Blockade of the Dopamine D3 Receptor Attenuates Opioids-Induced Addictive Behaviours Associated with Inhibiting the Mesolimbic Dopamine System

Opioid use disorder (OUD) has become a considerable global public health challenge; however, potential medications for the management of OUD that are effective, safe, and nonaddictive are not available. Accumulating preclinical evidence indicates that antagonists of the dopamine D3 receptor (D3R) have effects on addiction in different animal models. We have previously reported that YQA14, a D3R antagonist, exhibits very high affinity and selectivity for D3Rs over D2Rs, and is able to inhibit cocaine- or methamphetamine-induced reinforcement and reinstatement in self-administration tests. In the present study, our results illustrated that YQA14 dose-dependently reduced infusions under the fixed-ratio 2 procedure and lowered the breakpoint under the progressive-ratio procedure in heroin self-administered rats, also attenuated heroin-induced reinstatement of drug-seeking behavior. On the other hand, YQA14 not only reduced morphine-induced expression of conditioned place preference but also facilitated the extinguishing process in mice. Moreover, we elucidated that YQA14 attenuated opioid-induced reward or reinforcement mainly by inhibiting morphine-induced up-regulation of dopaminergic neuron activity in the ventral tegmental area and decreasing dopamine release in the nucleus accumbens with a fiber photometry recording system. These findings suggest that D3R might play a very important role in opioid addiction, and YQA14 may have pharmacotherapeutic potential in attenuating opioid-induced addictive behaviors dependent on the dopamine system.

[Development and application syndromic surveillance and early warning system in border area in Yunnan Province]

Objective: To establish a dynamic syndromic surveillance system in the border areas of Yunnan Province based on information technology, evaluate its effectiveness and timeliness in the response to common communicable disease epidemics and improve the communicable disease prevention and control in border areas. Methods: Three border counties were selected for full coverage as study areas, and dynamic surveillance for 14 symptoms and 6 syndromes were conducted in medical institutions, the daily collection of information about students' school absence in primary schools and febrile illness in inbound people at border ports were conducted in these counties from January 2016 to February 2018 to establish an early warning system based on mobile phone and computer platform for a field experimental study. Results: With syndromes of rash, influenza-like illness and the numbers of primary school absence, the most common communicable disease events, such as hand foot and mouth disease, influenza and chickenpox, can be identified 1-5 days in advance by using EARS-3C and Kulldorff time-space scanning models with high sensitivity and specificity. The system is easy to use with strong security and feasibility. All the information and the warning alerts are released in the form of interactive charts and visual maps, which can facilitate the timely response. Conclusions: This system is highly effective and easy to operate in the detection of possible outbreaks of common communicable diseases in border areas in real time, so the timely and effective intervention can be conducted to reduce the risk of local and cross-border communicable disease outbreaks. It has practical application value.

Resveratrol Enhances Inhibition Effects of Cisplatin on Cell Migration and Invasion and Tumor Growth in Breast Cancer MDA-MB-231 Cell Models In Vivo and In Vitro

Triple-negative breast cancer (TNBC) is a refractory type of breast cancer that does not yet have clinically effective drugs. The aim of this study is to investigate the synergistic effects and mechanisms of resveratrol combined with cisplatin on human breast cancer MDA-MB-231 (MDA231) cell viability, migration, and invasion in vivo and in vitro. In vitro, MTS assays showed that resveratrol combined with cisplatin inhibits cell viability as a concentration-dependent manner, and produced synergistic effects (CI < 1). Transwell assay showed that the combined treatment inhibits TGF-β1-induced cell migration and invasion. Immunofluorescence assays confirmed that resveratrol upregulated E-cadherin expression and downregulated vimentin expression. Western blot assay demonstrated that resveratrol combined with cisplatin significantly reduced the expression of fibronectin, vimentin, P-AKT, P-PI3K, P-JNK, P-ERK, Sma2, and Smad3 induced by TGF-β1 (p < 0.05), and increased the expression of E-cadherin (p < 0.05), respectively. In vivo, resveratrol enhanced tumor growth inhibition and reduced body weight loss and kidney function impairment by cisplatin in MDA231 xenografts, and significantly reduced the expressions of P-AKT, P-PI3K, Smad2, Smad3, P-JNK, P-ERK, and NF-κB in tumor tissues (p < 0.05). These results indicated that resveratrol combined with cisplatin inhibits the viability of breast cancer MDA231 cells synergistically, and inhibits MDA231 cells invasion and migration through Epithelial-mesenchymal transition (EMT) approach, and resveratrol enhanced anti-tumor effect and reduced side of cisplatin in MDA231 xenografts. The mechanism may be involved in the regulations of PI3K/AKT, JNK, ERK and NF-κB expressions.

