported, utilizing a free skin flap from the big toe and remodelled iliac bone graft, to create metacarpal and phalangeal configuration. Results show that the reconstructed thumbs have good functional recovery, cosmetic appearance, and varying degrees of sensation. The procedure preserves the big toe of the donor foot and produces minimal impairment.

Over-expression of DNA-PKcs in hepatocarcinoma tissues and the antiproliferative effect mediated by down-regulating its expression with siRNA

AIM: To characterize the difference in DNA-dependent protein kinase catalytic subunit (DNA-PKcs) expression between hepatocarcinoma tissues and non-tumor liver tissues, and to understand the biological significance of the altered expression of DNA-PKcs in cancer cells.

METHODS: DNA-PKcs expression was examined in 86 specimens of hepatocarcinoma and hepatic cholangiocarcinoma by immunohistochemistry analysis on tissue-arrays and ordinary pathological tissue slices. DNA-PKcs protein was detected in culture cells by Western blotting analysis. The siRNA was used to silence DNA-PKcs expression in HepG2 cells. Cell proliferation was evaluated by growth curve analysis, and radiosensitivity was tested using a colony-forming ability assay.

RESULTS: Tissue-array analysis showed that the proportions of cases with a DNA-PKcs expression level of < 25% (very low), 25%-50% (low), 51%-75% (medium) and > 75% (high) were 15%, 20%, 23.3% and 41.7%, respectively, among the 60 hepatocarcinoma tissue specimens. The proportions of the 64 normal liver tissues showing these DNA-PKcs expression levels were 68.7%, 10.9%, 12.6% and 7.8%, respectively. This result indicated that DNA-PKcs expression in cancer tissues was significantly higher than that in normal tissues (P = 0.0008). Immunohistochemistry analysis of ordinary pathological tissue slices also showed that DNA-PKcs levels in the hepatocarcinoma and hepatic cholangiocarcinoma tissues (total 26 specimens) were higher than those in the non-tumor liver tissues (P = 0.001). Moreover, the cultured human liver cancer cell lines HepG2, 7721 and 7402 also exhibited much higher levels of DNA-PKcs than normal liver LO2 cells. Silencing of DNA-PKcs mediated by siRNA resulted in not only an increased sensitivity of HepG2 cells to ionizing radiation, but also decreased proliferation HepG2 cells. We further demonstrated that the expression of c-Myc oncoprotein was also depressed following the down-regulation of DNA-PKcs.

CONCLUSION: DNA-PKcs is overexpressed in hepatocarcinoma tissues as well as cultured liver cancer cells. Targeting DNA-PKcs is an anticancer strategy acting through at least two mechanisms: directly decreasing the proliferation of cancer cells via, at least, depressing c-Myc oncoprotein; and sensitizing cancer cells to radiotherapy or chemotherapy with DNA-damaging agents.

Thumb reconstruction in a bilateral upper extremity amputee: an alternative to the Krukenburg procedure

A 23-year-old man sustained traumatic loss of both hands. His left defective forearm underwent lengthening with a 3-cm segment of the ipsilateral radius; this was immediately followed by an ipsilateral second toe microvascular transfer to the stump of the radius to provide pinch. Two years after the procedure the reconstructed hand had recovery of both motion and sensibility.

Modulatory effect of esophageal intraluminal mechanical and chemical stressors on salivary prostaglandin E2 in humans

