[Effects of FRNK on activation and migration of hepatic stellate cells]

Objective: To investigate the effect of focal adhesion kinase related non kinase (FRNK) on the activation and migration of hepatic stellate cells (HSCs). Methods: Human liver tissue was divided into healthy control group and fibrosis group from March 2019 to September 2019 in Affiliated Hospital of Guizhou Medical University. C57BL/6 mice were divided into wild type (WT) and FRNK gene knockout type (FRNK^-/-) groups. The liver fibrosis model was established with carbon tetrachloride (CCl₄). After that, FRNK gene overexpression (Ad-FRNK) was constructed with adenovirus vector. HE and Masson staining were used to evaluate the pathological changes and fiber deposition of liver tissue. Western blot was used to detect the expression of PY397-FAK and α-SMA protein. Mouse primary HSCs were extracted, and the effect of FRNK on HSCs migration was detected by wound healing, activation of Rac and Rho was detected by Western blot. Results: The expression of PY397-FAK protein in human liver tissue with hepatic fibrosis was significantly higher than that in healthy control group (0.88±0.09 vs. 0.73±0.09). FRNK was significantly lower than that in control group(0.68±0.09 vs. 0.79±0.11). After animal model was set up, the degree of liver fibrosis in FRNK^-/-mice (153±13)% was more serious than that in WT (100%) group. The expression of PY397-FAK and α-SMA protein was significantly elevated (2.50±0.23 vs. 0.75±0.09, 1.46±0.20 vs. 0.92±0.10). After FRNK gene was re-expressed (100%), the degree of liver fibrosis was mainly reversed [(74±6)%], and the expression of PY397-FAK and α-SMA was accordingly decreased(0.68±0.11 vs. 1.12±0.19,0.68±0.10 vs. 0.85±0.06). In vitro, FRNK inhibited the migration of HSCs [WT∶FRNK^-/-∶Ad-FRNK,(339±49)%∶(580±53)%∶(259±33)%] and the activation of Rac and Rho proteins (Rac: 0.54±0.07 vs. 0.91±0.10 vs. 0.77±0.12,Rho:0.45±0.05 vs. 0.64±0.06 vs. 0.53±0.07), all P<0.01. Conclusions: FRNK can inhibit the activation and migration of HSCs which contributed to liver fibrosis. The potential mechanism is related to down regulation of PY397-FAK and inhibition of Rac and Rho activation.

[Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]

Objective: To study the effect of COVID-19 on pregnancy outcomes and neonatal prognosis in Hubei Province. Method: s A retrospective comparison of the pregnancy outcomes was done between 16 women with COVID-19 and 45 women without COVID-19. Also, the results of laboratory tests, imaging examinations, and the 2019 novel coronavirus (2019-nCoV) nucleic acid test were performed in 10 cases of neonatal delivered from women with COVID-19. Result: s (1) Of the 16 pregnant women with COVID-19, 15 cases were ordinary type and 1 case was severe type. No one has progressed to critical pneumonia.The delivery method of the two groups was cesarean section, and the gestational age were (38.7±1.4) and (37.9±1.6) weeks,there was no significant difference between the two groups (P>0.05). Also, there wee no significant differences in the intraoperative blood loss and birth weight of the newborn between the two groups (all P>0.05). (2) Ten cases of neonates delivered from pregnant women with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative.There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups (all P>0.05).(3) In the treatment of uterine contraction fatigue, carbetocin or carboprost tromethamine was used more in cesarean section for pregnant women with COVID-19 (1.3±0.6), compared with Non-COVID-19 group (0.5±0.7),the difference was statistically significant (P=0.001). Conclusions: If there is an indication for obstetric surgery or critical illness of COVID-19 in pregnant women, timely termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn, but it is beneficial to the treatment and rehabilitation of maternal pneumonia. Preventive use of long-acting uterotonic agents could reduce the incidence of postpartum hemorrhage during surgery. 2019-nCoV infection has not been found in neonates delivered from pregnant women with COVID-19.

Detection and analysis of laser driven proton beams by calibrated Gafchromic HD-V2 and MD-V3 radiochromic films

The radiochromic film (RCF) is a high-dose, high-dynamic range dosimetry detection medium. A stack of RCFs can be used to detect both spatial and energetic distribution of laser driven ion beams with a large divergence angle and continuous energy spectrum. Two types of RCFs (HD-V2 and MD-V3, from Radiation Products Design, Inc.) have been calibrated using MeV energy protons and carbon ions produced by using a 2 × 6 MV tandem electrostatic accelerator. The proportional relationship is obtained between the optical density and the irradiation dose. For protons, the responses are consistent at all energies with a variation of about 15%. For carbon ions, the responses are energy related, which should be noted for heavy ion detection. Based on the calibration, the broad energy spectrum and charge distribution of laser accelerated proton beam with energy from 3 to 8 MeV and pC charge were detected and reconstructed at the Compact LAser Plasma Accelerator at Peking University.

