Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients

Background

Significant histopathologic changes of hepatic injury (SHCHI) play a decisive role in evaluating the condition and initiating antiviral in hepatitis B virus (HBV)-infected patients, especially those with normal or mildly elevated alanine transaminase levels. Considering that non-invasive methods were established through experience with chronic hepatitis C, the aim of this study was to establish and verify a nomogram based on hepatitis B for diagnosing SHCHI.

Methods

Three hundred eighty-four patients who fulfilled requirements for participation were randomly assigned to training cohort (n=270) and validation cohort (n=114) according to 7:3. The selection criteria for clinical factors were based on the previous research papers. SHCHI was subgrouped as followed: grade ≥ G2 inflammation and/or stage ≥ S2 fibrosis. The predictive accuracy and discriminative ability of nomogram were determined by a concordance index (C-index), calibration curve and the area under the receiver-operating characteristic curve (AUROC). We also compared diagnostic value of nomogram with model for AST-to-PLT ratio index (APRI) score and model for Fibrosis-4 (FIB-4) score.

Results

Two hundred and two patients (74.44%) and 87 patients (76.32%) were diagnosed as SHCHI, in the training and validation cohort. Logistic regression analysis illustrated that hepatitis B e antigen (HBeAg), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT), and prothrombin time (PT) all independently served as risk factors for SHCHI (P<0.05) and were thus utilized to create the nomogram. The nomogram had well-fitted calibration curves and attained excellent concordance indices of 0.80 and 0.75. The sensitivity of nomogram in the diagnosis of SHCHI was 79.7%, the specificity was 68.1%. The area under the curve {AUC; 0.80 [95% confidence interval (CI): 0.74-0.86]} for diagnosing SHCHI by the nomogram was greater in comparison to that of APRI [0.78 (95% CI: 0.71-0.84)], and FIB-4 [0.76 (95% CI: 0.69-0.82)]. Patients with nomogram scores less than 119 were considered to have a lower risk of SHCHI.

Conclusions

The constructed nomogram is suitable to serve as a SHCHI screening tool in chronic HBV-infected patients. But the dependability of the nomogram will necessitate further confirmation in a prospective study and further external validation is needed.

Gene testing for osteonecrosis of the femoral head in systemic lupus erythematosus using targeted next-generation sequencing: A pilot study

BACKGROUND

Previous publications indicated that genetic predisposition might play important roles in the onset of osteonecrosis of the femoral head (ONFH) in systemic lupus erythematosus (SLE). Some gene loci such as complement C3d receptor 2 (CR2), nitric oxide synthase 3 (NOS3), collagen type II alpha 1 chain (COL2A1), protein tyrosine phosphatase non-receptor type 22 (PTPN22), and transient receptor potential cation channel subfamily V member 4 (TRPV4) were reported to be involved in this process.

AIM

To investigate whether the risk of ONFH in SLE is associated with single nucleotide variations (SNVs) in these five genes.

METHODS

SNVs in the CR2, NOS3, COL2A1, PTPN22, and TRPV4 genes were examined by using FastTarget and Illumina Miseq sequencing technologies in 49 cases of SLE with ONFH. Burrows–wheeler aligner was used to align the sequencing reads to hg19, and GATK and Varscan programs were used to perform SNV calling. PolyPhen-2, SIFT, and MutationTaster were used to assess the functional effects of non-synonymous SNVs.

RESULTS

Six of the 49 patients were confirmed to have low frequency SNVs, including one patient with SNVs in NOS3 (exon 6: c.814G>A: p.E272K and exon 7: c.814G>A: p.E272K.), four in COL2A1 (rs41263847: exon 29: c.1913C>T: p.T638I, exon 28: c.1706C>T: p.T569I, and rs371445823: exon 8: c.580G>A: p.A194T, exon 7: c.373G>A: p.A125T), and one in CR2 (rs45573035: exon 2: c.200C>G: p.T67S).

CONCLUSION

The onset of ONFH in SLE might be associated with the identified SNVs in NOS3, COL2A1, and CR2.