As has been demonstrated, infusion of hydrochloric acid (HCl) and pepsin into the human esophageal lumen, which mimics the natural gastroesophageal reflux, results in a significant increase in salivary volume, salivary bicarbonate and epidermal growth factor. However, the impact of intraluminal acid/pepsin solution on salivary prostaglandin E2 (sPGE2), the major protective factor of the upper alimentary tract, has never been explored. Therefore, using the newly developed esophageal perfusion model, the impact of both mechanical and chemical stimuli of the esophagus on sPGE2 secretion in humans was studied. Salivary PGE2 was assessed in saliva collected during basal conditions, chewing of parafilm, placement of intraesophageal tubing, inflation of intraesophageal balloons, and perfusion with sodium chloride, HCl, or HCl/pepsin solutions. The concentration of sPGE2 was measured using the RIA kit from Amersham (Arlington Heights, IL) after the solid-phase extraction and derivatization. The concentration of sPGE2 in the basal saliva was (mean +/- standard error of mean) 186 +/- 31 pg/mL and was similar during the chewing of parafilm (171 +/- 32 pg/mL). The placement of intraesophageal tubing, however, resulted in a significant decline of sPGE2 concentration to the value of 91 +/- 22 pg/mL (P < 0.01). This decline was maintained when intraesophageal balloons, which compartmentalized a 7.5 cm perfused segment of the esophagus, were inflated (86 +/- 17 pg/mL; P < 0.01). This decline was potentiated further when subsequent perfusion with saline was implemented to reach the lowest value of 46 +/- 17 pg/mL (P < 0.001 versus basal and P < 0.05 versus tubing and balloon evoked values) at the end of the perfusing procedure. Esophageal perfusion with acid and acid/pepsin solution, however, partly restored the significant decline in sPGE2 concentration observed during prolonged perfusion with saline. The sPGE2 output during basal conditions was 89 +/- 13 pg/min and increased dramatically during stimulation by placement of intraesophageal tubing (241 +/- 48 pg/min; P < 0.01) and inflation of intraesophageal balloons (244 +/- 48 pg/min; P < 0.01). Subsequent esophageal perfusion with saline resulted in a gradual decline of sPGE2 output evoked by mechanical stimuli that reached the final value of 178 +/- 39, which was not significantly different from that observed in the basal condition (P < 0.1 versus basal value). Introduction of HCl and pepsin into the perfusing solution significantly prevented the decline of sPGE2 output observed during perfusion with saline (252 +/- 36 pg/min; P < 0.01 versus basal). The modulatory impact of mechanical and chemical stimulation on sPGE2, demonstrated for the first time in humans, may suggest the potential contribution of salivary prostanoids to the maintenance of the integrity of the esophageal mucosa.

[Study of psychological nursing to ease pain during labor]

100 labouring women were selected in the hospital and divided into psychological support group and control group randomly (50 in each group) in this study. The former was given psychological education and support by special staff and the later was managed in routine methods. The result showed that the serious pain rate of the psychological support group was lower than that of the control group in the first stage of labour (P < 0.01). There was a significant difference between the pain levels in two groups in the second stage of labor (P < 0.05). The time of the first stage, the second stage, and total labor course in the psychological support group was shorter than that of the control group (P < 0.05). The normal labor rate of the psychological support group was much higher than that of the control group (P < 0.001). This study indicated that providing psychological support to the parturients may reduce the pain level during delivery and decrease the difficult labor rate.

Distribution of three nicotinic receptor alpha 4 mRNA transcripts in rat brain: selective regulation by nicotine administration

Northern blot analysis determined whether multiple alpha 4 transcripts for neuronal nicotinic receptors in rat brain could be detected as distinct bands. When poly(A)+ RNA was isolated from brain regions and hybridized with a Hinfl fragment of alpha 4-1 cDNA containing a sequence shared by both alpha 4-1 and alpha 4-2, but little homology with other alpha or beta subunits, bands at 6.0, 4.6, and 2.6 kb were obtained. When a Taql fragment with selectivity for alpha 4-1 was used, a single band was present at 6.0 kb. The 6.0-kb band was least abundant in all brain regions; the 2.6-kb band was most abundant in frontal cortex, hippocampus, striatum, basal forebrain, and thalamus, whereas the 4.6-kb band was most abundant in midbrain and cerebellum. Nicotine (3.6 mumol/kg, a.c., twice daily) increased the abundance of the 4.6-kb transcript in frontal cortex significantly by 28% following 2.5 days of injections; the 6.0- and 2.6-kb transcripts were unchanged. Nicotine did not affect alpha 4 transcripts in other brain regions. Results suggest that increased mRNA levels may mediate the nicotine-induced up-regulation of receptors in cerebral cortex.

[Protective effect of endothelium-derived relaxing factor on ischemic (hypoxic) and reperfused (reoxygenated) myocardium]

The present study is undertaken to investigate the effects of NO, its inhibitor L-NNA and its procursor L-Arg on the status of myocardial tissue during ischemia (hypoxia) and reperfusion (reoxygenation) in two different models, i.e. Langendorff heart and cultured heart cells of rat. The results were as follows: (1) When heart perfusion was stopped for 30 min and reinstitued for 20 min with K-H buffer containing NO, the coronary flow rate (CFR), left ventricular pressure (LVP) and +/- dp/dtmax increased significantly. When NO was replaced by L-NNA opposite effects were observed. L-Arg alone was without effect on CFR, LVP and +/- dp/dtmax, but attenuated the decreasing effect of L-NNA on CFR. NO decreased MDA and NAGase content of myocardium while L-NNA increased them. (2) When cultured ventricular myocytes were subjected to hypoxia for 30 min and reoxygenated for 20 min, none of the substances under investigation showed any effects on Ca2+ content of heart cells, but all of them decreased MDA, NAGase content of the culture tissue after reoxygenation. The above findings show that NO plays an important role in protecting myocardium from ischemic and reperfused injury by improving blood supply of reperfused myocardium and attenuation of oxygen free radical injury.