Creation of Electron-Positron Pairs in Photon-Photon Collisions Driven by 10-PW Laser Pulses

A novel approach is proposed to demonstrate the two-photon Breit-Wheeler process by using collimated and wide-bandwidth γ-ray pulses driven by 10-PW lasers. Theoretical calculations suggest that more than 3.2×10^{8} electron-positron pairs with a divergence angle of 7° can be created per shot, and the signal-to-noise ratio is higher than 10^{3}. The positron signal, which is roughly 100 times higher than the detection limit, can be measured by using the existing spectrometers. This approach, which could demonstrate the e^{-}e^{+} pair creation process from two photons, would provide important tests for two-photon physics and other fundamental physical theories.

High-efficiency γ-ray flash generation via multiple-laser scattering in ponderomotive potential well

γ-ray flash generation in near-critical-density target irradiated by four symmetrical colliding laser pulses is numerically investigated. With peak intensities about 10^{23} W/cm^{2}, the laser pulses boost electron energy through direct laser acceleration, while pushing them inward with the ponderomotive force. After backscattering with counterpropagating laser, the accelerated electron is trapped in the electromagnetic standing waves or the ponderomotive potential well created by the coherent overlapping of the laser pulses, and emits γ-ray photons in a multiple-laser-scattering regime, where electrons act as a medium transferring energy from the laser to γ rays in the ponderomotive potential valley.

Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives

PURPOSE

This study sought to explore the motivation and dilemmas in the decision-making process encountered by Taiwan overseas orthotopic liver transplant (OLT) recipients.

PATIENTS AND METHODS

We used an exploratory qualitative research method on a sample of transplant recipients. Face-to-face in-depth interviews were performed with a semistructured interview guide. Data were evaluated by qualitative content analysis.

RESULTS

We interviewed 15 patients including 11 males and 4 females aged between 41 and 68 years (mean = 57.3) including 14 who received OLT in China and one in the United States. The most important motivations were saving lives from end-stage liver disease and avoiding a hopeless sense of their residual lives with the psychological torture of a waiting death. Their decision-making process leading to overseas OLT could be divided into several phases among which the phase of transplant data evaluation and decision was the most critical one. Nevertheless, every stage and phase had its unique contents, factors, and dilemmas.

CONCLUSION

This study demonstrated that patients encountered various dilemmas at different phases in the decision-making process of considering overseas OLT. This information is important for care providers and policy makers in dealing with patients who consider overseas OLT.

Do patients with acute liver failure have a better chance to receive liver grafting?

OBJECTIVE

Patients with acute hepatic failure (AHF) were always given first priority on the transplant waiting list. We investigated whether AHF patients will deprive other patients on the waiting list of the chance of liver transplantation (LTx).

METHODS AND RESULTS

From January 1999 to March 2003, a total of 423 patients were on the transplant waiting list at the National Taiwan University Hospital. Sixty-five of the patients had AHF caused by hepatitis-B-related disease (HBV, n = 52, 80%), Wilson disease (n = 3, 4.6%), drug-induced AHF (n = 3, 4.6%), and other causes (n = 7, 10.8%).Thirty-three patients died and 16 survived by medical treatment. Two received LTx abroad and 14 underwent LTx at our hospital (7 living-related; 7 cadaver). A total of 140 patients died while waiting for a transplant during the period studied. Of them, 107 were among 358 non-AHF patients (30%), and time-to-death interval was 133 +/- 175 days (median: 62); 33 were among 65 AHF patients (51%); time to death was 19 +/- 28 days (median: 8). There were 35 cadaver donor livers available during the period; 28 of 358 non-AHF patients (7.8%), and 7 of 65 AHF patients (10.7%) received cadaveric LTx. Their waiting time totaled 342 +/- 316 and 12 +/- 9 days, respectively (P < .0001).

CONCLUSION

Most AHF patients died unless they received liver grafts. Even with a higher priority assigned to them, AHF patients still have little chance to get a cadaver donor liver in Taiwan, and non-AHF patients have an even slimmer chance. Therefore, we need to encourage liver donation from living-related donors.

Salvaging procedures for dysfunctional peritoneovenous shunt

BACKGROUND/AIMS

Peritoneovenous shunt is one of the treatments for refractory ascites. However, the dysfunction of the shunt is frequently seen and needs further management. We in this manuscript reported our experience in the salvaging procedures of dysfunctional peritoneovenous shunt.

METHODOLOGY

A total of 29 Denver shunts were constructed for the management of refractory ascites at the Department of Surgery, National Taiwan University Hospital since January 1992 to February 1999. A cross-sectional case study was performed.