The emission of γ-Ray beams with orbital angular momentum in laser-driven micro-channel plasma target

We investigated the emission of multi-MeV γ-Ray beams with orbital angular momentum (OAM) from the interaction of an intense circularly polarized (CP) laser with a micro-channel plasma target. The driving laser can generate high energy electrons via direct laser acceleration within the channel. By attaching a plasma foil as the reflecting mirror, the CP laser is reflected and automatically colliding with the electrons. High energy gamma-photons are emitted through inverse Compton scattering (ICS) during collision. Three-dimensional particle-in-cell simulations reveal that the spin angular momentum (SAM) of the CP laser can be transferred to the OAM of accelerated electrons and further to the emitted gamma-ray beam. These results may guide future experiments in laser-driven gamma-ray sources using micro-structures.

Pancreatic Stent or Rectal Indomethacin-Which Better Prevents Post-ERCP Pancreatitis?: A Propensity Score Matching Analysis

We investigated and compared 2 clinical strategies to prevent postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).We retrospectively reviewed data from patients who underwent ERCP between 2008 and 2014. Of 623 patients at high risk for PEP, 145 were treated with prophylactic pancreatic stent placement (PSP) only, and 478 were treated with rectal indomethacin (RI) only, for PEP prevention. Patients were matched by one-to-one propensity score matching (PSM) by risk factors, with overall PEP incidence as primary outcome, and moderate or severe PEP and complication rates as secondary outcomes.Of 623 patients with high-risk factors, 145 pairs were generated after PSM. Thirty-two patients developed pancreatitis-10 (6.9 %) in the PSP group and 22 (15.2 %) in the RI group (P = 0.025). Moderate-to-severe pancreatitis developed in 5 patients (2.8%) in the PSP group and 14 patients (9.7 %) in the RI group (P = 0.047).Although indomethacin represents an easy, inexpensive treatment, prophylactic PSP is still the better prevention strategy for PEP.

Ursodeoxycholic acid induces apoptosis in hepatocellular carcinoma xenografts in mice

AIM: To evaluate the efficacy of ursodeoxycholic acid (UDCA) as a chemotherapeutic agent for the treatment of hepatocellular carcinoma (HCC).

METHODS: BALB/c nude mice were randomized into four groups 24 h before subcutaneous injection of hepatocarcinoma BEL7402 cells suspended in phosphate buffered saline (PBS) into the right flank. The control group (n = 10) was fed a standard diet while treatment groups (n = 10 each) were fed a standard daily diet supplemented with different concentrations of UDCA (30, 50 and 70 mg/kg per day) for 21 d. Tumor growth was measured once each week, and tumor volume (V) was calculated with the following equation: V = (L × W²) × 0.52, where L is the length and W is the width of the xenograft. After 21 d, mice were killed under ether anesthesia, and tumors were excised and weighed. Apoptosis was evaluated through detection of DNA fragmentation with gel electrophoresis and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay. Western blot analysis was performed to determine the expression of apoptosis-related proteins BAX, BCL2, APAF1, cleaved caspase-9, and cleaved caspase-3.

RESULTS: UDCA suppressed tumor growth relative to controls. The mean tumor volumes were the following: control, 1090 ± 89 mm³; 30 mg/kg per day, 612 ± 46 mm³; 50 mg/kg per day, 563 ± 38 mm³; and 70 mg/kg per day, 221 ± 26 mm³. Decreased tumor volumes reached statistical significance relative to control xenografts (30 mg/kg per day, P < 0.05; 50 mg/kg per day, P < 0.05; 70 mg/kg per day, P < 0.01). Increasing concentrations of UDCA led to increased DNA fragmentation observed on gel electrophoresis and in the TUNEL assay (control, 1.6% ± 0.3%; 30 mg/kg per day, 2.9% ± 0.5%; 50 mg/kg per day, 3.15% ± 0.7%, and 70 mg/kg per day, 4.86% ± 0.9%). Western blot analysis revealed increased expression of BAX, APAF1, cleaved-caspase-9 and cleaved-caspase-3 proteins, which induce apoptosis, but decreased expression of BCL2 protein, which is an inhibitor of apoptosis, following administration of UDCA.

CONCLUSION: UDCA suppresses growth of BEL7402 hepatocellular carcinoma cells in vivo, in part through apoptosis induction, and is thus a candidate for therapeutic treatment of HCC.

Submucosal tunnelling endoscopic resection (STER) for the treatment of a case of huge esophageal tumor arising in the muscularis propria: a case report and review of literature

BACKGROUND AND AIMS

Endoscopic Interventional Treatment is of little trauma and less complications in the treatment of esophageal tumor and leads to faster recovery and fewer days of hospitalization. This study was aimed to investigate the safety and efficacy of endoscopic interventional therapy for huge esophageal tumor arising in the muscularis propria.