[Study of H(+)-Ca2+ exchange in cultured heart cells after hypoxia and reoxygenation]

Reoxygenation is more serious for hypoxic myocardial cells because of the subsequent calcium overload. The calcium overload is known due to augmentation of H(+)-Na+, Na(+)-Ca2+, exchange during pH paradox. But the present experiment showed that, when H(+)-Na+, Na(+)-Ca2+ exchange was inhibited, calcium could still enter myocardial cells after hypoxia or reoxygenation. Similar result was observed after using Na(+)-Free solution, suggesting that calcium entrance into the cell was unrelated to Na+ channel. It was further shown that calcium accumulation was related to pH gradient across the myocardial cell membrane, i.e., being increased with increase of H+ concentration in the cell. Therefore, it appears that, besides H(+)-Na+, Na(+)-Ca2+ exchange, H(+)-Ca2+ exchange is one of the reasons of calcium overload during intracellular pH paradox.

Chronic nicotine administration differentially affects neurotransmitter release from rat striatal slices

The objective of these experiments was to determine whether the chronic administration of nicotine, at a dose regimen that increases the density of nicotine binding sites, alters the nicotine-induced release of [3H]-dopamine ([3H]DA), [3H]norepinephrine ([3H]NE), [3H]-serotonin ([3H]5-HT), or [3H]acetylcholine ([3H]ACh) from rat striatal slices. For these experiments, rats received subcutaneous injections of either saline or nicotine bitartrate [1.76 mg (3.6 mumol)/kg, dissolved in saline] twice daily for 10 days, and neurotransmitter release was measured following preloading of the tissues with [3H]DA, [3H]NE, [3H]5-HT, or [3H]choline. Chronic nicotine administration did not affect the accumulation of tritium by striatal slices, the basal release of radioactivity, or the 25 mM KCl-evoked release of neurotransmitter. Superfusion of striatal slices with 1, 10, and 100 microM nicotine increased [3H]DA release in a concentration-dependent manner, and release from slices from nicotine-injected animals was significantly (p < 0.05) greater than release from saline-injected controls; release from the former increased to 132, 191, and 172% of release from the controls following superfusion with 1, 10, and 100 microM nicotine, respectively. Similarly, [3H]5-HT release increased in a concentration-related manner following superfusion with nicotine, and release from slices from nicotine-injected rats was significantly (p < 0.05) greater than that from controls. [3H]5-HT release from slices from nicotine-injected rats evoked by superfusion with 1 and 10 microM nicotine increased to 453 and 217%, respectively, of release from slices from saline-injected animals. The nicotine-induced release of [3H]NE from striatal slices was also concentration dependent but was unaffected by chronic nicotine administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Site and mechanism of behavioral tolerance to cocaine: a study of dopamine release in Wistar-Kyoto and spontaneously hypertensive rats

Wistar-Kyoto and spontaneously hypertensive rats received i.v. infusions of cocaine hydrochloride (60 mg/kg per day) for 3, 7, and 14 days, or saline for 7 days. Acute cocaine challenge (40 mg/kg, s.c.) was given to treated and control rats 24 hr after the termination of each infusion period. There were no strain differences in brain levels of cocaine during cocaine infusion, nor after cocaine challenges. There were no strain differences in resting levels of [3H]dopamine release. Release of [3H]dopamine decreased in nuclei accumbens of 7- and 14-day cocaine-infused animals. Release of [3H]dopamine was maximal in both brain regions 2 hr after acute cocaine challenge. After 14 days of cocaine infusion, cocaine challenge in both strains reduced [3H]dopamine release in the nucleus accumbens, but not in the striatum; the reduction being greater in Wistar-Kyoto rats. The behavioral tolerance which accompanies similar cocaine infusion regimens may be related to striatal "tolerance" to cocaine-induced dopamine release.