RESULTS

There was a total of 20 cases of mechanical dysfunction for these 29 patients. In the management of 6 peritoneal catheter occlusions which occurred in the early phase of this series, revision was performed by lengthening of the peritoneal catheter with a peritoneal dialysis catheter so that the catheter tip could rest in the Douglas pouch. The same procedure was adopted in the last 14 consecutive Denver shunts and this significantly decreased the incidence of peritoneal catheter occlusion (6/15 vs. 0/14, P = 0.011 by Fisher's exact test). In the 6 episodes of valve occlusion, the reservoir of the Denver shunt was replaced with a new one but the peritoneal and venous catheters were not changed. In the 8 episodes of venous catheter dysfunction, two venous catheters slipping out were managed by lengthening the catheter with a large-bore Hickmann catheter. In the other 6 episodes, a new venous catheter was inserted to the other side of the internal jugular vein or saphenous vein through a subcutaneous tunnel and the catheter was connected to the reservoir with a connector.

CONCLUSIONS

Although peritoneovenous shunt did not prolong the life expectancy of the patients with decompensated liver cirrhosis, it did relieve tense ascites rapidly and improve the quality of life remarkably. The modifications and salvaging procedures we used in our series could restore a dysfunctional Denver shunt easier, safer and with a higher cost-saving than a total revision of the shunt.

Suppression of tumor necrosis factor secretion from white blood cells by synthetic antisense phosphorothioate oligodeoxynucleotides

In this ex vivo, rather than in vitro, experiment, a synthetic antisense oligodeoxynucleotide was tested to suppress tumor necrosis factor - alpha(TNF) secretion from lipopolysaccharide-stimulated white blood cells. Antisense oligomer showed significant and specific suppressive effect to the secretion of TNF at concentrations of 1.0 and 10 microM. At the concentration of 1 microM, there were 68.4 and 63.9% suppression of TNF secretion at 2 and 24 h after resuspension of blood cells. At the concentration of 10 microM, the suppressions were slightly higher than those at 1 microM, which were 71.8 and 76.2%, respectively. A 50%-matched scrambler showed suppressive effect only at 10 microM concentration, and the suppression only occurred at 2 and 24 h after incubation. Sense oligomer showed no suppressive effects at any of the concentrations. The specificity of this oligomer was documented by dose-effect phenomenon, sequence-dependent suppression and absence of effect on the synthesis of another cytokine (interleukin-6). A series of parallel studies was performed and showed that all three oligomers at any concentration tested had no effect on the interleukin-6 secretion after LPS stimulation.In conclusion, properly designed antisense oligodeoxynucleotide can significantly and specifically suppress the secretion of TNF by blood cells in an ex vivo system and it may be a good "information" drug to treat diseases that are caused by over production of TNF.

Serum hepatocyte growth factor before and after resection for hepatocellular carcinoma

BACKGROUND/AIMS

Hepatocyte growth factor (HGF) is the most potent hepatocyte proliferation stimulator. Serum HGF levels are high in various liver disease states such as cirrhosis, hepatocellular carcinoma (HCC) and hepatitis. But the role HGF plays in HCC is not clear at present. The purposes of this study are: 1) to reveal the HGF profile pre- and post-HCC resection, which has not been well-described before; and, 2) to analyze the relationships between the pre- and post-operative HGF levels and various clinical parameters.

METHODOLOGY

We performed a retrospective cohort study to check the HGF profiles before and after curative resections for HCC and to analyze the relationships between them by using clinical parameters from 35 consecutive patients at the Department of Surgery, National Taiwan University Hospital. Blood samples collected from another 23 healthy individuals admitted for health check-ups were used as normal controls. Serum HGF was determined with an ELISA kit.

RESULTS

The baseline HGF concentration in HCC patients was significantly higher than that in normal controls (1743+/-73 vs. 948+/-54 pg/ml, p<0.0001). The HGF concentrations on post-operative days (POD) 1, 3, 5, 7, and 14 were all significantly higher than those seen in normal controls (all p less than 0.0001). The first and third POD HGF values were significantly higher than the pre-operative level (p=0.00135 and 0.00187 respectively). The HGF concentrations would return to the pre-operative level on the fifth POD, but they never returned to normal level at the end of the two-week study. The pre-operative HGF level was affected by patient age (p=0.0236), and the post-operative peak HGF level was positively correlated with the pre-operative indocyanin green retention rate (ICGR15) and GOT level (p=0.0320 and 0.0234 respectively).

CONCLUSIONS

In this study, we proved, indirectly, that HGF was not secreted by the HCC tumor cells per se. The peak post-operative HGF level reflected the relative stress of the operation on the diseased liver, but did not reflect the absolute physical extent of liver resection. The relationships between HGF and the prognosis of the patients after HCC resection demands further investigation.