METHODS

The patient was treated by submucosal tunneling endoscopic resection (STER).

RESULTS

The huge esophageal tumor was resected completely by STER technique, with little trauma and less complications. The size of the resected tumor was 5.5×3.5×3.0 cm.

CONCLUSION

Submucosal tunneling endoscopic resection is a safe and efficient technique for treating Huge Esophageal Tumor originating from muscularis propria layer.

Newly designed “pieced” stent in a rabbit model of benign esophageal stricture

AIM: To investigate a newly designed stent and its dilatation effect in a rabbit model of benign esophageal stricture.

METHODS: Thirty-four New Zealand white rabbits underwent a corrosive injury in the middle esophagus for esophageal stricture formation. Thirty rabbits with a successful formation of esophageal strictures were randomly allocated into two groups. The control group (n = 15) was implanted with a conventional stent, and the study group (n = 15) was implanted with a detachable “pieced” stent. The study stent (30 mm in length, 10 mm in diameter) was composed of three covered metallic pieces connected by surgical suture lines. The stent was collapsed by pulling the suture lines out of the mesh. Two weeks after stricture formation, endoscopic placement of a conventional stent or the new stent was performed. Endoscopic extraction was carried out four weeks later. The extraction rate, ease of extraction, migration, complications, and survival were evaluated.

RESULTS: Stent migration occurred in 3/15 (20%) animals in the control group and 2/15 (13%) animals in the study group; the difference between the two groups was not statistically significant. At the end of four weeks, the remaining stents were successfully extracted with the endoscope in 100% (11/11) of the animals in the study group, and 60% (6/10) of the animals in the control group; this difference was statistically significant (P < 0.05). There was no difference in the mean number of follow-up days between the control and study groups (25.33 vs 25.85). Minor bleeding was reported in five cases in the study group and four in the control group. There were no severe complications directly associated with stent implantation or extraction in either of the two groups.

CONCLUSION: In this experimental protocol of benign esophageal strictures, the novel “pieced” stent demonstrated a superior removal rate with a similar migration rate compared to a conventional stent.

Sirt6 suppresses hepatocellular carcinoma cell growth via inhibiting the extracellular signal‑regulated kinase signaling pathway

Sirt6, a member of the mammalian sirtuin family, is a protein that is located in the nucleus and is an NAD+‑dependent deacetylase important in the control of metabolic activity and genome stability. Recently, several studies have demonstrated the potential role of Sirt6 in tumor biology; however, the role of Sirt6 in hepatocellular carcinoma (HCC) remains unclear. In the present study, Sirt6 protein expression was found to be downregulated in human HCC tissue compared with adjacent normal tissue. Knockdown of Sirt6 promoted growth of the HepG2 HCC cell line, whereas overexpression of Sirt6 inhibited the growth of HepG2 cells. Overexpression of Sirt6 induced apoptosis in HepG2 cells, which was demonstrated by a terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling assay and cleaved caspase-3 immunoblotting. Furthermore, overexpression of Sirt6 decreased intracellular reactive oxygen species and superoxide anion levels. Finally, overexpression of Sirt6 inhibited phosphorylation of extracellular signal-regulated kinases 1/2 (ERK1/2), and blocking the ERK1/2 pathway with chemical-specific inhibitor U0126, attenuated the tumor suppressive effect of overexpression of Sirt6. Collectively, these data suggest that Sirt6 is a tumor suppressor in HCC cells and may be a promising therapeutic target in HCC.

Epigenetic modifications in hepatic stellate cells contribute to liver fibrosis

Liver fibrosis represents the final common pathway of virtually all types of chronic liver diseases, and it has been a major public health concern. Many genes have been demonstrated to be involved in the pathogenesis of liver fibrosis, while the mechanisms underlying gene regulation still needs further research. On the other hand, hepatic stellate cells (HSCs) are quiescent cells in the perisinusoidal space in liver. HSCs facilitate hepatocytes interactions via releasing soluble inflammatory factors and producing extracellular matrix. HSCs can be activated in response to liver injury, and they differentiate to myofibroblasts, which greatly contribute to the fibrogenesis process. Various epigenetic procedures, including DNA methylation, histone modification and formation of particular chromatin structure, play crucial roles in the gene transcriptional expression in HSCs, regulating various vital processes. For instance, epigenetic modulation on the peroxisome proliferator-activated receptor gamma (PPAR-γ) gene promoter accounts for HSC differentiation through interacting pathways. Aberrant expression of a series of histones and chemokines in activated HSCs can aggravate inflammation and oxidative stress, which in turn promotes differentiation of HSCs to myofibroblasts and enhances the whole fibrogenesis process. Degradation of extracellular matrix is also regulated through epigenetic modulation on matrix associated enzymes. Moreover, fibrosis-related epigenetic modifications in the parental generation may be inherited to their offspring. In this review, we firstly summarize the vital epigenetic modifications of fibrosis-related genes in HSCs, and highlight specific nucleic acid sequences and structures in gene promoters as important action sites, which may provide indicators for liver fibrosis diagnosis in the future.

