bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis D virus infection among prostitutes in Taiwan
Authors: WU JAW‐CHING , WANG YUAN‐JEN , HWANG SHINN‐JANG , CHEN TRONG‐ZONG , WANG YU‐SHINN , LIN HWA‐CHEN , LEE SHOU‐DONG , SHENG WEN‐YUNG
Published: March 2008

Two hundred and sixty‐three adult licensed, 233 adult and 157 teenage unlicensed prostitutes from Taiwan were studied for prevalence and risk factors of hepatitis D virus (HDV) infection. The hepatitis B carrier rate among the three groups was 21, 15 and 20%, respectively, not significantly different from that of the general population in this area. However, the prevalence of HDV infection among carrier prostitutes was 55, 36 and 16%, respectively, much higher than that in general hepatitis B carriers. Univariate analysis revealed that the history of conducting paid sex for more than 12 months (P≤ 0.03), ear‐piercing (P≤ 0.02), tattooing (P≤ 0.02), and gonorrhoea or syphilis (P≤ 0.005) were significant factors associated with HDV infection among these subjects. Multivariate analysis revealed that the history of ear‐piercing and venereal diseases (P≤ 0.001) were still significant. In summary, genital ulcers caused by venereal diseases due to frequent sexual contact with multiple partners, and use of unsterilized needles in ear‐piercing or tattooing play important roles in the high prevalence of HDV infection in prostitutes.
Histological findings in asymptomatic hepatitis C virus carriers
Authors: KODAMA TOSHINORI , TAMAKI TOMOHIRO , KATABAMI SHIGEO , KATAMUMA AKIO , YAMASHITA KENTARO , AZUMA NAOKI , KAMIJO KEIICHI , KINOSHITA HIROSHI , YACHI AKIRA
Published: March 2008

There is controversy about clinical management of individuals who persistently have hepatitis C virus antibodies (HCVAb) but who have no symptoms or signs of liver disease. Liver biopsy samples were taken from 15 individuals, all of whom had normal alanine aminotransferase (ALT) levels, to determine the prevalence of liver disease and whether HCVAb and HCV‐RNA correlate with histological findings. Eleven patients with hepatitis C viremia had histological evidence of chronic hepatitis on biopsy. On the other hand, four HCV‐RNA‐negative individuals had almost normal liver histology. These findings indicate that serum HCV‐RNA is a sensitive and specific marker of liver disease in HCVAb‐positive subjects, independent of ALT levels. Furthermore, these results suggest that there are very few histologically healthy carriers of HCV among HCV‐RNA‐positive individuals.
Induced gall‐bladder contraction accelerates fragment clearance after extracorporeal shockwave lithotripsy
Authors: ZIEGENHAGEN DIETER J. , ZEHNTER ELMAR , KRUIS WOLFGANG , POHL CHRISTOPH
Published: March 2008

At the end of extracorporeal shockwave lithotripsy (ESWL) gallstone fragments are dispersed throughout the gall‐bladder. In this state they should be expelled more easily than when later sedimented to the gall‐bladder fundus. Thus, a randomized study was performed to evaluate the clinical benefit of induced gall‐bladder contraction after ESWL. One hundred and five patients with radiolucent gallstones (1–3 stones, diameter ≤ 30 mm) were randomized to received either saline or an infusion of 0.2 μg/kg ceruletide. Stone clearance rates and incidence of biliary symptoms were recorded. Clearance rates at 6 weeks and 3 months after ESWL were significantly (P≤ 0.025) improved by the ceruletide infusion. This effect, resulting in shortened bile acid therapy, was limited to patients with small solitary stones and dependent on a good initial fragmentation. Major side effects attributable to ceruletide were not observed. These results suggest that induced gall‐bladder contraction can be successfully applied as an adjuvant treatment in a subgroup of patients with small solitary gallstones.
Trimethadione tolerance tests for the assessment of feasible size of hepatic resection in patients with hepatocellular carcinoma
Authors: ISHIKAWA AKIO , FUKAO KATASHI , TSUJI KATSUHISA , OSADA AKIRA , YAMAMOTO YUJI , OHTSUKA MASAAKI , TANAKA EINOSUKE
Published: March 2008

Pre‐operative evaluation of the quantity of functional remnant hepatic parenchyma after hepatectomy was carried out to predict the optimal amount of hepatic resection using the trimethadione (TMO) tolerance test. This test is an estimate based on serum diamethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 h after oral administration of TMO, and computed tomography (CT) scans of the liver in patients with hepatocellular carcinoma (HCC). The percentage of remnant hepatic parenchyma was calculated pre‐operatively from the remaining non‐cancerous portion and the whole hepatic parenchyma, excluding the HCC portion, using the CT scans. Presumptive remnant DMO/TMO ratio was calculated by multiplying the percentage of remnant hepatic parenchyma and pre‐operative serum DMO/TMO ratio in 45 patients with HCC undergoing resection. The presumptive remnant DMO/TMO ratios were 0.31 ± 0.10 (mean ±s.d.) in 42 patients who survived hepatectomy and 0.13 ± 0.02 (below 0.15) in the three patients who died from postoperative hepatic failure. Of these surviving patients, two patients who had the presumptive remnant DMO/TMO ratios under 0.15 developed postoperative severe complications. Thus, hepatectomy may not be indicated in patients where presumptive remnant DMO/TMO ratio is 0.15 and lower.