Secretion of acute-phase proteins before and after hepatocellular carcinoma resection

Hepatocyte growth factor (HGF), interleukin-6 (IL-6), and C-reactive protein (CRP) are acute-phase reactants that are usually present at high concentrations in the serum of patients with liver disease. However, the origin of these high serum concentrations is not completely understood, and whether hepatocellular carcinoma (HCC) tissue is a contributing factor is a controversial issue. The purpose of this study was to investigate the profiles of these three proteins in patients with HCC before and after tumor resection, and to study factors that might affect the serum concentrations of these proteins. A retrospective cohort study was performed in 34 consecutive patients who underwent HCC resection at the National Taiwan University Hospital. Blood samples were collected before surgery and on days 1, 3, 5, 7, and 14 postoperatively for serum concentration determinations of these three proteins. Twenty-three patients admitted for health examinations were enrolled as normal controls. Multiple regression analysis was conducted to evaluate the correlations between the pre- and postoperative cytokine concentrations and various clinical parameters. Compared with normal controls, the HCC patients had a significantly higher preoperative concentration of HGF (1,472 +/- 73 vs 948 +/- 54 ng/mL, p < 0.001) and IL-6 (44.1 +/- 6.9 vs 8.1 +/- 3.2 pg/mL, p = 0.012). These concentrations peaked on the first postoperative day and then declined to preoperative values on the fifth postoperative day. The CRP concentration was also higher in HCC patients (0.88 +/- 0.22 vs 0.21 +/- 0.06 mg/dL, p = 0.222), but the difference was not statistically significant. However, the CRP concentration did not return to the preoperative value within 2 weeks postoperatively. Preoperatively, HGF and CRP concentrations were positively affected by larger tumor size, and IL-6 concentration was negatively affected by hepatitis B surface antigen positivity and a higher indocyanine green (ICG) retention rate. In summary, the serum concentrations of HGF and IL-6 were significantly higher in HCC patients than in normal controls. The serum concentrations of HGF, IL-6, and CRP rose dramatically after HCC resection. The concentrations of these proteins were affected by different clinical parameters. We proved indirectly that high serum concentrations of HGF, IL-6, and CRP in patients with HCC do not result primarily from synthesis by the tumor cells. Whether the preoperative concentrations of these proteins correlate with the clinical outcome needs further follow-up.

A rabbit model for metabolic studies after burn injury

BACKGROUND

A rabbit burn model was developed and characterized, which will allow conduct of repeated, noninvasive and more sophisticated in vivo metabolic studies to explore the pathophysiology of burn injury, owing to its larger blood volume and tissue mass than the rat.

MATERIALS AND METHODS

A 20% body surface, full thickness burn was applied to the backs of six anesthetized rabbits by immersion into a boiling-water bath for 10 s, followed by resuscitation with saline. Resting energy expenditure (REE) was measured daily in pre- and postburn periods. Whole body protein kinetics were evaluated using L-[1(-13)C]leucine tracer, on the preburn and the third postburn day. Fasting plasma glucose was also measured.

RESULTS

A significant elevation of REE began on the second postburn day and reached 34 +/- 8% above the preburn level (P < 0.05, paired t test) on the third postburn day. The fasting plasma leucine flux and oxidation were significantly elevated from their preburn levels (both P < 0.05), indicating an accelerated proteolysis and a more negative body protein balance (P < 0.05); however, the rate of whole body protein synthesis did not differ significantly pre- and postburn injury. Fasting plasma glucose also increased (P < 0.001). on the third postburn day. The burn scar remained intact during the study, without any sign of infection.

CONCLUSIONS

The metabolic changes observed in this animal model can be attributed to burn injury per se and they mimic those for flow phase in burn patients. This rabbit burn model should be suitable for exploring mechanistic aspects of the burn-induced changes in metabolism and nutrient balance.

Rapid induction of apoptosis by deregulated uptake of polyamine analogues

Treatment of Chinese hamster ovary cells with alpha-difluoromethylornithine for 3 days, followed by exposure to cycloheximide, led to an unregulated, rapid and massive accumulation of polyamine analogues. This accumulation led to cell death by apoptosis within a few hours. Clear evidence of DNA fragmentation was seen in response to both N-terminally ethylated polyamines and to polyamines containing methyl groups on the terminal carbon atoms. Programmed cell death was induced within 2-4 h of exposure to 1 microM or higher concentrations of N1,N11-bis(ethyl)norspermine. The presence of cycloheximide increased the uptake of the polyamine analogues and therefore led to cell death at lower analogue concentrations, but it was not essential for the induction of apoptosis, since similar effects were seen when the protein synthesis inhibitor was omitted and the concentration of N1, N11-bis(ethyl)norspermine was increased to 5 microM or more. The induction of apoptosis was blocked both by the addition of the caspase inhibitor N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone, or by the addition of the polyamine oxidase inhibitor N1-methyl-N2-(2,3-butadienyl)butane-1,4-diamine (MDL 72,527). These experiments provide evidence to support the concepts that: (1) polyamines or their oxidation products may be initiators of programmed cell death; (2) regulation of polyamine biosynthesis and uptake prevents the accumulation of toxic levels of polyamines; and (3) the anti-neoplastic effects of bis(ethyl) polyamine analogues may be due to the induction of apoptosis in sensitive tumour cells.