4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone induces retinoic acid receptor β hypermethylation through DNA methyltransferase 1 accumulation in esophageal squamous epithelial cells

Overexpression of DNA methyltransferase 1 (DNMT1) has been detected in many cancers. Tobacco exposure is known to induce genetic and epigenetic changes in the pathogenesis of malignancy. 4-(Methylnitrosamino)- 1-(3-pyridyl)-1-butanone (NNK) is an important carcinogen present in tobacco smoke; however the detailed molecular mechanism of how NNK induces esophageal carcinogenesis is still unclear. We found that DNMT1 was overexpressed in ESCC tissues compared with paired non-cancerous tissues, the overexpression being correlated with smoking status and low expression of RARβ. The latter could be upregulated by NNK treatment in Het-1A cells, and the increased DNMT1 expression level reflected promoter hypermethylation and downregulation of retinoic acid receptor β (RARβ). RNA interference mediated knockdown of DNMT1 resulted in promoter demethylation and upregulation of RARβ in KYSE30 and TE-1 cells. 3-(4,5-Dimethyl-thiazol-2yl)- 2,5-diphenyltetrazolium bromide (MTT) and flow cytometric analysis demonstrated that NNK treatment in Het- 1A cells could enhance cell proliferation and inhibit cell apoptosis in a dose-dependent manner. In conclusion, DNMT1 overexpression is correlated with smoking status and low expression of RARβ in esophageal SCC patients. NNK could induce RARβ promoter hypermethylation through upregulation of DNMT1 in esophageal squamous epithelial cells, finally leading to enhancement of cell proliferation and inhibition of apoptosis.

[Serum sodium concentration profile for cirrhotic patients and its effect on the prognostic value of the MELD score]

To analyze the characteristics of serum sodium in decompensated cirrhosis and evaluate the prognostic ability of the model for end-stage liver disease (MELD) in Na-containing models. Patients diagnosed with decompensated cirrhosis at our hospital were enrolled for study between June 2005 and October 2010. Patients were classified among three groups, according to serum sodium concentration: less than 125 mmol/L, 125 to 135 mmol/L, and more than 135 mmol/L. Mortality rates among the three groups were compared by Kaplan-Meier survival analysis. In addition, the different serum sodium concentrations were analyzed for correlations between Child-Pugh score and complication incidence rates of portal hypertension. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the predictive abilities of MELD, MELD-Na, and the integrated (i) MELD scores for 3-month, 6-month and 1-year mortalities. A total of 467 patients were analyzed, and 50.54% had hyponatremia ( less than 135 mmol/L). Sodium concentration was correlated with mortality, and Kaplan-Meier survival analysis indicated that mortality was significantly higher in each subgroup with lower sodium concentration (all, P = 0.000). Likewise, sodium concentration decreased in conjunction with increased severity of decompensation, as classified by Child-Pugh scoring (sodium: A more than B more than C; mortality: A less than B less than C). With the exception of digestive tract bleeding, complication incidence rates of hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome increased when sodium concentration decreased. For predicting 3-month mortality, the AUC scores of MELD were not significantly different from the MELD-Na and iMELD scores (P more than 0.05). For predicting 6-month and 1-year mortality, the AUC scores of MELD-Na and iMELD were significantly higher than those of MELD (P less than 0.05). Hyponatremia is correlated with mortality and complications in decompensated cirrhosis patients. Incorporation of Na into the MELD may enhance it's prognostic ability.

Clinical significance of GRIM-19 expression in hepatocellular carcinoma

AIM: To investigate the clinical significance of expression of gene associated with retinoid-interferon-induced mortality-19 (GRIM-19) in hepatocellular carcinoma (HCC).