These findings suggest that pre‐operative measurement of presumptive remnant DMO/TMO ratio, when obtained with the CT of the liver and TMO tolerance test, is useful for prediction of the quantity of functional remnant hepatic parenchyma after hepatectomy in patients with chronic liver disease.
Serum interleukin‐8 in inflammatory bowel disease
Authors: JONES SUSAN C. , EVANS STUART W. , LOBO ALAN J. , CESKA MIROSLAV , AXON ANTHONY T. R. , WHICHER JOHN T.
Published: March 2008

To investigate the relationship between serum concentrations of interleukin‐8 (IL‐8) and disease activity in inflammatory bowel disease, serum IL‐8 concentrations were measured by enzyme‐linked immunosorbent assay (ELISA) in 93 patients. Interleukin‐8 levels were compared with plasma interleukin‐6 (IL‐6) levels in 80 of these patients. Interleukin‐8 levels were also measured in ten patients with active Crohn's disease, before and after treatment with a defined formula polymeric diet. Of these patients, 70 out of 93 IL‐8 concentrations were below the detection limit of the assay. Levels were higher in patients with active ulcerative colitis (median < 20 pg/mL, 75th centile value = 190) compared with inactive disease (median and 75th centile value < 20; P 0.05). Interleukin‐8 concentrations correlated with a combined score for disease severity and extent (P= 0.01). Thirty‐eight per cent (8/20) of patients with active Crohn's disease also had high levels of IL‐8 but there was no significant difference between active and inactive disease. There was no correlation between serum IL‐8 and plasma IL‐6; on the contrary, very few patients had raised blood levels of both cytokines. In the diet treated group, serum IL‐8 fell significantly after treatment (median = 37 pg/mL, range < 20–4615 before treatment, median < 20, range < 20–104 after treatment; P= 0.03). The results suggest that although IL‐8 may be involved in the inflammatory process in inflammatory bowel disease, it is a poor marker of disease activity.
The effect of chilli and its pungent ingredient capsaicin on gastrointestinal transit in the rat
Authors: KANG J. Y. , ALEXANDER B. , MATH M. V. , WILLIAMSON R. C. N.
Published: March 2008

The effect of chilli powder and its pungent ingredient capsaicin on gastrointestinal transit in the rat was studied. Fasted unanaesthetized male Sprague‐Dawley rats (n= 144) received by gavage a test meal containing charcoal and cellulose in water or capsaicin solvent plus 51Cr as a radioactive marker. Either 100 or 200 mg of chilli powder (containing 0.13 and 0.26 mg of capsaicin, respectively) or 0.5 or 1 mg of capsaicin were added, the final volume of each meal being 1.5 mL. At 10 and 20 min, animals were killed and the amount of isotope that had left the stomach was measured, together with the distance the charcoal column had travelled along the small intestine. Compared to controls, animals given chilli powder emptied less of their gastric content at 10 and 20 min, an effect partly reproduced by capsaicin. However overall gastric‐small intestinal transit was unaffected by chilli powder or capsaicin. Another 12 male Sprague‐Dawley rats received, under light ether anaesthesia, on six occasions at 1–2 week intervals, the same six test meals as used in the previous experiment except that charcoal was not used. Total gut transit as measured by the amount of radioactive marker excreted in the stools at 18 and 24 h was unaffected by the use of chilli or capsaicin.
Model‐derived assessment of urea appearance in response to alanine infusion: A quantitative measure of liver function in cirrhosis
Authors: BIANCHI G. P. , MARCHESINI G. , BOLZANI R. , FABBRI A. , SARTI E. , PISI E.
Published: March 2008

A three compartment mathematical model was used to analyse the urea response to an alanine infusion in six control subjects, and in 15 patients with liver cirrhosis and variable degree of hepatocellular failure. Model‐derived coefficients were used to calculate two parameters (Ymax and Tmax), able to describe the theoretical response of the conversion of amino acid derived nitrogen into urea, in response to a unit impulse in alanine concentration. They correspond to the maximum rate of conversion of nitrogen from an intermediary pool into urea and to the time delay between the impulse and Ymax, respectively. In cirrhosis, the apparent volume of distribution of infused alanine was smaller than in controls, while the conversion of alanine nitrogen into an intermediary pool of nitrogen and finally into urea nitrogen were both reduced. Also Ymax was reduced by 50% in cirrhosis, whereas Tmax was increased by 50%, and both significantly correlated with galactose elimination capacity (GEC; R2= 0.706 and R2= 0.505, respectively) and with antipyrine clearance (Ap Cl; R2= 0.823 and R2= 0.576, respectively). Model‐derived assessment of urea appearance in response to alanine infusion is able to quantify the functional liver cell mass, and may prove useful for the study of nitrogen metabolism in cirrhosis, mainly in relation to encephalopathy.
Evaluation of the maximal excretion rate of indocyanin green as a prognostic indicator in patients undergoing biliary decompression for obstructive jaundice
Authors: IZAWA K. , SASAKI M. , TOMIOKA T. , OKA S. , SEGAWA T. , YAMAGUCHI T. , TSUNODA T. , KANEMATSU T.
Published: March 2008

To assess the postoperative outcome of jaundiced patients and to select the optimal timing for surgical intervention, indocyanin green (ICG) concentrations in the bile were measured after biliary decompression in patients with obstructive jaundice. The maximal excretion rate of ICG in the bile was calculated as a function of time (ICG Bmax).