Therapeutic Effect and Mechanism of Bushen-Jianpi-Jiedu Decoction Combined with Chemotherapeutic Drugs on Postoperative Colorectal Cancer

There is a lack of effective therapeutic drugs in patients with postoperative colorectal cancer (PCRC). This study aimed to investigate the therapeutic effect and mechanisms of Bushen-Jianpi-Jiedu decoction (BSJPJDD) combined with chemotherapeutic drugs (oxaliplatin) on PCRC with liver and kidney yin deficiency and spleen deficiency syndrome (LKYD-SDS) through the therapeutic evaluation of clinical therapy and the integrative analysis of network pharmacology, RNA-seq and label-free data, and experiment verification in vitro. In clinical therapy, the median progression-free survival (PFS) and Karnofsky performance score (KPS) were increased in PCRC patients by the aqueous extract of BSJPJDD combined with oxaliplatin treatment for three months, compared to oxaliplatin alone (p < 0.05). The integrative analysis showed that 559 differentially expressed genes (DEGs) and 11 differentially expressed proteins (DEPs) were regulated by BSJPJDD, among which seven bioactive compounds through 39 potential targets were involved in the regulation of multiple signaling pathways including MAPK, PI3K-Akt, and HIF-1, etc. In the experimental verification, an ELISA assay showed that plasma ZEB2, CAT, and KRT78 were decreased, and IL-1Α, CD5L, FBLN5, EGF, and KRT78 were increased in comparison to the above (p < 0.05). Furthermore, the SW620 cell viability was inhibited and the expressions of MAPK and the p-ERK/ERK ratio were significantly downregulated by the aqueous extract of BSJPJDD combined with oxaliplatin treatment, compared with oxaliplatin treatment alone (p < 0.05). These data suggested that BSJPJDD combined with oxaliplatin prolongs the survival and improves Karnofsky performance status of PCRC patients with LKYD-SDS, and may be associated with the regulation of multiple signaling pathways.

Systematic analysis using a bioinformatics strategy identifies SFTA1P and LINC00519 as potential prognostic biomarkers for lung squamous cell carcinoma

Lung cancer has high incidence and mortality rates, in which lung squamous cell carcinoma (LUSC) is a primary type of non-small cell lung carcinoma (NSCLC). The aim of our study was to discover long non-coding RNAs (lncRNAs) associated with diagnose and prognosis for LUSC. RNA sequencing data obtained from LUSC samples were extracted from The Cancer Genome Atlas database (TCGA). Two prognosis-associated lncRNAs (including SFTA1P and LINC00519) were selected from LUSC samples, and the expression levels were also verified to be associated abnormal in LUSC clinical samples. Our findings demonstrate that lncRNAs SFTA1P and LINC00519 exert important functions in human LUSC and may serve as new targets for LUSC diagnosis and therapy.

[Synthesis, biological activity, computer aided drug design of alpha-pinene derivatives]

Based on the anticancer mechanism of biological alkylating agent, we designed and synthesized two alpha pinene derivatives:(1R,5S)-(6,6-dimethylbicyclo[3,1,1]hept-2-en-2-yl)methyl benzenesulfonate and (1R,5S)-(6,6-dimethylbicyclo[3,1,1]hept-2-en-2-yl)methyl 4-methylbenzenesulfonate, of which structures were confirmed by ¹H-NMR, HPLC and MS date. These two compounds showed a good inhibition of tumor cells' proliferation. Further, the computer siuulation of molecular docking and metabolic kinetics indicated that these two copounds may have stable molecular complexation with protein CDK2, which closely related to the cell cycle.