METHODS: The expression of GRIM-19 mRNA and protein in 40 cases of HCC tissues and matched non-cancerous tissues was detected by reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry and Western blot. The correlation between GRIM-19 expression and clinicopathologic features of HCC was analyzed statistically.

RESULTS: The expression of GRIM-19 mRNA was significantly lower in HCC than in matched non-cancerous tissue (0.40 ± 0.31 vs 0.56 ± 0.67, P < 0.05). The positive rate of GRIM-19 protein expression in HCC was significantly lower than that in matched non-cancerous tissue (47.5% vs 80%, P < 0.05). The expression level of GRIM-19 protein was also significantly lower in HCC than in matched non-cancerous tissue (0.30 ± 0.29 vs 0.57 ± 0.10, P < 0.05). GRIM-19 expression differed significantly between patients with stages I + II disease and those with stages III+IV disease (0.57 ± 0.38 vs 0.30 ± 0.20, P < 0.05) as well as between patients with and without portal vein thrombosis (0.04 ± 0.02 vs 0.44 ± 0.32, P < 0.05). The expression of GRIM-19 was negatively correlated with serum AFP (r = -0.352, P < 0.05).

CONCLUSION: Decreased GRIM-19 expression is probably a significant event in the carcinogenesis of HCC and may be associated with tumor development, progression and invasion.

Protective effects of ursodeoxycholic acid against immune-mediated liver fibrosis in rats

BACKGROUND/AIMS

Ursodeoxycholic acid (UDCA), a natural component of bile, has been synthesized to treat cholestatic liver diseases such as primary biliary cirrhosis. Broad biochemical changes in UDCA-treated patients suggest beneficial effects of UDCA beyond stimulating hepatobiliary secretion and possible efficacy of the medicine in treating cirrhosis of other causes. The aim was to explore the potential benefit of UDCA in controlling immune-mediated hepatic fibrosis.

METHODOLOGY

We applied the rat experimental model of liver fibrosis induced by intraperitoneal injection of porcine serum. UDCA was administered orally during the course of the serum injections.

RESULTS

Compared with the untreated group, the rats treated with UDCA ended with significantly higher body weight, lower liver weight, and lower spleen weight. The treated groups also demonstrated less severe liver fibrosis, with significantly lowered hepatic expression of type I and type III collagens, in terms of both mRNA and proteins. Moreover, serum levels of hyaluronic acid (HA), laminin (LN), type IV collagen (C IV), and type III procollagen (PC III) were also lower in the UDCA-treated animals.

CONCLUSION

UDCA deters development of immune-mediated liver fibrosis by inhibiting the expression of collagen and other extracelluar matrix components.

Apoptosis-inducing effect of synthetic chenodeoxycholic acid derivative, HS-1200, in human hepatoma cell line BEL-7402 and the mechanisms involved

Chenodeoxycholic acid (CDCA) derivative HS-1200 can inhibit the proliferation and induce the apoptosis of human hepatoma BEL7402 cells in a dose- and time-dependent manner. In contrast, HS-1200 shows no apoptosis-inducing effect in normal human hepatic cell lines. HS-1200 induces the apoptosis of BEL7402 cells perhaps by up-regulating the expression of Bax protein and down-regulating the expression of Bcl-2 protein. The increased ratio of Bax to Bcl-2 might contribute to the permeabilization of the outer mitochondrial membrane (OMM) and make it permeable to intermembrane space proteins such as cytochrome C. Once released, cytochrome C promotes the activation of caspase-9 and thereby results in the activation of caspase-3, which functions as the downstream effector of the cell death program. Furthermore, as caspase-8-specific inhibitor z-IETDfmk shows no impact on HS-1200-mediated apoptosis of BEL7402 cells, HS-1200 induces apoptosis perhaps via the activation of mitochondrial pathway.

The emerging role of microRNAs in immune cell development and differentiation

MicroRNAs (miRNAs) are small RNA strands (20-25 nucleotides) that regulate gene expression by translational repression as well as by messenger RNA degradation. This review will examine the application and function of miRNAs in immune cell development and differentiation.

[Based on EMR for design of telemedical regional healthcare platform]

According to international medical information standard and Chinese healthcare management criterion,this paper study EMR features which focus on standard documents exchange and sharing.Tele Regional Healthcare Platform is established by EMR in order to realize medical resource sharing between big hospital in the situation of China, one solution is offered to stave difficulty and high expense of medical service in countryside.