Among 59 patients with positive ICG Bmax values, morbidity was 15.2% and postoperative hospital mortality was 3.3%. However, the morbidity and mortality in nine patients with values between ‐ 0.5 and 0 were 88.8 and 44.4%, respectively. The 13 patients with in ICG Bmax below ‐ 0.5 had a 76.9% morbidity and a 61.5% mortality. The patients with ICG Bmax values below 0 showed a significantly higher morbidity and mortality than positive ICG Bmax patients. In patients showing ICG Bmax values below ‐ 0.5, surgery is contraindicated despite intensive postoperative care. The ICG Bmax value improved according to the increasing effect of biliary decompression. The index is useful not only as a prognostic index in the early phase of biliary decompression but also as an index of bile secretory capacity at a given time. By means of time course measurement of this index, the suitable time for operation can be determined. The ICG Bmax is a useful and reliable indicator in the assessment of hepatobiliary functional reserve in jaundiced patients after biliary decompression and prior to further surgical intervention.
Hepatocellular carcinoma in 13 patients with hepatitis C virus‐associated chronic hepatitis
Authors: WATANABE A. , NISHIMORI H. , TSUKISHIRO T. , OKADA K. , SHIMIZU Y. , NAMBU S. , MIYABAYASHI C. , TAKAHARA T. , HIGUCHI K.
Published: March 2008

Abstract Thirteen of 81 patients with chronic hepatitis and positive hepatitis C virus (HCV) antibody developed hepatocellular carcinoma (HCC) during a follow‐up period of 54 ± 38 months. The histopathological findings in HCC‐bearing liver in these patients included six cases of chronic persistent hepatitis [CPH; mean hepatitis activity index (HAI) score: 5.8] and seven cases of chronic aggressive hepatitis (CAH) 2A, or 2B (HAI) score: 13.6). Multiple biopsies of the liver in six cases revealed that five cases, including four with CPH at the time of HCC diagnosis, previously had histopathological findings identical to CAH 2A, and another case constantly had CPH during the 8‐year follow‐up. These findings suggest that HCV‐associated HCC can occur even in patients with HCV antibody positivity and inactive or mild chronic hepatitis. This is of interest in the pathogenetic mechanisms of HCV‐associated HCC.
Reversibility of organic anion‐induced cholestasis: Association with compensatory hypersecretion of biliary phospholipid and protein in the dog
Authors: TAZUMA SUSUMU , TOKUMO HIRONORI , YAMASHITA GUNJI , HORIKAWA KAZUHIKO , MIURA HIROYUKI , HIRANO NAOMICHI , AIHARA NAOKI , SASAKI MASATOSHI , TERAMEN KAZUSHI , OCHI HIDENORI , YAMASHITA YOSHIFUMI , OHYA TOSHIHIDE , KAJIYAMA GORO , HOLZBACH R. THOMAS
Published: March 2008

Abstract The effect of a concomitant infusion of organic anions, structurally related phthaleins, on bile flow was studied in anaesthetized dogs. A combination of rose bengal and sulfobromophthalein was found to uniquely and synergistically produce an acute, reversible form of intrahepatic cholestasis (< 10% of control level). This phenomenon was not observed with the administration of those individual organic anions at concentrations previously associated with the induction of intrahepatic cholestasis. The infusion of either a micelle forming bile salt, sodium taurocholate, or a non‐micelle forming bile salt, sodium dehydrocholate, rapidly reversed the intrahepatic cholestasis (within 20 min after bile salt infusion). During the choleretic phase immediately following the bile salt infusion, a transient but marked hypersecretion, a disproportionately increased output in relation to that of bile acids, of biliary phospholipid (176% of control level by taurocholate and 138% of control level by dehydrocholate), and an even more striking amount of biliary protein hypersecretion were observed (392% of control level by taurocholate and 357% of control leverl by dehydrocholate). Although the significance of these new post‐cholestatic observations requires clarification, it is suggested that the intrahepatic cholestasis induced by organic anions reflects a reversible defect in the mechanism(s) involved in transcellular transport.
Anti‐neutrophil cytoplasmic antibody: A prognostic indicator in primary sclerosing cholangitis
Authors: POKORNY CHRISTOPHER S. , NORTON IAN D. , McCAUGHAN GEOFFREY W. , SELBY WARWICK S.
Published: March 2008

Abstract Considerable variability has been reported in the frequency and specificity of anti‐neutrophil cytoplasmic antibody with a perinuclear staining pattern (pANCA) in patients with chronic liver disease, especially in primary sclerosing cholagitis (PSC), and in inflammatory bowel disease. This study examines the presence of pANCA in patients with these disorders, in particular those with PSC complicated by other biliary disease, and also patients who had undergone orthotopic liver transplantation. An indirect immunofluorescent technique was used to measure pANCA with serum diluted 1 : 20.

Ten of 39 (26%) patients with PSC had detectable pANCA, as did two of nine (22%) with autoimmune chronic active hepatitis (AICAH) but none of the 51 patients with other forms of chronic liver disease. The presence of pANCA was significantly more frequent in patients who had PSC with biliary tract complications, in particular calculi (seven of 16 with vs three of 23 without; P= 0.03). Eight of the 12 pANCA‐positive patients with PSC or AICAH had undergone hepatic transplantation. This was more likely than in patients with PSC or AICAH who were pANCA negative (10 of 36; P= 0.02). To date, pANCA has been detected after transplantation in four patients with PSC and one with AICAH. In patients with PSC or AICAH, pANCA should be sought as a marker of prognosis.
Chemical dissolution of gallstones in Taiwan: An in vitro study
Authors: LIN XI‐ZHANG , CHOU TSE‐CHUAN , LIN PING‐WEN , LI CHOU YOU , LI CHI‐CHEN , CHEN SHOU‐KANG
Published: March 2008