Yinchenhao decoction suppresses rat liver fibrosis involved in an apoptosis regulation mechanism based on network pharmacology and transcriptomic analysis

Yinchenhao decoction (YCHD) is a classical Traditional Chinese Medicine (TCM) formula that has been widely used in the treatment of liver fibrosis caused by chronic hepatitis B and jaundice for more than 1800 years. The purpose of this study was to investigate the apoptosis regulation mechanisms of YCHD and its active components suppresses liver fibrosis. The active components and putative targets of YCHD were predicted by network pharmacology approach. Functional and pathway enrichment analysis were presented in the present study by using clusterProfiler. Further, experimental validation was done by using terminal deoxynucleotidyl transferase (TDT) dUTP nick end labelling (TUNEL) assay and western blotting in dimethylnitrosamine (DMN)-induced liver fibrosis rats, and cell proliferation assay, apoptosis assay, and western blotting in human hepatic L02 cells and LX2 cells. 45 active compounds in YCHD formula, 592 potential target proteins and 1191 liver fibrosis-related human genes were identified. Functional and pathway enrichment analysis indicated that YCHD obviously influenced TNF, PI3K-Akt signaling pathways. Further, In vivo experiment indicated that YCHD treatment not only attenuated the symptoms of liver fibrosis, but also decrease the apoptosis of hepatic parenchyma cells. Moreover, in vitro experiments showed that rhein, kaempferol and quercetin treatments remarkably decreased the protein levels of cleaved caspase-3 and increased p-ERK1/2, PI3K and Bcl-XL protein expression in TNF-α-stimulated L02 cells. On the contrary, rhein, kaempferol, aloe-emodin and quercetin inhibited the proliferation of LX2 cells and up-regulated the protein levels of Bax and cleaved caspase-8. In conclusion, 45 active components and 296 potential targets of YCHD against liver fibrosis were identified by the analysis of network pharmacology and transcriptomics combination. The mechanisms of YCHD against liver fibrosis were involved in the regulation of multiple targets, especially affecting the apoptosis-related signaling pathways.

Active Compounds Derived from Fuzheng Huayu Formula Protect Hepatic Parenchymal Cells from Apoptosis Based on Network Pharmacology and Transcriptomic Analysis

Fuzheng huayu formula (FZHY), an antifibrotic traditional Chinese medicine, is frequently used for the treatment of liver fibrosis. In this study, network analysis, transcriptomic analysis, assays of cell apoptosis, viability and protein expression were used for investigating the effects and mechanisms of compounds derived from FZHY on hepatic parenchymal cell (HPC) protection and hepatic stellate cell activation. Network pharmacology analysis found that 6 major compounds and 39 potential targets were important network nodes. Our analysis predicted that the active compounds of FZHY, including hederagenin, luteolin and tanshinone IIA inhibited cell apoptosis (p < 0.05), increased PI3K expression and reduced cleaved caspase 3 expression and the Bax/Bcl-w ratio (p < 0.05) in L02 cells that had apoptosis induced by TNF-α. Few significant changes caused by FZHY, hederagenin, luteolin and tanshinone IIA were observed in hepatic stellate Lx2 cells upon TGF-β1 induction. These data suggest that FZHY is active against liver fibrosis, protects hepatic parenchymal cells from apoptosis, and recovers liver function, possibly through the effects of its active compounds hederagenin, luteolin and tanshinone IIA and is involved in the inhibition of apoptosis in HPCs, possibly through regulating the PI3K, ERK, cleaved caspase 3 and Bax/Bcl-w levels.

Improvement of conversion efficiency for multi-junction solar cells by incorporation of Au nanoclusters

We studied the photoluminescence (PL) and photovoltaic current-voltage characteristics of the three-junction InGaP/InGaAs/Ge solar cells by depositing Au nanoclusters on the cell surface. The increases of the PL intensity and short-circuit current after incorporation of Au nanoclusters are evident. An increase of 15.3% in energy conversion efficiency (from 19.6 to 22.6%) is obtained for the three-junction solar cells in which Au nanoclusters have been incorporated. We suggest that the increased light trapping due to radiative scattering from Au nanoclusters is responsible for improving the performance of the three-junction solar cells.