Advances in calcium-binding protein S100A4 and digestive neoplasms

S100A4 protein, encoded by S100A4 gene, is a kind of calcium-binding regulatory proteins. Combining with the calcium ions, this protein plays an important role in the progress of tumor growth and metastasis. Recent investigations concluded that there is a relationship between S100A4 protein and tumor invasion or metastasis. This article reviews the biochemical property of this protein and summarizes its action and potential mechanism in digestive tumor progression and metastasis.

Growth inhibition and gene induction in human hepatocellular carcinoma cell exposed to sodium 4-phenylbutanoate

BACKGROUND

Sodium 4-phenylbutanoate (NaPB) can induce cellular differentiation and cell cycle arrest. However, its potential anticancer properties in hepatocellular carcinoma and influence on normal liver cell are still unclear. We observed the effects of NaPB on growth inhibition, including differentiation and phase growth arrest in normal liver cell line L-02 and hepatocellular carcinoma cell line Bel-7402. Furthermore, we investigated its mechanism in Bel-7402. METHODS; Hepatocellular carcinoma cells Bel-7402 and normal liver cell line L-02 were treated with NaPB at different concentrations. Light microscopy was used to find morphological change in cells. Cell cycle was detected by flow cytometry. Expression of acetylating histone H4 and of histones deacetylase 4 (HDAC4) were determined by Western blot. The expression of P21WAF1/CIP1 and E-cadherin were observed through immunocytochemistry.

RESULTS

NaPB treatment led to time dependent growth inhibition in hepatocellular carcinoma cells Bel-7402. NaPB treatment caused a significant decline in the fraction of S phase cells and a significant increase in G0/G1 cells. NaPB increased the expression of P21(WAF1/CIP1) and E-cadherin in Bel-7402 and significantly decreased the level of HDAC4 in Bel-7402. NaPB significantly improved the level of acetylating histone H4. The normal liver cell line L-02 showed no distinct changes under treatment with NaPB.

CONCLUSIONS

NaPB inhibited the growth of hepatocellular carcinoma cells Bel-7402 and induced partial differentiation through enhancing the acetylating histones. In Bel-7402, the expressions of P21(WAF1/CIP1) and E-cadherin may be related to level of acetylating histones and inhibition of cellular growth. NaPB showed no significant effect on normal liver cells.

Synthetic chenodeoxycholic acid derivative, HS-1200, induces apoptosis of human hepatoma cells via a mitochondrial pathway

We investigated whether HS-1200 has anti-proliferation effects on human hepatoma cells in vitro. Here, chromatin condensation, DNA ladder formation and proteolytic cleavage of poly (ADP-ribose) polymerase (PARP) were observed after treatment of HS-1200, indicating the occurrence of apoptotic cell death, which was associated with up-regulation of Bax, cleaved-caspase-3 and cleaved-caspase-9. Inhibition of caspase-9 rescued HS-1200-induced apoptosis. Furthermore, cells treated with HS-1200 showed a reduction in mitochondrial membrane potential (Deltapsi(m)) and caused cytochrome c release into the cytosol. The results indicated that synthetic chenodeoxycholic acid HS-1200 could induce cell apoptosis in BEL7402 human hepatoma cell line, via a Bax/cytochrome c/caspase-9 independent pathway. This study suggested that HS-1200 is potentially useful as an apoptosis inducer for the treatment of hepatocellular carcinoma.

Mechanism of apoptotic effects induced selectively by ursodeoxycholic acid on human hepatoma cell lines

AIM: To investigate the effects of ursodeoxycholic acid (UDCA) on apoptosis and proliferation of hepatoma cell lines.

METHODS: Human hepatoma cell lines HepG2 and BEL 7402 were cultured in medium supplemented with different concentrations of UDCA, normal human hepatic line L-02 was used as control. Cell proliferation, apoptosis and gene expression were detected using methyl thiazolyl tetrazolium (MTT) assay, flow cytometry, Western blot, DNA ladder assay, electron microscopy, and immunocytochemistry.

