The value of serum alpha-fetoprotein in predicting tumor recurrence after liver transplantation for hepatocellular carcinoma.

BACKGROUND: Many patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT) subsequently develop tumor recurrence; this is the main factor affecting long-term survival after LT. Factors associated with tumor recurrence should be determined to improve the outcome of LT. The purpose of the study was to evaluate the value of alpha-fetoprotein (AFP) in forecasting tumor recurrence after LT for patients with HCC. METHODS: AFP data before and after LT for 97 patients with HCC who underwent LT in our center were analyzed retrospectively. RESULTS: The mean follow-up time was 17.1 +/- 2.1 months for all 97 patients, overall tumor recurrence rate was 32.9% (32/97), and mean recurrence time was 7.2 +/- 3.2 months. The most common tumor recurrence sites were liver, lung, skeleton, and other sites. Pre-transplant AFP levels >400 ng/ml were associated with higher tumor recurrence. Post-transplant AFP levels not decreasing to

[Change of cytoskeleton and variance of Ca2+ in cultured cells during the invasion of Toxoplasma gondii].

OBJECTIVE: To explore the change of cytoskeleton and the variance of Ca2+ in cultured cells during the invasion of Toxoplasma gondii. METHODS: Tachyzoites suspensions were gathered by routine method and used to infect phagocytic cells (J774A.1) and non-phagocytic cells (HUVEC). The ability of T. gondii invading into the cells and the influence of cytoskeleton inhibitor, colchicine and cytochalasin D, were observed by microscopy. The rearrangement of cytoskeleton of cells was observed by fluoromicroscopy. By using laser scanning confocal microscope, the variance of Ca2+ in J774A.1 and HUVEC was detected. RESULTS: Ca2+ increased greatly in J774A.1 during the invasion of T. gondii (P<0.01) and PLC inhibitor, U73122, could block the increase of Ca2+ (P>0.05). The microfilaments of J774A.1 were agglomerated during the invasion of T. gondii. Cytoskeleton inhibitor, cytochalasin D (P<0.01) and colchicine (P< 0.05) significantly reduced the infection rate of J774A.1 cells. No considerable change of Ca2+ in HUVEC was found (P>0.05) during the invasion and cytoskeleton was not changed. Cytochalasin D and colchicine showed little effect on the infection rate of HUVEC. CONCLUSION: The concentration of Ca2+ increases greatly and cytoskeleton (mainly the microfilament) has been rearranged in phagocytic cell during the invasion of T. gondii, while both of them show no significant change in non-phagocytic cell.

Lipase and pancreatic amylase activities in diagnosis of acute pancreatitis in patients with hyperamylasemia.

BACKGROUND: Measurement of total serum amylase (AMY) is the most widely used biochemical test for the diagnosis of acute pancreatitis, but it is commonly considered a nonspecific marker. To improve the biochemical diagnosis of acute pancreatitis, lipase (LIP) and pancreatic amylase (PAMY) have been tested in recent years. The present study was designed to evaluate whether serum LIP and pancreatic PAMY tests could replace total amylase test to improve diagnostic efficiency in the evaluation of acute pancreatitis in patients with hyperamylasemia. METHODS: LIP and PAMY values were determined in serum samples from 92 patients with hyperamylasemia. Reference values for each enzyme were derived from serum samples of 147 healthy subjects. The activities of LIP and PAMY in patients with various diseases were shown directly by the boxplot graph. The diagnostic accuracy of LIP and PAMY was defined as the area under the receiver operating characteristic (ROC) curve. Their sensitivity and specificity in detecting acute pancreatitis at varying cutoff points were shown by the curve, and the best cutoff value for each enzyme was shown by the modified ROC curve. The diagnostic values of LIP, PAMY and LIP+AMY with each upper limit of reference range (ULR) were compared with the corresponding best cutoff values. RESULTS: The references values of LIP and PAMY were 12.2-47.6 U/L and 28-95 U/L, respectively. These values in patients with acute pancreatitis were higher than those patients with other diseases. The areas under the ROC curve (AUC) of LIP and PAMY were 0.799 and 0.792, respectively. With the best diagnostic cutoff point of maximum (sensitivity + specificity)-100%, we obtained values of 97.9 U/L (LIP(97.9)=2.06 X ULR) for LIP and 209 U/L (PAMY(209)=2.20 X ULR) for PAMY. The best cutoff values for LIP, PAMY and LIP+AMY demonstrated the specificity, positive predictive value, and diagnostic efficiency higher than the corresponding ULRs. CONCLUSIONS: Serum LIP and PAMY are specific for the pancreas and might replace total amylase for the diagnosis of acute pancreatitis in hyperamylasemia patients. LIP(97.9) is more efficient than PAMY(209) in the diagnosis of acute pancreatitis. A combined test of both enzymes is not superior to single test of either enzyme in diagnostic accuracy.

[Liver transplantation for hepatocellular carcinoma: prognostic analysis of 89 cases].