Automation model of sewerage rehabilitation planning

The major steps of sewerage rehabilitation include inspection of sewerage, assessment of structural conditions, computation of structural condition grades, and determination of rehabilitation methods and materials. Conventionally, sewerage rehabilitation planning relies on experts with professional background that is tedious and time-consuming. This paper proposes an automation model of planning optimal sewerage rehabilitation strategies for the sewer system by integrating image process, clustering technology, optimization, and visualization display. Firstly, image processing techniques, such as wavelet transformation and co-occurrence features extraction, were employed to extract various characteristics of structural failures from CCTV inspection images. Secondly, a classification neural network was established to automatically interpret the structural conditions by comparing the extracted features with the typical failures in a databank. Then, to achieve optimal rehabilitation efficiency, a genetic algorithm was used to determine appropriate rehabilitation methods and substitution materials for the pipe sections with a risk of mal-function and even collapse. Finally, the result from the automation model can be visualized in a geographic information system in which essential information of the sewer system and sewerage rehabilitation plans are graphically displayed. For demonstration, the automation model of optimal sewerage rehabilitation planning was applied to a sewer system in east Taichung, Chinese Taiwan.

Usefulness of technetium-99m methoxyisobutylisonitrile liver single photon emission computed tomography to detect hepatocellular carcinoma

Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) has been shown to be useful in identifying several types of tumors, such as breast, lung and thyroid cancers. The usefulness of Tc-99m MIBI liver imaging in detecting hepatocellular carcinoma (HCC) is still controversial. In this study, 22 patients with HCC performed Tc-99m MIBI liver single photon emission computed tomography (SPECT). Twenty of 22 patients (90.9%) showed negative liver SPECT findings without significant Tc-99m MIBI uptake in HCC, and only 2 patients (9.1%) showed positive liver SPECT findings with significant Tc-99m MIBI uptake in HCC. In addition, no significant correlation between liver SPECT findings with sex, age, alpha feto-protein serum level, HCC differentiation, and virus hepatitis status was found. We concluded that Tc-99m MIBI liver SPECT is not a sensitive tool to detect HCC.

Ellagic [correction of ellagica] acid inhibits arylamine N-acetyltransferase activity and DNA adduct formation in human bladder tumor cell lines (T24 and TSGH 8301)

The fact that vitamin C (ascorbic acid) exhibits a protective effect in certain types of cancer is well documented. Our previous studies demonstrated that human bladder tumor cell line (T24) has N-acetyltransferase (NAT) activity in cytosols and intact cells. The present studies examined the inhibition of arylamine NAT activity and carcinogen (2-aminofluorene)-DNA adduct formation by ellagic acid (EA) in human bladder tumor cell lines (T24 and TSGH 8301). Two assay systems were performed, one with cellular cytosols (9,000 g supernatant), the other with intact bladder tumor cell suspensions. NAT activity and 2-aminofluorene-DNA adduct formation in T24 and TSGH 8301 cells was inhibited by EA in a dose-dependent manner in both systems, i.e.. the greater the concentration of EA in the reaction the greater the inhibition of NAT activity (dose- and time-course dependent effects). The data also indicated that EA decreased the apparent Km and Vmax of NAT enzymes from T24 and TSGH 8301 cells in cytosols. NAT activity and 2-aminofluorene-DNA adducts in T24 is higher than in TSGH 8301. This report is the first to demonstrate that EA affects human bladder tumor cell NAT activity.

The Chinese medicine Bu-Zhong-Yi-Qi-Tang inhibited proliferation of hepatoma cell lines by inducing apoptosis via G0/G1 arrest

Bu-Zhong-Yi-Qi-Tang (BZYQT), a Chinese herbal medicine, inhibited the proliferation of human hepatoma cell lines (Hep3B, HepG2 and HA22T) dose-dependently. The IC50s of BZYQT on the proliferation of Hep3B, HepG2 and HA22T were 432.5+/-31.8 microg/ml, 455.4+/-24.2 microg/ml, and 2284.3+/-77.2 microg/ml respectively on day 3. However, BZYQT did not significantly inhibit the proliferation of normal human hepatocytes (Chang liver, CCL-13) at the concentration under 5,000 microg/ml. Major compounds of BZYQT, including astragaloside IV, ginsenoside Rb1 and Rg1, saikosaponin a and c, and glycyrrhizin, have been identified. To investigate the key inhibitors of BZYQT. Hep3B cells were treated with BZYQT, individual major compounds of BZYQT, and mixture of major compounds in the same ratio as present in BZYQT. Significant inhibition of proliferation was detected in BZYQT and its major compounds mixture in a comparable level. Not any individual major compound examined could suppress the proliferation of Hep3B cells. This data indicated that there could be synergistic or additive effects of the ingredients in BZYQT. BrdU incorporation, cell cycle analysis and DNA fragmentation assay revealed that BZYQT suppressed the proliferation of hepatoma cells via G0/G1 cell cycle arrest and inhibition of DNA synthesis followed by apoptosis.