Abstract To evaluate the potential for the chemical dissolution of gallstones, 480 stones from 214 patients were studied. The stones were obtained via surgery or endoscopically. They were classified into cholesterol‐rich mixed stones, brown pigment stones and black stones. The composition of bilirubin and cholesterol was determined by Fourier transformed infrared spectroscopy. Two per cent tetrasodium ethylenediamine acetate (EDTA), dimethylsulfoxide (DMSO) or methyl‐tert‐butyl‐ethylene (MTBE) were used to dissolve the stones. To enhance solubility, surfactant polysorbate‐20 was used to mix two of the individual three solvents. Methyl‐tert‐butyl‐ethylene was found to have the best dissolution ability (by dry weight) 94, 13.4 and 20% for mixed, brown and black stones, respectively. Dimethylsulfoxide resulted in 13, 14 and 25% dissolution and EDTA 9.5, 13 and 16.5%. In contrast, pure water dissolved 4, 6 and 10.4% of the stones, respectively. A combination of the dissolution agents did not enhance the dissolution rate. In fact, the combination of solvents unexpectedly reduced the solubility of the stones: EDTA/MTBE was 17.5, 6.7 and 16.0%; DMSO/MTBE 43.2, 21.9 and 18.0%; DMSO/EDTA 9.1, 7.0 and 9.6%. In conclusion, cholesterol‐rich mixed stones were able to be dissolved using MTBE but results of contact dissolution for gallstones are still far from satisfactory.
Helicobacter pylori epidemiology in relation to peptic ulcer and gastric cancer in South and North China
Authors: CHING C. K. , LAM S. K.
Published: March 2008

Abstract Peptic ulcer disease is twice as common in people living in South China when compared with those in North China. However, the gastric cancer rate in North China is three times that of South China. The overall Helicobacter pylori prevalence rate is similar in North and South China populations and it is higher than Caucasians living in Western societies. However, there is a significantly higher prevalence of H. pylori seropositivity among those who live in the high gastric cancer areas of China. On the other hand, there is no significant difference in the H. pylori positive rate in the peptic ulcer disease patients between the two regions of China. Other permissive/associated co‐factors in the development of peptic ulcer disease or gastric cancer remain unknown at this stage.
How does Helicobacter pylori cause duodenal ulcer disease: The bug, the host, or both?
Authors: GO M. F. , GRAHAM D. Y.
Published: March 2008

Abstract Helicobacter pylori infection is the most common cause of duodenal ulcer disease, yet duodenal ulcer is an uncommon outcome of H. pylori infection. We reviewed the possible explanations such as differences in the host or in the strain of H. pylori. Host factors reviewed included genetic susceptibility to H. pylori infection and excess gastric acid secretion. The role of potential H. pylori virulence factors not present in all strains such as the cagA gene and the results of other molecular methods to identify disease‐specific differences among isolates was also reviewed. Although cure of H. pylori infection resolves gastrin releasing peptide stimulated acid secretion there was no change in parietal cell mass. Twin studies have shown genetic differences in H. pylori susceptibility. There was no difference in the prevalence of the cagA gene between H. pylori infected asymptomatic volunteers and duodenal ulcer patients (P= 1.0). DNA‐DNA hybridization of whole genomic DNA in solution and cluster analysis of rep‐PCR genomic DNA fingerprints suggest that isolates from patients with duodenal ulcer disease are different from those obtained from individuals with asymptomatic gastritis. Cluster analysis of the rep‐PCR DNA fingerprints revealed two major groups of the strains; one set consisted of strains from patients with duodenal ulcer disease and the second cluster consisted largely of strains from individuals with asymptomatic gastritis. Recent molecular studies suggest that disease‐specific cell lineages or strains may exist among H. pylori isolates leading to the various outcomes observed in patients with H. pylori infection.
Effect of ammonium ion on the hydrophobic and barrier properties of the gastric mucus gel layer: Implications on the role of ammonium in H. pylori‐induced gastritis
Authors: LICHTENBERGER L. M. , ROMERO J. J.
Published: March 2008

Abstract Infection with the bacterium Helicobacter pylori is associated with both the development of gastritis and an attenuation in the hydrophobic properties of the stomach. In order to better understand the effect of ammonium, one of the major products of H. pylori urease on these properties, a series of in vivo and in vitro experiments was performed. In the in vivo studies rats were intragastrically administered NH4Cl alone and in combination with the mucolytic agent, Muco‐Mist, in various dosing strategies and concentrations. It was determined that the intragastric administration of four consecutive doses of a NH4Cl/Muco‐Mist mixture (20 mmol/L/5%) was capable of converting the stomach from a hydrophobic to hydrophilic state as determined by contact angle analysis. Further, the treated rats became more susceptible to the injurious effect of luminal acid as determined by measuring the haemoglobin concentration of a collected gastric perfusate. In the in vitro studies it was determined that exposure of the hydrophobic surface of a synthetic mucus gel layer to increasing concentrations of NH4Cl (0–20 mmol/L) resulted in a rapid transition to a hydrophilic state and an associated increase in the flux of H+ across its surface.

Helicobacter pylori may induce an attenuation in both mucosal hydrophobicity and barrier properties by producing high concentrations of NH+4 in the mucus gel layer. The molecular mechanism of this action may be related to the chemical similarities of NH+4 and choline‐based phospholipids which contribute to the stomach's hydophobic surface.
The differential mechanisms of mild irritants on adaptive cytoprotection
Authors: CHO C. H. , KO J. K. S. , TANG X. L.
Published: March 2008