RESULTS: Ursodeoxycholic acid inhibited the proli-feration of HepG2 and BEL7402 cell lines in a dose-dependent manner. Ursodeoxycholic acid can change cell cycle distribution of HepG2 and BEL7402, the proportion of cells in G₀-G₁ phase increased whereas the proportion of S phase cells and G₂-M phase cells decreased. Ursodeoxycholic acid arrested the cell cycle in G₀-G₁ phase by down-regulating the cell cycle related proteins cyclin D₁, D₃ and retinoblastoma protein (p^Rb). The apoptotic rates of HepG2 and BEL7402 treated with UDCA (1.0 mmol/L) were significantly higher than those of control. In the HepG2 and BEL7402 treated with UDCA, expression of bcl-2 decreased whereas expression of Bax increased, the nuclear fragmentation and chromosomal condensed, cells shrank and lost attachment, apoptotic bodies and DNA ladders appeared. UDCA had no effect in inducing apoptosis on L-02 cell lines.

CONCLUSION: UDCA can selectively inhibit proliferation and induce apoptosis of HepG2 and BEL7402 cell lines by blocking cell cycle and regulating the expression of Bax/bcl-2 genes.

Networking possibilities for waste recycling in Miyagi prefecture, Japan

Successful case studies for waste recycling in Japan have not been evaluated. The evaluation of economic efficiency and environmental effects were lacking at the time the actual network was established. A waste/resource input/output (I/O) coincidence retrieval system called ZENESYS was developed to examine the usefulness of a waste-exchange network in a nonmanufacturing district. We analyzed data from the Miyagi prefecture, a region without heavy industry. The data were collected from 77 companies using a questionnaire and interviews. A total of 33 possible waste exchange links arose after analysis using ZENESYS. However, these were frail networks that relied heavily on the construction industry. Two waste recycling technologies were selected from the ZENESYS database: reclaiming fuel from waste plastic and making construction materials from bottom ash. Evaluation of the environmental effects and economics of these two technologies showed they were both suitable for the environment, but no profit was made from reclaiming fuel from waste plastics. We concluded that in an area with no heavy industry, it may be difficult to adopt recycling technologies that have high environmental and economic performance. Materials are difficult to circulate among manufacturing industries even if a waste-exchange network exists, and resources are consumed during transportation and recycling.

Modulatory roles of cyclooxygenase-2 in proliferation and apoptosis of hepatocarcinoma cells

AIM: To observe the expression of cyclooxy-genase-2(COX-2) and investigate the effects of COX-2 inhibitor, celecoxib, on the proliferation and apoptosis of hepatocarcinoma cells.

METHODS: The expression of COX-2 was detected by immunohistochemistry and reverse transcription polymerase chain reaction(RT-PCR). The effect of celecoxib on the growth of hepatocarcinoma cells(HepG₂ and Bel-7402) were evaluated by MTT assay and changes proliferation cell nuclear antigen(PCNA). The apoptosis of hepatocarcinoma cells induced by celecoxib and P-gp expression were detected by electron microscopy and flow cytometry. The expression of Survivin was analyzed by RT-PCR.

RESULTS: Celecoxib inhibited the growth and induced apoptosis of hepatocarcinoma cells in a time- and concentration-dependent manner. The inhibitory rates for HepG₂ cells were 70.98% ± 0.67% and 47.93% ± 1.08% after the cells were exposed to 200 and 100 mmol/L celecoxib, respectively, for 48 h, and 45.51% ± 1.35% and 14.35% ± 1.55% for 24 h; while the rates for Bel-7402 cells were 57.29% ± 0.67% and 43.84% ± 0.86% for 48 h, and 34.35% ± 0.63% and 15.35% ± 0.88% for 24 h(all P < 0.01). Substantial apoptosis was revealed by increment of apoptotic body under electron microscopy. After treatment with 100 mmol/L celecoxib for 24, 48, 72 and 96 h, the apoptosis rates of HepG₂ cells were 12.2% ± 2.44%, 4.0% ± 1.67%, 20.4% ± 4.38%, and 57.9% ± 5.74%, respectively, while those of Bel-7402 cells were 3.0% ± 1.05%, 18.5% ± 3.51%, 29.3% ± 3.25%, and 48.4% ± 4.77%, respectively, which were significantly different from those in the controls. The percentage of G₀/G₁ phase cells was markedly increased(HepG₂: 44.17% ± 1.01%, 59.60% ± 0.61%, 62.7% ± 1.22%; Bel-7402: 47.80% ± 0.41%, 58.60% ± 0.46%, 78.40% ± 1.95%; at 24, 48, and 72 h, respectively) in comparison with that of the controls(P < 0.01). COX-2 protein expression was obviously lower in HepG₂ cells than that in Bel-7402 cells. PCNA expression was greatly lessened after celecoxib treatment. COX-2 and Survivin were down-regulated by celecoxib, but not linearly correlated. MDR1/P-gp expression was reduced or changed little as time went by after celecoxib treatment.