Regulation of ornithine decarboxylase in a transformed cell line that overexpresses translation initiation factor eIF-4E

pMV7-4E cells (4E-P2), derived from NIH-3T3 cells, overexpress eIF-4E and exhibit characteristics of transformation, possibly due to translational relief of mRNAs encoding proteins that regulate cell growth. Ornithine decarboxylase (ODC), the rate-limiting enzyme in polyamine biosynthesis, is induced in 4E-P2 cells, and this induction appears to be related to the transformed phenotype of these cells. ODC mRNA contains extensive secondary structure in its 5' untranslated region (5'UTR) and may be regulated by eIF-4E, which melts mRNA secondary structure. To better understand this regulation, cDNA constructs containing the wild-type 5'UTR of ODC or deletion mutants inserted ahead of the luciferase gene were transfected into 4E-P2 and 3T3 cells. Expression of luciferase was higher in 4E-P2 cells in all cases, suggesting that the secondary structure of the ODC 5'UTR inhibits expression in 3T3 cells, and this inhibition is overcome by the high eIF-4E levels in 4E-P2 cells. When a small open reading frame present in the 5'UTR of ODC was destroyed by a point mutation, this luciferase construct was expressed about 6-fold over that containing the wild-type 5'UTR in both cell lines, although both of these 5'UTRs contain the same predicted secondary structure. Thus, factors in addition to eIF-4E may be involved in the regulation of ODC. To examine the differences in ODC regulation by polyamines in normal and transformed cells, the effect of N1,N12-bis(ethyl)spermine (BE-3-4-3) on the synthesis and degradation of ODC was examined. ODC activity in 4E-P2 cells was 10 times less sensitive to reduction by BE-3-4-3 compared to 3T3 cells, suggesting that high ODC levels in eIF-4E-overexpressing cells are the result of decreased regulation by polyamines as well as relief of translational regulation by eIF-4E.

Surgical resection for recurrent hepatocellular carcinoma: prognosis and analysis of risk factors

BACKGROUND

Hepatocellular carcinoma (HCC) is common in Asian countries, and tumor recurrence is the most common cause of treatment failure after curative resection. Repeated hepatectomy is performed only for selected patients because most patients with HCC also have liver cirrhosis and poor liver function reserve. The purposes of this study were to clarify the outcome of the patients after second hepatectomy for recurrent HCC and to evaluate the prognostic factors after second hepatectomy.

METHODS

We used retrospective cohort study to examine the disease-free survival, cumulative survival, and possible prognostic factors for recurrence and death in 59 patients who underwent surgical resection for recurrent HCC at the National Taiwan University Hospital from August 1986 to December 1993. Another 64 patients with unresectable recurrent HCC were used as a historical control group. The survival curves between those patients with resectable HCC and those with unresectable HCC were compared.

RESULTS

After resection for recurrent HCC, gender and multiplicity (n > 3) of tumor affect recurrence rate (p = 0.046 and 0.021, respectively), whereas gender, age, and tumor invasiveness affect survival rate significantly (p = 0.024, 0.021, and 0.046, respectively). The survival rate of patients with resectable HCC was significantly better than that of those with unresectable HCC.

CONCLUSIONS

For recurrent HCC surgical resection is an effective mode of treatment in selected patients. Whether surgery is better than other modes of treatment in the treatment of resectable recurrent HCC demands further investigation.

Surgical treatment of hepatocellular carcinoma originating from the caudate lobe

Hepatocellular carcinoma (HCC) originating from the caudate lobe is rare, and its surgical management is difficult because of its unique anatomic location. We have seen six such cases at our hospital. For patients with fair to excellent liver reserve, we advocated caudate lobectomy combining other types of hepatic resection. For patients with marked liver cirrhosis and poor liver reserve or a small HCC, we advocated simple partial caudate lobectomy (limited hepatic resection). There was no operative mortality or major operative morbidity. We conclude that such approaches are safer, less time-consuming, and less technique-demanding, and they produce a fair survival result compared with the approaches of other procedures. With such approaches, it is our experience that patients with HCC from the caudate lobe have a prognosis comparable to that of patients with HCC in other parts of the liver.

Clinical management of recurrent hepatocellular carcinoma

OBJECTIVE

The aim of this study was to evaluate the long-term benefits of the aggressive treatments with resection or transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC).

SUMMARY BACKGROUND DATA

Primary HCC is one of the most fatal malignancies in Taiwan. The result of resection for HCC remains unsatisfactory, primarily due to the high recurrence rate. To improve surgical results, recurrent HCC must be treated with aggressive resection or TACE.

METHODS

The authors evaluated the results of repeated hepatic resection among 25 patients with recurrent HCC and of TACE among 12 patients with resectable recurrent HCC. The outcomes of an additional 64 patients with unresectable recurrent HCC were also evaluated.