Abstract The protective action of mild irritants has been established. However, the mechanisms as to how they antagonize the injurious action produced by the subsequent challenge with an ulcerogenic stimulus are still unclear. The present study examined the different protective mechanisms of an oral administration of the three mild irritants, 20% ethanol, 0.3 mol/L HCl or 5% NaCl against the gastric injurious actions of absolute ethanol in rats. In an attempt to clarify the pathways and mediators involved in the adaptive cytoprotection, [d‐Pro2, d‐Trp7,9]‐substance P (substance P antagonist), Nw‐nitro‐l‐arginine methyl ester (l‐Name), indomethacin, capsaicin, lidocaine, atropine or hexamethonium was given. The protective action of 20% ethanol but not the other two mild irritants, was antagonized by l‐Name, indomethacin and capsaicin, which are the inhibitors of nitric oxide (NO) and prostaglandins (PG) synthesis, and afferent sensory neuron blocker, respectively. Substance P antagonist, lidocaine or atropine given alone, prevented mucosal damage; however, only substance P antagonist enhanced the anti‐lesion action of 20% ethanol, while atropine and lidocaine increased the protective effect of NaCl and HCl. The three mild irritants increased the residual gastric secretion. Only 20% ethanol and 5% NaCl but not 0.3% HCl significantly increased the basal adherent mucus and also attenuated the mucus depletion by absolute ethanol. It is concluded that the cytoprotective action of either ethanol or NaCl seems to be mediated through the increase of residual gastric secretion and adherent mucus. In the ethanol‐treated group, these actions could act through the afferent sensory fibres, with NO and PG as the possible mediators. The antilesion action of HCl is partly contributed by the increase of residual gastric secretion through its dilution action. However, the protective factors and mediators involved in this action need further investigations.
The gastroduodenal mucus barrier and its role in protection against luminal pepsins: The effect of 16,16 dimethyl prostaglandin E2, carbopol‐polyacrylate, sucralfate and bismuth subsalicylate
Authors: COPEMAN M. , MATUZ J. , LEONARD A. J. , PEARSON J. P. , DETTMAR P. W. , ALLEN A.
Published: March 2008

Abstract Mucus and bicarbonate secretions have been widely implicated as an important pre‐epithelial protective barrier against autodigestion of the gastric mucosa by acid and pepsin. Evidence from several independent studies shows there is a continuous layer of resilient viscoelastic mucus gel adherent to the surface of the gastroduodenal mucosa. The median thickness of the adherent gastric mucus layer in humans is 180 μm, range 50–450 μm. The epithelial bicarbonate secretion permeates the unstirred matrix of mucus gel neutralizing luminal acid and establishing a pH gradient within the gel. In the duodenum, evidence supports the mucus bicarbonate barrier as a major protective mechanism aganist acid aggression.

The adherent mucus gel, by acting as an effective ‘permeability’ barrier to pepsin, protects the underlying sensitive mucosa from digestion. However, pepsin slowly digests mucus gel at its luminal surface to produce soluble degraded mucin. In a rat gastric damage model in vivo, pepsin in excess digests the gastric mucus barrier sufficiently rapidly to outweigh new mucus secretion and lead to breaching of the mucus barrier with the formation of small punctate ulcers in the epithelium accompanied by mucosal haemorrhage. The mucus secretagogue 16,16 dimethyl prostaglandin E2 and the muco‐adhesive carbopol‐polyacrylate both fully protected the mucosa against pepsin damage by enhancing the protective properties of the mucus barrier. Sucralfate and bismuth subsalicylate were partially effective in protection against pepsin damage but this protection was mainly mediated at the level of the mucosa. In peptic ulcer disease, there is increased mucolytic (mucus degrading) activity in gastric juice and this is associated with an impaired mucin polymeric structure and a weaker mucus barrier. This enhanced mucolysis can be explained by increased levels of pepsin 1 secretion in peptic ulcer disease.

Evidence from these studies supports (i) the adherent mucus layer as a major protective barrier against pepsin aggression in the stomach; (ii) that pepsin is a mucosal damaging agent per se under conditions where acid alone is ineffective; and (iii) decreased resistance of the mucus barrier to pepsin aggression could be a factor in the aetiology of peptic ulcer disease.
Gastric ulcer treatment with intravenous human epidermal growth factor: A double‐blind controlled clinical study
Authors: ITOH M. , MATSUO Y.
Published: March 2008

Abstract We introduced a double‐blind controlled clinical study to compare intravenous human epidermal growth factor (hEGF) to cetraxate hydrochloride (CH), an antiulcer drug, for their healing effect on gastric ulcers. We also prospected an oral use of EGF on the basis of our experimental evidence. In the clinical trial, the rate of ulcer healing within 8 weeks was 77.9% (67/86) in patients receiving 6 μg EGF intravenously twice a week, being significantly greater than 51.7% (45/87) in those given CH. Taking together all aspects assessed including the healing rate, pain relief, blood examination and adverse reactions, we judged the hEGF to be a useful and safe antiulcer drug. In rats, 50 μg/kg mouse EGF (mEGF) and 2% hydroxypropyl cellulose (HPC) or 1.0 g/kg sucralfate given by gastric intubation significantly raised the residual mEGF levels in both gastric luminal content (HPC: x 30; sucralfate: x 300 as high as those in EGF alone) and tissue (HPC: x 60; sucralfate: x 100). In addition, the combined treatments significantly promoted healing of rat gastric ulcers whereas each agent alone had no significant effect as compared with control (saline). This indicated the beneficial effect on ulcers of oral administration of EGF with agents allowing it to remain at high levels in the stomach, whereas most reports suggested less effect of oral EGF on healing of gastroduodenal ulcers. Subsequent to the clinical study, evaluation of oral use of EGF may be expected as the next step in the treatment of ulcers. The experimental evidence above would possibly be a guide for such trial.
The therapeutic strategy for peptic ulcer disease
Authors: IVEY K. J.
Published: March 2008