The use of dual phase 201Tl thyroid scan for equivocal fine-needle aspiration results in cold thyroid nodules

We assessed the usefulness of dual phase 201Tl thyroid scan for equivocal fine-needle aspiration (FNA) biopsy results to differentiate malignant from benign lesions. The findings of the dual phase 201TI thyroid scan were compared with those of surgical histopathology for 27 patients with cold thyroid nodules. The FNA results were assessed and classified by experienced pathologists equivocal ENS results. Dual phase thyroid scan, including an early image and a delayed image, were acquired 10 minutes and 3 hours, respectively after mCi (74 MBq) of 201TI was injected intravenously. Dual phase 201Tl thyroid scan findings were visually interpreted as positive or negative results. Based on the final diagnoses of the surgical histopathology results, the dual phase Tl thyroid scan showed a sensitivity, specificity, and accuracy of 100%, 90%, and 96%, respectively. We concluded that dual phase Tl thyroid scan was very helpful in differentiating between benign and malignant thyroid nodules when FNA results were equivocal.

Immunomodulation of Bu-Zhong-Yi-Qi-Tang on in vitro granulocyte colony-stimulating-factor and tumor necrosis factor-alpha production by peripheral blood mononuclear cells

Bu-Zhong-Yi-Qi-Tang (BZYQT) is a Chinese medicine, and has been used for the treatment of hepatocellular carcinoma (HCC) patients. At present, we still do not fully understand the effects of BZYQT on the cellular physiology. Present in vitro study demonstrated that BZYQT is capable of increasing granulocyte colony-stimulating-factor (G-CSF) and tumor necrosis factor-alpha (TNF-alpha) production by peripheral blood mononuclear cells (PBMC) in healthy volunteers and patients with HCC. The productions of G-CSF and TNF-alpha by PBMC of volunteers were significantly stimulated by more than 125 microg/ml of BZYQT. G-CSF levels stimulated by PBMC of healthy volunteers were higher than in PBMC of the HCC patients when more than 625 microg/ml of BZYQT was administrated. The reason may be due to the impaired immunologic reactivity of mononuclear cells in HCC patients. However, the production levels of TNF-alpha in HCC patients can be stimulated to levels as high as those in healthy volunteers. When adding high concentration (3.125 mg/ml) of BZYQT to the cultured PBMC, the increments of G-CSF and TNF-alpha production decreased although there were no obvious changes in the number of metabolic active PBMC changed. TNF-alpha andG-CSF are known to play important roles in the biological defensive mechanism. These findings show that BZYQT is a unique formula for the stimulation of PBMC to produce G-CSF and TNF-alpha. Administration of BZYQT may be beneficial for patients with HCC to modulate these cytokines.

Cytomegalovirus colitis in an immunocompetent old woman successfully treated with ganciclovir: a case report

Cytomegalovirus (CMV) diseases occur almost exclusively in the immunocompromised hosts. Persons most commonly affected are patients with acquired immunodeficiency syndrome (AIDS). On rare occasions, however, CMV diseases can be seen in apparently immunocompetent persons. A CMV colitis in a 68-year old immunocompetent woman presenting with watery diarrhea, malaise, and body weight loss of about 5 kg over a three week period is reported. Colonoscopy and mucosal biopsy revealed CMV colitis involving the sigmoid colon. Treatment for two weeks with ganciclovir (10 gm/kg/day I.V. in 2 divided doses) resulted in resolution of colitis and clinical symptoms without any noticeable side-effects. There was no relapse of infection by six months of follow-up. The possibility of CMV colitis should be considered in any elderly person with watery diarrhea, general debilitation, marked body weight loss and with negative stool cultures. CMV colitis may be more frequent than is usually believed. It has a favorable response to ganciclovir without further relapse after the successful treatment in patients with normal immune function.