RESULTS

During the follow-up period from 2-112 months, 52% (13/25) of patients receiving repeat resection (group 1) were alive, whereas 42% (5/12) of patients receiving TACE (group 2) were alive. No perioperative deaths within 30 days after surgery occurred in the repeated resection group. The cumulative survival rates at 1, 2, 3, and 5 years after the first operation were 92%, 84%, 71.6%, and 65.1% in group 1 and 83.3%, 75%, 75%, and 22.5% in group 2. The survival rates at 6 months and at 1, 2, and 3 years after recurrence were 92%, 72%, 64%, and 44.8% in group 1 and 83.3%, 75%, 66.7%, and 48% in group 2. The survival of patients with unresectable recurrent HCC was much worse: 1-, 2-, 3-, and 5-year survival after surgery was 57.8%, 29.8%, 15.5%, and 0%; and 6-month and 1-, 2-, and 3-year survival after recurrence was 46.5%, 29.2%, 12.5% and 7.8%.

CONCLUSIONS

More aggressive treatment with repeated hepatic resection can prolong survival time after recurrence of HCC in selected patients. However, TACE can also achieve good results although it is not thought of as curative.

Hepatic portal vein gas following blunt colon injury: report of a case

Blunt colon injuries sometimes result in signs of peritoneal irritation requiring exploratory laparotomy. More frequently there are no specific symptoms, and this leads to a delay in diagnosis and management. Some imaging studies point to blunt colon injury, but gas in both the hepatic portal and mesenteric veins has rarely been reported. Hepatic portal venous gas (HPVG) is a rare roentgenographic picture, and its presence usually represents a serious intra-abdominal catastrophe. Computed tomography and plain abdominal X ray in a 52-year-old man with blunt abdominal injury showed significant gas in the portal venous system and pneumatosis intestinales of the ascending colon. Exploratory laparotomy revealed segmental necrosis of the transverse colon in front of the vertebrae. The presence of HPVG may have been due to mucosal disruption, vascular compromise or prolonged increased intra-abdominal pressure. Its presence in patients with blunt abdominal trauma suggests the possibility of bowel injury. Surgical exploration should be considered when HPVG is noted on roentgenographic studies.

Effect of polyamine analogues and inhibition of polyamine oxidase on spermidine/spermine N1-acetyltransferase activity and cell proliferation

Several bis(ethyl)polyamine analogues are currently undergoing trials as antitumor agents. The ability of some of these analogues to induce spermidine/spermine N1-acetyltransferase and to inhibit cell proliferation was examined in a number of different cell lines. Although N1,N11 bis(ethyl)norspermine was a potent inducer of the acetylase in all cell lines tested, there was a striking difference in the acetylase induction in response to N,N'-bis(ethylamino)propyl]-1,7-heptanediamine. This was a very strong inducer in CHO cells but had no effect in HT29 cells and very little effect in COS-7 or L1210 cells. There was no correlation between the induction of the acetylase and the ability of these analogues to inhibit cell proliferation since N1,N11-bis(ethylamino)-propyl]-1,7-heptanediamine was as at least as strongly antiproliferative as N1,N11-bis(ethyl)-norspermine or N1,N12-bis(ethyl)spermine. Acetylase induction and the intracellular level of the analogues were increased in CHO cells by treatment with a polyamine oxidase inhibitor suggesting that they are degraded by polyamine oxidase. The absence of polyamine oxidase in some tumors may therefore contribute to their sensitivity to these analogues.

Changes of white blood cells, immunosuppressive acidic protein, and interleukin-2 receptor after open heart surgery

There are a lot of immunological changes after major surgery, especially in open heart surgery when blood flows through a cardiopulmonary bypass system. We monitored leukocyte count, lymphocyte subpopulation count, soluble IL- 2 receptor (sIL-2r) and serum IL-2 levels, and an immunosuppressive acidic protein (IAP) level before and on the 1st, 7th, and 14th day after open heart surgery. It was noted that there were significant increases of total leukocyte and granulocyte counts for more than two weeks. But total lymphocyte, T-lymphocyte, b-lymphocyte, natural killer cell, suppressor T-cell, and helper T-cell all showed significant decreases in absolute numbers for more than one week as compared to the preoperative values. Serum IAP level was elevated for more than two weeks after operation. Serum IL-2 decreased but serum sIL-2R increased in the postoperative period. It is concluded that there is a period of immunosuppression after open heart surgery which lasts for at least one week and perhaps more than two weeks.

Treatment of renal artery stenosis after kidney transplantation by percutaneous transluminal angioplasty: report of two cases

Graft renal artery stenosis is one of the causes of hypertension after kidney transplantation. Surgical angioplasty was the treatment of choice before the development of percutaneous transluminal angioplasty (PTA) in the 1970s. Surgical repair was associated with some morbidity and graft loss while PTA was reported to have controversial results in the treatment of this disease. This is a report of two cases of graft renal artery stenosis occurring four and seven months after kidney transplantation that were treated with PTA. The immediate and short-term results of PTA were excellent, but the long-term effects require further follow-up.