Abstract Therapy of acid/peptic disease has evolved since the 1970s with development of: (i) more accurate endoscopes which permit precise examination and documentation of upper gastrointestinal lesions; and (ii) the histamine H2‐receptor antagonists. As well, refined standards for clinical investigation have contributed to the clinical study of acid/peptic diseases. Initially, ulcer diseases were considered to be principally secondary to increased ‘aggressive’ factors (acid, pepsin) and the therapeutic focus was directed at antacids, the progressive evolution of additional histamine H2‐receptor antagonists and recently the H+/K+‐ATPase inhibitors. Later studies indicated efficacy of sucralfate, low dose antacids and prostaglandin analogues, drugs with either no or only modest antisecretory effect. This led to studies on the role of gastroduodenal mucosal defensive factors (mucus and bicarbonate secretion, blood flow, leucocyte adherence, cytokines, reactive oxygen radicals). The prominent role played by aspirin and other non‐steroidal anti‐inflammatory drugs (NSAID) in initiating and causing recurrence of peptic ulcer disease has been increasingly realized. Recognition of those most at risk for NSAID‐induced complication has led to newer approaches to treatment and prevention. Since 1983, Helicobacter pylori has been incriminated as a major factor in the pathogenesis of ulcer disease, particularly ulcer recurrences. Treatment of such ulcers now includes antibiotics and bismuth compounds in order to eradicate H. pylori. This therapeutic regimen is in a state of flux (‘triple therapy’vs a H+/K+‐ATPase inhibitor plus antibiotic) as is the question of how to work up and treat patients initially presenting with ulcer symptoms.
Rise and fall of the Plummer‐Vinson syndrome
Authors: CHEN THOMAS S. N. , CHEN PETER S. Y.
Published: March 2008

Three hypotheses have been proposed for the decreased incidence of Plummer‐Vinson disease: non‐existence, identity with inlet gastric mucosa of the oesophagus and disappearance of the predisposing condition(s). We examined these possibilities by reviewing our understanding of the syndrome. The early framers disagreed on the cause, but many thought it was a precursor for upper oesophageal carcinoma. Four explanations arose to account for the pathogenesis: iron deficiency; nutritional deficits; autoimmunity; and gastric lesion. We believe the decline in recognition paralleled the improve of dietary status and the treatment of sideropenic anaemia with inorganic iron salts.
A study of primary‐ and re‐infection with hepatitis C virus in blood transfusion recipients
Authors: MENG ZONG‐DA , XU DONG‐GANG , SUN DE‐GUI , LU HO‐YING , COPLAND JOY , LIU CAI‐YUN , MA XIAN‐KAI , CHEN SHU‐FEN , NIU JIAN‐ZHANG , SUN YON‐DE , GOWANS ERIC J.
Published: March 2008

A nested polymerase chain reaction was used to assess viraemia in blood transfusion recipients with no serological evidence of hepatitis C virus (HCV) infection (naive recipients) and in recipients with prior or existing HCV infection (infected recipients), who were transfused with HCV‐positive blood. In 10 hepatitis cases in naive recipients, defined as primary infection, nine showed clinical hepatitis, and one was sub‐clinical; the time between transfusion and elevation of alanine aminotransferase (ALT) levels was 15–60 days (37.9 ± 13.9). All 10 naive recipients showed abnormal ALT, and 10/10 and 7/10 were persistently positive for anti‐HCV and HCV‐RNA, respectively, for more than 1 year. Similarly, in five cases in previously infected recipients, defined as re‐infection, 4/5 showed clinical hepatitis, the time to elevation of ALT was 30–46 days (34.8 ± 6.4), and 5/5 and 3/5 were persistently positive for anti‐HCV and HCV‐RNA, respectively, for more than 1 year. All five infected recipients showed abnormal ALT. In conclusion, there was no significant difference (P= 0.05) in the frequency of the markers of infection resulting from primary or re‐infection with HCV, suggesting that primary infection fails to induce a protective immune response.
Decreased variation of electrocardiographic R–R interval in patients with liver cirrhosis
Authors: ISOBE HIDEHIKO , SAKAI HIRONORI , SAKAMOTO SHIGERU , NAWATA HAJIME
Published: March 2008

Electrocardiographic R–R interval variations were assessed to determine the functional integrity of the cardiac vagal nervous system in 20 normal controls and 71 cirrhotic patients. The ratio of the coefficient of variation to standard prediction value was used as an index. The cirrhotic patients showed significant reductions in the ratio of the coefficient compared with controls (0.71 ± 0.27 vs 0.91 ± 0.14; P < 0.01). There was a significant relationship between decreased R–R interval variation and the liver function tests. The ratio of the coefficient increased with improvement in encephalopathy, and decreased with the development of encephalopathy.

These results show that there is dysfunction of the cardiac vagal nervous system in patients with liver cirrhosis, and that this abnormality is partially reversible and might be related to liver dysfunction.
Endoscopic palliation of oesophageal carcinoma with Atkinson prosthesis
Authors: HO KHEK Y. , SAMARASINGHE DEV A. , NICHOLSON GORDON I. , LANE MARK R.
Published: March 2008

Abstract To assess the degree of palliation, the associated morbidity and mortality and to compare our results with other published series, we reviewed our use of the Atkinson prosthesis in 100 consecutive patients for the palliation of unresectable oesophageal carcinoma. The group had a mean age of 71.2 ± 2.3 years. All prostheses were placed by the pulsion method. Intubation was successful in 91%. Improvement in swallowing was seen in 82.1%. Major early procedure‐related morbidity was high at 23% with 11 perforations (11%). Procedure‐related mortality was 12%. Those aged 70 years or more had a 34.5% risk of morbidity and 15.5% risk of dying from the procedure. Late procedure‐related complications requiring further endoscopic procedures occurred in 27%. Our 7 day mortality was 14.7% (14 patients) and 31 patients (32.6%) had died within 30 days, usually from the disease itself. Those surviving the procedure (> 7 days) had a mean survival of 105 (range 9–735) days.