CONCLUSION: COX-2 inhibitor, celecoxib, inhibits the proliferation and induces the apoptosis of hepatocarcinoma cells in vitro a time- and concentration-dependent manner by down-regulating the expression of COX-2 and Survivin. COX-2 is correlated with MDR/P-gp and Survivin expression.

Long-term effect of stent placement in 115 patients with Budd-Chiari syndrome

AIM: To report the long-term effect of stent placement in 115 patients with Budd-Chiari syndrome (BCS).

METHODS: One hundred and fifteen patients with BCS were treated by percutaneous stent placement. One hundred and two patients had IVC stent placement, 30 patients had HV stent placement, 17 of them underwent both IVC stent and HV stent. All the procedures were performed with guidance of ultrasound.

RESULTS: The successful rates in placing IVC stent and HV stent were 94% (96/102) and 87% (26/30), respectively. Ninety-seven patients with 112 stents (90 IVC stents, 22 HV stents) were followed up. 96.7% (87/90) IVC stents and 90.9% (20/22) HV stents remained patent during follow up periods (mean 49 mo, 45 mo, respectively). Five of 112 stents in the 97 patients developed occlusion. Absence of anticoagulants after the procedure and types of obstruction (segmental and occlusive) before the procedure were related to a higher incidence of stent occlusion.

CONCLUSION: Patients with BCS caused by short length obstruction can be treated by IVC stent placement, HV stent placement or both IVC and HV stent placement depending on the sites of obstruction. The long-term effect is satisfactory. Anticoagulants are strongly recommended after the procedure especially for BCS patients caused by segmental occlusion.

The analysis of γ-glutamyl transpeptidase gene in different type liver tissues

AIM: To probe the value of γ-glutamyl transpeptidase (GGT) messenger RNA in monitoring canceration of liver cells and for early diagnosis of hepatocellular carcinoma (HCC), by researching the types of GGT messenger RNA (GGTmRNA) in liver tissues and peripheral blood of different hepatopathy.

METHODS: The three types of GGTmRNA (A, B, C) in liver tissues and peripheral blood from the patients with HCC, noncancerous hepatopathy, hepatic benign tumor, secondary carcinoma of liver, and healthy persons were detected by reverse-transcription polymerase chain reaction (RT-PCR).

RESULTS: (1) In normal liver tissues, type A was predominantly found (100.00%), type B was not found, type C was found occasionally (25.00%); (2) The distribution of types of GGTmRNA in liver tissues with acute hepatitis, chronic hepatitis, cirrhosis, alcoholic hepatopathy was similar as in normal liver tissues (P > 0.05), but type B was found in 3 of 18 patients with chronic hepatitis (16.67%), and also in 3 of 11 patients with cirrhosis (27.27%); (3) There was no significant difference of types of GGTmRNA between liver tissues with hepatic benign tumor, secondary carcinoma of liver and normal liver tissues (P > 0.05); (4) Type B was predominant in cancerous tissues with HCC (87.5%), the prevalence of type B in cancerous tissues was significantly higher than that in normal liver tissues (0/12) (P < 0.05), but the prevalence of type A in cancerous tissues (46.88%) was significantly lower than that in normal liver tissues (100.00%) (P < 0.05), and the prevalence of type C (6.25%) in cancerous was the same as that in normal liver tissues (25.00%) (P > 0.05). In noncancerous tissues of livers with HCC, the main types were type A and type B, the prevalence of type A (85.71%, 90.48%) and type C (14.29%, 9.52%) in noncancerous tissues of liver with HCC was similar as that in normal liver tissues (A: 100.00%; C: 25.00%) (P > 0.05), but the prevalence of type B (80.95%, 76.19%) in noncancerous tissues of livers with HCC was significantly higher than that in normal liver tissues (0/12) (P < 0.05); (5) The prevalence of type B (37.5%) in peripheral blood with HCC was higher than that in normal person (0/12) (P < 0.05). In peripheral blood, type B was found in 4 of 11 cases of HCC with serum AFP negative.

CONCLUSION: The shift of types of GGTmRNA from A to B in liver tissues may be closely related to the development of HCC, and the analysis of GGT gene may provide a useful tool for early diagnosis of HCC.