Effects of the S-adenosylmethionine decarboxylase inhibitor, 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine, on cell growth and polyamine metabolism and transport in Chinese hamster ovary cell cultures

The regulation of polyamine transport and the roles of polyamine transport and synthesis in cell growth were investigated using cultured Chinese hamster ovary (CHO) cells and CHOMG cells which are mutants lacking polyamine-transport activity. Metabolically stable methylated polyamine analogues were used to measure polyamine accumulation, and the irreversible S-adenosyl-L-methionine decarboxylase inhibitor, 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine (AbeAdo), was used to inhibit synthesis. Exposure to AbeAdo lead to a dose-dependent decrease in growth for both cell lines, although CHOMG cells were more sensitive. Intracellular putrescine levels were greatly increased in AbeAdo-treated CHO cells and to a lesser extent in CHOMG cells, whereas intracellular spermidine and spermine levels were substantially reduced in both. Treatment with AbeAdo increased putrescine content in the culture medium to a much greater extent in CHOMG cultures indicating that a portion of the excess putrescine synthesized in response to AbeAdo treatment is excreted, but that CHO cells salvage this putrescine whereas it is lost to CHOMG cells which cannot take up polyamines. AbeAdo treatment increased polyamine transport into CHO cells despite high intracellular putrescine, suggesting that spermidine and/or spermine, and not putrescine, are the major factors regulating transport activity. The accumulation of either 1-methylspermidine or 1,12-dimethylspermine was significantly increased by AbeAdo treatment. Accumulation was increased even further when protein synthesis was blocked by cycloheximide, indicating that a short-lived protein is involved in the regulation of polyamine uptake. In the presence of cycloheximide and AbeAdo or alpha-difluoromethylornithine, methylated polyamine derivatives accumulated to very high levels leading to cell death. These results show that the polyamine-transport system plays an important role in retaining intracellular polyamines and that down-regulation of the transport system in response to increased intracellular polyamine content is necessary to prevent accumulation of toxic levels of polyamines.

Use of microwave tissue coagulator in hepatocellular carcinoma resection: compared with Lin's hepatic clamp

Fifty-nine patients with hepatocellular carcinoma (HCC) underwent resection with the aid of a microwave tissue coagulator at the Department of Surgery, National Taiwan University Hospital from July 1987 to December 1992. There were 41 men and 18 women with an average age of 59.2 years (range, 32-79 years). The intraoperative blood transfusion included packed RBC 1.53 +/- 1.34 U, fresh frozen plasma 3.85 +/- 1.69 U and/or platelet 1.58 +/- 3.07 U. The operation time from skin incision to skin closure was 250 +/- 74.9 minutes (range, 125 range, 495 minutes) and the average hospital stay was 20 +/- 9.7 days (nine to 50 days, median 17 days). The complication rate was 16.9% (10/59), including two with biliary fistula, prolonged impaired liver function and pleural effusion. Subphrenic abscess was seen in one patient and ascites in three. There was no operative mortality. Compared to 34 patients who underwent similar hepatic resections for HCC carcinoma with the aid of Lin's hepatic clamp, there was no statistical difference between the operation time, and intraoperative blood transfusion. However, the hospital stay was shorter in the microwave group. The change in liver function was also less remarkable in the microwave group and the postoperative complication rate was lower. We conclude that the application of microwave tissue coagulator is useful and safe in the resection of HCC.

Cleavage of epitectin, a mucin-type sialoglycoprotein, from the surface of human laryngeal carcinoma cells by a glycoprotease from Pasteurella haemolytica

In this study we have assessed the action of a novel glycoprotease, secreted by the bovine pneumonia pathogen Pasteurella haemolytica, on epitectin expressed on the surface of human laryngeal carcinoma (H.Ep.2) cells. Epitectin has been previously characterized as a high buoyant density glycoprotein of mass of over 350 kDa extensively glycosylated on serine and threonine by small oligosaccharides. Purified metabolically labeled epitectin was very effectively hydrolyzed by the glycoprotease. However, short- and long-term treatments yielded a complex mixture of products which could not be resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) or column chromatography, probably because of the heterogeneity of the structure and the distribution of the saccharides. Treatment of H.Ep.2 cells with glycoprotease followed by flow cytometric analysis revealed a significant loss in the cell surface epitopes detected by the anti-epitectin Ca2 monoclonal antibody. The action of the glycoprotease on cell surface epitectin was blocked by anti-glycoprotease antisera and was absent in an extract of a glycoprotease-negative strain of P. haemolytica. When extracts of cells treated with glycoprotease for 4 h were subjected to SDS-PAGE followed by 125I-wheat germ agglutinin overlay and autoradiography, the intensity of the characteristic epitectin bands was found to be drastically reduced compared to controls. H.Ep.2 cells metabolically labeled with [3H]glucosamine were also incubated with or without the glycoprotease and the released products were fractionated and analyzed. The enzyme-released products were found to be enriched in mucin-type glycopeptides. Thus the P. haemolytica glycoprotease could be used to selectively degrade mucin glycoproteins on cancer cell surface.