[Chinese material medica combined with cisplatin and lipiodol through transcatheter arterial embolization in the treatment of primary hepatoma]

Transcatheter arterial embolization (TAE) using hydroxycamptothecin, cantharidin and cisplatin which were mixed thoroughly with lipiodol, combined with large doses interferon and interleukin-2 as adoptive immunotherapy were carried out in the treatment of 48 patients with unresectable advanced stage primary hepatoma, evaluation of therapeutic effect showed that partial remission rate was 54.2%, significantly higher than that of embolization group using chemotherapeutic agents alone (cisplatin, adriamycin and mitomycin), the partial remission rate was 32.1% (P < 0.01). The side effects of camptothecin and cantharidin including hematuria, urodynia were also successfully eliminated.

[Repair of large soft tissue defects in the lower extremity of children by bilateral latissimus dorsi myocutaneous flap transference]

Large soft tissue defects of the lower extremity of 8 children was repaired with latissimus dorsi myocutaneous flaps. The age of the children ranged from 6 to 9 years. Both functional recovery and cosmetic appearance of the repaired limbs were satisfactory. Cross-bridge vascular anastomoses were used in four cases because no vessels were available for anastomosis at the recipient site. No significant functional impairments have been noted at the donor site. Operative techniques, indications for this procedure and related problems are discussed.

Effects of acute and subacute cocaine administration on the CNS dopaminergic system in Wistar-Kyoto and spontaneously hypertensive rats: III. Dopamine uptake

The characteristics of dopamine uptake after acute and subacute cocaine administration were determined in striata from WKY and SHR. In acutely-treated (40 mg/kg, s.c.) rats, significant increases in the Vmax of dopamine uptake were observed 30 min after the cocaine injection in both strains, without changes in Km values. The in vitro IC50 for cocaine was significantly decreased at 30 min in WKY and at 2 h in SHR. However, the in vitro IC50 for GBR-12909 was significantly increased at 30 min and at 2 h in both strains following cocaine administration. In both strains, the density (Bmax) of the [3H]GBR-12935 binding site was significantly increased at 30 min and at 2 h with no changes in Kd. In subacutely-treated (20 mg/kg, twice daily for 3 or 7 days) rats, a significant increase in the Km for dopamine uptake was observed in 7 day treated SHR. The in vitro IC50 for GBR-12909 was significantly increased in 3 day treated WKY. The results suggest that cocaine administration alters dopamine uptake and characteristics of dopamine uptake sites in the rat brain.

Effects of acute and subacute cocaine administration on the CNS dopaminergic system in Wistar-Kyoto and spontaneously hypertensive rats: I. Levels of dopamine and metabolites

Effects of acute and subacute cocaine administration on dopamine (DA) and its metabolites in striata and nucleus accumbens of nine week-old Wistar-Kyoto and spontaneously hypertensive rats were studied. Levels of DA,3,4-dihydroxphenylacetic acid (DOPAC) and homovanillic acid (HVA) were determined by HPLC-EC. There were no differences in DA levels in striata and nucleus accumbens between control WKY and SHR. Levels of DA in two brain regions were unaffected in groups treated acutely with cocaine. Both strains showed a significant increase in striatal HVA 2 hr after cocaine injection. Seven day treatment declined DA levels in striatum of WKY and in nucleus accumbens of SHR. However, only WKY treated subacutely with cocaine showed significantly increased HVA either with or without changes in DOPAC in nucleus accumbens and striatum, respectively. Increased DOPAC/DA and HVA/DA ratios appeared only in striatum of WKY and in nucleus accumbens of SHR following subacute treatment. These results suggest that subacute cocaine administration affects DA levels in striata and nucleus accumbens differently between WKY and SHR.

Effects of acute and subacute cocaine administration on the CNS dopaminergic system in Wistar-Kyoto and spontaneously hypertensive rats: II. Dopamine receptors

The characteristics of D-1 and D-2 dopamine receptors after acute and subacute cocaine administration were determined in striata and nuclei accumbens from WKY and SHR. In striata from acutely treated rats, significant increases in D-2 receptor density were observed at 30 min, 2 or 24 h following cocaine injection in both strains without changes in affinities. The density of D-1 receptors was significantly decreased 30 min after the injection in WKY, but not in SHR. In striata from subacutely treated rats, the density of D-1 receptors was significantly increased in 3- and 7-day treated WKY, but not in SHR. The affinities of both binding sites remained unchanged. In nuclei accumbens, the change in both D-1 and D-2 receptors after cocaine administration were similar to those observed in the striatum. The results suggest that cocaine administration alters dopamine receptor binding characteristics. Furthermore, D-1 and D-2 dopamine receptors appear to be differently regulated.