OBJECTIVE: To summarize the experience of liver transplantation (LT) for hepatocellular carcinoma (HCC) in one center and identify prognostic factors for survival. METHODS: The clinical data and survival results of 89 patients with HCC receiving LT from January 1999 to December 2003 were retrospectively analyzed and various clinicopathologic risk factors for actuarial survival and tumor free survival were evaluated by univariate and multivariate analysis. RESULTS: Six-month, 1-, and 2-year survival rates were 81.8%, 55.3% and 43.7%, respectively. The 6-month, 1-, and 2-year tumor free survival rates were 62.4%, 35.6% and 24.9%, respectively. The overall tumor recurrence and metastasis rate was 52.8%. In the univariate analysis, portal vein tumor thrombi (PVTT) (chi(2) = 15.14, P = 0.0001), tumor size (chi(2) = 15.05, P = 0.0001), hepatic cirrhosis background (chi(2) = 6.14, P = 0.0132), preoperative alpha-fetoprotein (AFP) level (chi(2) = 5.82, P = 0.0159) and histopathologic grading (chi(2) = 4.61, P = 0.0319) were found to be significantly associated with actuarial survival rate. Seven factors influencing tumor free survival included PVTT (chi(2) = 26.30, P < 0.0001), tumor size (chi(2) = 25.25, P < 0.0001), preoperative AFP level (chi(2) = 14.83, P = 0.0001), histopathologic grading (chi(2) = 12.54, P = 0.0004), tumor distribution (chi(2) = 12.73, P = 0.0004), number of nodules (chi(2) = 9.81, P = 0.0017) and cirrhosis background (chi(2) = 9.76, P = 0.0018). In the multivariate Cox regression analysis, the prognostic factors independently associated with patient survival were identified to be PVTT (RR = 4.721, P = 0.001), age (RR = 3.282, P = 0.007) and histopathologic grading (RR = 2.368, P = 0.037). For tumor free survival, histopathologic grading (RR = 3.739, P < 0.0001), PVTT (RR = 4.382, P = 0.001), cirrhosis background (RR = 0.421, P = 0.011), age (RR = 2.312, P = 0.027) and AFP (RR = 2.301, P = 0.047) were identified as prognostic parameters. CONCLUSIONS: LT is a good therapeutic option for strictly selected patients with HCC. PVTT and histopathologic grading are the most important factors of predicting outcomes of HCC patients undergoing LT. Further studies should be strengthened to establish a reliable and feasible selection criteria and an optimal prognosis scoring system for LT.

Frequencies of the expression of main protein antigens from Helicobacter pylori isolates and production of specific serum antibodies in infected patients.

AIM: To investigate the frequencies of the expression of main protein antigens of Helicobacter pylori (H pylori) isolates, such as UreB, VacA, CagA1, HpaA, NapA, FlaA and FlaB and the production of specific antibodies in sera from H pylori-infected patients, and to understand the correlations among the different clinical types of chronic gastritis and peptic ulcer and the infection and virulence of H pylori. METHODS: H pylori strains in biopsy specimens from 157 patients with chronic gastritis and peptic ulcer were isolated and serum samples from the patients were also collected. The target recombinant proteins rUreB, rVacA, rCagA1, rHpaA, rNapA, rFlaA and rFlaB expressed by the prokaryotic expression systems constructed in our previous studies were collected through Ni-NTA affinity chromatography. Rabbit antisera against rUreB, rVacA, rCagA1, rHpaA, rNapA, rFlaA and rFlaB were prepared by using routine subcutaneous immunization. By using ultrasonic lysates of the isolates as coated antigens, and the self-prepared rabbit antisera as the first antibodies and commercial HRP-labeling sheep anti-rabbit IgG as the second antibody, expression frequencies of the seven antigens in the isolates were detected by ELISA. Another ELISA was established to detect antibodies against the seven antigens in sera of the patients by using the corresponding recombinant proteins as coated antigens, and the sera as the first antibody and HRP-labeling sheep anti-human IgG as the second antibody respectively. Correlations among the different clinical types of chronic gastritis and peptic ulcer and the infection and virulence of H pylori were statistically analysed. RESULTS: In the 125 isolates of H pylori, the positive rates of UreB, VacA, CagA1, HpaA, NapA, FlaA and FlaB were 100%, 65.6%, 92.8%, 100%, 93.6%, 100% and 99.2% respectively. In the 125 serum samples from the H pylori-infected patients, the positive rates of antibodies against recombinant UreB, VacA, CagA1, HpaA, NapA, FlaA and FlaB were 100%, 42.4%, 89.6%, 81.6%, 93.6%, 98.4% and 92.8% respectively. H pylori strains were isolated from 79.6% (125/157) of the biopsy specimens, but no close correlations among the H pylori infection frequencies and different types of chronic gastritis and peptic ulcer could be found (P>0.05, chi2 = 0.01-0.87). The VacA positive rate (82.40%) in the strains isolated from the specimens of patients with peptic ulcer and the anti-VacA positive rate (54.3%) in the sera from the patients were significantly higher than those (51.5%, 32.3%) from the patients with chronic gastritis (P<0.01, chi2 = 13.19; P<0.05, chi2 = 6.13). When analysis was performed in the different types of chronic gastritis, the VacA in the strains isolated from the specimems of patients with active gastritis showed a higher expression frequency (90.0%) than those from superficial (47.9%) and atrophic gastritis (30.0%) (P<0.05, chi2 = 5.93; P<0.01, chi2 = 7.50). While analysis was carried out in the strains isolated from the specimens with superficial (93.8%) and active gastritis (100%), NapA showed a higher expression frequency compared to that from atrophic gastritis (60.0%) (P<0.01, chi2 = 8.88; P<0.05, chi2 = 5.00). CONCLUSION: The types of chronic gastritis and peptic ulcer and their severity are not associated with H pylori infection frequency but closely related to the infection frequency of different virulent H pylori strains. The optimal antigens for developing vaccine and diagnostic kit are UreB, FlaA, HpaA, FlaB, NapA and CagA1, but not VacA.