We obtained acceptable palliation but with a significant morbidity and mortality. Endoscopic intubation remains a useful palliative treatment for patients with unresectable carcinoma of the oesophagus and cardia.
Successful in vitro fertilization and pregnancy in a patient with autoimmune chronic active hepatitis and cirrhosis
Authors: POWELL ELIZABETH E. , MOLLOY DAVID
Published: March 2008

Abstract Fertility is reduced in women with chronic active autoimmune hepatitis (AIH) and pregnancy is hazardous. This report describes a 33 year old woman with AIH and cirrhosis in whom a successful pregnancy was achieved following in vitro fertilization/embryo transfer. Disease exacerbation during pregnancy was controlled by azathioprine and an increased dose of prednisone, and a healthy child was delivered by Caesarean section at 36 weeks gestation. Since the perinatal care of preterm infants and the obstetric care available to women with complicated medical problems has improved markedly in recent years and since active disease can be controlled by adequate immunosuppressive therapy, we propose that it is justified to allow these patients access to in vitro fertilization programmes.
Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis
Authors: YEN FU‐SHUN , WU JAW‐CHING , KUO BENJAMIN ING‐TIAU , CHIANG JEN‐HUEY , CHEN TRONG‐ZONG , LEE SHOU‐DONG
Published: March 2008

Abstract In order to evaluate the possible benefits of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients with peripheral portal vein thrombosis, 96 consecutive HCC cases with peripheral portal vein thrombosis were analysed. Of them, 35 cases received TAE and 61 cases did not. Most (77.8%) of the TAE‐treated cases showed decreased α‐fetoprotein (AFP) levels after treatment, but 57.1% of them suffered another rise in AFP levels and subsequently died. One patient (2.8%) developed progressive jaundice after TAE and died within 1 month, while four of the non‐TAE cases died within 1 month after diagnosis. In general, TAE is safe for HCC patients with peripheral portal vein thrombosis. In addition, using Cox's regression model for multivariate survival analysis, serum total bilirubin (≤, > 2 mg/dL; P= 0.0254), AFP (≤ 3155 ng/mL, > 3155 ng/mL; P= 0.0002) and treatments (TAE, non‐TAE; P= 0.0059) were found to affect their prognosis. There was significant difference in survival between TAE and non‐TAE groups, the 6 month, 1 year and 2 year survival rates were 91.4 versus 62.3%, 51.4 versus 26.2% and 17.1 versus 4.9% (P= 0.0017). The median survival times of TAE and non‐TAE groups were 10.3 versus 3.7 months, respectively. Though TAE only provided palliative treatment, it did prolong survival in HCC patients with peripheral portal vein thrombosis.
Overexpression of p53 in hepatocellular carcinomas: A clinicopathological and prognostic correlation
Authors: NG IRENE O. L. , LAI EDWARD C. S. , CHAN ANNIE S. Y. , SO MIKE K. P.
Published: March 2008

Abstract Overexpression of the p53 tumour suppressor gene is one of the most common abnormalities in primary human cancers and appears to be a result of point mutation within a highly conserved region of the gene with subsequent encoding for a mutant, more stable protein. In this study, 71 surgically resected hepatocellular carcinomas (HCC) were examined to study the expression of the p53 gene, its relation with clinicopathological parameters and its prognostic significance. Using immunohistochemical detection for mutant p53 protein with monoclonal antibody PAb1801, p53 overexpression was found in 22 tumours (31%) but in none of the non‐tumorous liver specimens. Overexpression of p53 was more frequent in tumours with poor cellular differentiation (P= 0.01), in tumours > 5 cm in diameter (P= 0.05), and in those with giant cells present (P= 0.03) and, less significantly, of massive type of Eggel's classification (P= 0.06). It did not have any significant correlation with hepatitis B or C status, background liver disease or serum α‐fetoprotein levels, nor was it related to tumour invasiveness (venous permeation, direct liver invasion and tumour microsatellite formation). In addition, the presence of p53 mutant protein did not influence tumour recurrence or patients’ survival rates. The data suggested that p53 mutation in HCC was associated with a later stage of oncogenesis. However, it was not apparently related to tumour invasiveness/aggressiveness and prognosis.
Dietary modulation of colonic mucosal urokinase activity in rats
Authors: GIBSON PETER , FOLINO MARISA , McINTYRE ANN , ROSELLA OURANIA , FINCH CAROLINE , YOUNG GRAEME
Published: March 2008

Abstract The amount and type of dietary fibre ingested influences colonic luminal characteristics, especially the concentration of carbohydrate fermentation products such as butyrate. This study aimed to assess whether diets supplemented with fibres of differing fermentability (delivering different amounts of butyrate to the colon) influence mucosal activities of urokinase and brush border hydrolases, and epithelial turnover. Groups of five rats were fed one of four diets containing low (2%), highly fermented (guar 10% or oat bran 10%) or slowly fermented fibre (wheat bran 10%) for 4 weeks. Activities of urokinase, alkaline phosphatase, dipeptidyl peptidase IV and maltase were measured in mucosal homogenates of proximal and distal colon and from rectum. Proliferative kinetics were assessed in distal and proximal colon by the metaphase arrest technique. Hydrolase activities were similar across all four dietary groups but a significant difference was found for urokinase (P= 0.014). This was due to a reduction in urokinase activities of > 30% at the three sites in the wheat bran group compared with the other groups. Of proliferative indices, only crypt column height differed across the groups (P= 0.038) and was highest in rats fed wheat bran and lowest in those fed the low fibre diet (P= 0.047). The proportion of mitoses in the top one‐fifth of the crypt also differed across groups (P= 0.038) due to the high values in the distal colon of the low fibre group. Thus, addition of a slowly fermented (but not highly fermented) fibre to the diet of rats reduces net urokinase activity in large bowel mucosa and increases the life span of colonic epithelial cells without changing activities of brush border hydrolases.
A long‐term survivor of ruptured hepatocellular carcinoma after hepatic resection
Authors: SHIRABE KEN , KITAMURA MASAYUKI , TSUTSUI SHINICHI , MAEDA TAKASHI , MATSUMATA TAKASHI , SUGIMACHI KEIZO
Published: March 2008

Abstract We treated a patient who had previously undergone a hepatic resection for ruptured hepatocellular carcinoma (HCC) but developed a solitary peritoneal recurrence at the site of the incision 8 years and 9 months later. Since no other recurrence was evident, we resected the tumour. The primary tumour was 2.5 cm in size and histological examination revealed HCC without any histological risk factors for intrahepatic recurrence. The peritoneal tumour consisted of less differentiated cancer cells than those found in the primary tumour. The positive rates of Ki‐67 were 10% in the primary tumour and 23.3% in the peritoneal recurrence. The DNA indexes in both tumours were considered to be identical.