Isolation and some properties of glycated D-glyceraldehyde-3-phosphate dehydrogenase from rabbit muscle

Glycated D-glyceraldehyde-3-phosphate dehydrogenases (GAPDH) from rabbit muscle and human erythrocytes have been investigated. The specific activity of the non-glycated GAPDH from rabbit muscle is approx. 180 units. (One unit is defined as the specific activity required to convert 1 microM of substrate/min per mg of enzyme.) The activity of the glycated enzyme, consisting of two sugars per tetramer, is lower than that of the non-glycated GAPDH. Non-enzymic transamination of the N-termini of glycated GAPDH (gGAPDH) indicates that they are not blocked by glycation. The rate of modification of thiols (Cys-149) with 5,5'-dithiobis-(2-nitrobenzoic acid) was greater for the glycated than the non-glycated enzymes. The rate of modification of amino groups of Lys residues of gGAPDH with o-phthalaldehyde was greater for the non-glycated enzyme. In 0.18 M guanidine-HC1 solution, the emission intensity at 410 nm of a fluorescent NAD+ derivative introduced into the active site decreased to 80%, whereas that of gGAPDH decreased to 50%. This suggests that the glycated sites are near the active site; glycation of the enzyme leads to a change of the microenvironment of Cys-149, alters the conformation of the active site and decreases the activity.

Preliminary results of hepatic resection for centrally located large hepatocellular carcinoma

Resection of large hepatocellular carcinoma (HCC) located in the central portion of the liver remains a surgical challenge. Over a 2 year period, from July 1989, 19 HCC patients whose main tumour (mean diameter 11.3 cm, range 6-19 cm) was located in the central part of the liver (defined as Couinaud's segments IV, V, VIII) had liver resections. Liver cirrhosis was found in 14 patients (73.7%). Extended major hepatectomy could be performed in only three patients. The operative morbidity and mortality were 26.3% and 0%, respectively. The resection margin in 14 patients was less than 1 cm. At the time this paper was written 11 patients were alive and disease free, five patients survived longer than 30 months. The 1 year disease free rate and survival rate were 73.7% and 84.2%, respectively. The preliminary results reveal that with careful preservation of non-tumourous liver, resection of centrally located large HCC is still advocated even in a cirrhotic liver, and that the resection margin width should not be a major concern.

Malignant peritoneal mesothelioma: a case report

Malignant peritoneal mesothelioma is a rare disease, not previously reported in Taiwan. The reported case concerns a 64-year-old veteran who had suffered from abdominal pain and distension for several days. After exploratory laparotomy, segmental resection of the small intestine, excised a mesenteric mass. A characteristic biphasic pattern resulting from the admixture of gland-like area and a sarcomatous stroma presented in the histologic section. A series of histochemical, immunohistochemical and ultrastructural studies proved this to be a malignant peritoneal mesothelioma. The patient died after a course of post-operative chemotherapy. History of asbestos exposure, with which the tumor is usually intimately associated, could not be traced with certainty. Poor prognosis is the rule of the disease; almost all patients die within two years of diagnosis. An effective therapeutic modality is still unavailable. Here the clinical and pathologic characteristics of the tumor are described, with a brief review and discussion of the pathogenesis as well as the obscured therapeutic problem.

[Perforated peptic ulcer in patients with central nervous system injury]

There were 10 cases of perforated peptic ulcer (PPU) occurring in patients with central nervous system injury from July 1982 to December 1991; 7 cases occurred in intensive care unit whereas 3 cases occurred in the ordinary ward. Because of inability of these patients to express abdominal pain, the diagnosis of PPU was suspected only in the presence of the frequently associated clinical signs such as abdominal distension, fever, tachypnea, tachycardia, and hypotension. Because the diagnosis of PPU in these patients is generally delayed, mortality up to 60% is noted. The diagnosis of PPU was made by chest X-ray with pneumoperitoneum in only 5 of the 10 patients, whereas that of the remaining 5 patients was made by peritoneal lavage with bile-like ascites. There is a good correlation between the presence of shock after PPU and the survival of the patients. We recommend that once there are abnormal abdominal signs, inexplicable hemodynamic changes in patients with central nervous system injury, immediate thorough examination in search of PPU should be made to detect early the life-threatening PPU and to reduce the mortality thereafter.

Spontaneous rupture of splenic hemangioma: a case report

Splenic hemangioma is rare. The major problem concerning splenic hemangioma is the difficulty of preoperative diagnosis. No characteristic signs allow the specific diagnosis of this tumor. Spontaneous rupture is the main complication, occurring in up to 25% of cases reported. In cases of rupture of the tumor, splenectomy is a life-saving and mandatory procedure. A case of spontaneous rupture of splenic cavernous hemangioma is presented and the literature is reviewed.