Prevention of soman toxicity after the continuous administration of physostigmine

Protective effects of continuous administration of physostigmine alone, or in addition to scopolamine, against soman-induced toxicity were studied in guinea pigs. The results clearly demonstrated that treatment with physostigmine continuously via implanted mini-osmotic pumps for 4 or 7 days prior to soman exposure significantly protected from soman-induced mortality. In vehicle-infused guinea pigs, tremors, convulsions and loss of righting reflex occurred prior to their deaths induced by soman. Although all of the guinea pigs which received physostigmine pretreatment for 4 days prior to soman administration also displayed soman-induced tremors and convulsions, the onsets of these symptoms were significantly delayed. When animals continuously treated with physostigmine received injections of scopolamine 10 min prior to soman injections, there was a decreased incidence of all three toxicity symptoms as well as an increase in the latency to onset of tremors. Scopolamine was also able to reverse toxicity symptoms when soman was administered earlier. In animals which had been continuously treated with physostigmine via mini-osmotic pumps, the protective action against soman-induced toxicity was still apparent. On the contrary, acute physostigmine administration failed to protect against soman lethality. The present results suggest that the prophylactic uses of physostigmine via mini-osmotic pumps might be more useful than the acute bolus administration of physostigmine.

The use of bilateral latissimus dorsi myocutaneous flaps to cover large soft tissue defects in the lower limbs of children

Large soft tissue lower leg defects in children, especially those around joints, can cause severe secondary and progressive deformity and can interfere with growth of the affected limb. If function is to be restored and possible amputation prevented, repair procedures are necessary. Eight children with such defects, ranging from six to nine years of age, have been treated successfully, using bilateral latissimus dorsi myocutaneous flaps. All the flaps survived, and both functional recovery and cosmetic improvement of the repaired limbs have been satisfactory. Cross-bridge flaps from the contralateral leg were used in four of the cases because no vessels were available for anastomosis at the recipient site. No significant functional impairments at the donor site have been noted. Operative techniques, indications for the procedure, and related problems are discussed.

Reconstruction of a digitless hand

A digitless left hand was reconstructed by transplanting a big toe skin-nail flap and the adjacent second and third toes taken from the left foot and the second and third toes taken from the right foot. Five months follow-up showed satisfactory functional recovery and cosmetic results. The digits have regained normal sensibility and possess independent motor ability.

Combined transplantation of free tissues

Combined transplantation of free tissues is a new microsurgical technique by which, with only one set of vessels supplying blood, two or more free tissues can be transplanted simultaneously. Very large soft-tissue defects that are not amenable to conventional transplantation, or defects of two or more tissues, either similar or different in nature, can be repaired in a one-stage operation. It is accomplished by vascular combination; i.e., by means of anastomosing the corresponding vessels of their pedicle, the free tissues to be transplanted are reconstituted into an assembly with only one common vascular pedicle which is then rejoined to the vessels selected to supply blood to the grafts in the recipient site. From December of 1983 to July of 1985, the author has performed 17 combined free-tissue transplantations of seven different clinical types for microsurgical repair and reconstruction of extremities. All the transplanted parts survived, and the extremities regained very good function. Seven patients are reported individually in the paper, each representing a definite clinical type. The concepts and operative technique introduced and the indications and advantages of the newly designed procedure are discussed.

The diagnostic value of a hepatoma-specific band of serum gamma-glutamyl transferase

Using a vertical slab electrophoretic apparatus loaded with polyacrylamide stage gel plate, we observed a total of II bands of gamma-glutamyl transferase (EC 2.3.2.2,GGT) on a gel plate and designated these GGT I-XI by order of distance beginning at the positive pole. Positive GGT II was found in 81 (90%) of 90 cases of primary hepatic carcinoma (PHC), in 9(90%) of 10 cases of secondary hepatic carcinoma (SHC), and in only 4 (3.1%) of a total of 128 cases of acute and chronic liver disease. There was one case with positive GGT II among 45 cases of cancer of ampulla of Vater, but the possibility of hepatic metastasis could not be excluded. No GGT II was found in a total of 250 healthy persons and 21 pregnant women. PHC patients with negative alpha-fetoprotein (AFP) had a positive GGT II rate of 84.6%, whereas in those with negative GGT II the positive rate for AFP was only 44.4%.