[Reduced-size liver transplantation in mini pigs]

Liver transplantation as therapy for end stage hepatic disease has developed rapidly since the 1980s. Pediatric candidates, however, have suffered the greatest delay in receiving suitable organs, with 20% to 50% of deaths occurring in patients on the waiting list. To overcome the shortage of young donors, surgeons are currently experimenting with the technique of partial liver transplantation. In this study, 10 pairs of mini pigs were used for partial liver transplantation. UW (University Wisconsin) solution was used for liver preservation after the liver was procured. The left lobe was separated using the intact vascular branches method. The raw surface was covered with histoacryl orthotopically in the smaller pig in a position of 60 degrees-90 degrees counter clockwise rotation. The results were: (1) six of the ten transplanted pigs survived for more then one week without any immunosuppressive drugs; (2) the mean operation time was 5h 18 mins; (3) the mean ischemic time of the donor liver was 6h 25 mins; (4) the liver functions tests were acceptable until the day before death. Based on this experiment, we suggest that partial liver transplantation is feasible, both technically functionally.

Therapeutic effect of liver resection in patients with metastatic liver tumors

Thirty-five hepatectomies for metastatic liver malignancy were performed from January 1986 to July 1992 at the National Taiwan University Hospital. Twenty-six of them were of colorectal origin and nine were of other origins. We analyzed the risk factors for recurrence and survival rate after hepatectomy of colorectal origin under curative intention with both univariate and multivariate analysis. The calculated median disease free interval after hepatectomy was 11 months (recurrence rate 65% in one year and 85% in two years). The median survival rate was 24 months (calculated one-year survival 86%, two-year survival 41%). In univariate analysis, the number of metastatic lesions and operation procedures significantly affect the recurrence rate (p = 0.033 and p = 0.042, respectively). In survival univariate analysis, only a safety margin > 1 cm and age > 50 years had significant benefit (p = 0.0014 and p = 0.045, respectively). By multivariate analysis, only solitary metastasis was beneficial to the recurrence rate (p = 0.013), an age > 50 years had a borderline beneficial effect to the recurrence rate (p = 0.052), while earlier liver stage, older age, larger safety margin and minor operative procedures positively affected the survival rate (p = 0.039, 0.018, 0.034 and 0.017, respectively). As the sample number was small, it was hard to draw any conclusions for metastatic liver tumors of other origins. The complication rate (5/35) and mortality rate (1/35) of hepatectomy were low. We concluded that for selected cases of metastatic hepatic malignancy, especially from colorectal cancer, hepatectomy is a promising treatment of choice.

Monitoring of serum neopterin in renal transplant recipients

Postoperative management of kidney allograft recipients requires a reliable and rapid diagnostic method so that proper therapy can be initiated. In this study, we tried to correlate serum neopterin levels with different conditions after transplantation. Serial serum neopterin levels were assessed after operation. Serum neopterin levels of uremic patients were significantly higher than those of healthy persons (239.9 +/- 177.7 nmole/L, n = 33 vs 6.14 +/- 2.78 nmole/L, n = 10, p < 0.001). In recipients with a stable post-transplant course, the serum neopterin level was low. On the contrary, acute rejection episodes were associated with a high level of serum neopterin which declined after successful treatment, although the difference was not significant (96.2 +/- 57.7 nmole/L vs 56 +/- 38.1 nmole/L, p > 0.05). The serum neopterin level was also high in post-transplant acute tubular necrosis (ATN, 256.6 nmole/L), which gradually declined parallel to the resolution of ATN. The neopterin level was low in patients with cyclosporine nephrotoxicity (17.8 +/- 7.6 nmole/L). In summary, the serum neopterin levels were persistently high in uremic and post-transplant ATN patients. Acute rejection episodes were correlated with an increased level of neopterin. It appears that daily measurement of the serum neopterin level may be useful for biochemical detection of immunologic complications in allograft recipients.

Calorimetric study of thermal denaturation of type I human placenta collagen

The thermal denaturations of type I human placenta collagen were studied in different aqueous solutions in the temperature range from 274 to 345 K by differential scanning calorimetry. The thermodynamic parameters of denaturational process were accurately. The average temperature of denaturation of the collagen Td is 47.1 degrees C, and the denaturational enthalpy delta Hd is 8.43 kJ per mole of residue in salt-free aqueous solution at pH 3.7. The linear relationship of delta Hd with Td has been obtained for the various collagens studied. The various factors concerning the stabilization of collagen structure of the Sigma collagen have been demonstrated. The dominant factors are hydrogen bonding and the participation of water molecules in the collagen structure. It is concluded from the thermodynamic evidence obtained that the water-carbonyl model is preferable to other models. By means of calculating the van't Hoff enthalpy of the collagen denaturation, the number and the size of cooperative blocks of the Sigma collagen have been evaluated. Its molecule contains five cooperative blocks, each having 600 residues or so. The type I human placenta collagen is a multi-domain protein.