Gastrectomy for advanced gastric carcinoma with invasion to the serosa

A review of gastrectomy for 332 patients who had advanced gastric cancer with serosal exposed (S2) or adjacent organs invaded (S3) was made. Simple gastrectomy (SG) was carried out in 144 patients while radical gastrectomy (RG), which consisted of systemic lymphadenectomy in addition to SG, was used for the other 188 patients. The type of gastrectomy was chosen arbitrarily by the surgeons except that SG was usually selected when some non-curable factors were present. The operative mortality of SG was 2.7% and that of RG was 3.2%. More lymphnodes could be obtained by RG. Of the 152 patients with S2 who received RG, 46.7% of metastatic lymphnodes could not be identified by SG, while of the 36 patients with S3, 75% of metastatic nodes would be misjudged if SG was carried out. The 5-year-survival rate of RG for stage 3 patients was 42.4% and that for stage 4 patients was 28.2%. Better postoperative long-term-survival was achieved by RG than SG in both stage 3 and 4 patients. When considering the curability of the gastrectomy, the best outcome in stage 3 patients was found in those who underwent an absolute curative resection. Of the stage 4 patients those who received an absolute non-curative resection had the worst result. We recommend that RG be the procedure of choice in treatment of serosal gastric cancer in the absence of non-curable factors. Other adjuvant therapies may be considered after an absolute non-curative gastrectomy in stage 4 serosal cancer patients when multiple non-curable factors were present.

Improvements in hepatocellular carcinoma resection by intraoperative ultrasonography and intermittent hepatic inflow blood occlusion

From September, 1989, to December, 1990 (late period), intraoperative ultrasonography (IOU) and intermittent hepatic inflow blood occlusion were introduced in hepatectomy. Compared with the early period from January, 1983, to August, 1989, the resectability of hepatocellular carcinoma (HCC) increased from 12.1 to 62.1% (P less than 0.0001). More resections on cirrhotic patients (P less than 0.05) and more combined resections with other organs (P less than 0.005) were carried out. Although the operation time was longer (P less than 0.01), less blood loss during surgery and fewer perioperative blood transfusions (P less than 0.001) were found during the late period. Since the rate at which classical resections were performed has reduced (P less than 0.001), postoperative morbidity has also decreased (P less than 0.05). Although the surgical mortality did not differ between the two periods, most deaths in the early period were caused by postoperative hepatic failure which was not found in the late period. Since IOU can clarify the intrahepatic vasculature and identify impalpable and invisible tumors, more precise resections can now be carried out. Intermittent hepatic inflow occlusion reduces blood loss during surgery without increasing risk. We suggest both techniques should be mandatory in hepatectomy for HCC in order for the safety range of resections to be broadened.

Management of penetrating abdominal injury

We present the results of immediate exploratory laparotomies for penetrating abdominal injuries that were performed in the past five and half years. Thirty-eight cases (37 males and 1 female) were collected in this study, ranging in age from 17 to 74 years, with a mean of 36 years. Nine suffered from gunshot injuries and 29 from stab injuries. The negative exploratory laparotomy rate was 22.2%, the surgical complication rate was 18.4%, and the mortality rate was 5%. In this retrospective study, we conclude that: 1. Patients with injuries of the abdomen or unstable vital signs should be operated on immediately. 2. Peritonitis signs are not absolute indications of the need for emergent exploration. 3. For the stab injury patients with stable pre-operative vital signs, conservative treatment with simple closure of wounds is adequate. Frequent checks of vital signs and abdominal condition can possibly prevent unnecessary operations.

The barefoot doctor: Shanghai County revisited

Since a 1981 review of health status and health services in Shanghai County, there have been considerable social and economic changes in the People's Republic of China. A major question currently is the impact of the new economic "responsibility system," which was introduced in 1982, on the cooperative health structure and the "barefoot doctors" (BFDs). Investigators in other areas of China have reported the collapse of the cooperative systems and a shift in the role of the BFDs as a result of incentives for them to spend more time in agricultural production. In Shanghai County, however, BFDs continue essentially full time as before, salaried by the brigade, with fee-for-service charges prohibited. Recent evidence from Shanghai County shows that the health care system and those who direct it can remain flexible and respond positively to changes in the social, economic, and political structures.