The comparison between the primary and peritoneal tumours suggested that the histological differentiation and proliferation activity can change after recurrence, in spite of consistent DNA ploidy contents. Clinically, a patient who undergoes a hepatic resection for ruptured HCC can survive for a long time, such as 10 years, if they have good liver function and small HCC without any histological risk factors for intrahepatic recurrence. However, since late recurrence is possible, a follow up for as long as 10 years is recommended.
Anti‐peptide monoclonal antibodies to intestinal mucin 3
Authors: APOSTOLOPOULOS VASSO , XING PEI‐XIANG , MCKENZIE IAN F C
Published: March 2008

Second generation anti‐peptide monoclonal antibodies were produced using synthetic peptide SIB35 (C‐HSTPSFTSSITTTETTSHSTPSFTSSITTTETTS) as an antigen which contains two of the MUC3 tandem repeats. Three monoclonal antibodies were produced (M3.1, M3.2 and M3.3) which reacted with the immunizing peptide, but also reacted strongly with colon tissues. Using the immunoperoxidase staining technique, two of the monoclonal antibodies, M3.1 and M3.2, reacted with both colon carcinoma and normal colon tissue whereas the antibody M3.3 reacted with normal colon tissues but very weakly, if not at all, with colon carcinoma. MUC3 was found to be distributed in colon and rectum, and was also present to a lesser extent in breast, lung and salivary gland tissues. Analysis of mucin molecules by Western blotting, revealed the antigen detected by the antibodies (M3.1 and M3.2) to be of a high relative molecular mass. M3.1 and M3.3 reacted with epitopes SITTTE and PSFTSS, respectively. M3.2 did not react with any of the 6‐mer peptides, even though it reacted with the full length VNTR (2 repeat peptide—SIB35). Anti‐MUC3 peptide antibodies appear to react with colon, rectum, breast, salivary gland and lung tissues, and represent a new method of producing antitumour antibodies.
Helicobacter pylori in Melbourne Chinese immigrants: Evidence for oral‐oral transmission via chopsticks
Authors: CHOW TONY K‐F , LAMBERT JOHN R , WAHLQVIST MARK L , HSU‐HAGE BRIDGET H‐H
Published: March 2008

The Helicobacter pylori seroprevalence in a representative population of 328 Melbourne Chinese immigrants (162 men and 166 women) aged 25 years and older were studied. The population consisted of Chinese people born in China/Hong Kong (n= 110, 33.5%), Vietnam (n= 79, 24.1%), Malaysia/Singapore (n= 102, 31.1%), and elsewhere (n= 37, 11.3%). The overall seroprevalence of H. pylori was 59.5%; 60.5% in men and 58.4% in women. Gender specific analysis showed associations between higher seroprevalence and several socio‐demographic factors; in men, age (P< 0.0001), lower education level (P< 0.002), cigarette smoking (P< 0.042), the use of antibiotics (P< 0.015) and chopsticks (P< 0.047), and in women, lower socioeconomical status [education level (P< 0.030), gross household income (P< 0.0001) and occupational status (P< 0.0001)] and use of chopsticks (P< 0.002). Seroprevalence differed between immigrants of various birthplaces (P< 0.001); those born in Malaysia/Singapore (43.1%) were lower than those born in China/Hong Kong (68.2%), Vietnam (68.4%), and elsewhere (59.5%). Immigrants of various birthplaces also differed in their pattern of socio‐demographics.

Multivariate analyses showed that risk factors for H. pylori infection within the Melbourne Chinese immigrants were, in men, age (B = 1.081) and birthplace (B = 1.769) and, in women, household income (B = 0.541) and use of chopsticks (B = 1.654). This study suggests person‐to‐person transmission of H. pylori via the oral‐oral route with ethno‐specific food practices an important risk factor.
Basic fibroblast growth factor accelerates gastric mucosal restoration in vitro by promoting mesenchymal cell migration and proliferation
Authors: WATANABE SUMIO , WANG XIAN‐EN , HIROSE MIYOKO , OIDE HIROSUMI , KITAMURA TSUNEO , MIYAZAKI AKIHISA , SATO NOBUHIRO
Published: March 2008

It has been generally accepted that basic fibroblast growth factor is a potent stimulator of duodenal ulcer healing. However, the detailed mechanism and mode of action of growth factor on gastric ulcer healing is still controversial. Therefore, in the present study, the effects of basic fibroblast growth factor on gastric mucosal repair were studied using an in vitro cultured cell system. Artificial wounds were made in confluent monolayer rabbit gastric fibroblast and epithelial cell sheets by mechanical denudation. Changes in the size of the cell‐free area were analysed quantitatively. Cell proliferation was assessed by BrdU staining. For both cell types, mucosal restoration involved cell migration and proliferation. Although the speed of restoration of epithelial cells was not affected by the addition of basic fibroblast growth factor, it was much faster for epithelial cells than for fibroblasts. Basic fibroblast growth factor accelerated wound repair of fibroblasts but not epithelial cells. Basic fibroblast growth factor accelerated wound repair by stimulating both cell migration and proliferation. Therefore, the effects of basic fibroblast growth factor in peptic ulcer diseases may be mainly due to the stimulation of mesenchymal cells.