Percutaneous ethanol injection therapy (PEIT) has been administered as a safe therapeutic modality for patients with small hepatocellular carcinoma (HCC). Due to the nature of the straight approaching line of a PEIT or radiofrequency ablation needle, penetrating the vessels that are interposed between the dermal insertion point and the nodule is unavoidable. A device with an overcoat needle and coaxial curved PEIT needle was created that facilitated a detour around interposing large vessels in order to avoid unnecessary harmful effects that result from the PEIT procedure. Two cases of HCC located adjacent to a neighboring large vessel were treated with a curved PEIT needle. The curved PEIT needle, which is connected to an outer needle, enabled deviation around the interposing vessels and successful connection with the HCC. Careful use of the curved line of the PEIT needle enabled the safe and successful performance of the PEIT without any requirement for specific training. This hand-assisted technique may be an applicable treatment for small HCC located beneath large vessels as a direct therapeutic method using ultrasound guidance.

AIM:Recent studies have revealed that primary biliary cirrhosis patients with anticentromere antibody (ACA) commonly develop portal hypertension. However, the clinical characteristics of autoimmune hepatitis (AIH) remain uncertain. We investigated the clinical features of patients with AIH seropositive for ACA (ACA-AIH), comparing them with those of patients with AIH seropositive for other immunofluorescent patterns of antinuclear antibodies (ANA) (other-AIH).METHODS:AIH was diagnosed on the basis of the scoring system proposed by the International Autoimmune Hepatitis Group. Seropositivity for ACA was determined by a discrete speckled pattern on HEp-2 cells by an immunofluorescent technique. The severity of histological grading and staging was evaluated by the histological activity index (HAI) score.RESULTS:Eight (17%) of 47 patients with AIH had ACA. No significant differences in age, sex, onset pattern of the disease, progression to hepatic failure and relapse rate were present between the ACA-AIH and other-AIH groups. The frequency of concurrent autoimmune diseases in ACA-AIH was significantly higher than that in other-AIH (75% vs 36%, P = 0.0406). Biochemical analysis revealed a significantly lower mean immunoglobulin G (IgG) level than that in other-AIH (2176 +/- 641 vs 3013 +/- 923 mg/dL, P = 0.0150). However, there were no differences in serum alanine aminotransferase levels, titers of ANA, HAI scores or the positive rate of human leukocyte antigen (HLA)-DR4 between the groups.CONCLUSION:These results suggest that the emergence of ACA is not a distinct entity of AIH, despite its clinical characteristics of a significantly higher frequency of concurrent autoimmune diseases and lower serum IgG levels.

Although a number of studies have shown that vitamin K possesses antitumor activities on various neoplastic cell lines, there are few reports demonstrating in vivo antitumor effects of vitamin K, and the antitumor effect on colorectal cancer (CRC) remains to be examined. Therefore, antitumor effects of vitamin K on CRC were examined both in vitro and in vivo. Vitamins K2, K3 and K5 suppressed the proliferation of colon 26 cells in a dose-dependent manner, while vitamin K1 did not. On flow cytometry, induction of apoptosis by vitamins K2, K3 and K5 was suggested by population in sub-G1 phase of the cell cycle. Hoechst 33342 staining and a two-color flow cytometric assay using fluorescein isothiocyanate-conjugated annexin V and propidium iodide confirmed that vitamins K2, K3 and K5 induced apoptotic death of colon 26 cells. Enzymatic activity of caspase-3 in colon 26 cells was significantly up-regulated by vitamins K2, K3 and K5. The pan-caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp-fluoromethyl ketone, substantially prevented vitamin K-mediated apoptosis. In vivo study using syngeneic mice with subcutaneously established colon 26 tumors demonstrated that intravenous administration of vitamins K2, K3 and K5 significantly suppressed the tumor growth. The number of apoptotic tumor cells was significantly larger in the vitamin K-treated groups than in the control group. These results suggest that vitamins K2, K3 and K5 exerted effective antitumor effects on CRC in vitro and in vivo by inducing caspase-dependent apoptotic death of tumor cells, suggesting that these K vitamins may be promising agents for the treatment of patients with CRC.

Objective. Zinc supplementation has been shown to contribute to inhibition of liver fibrosis and improvement in hepatic encephalopathy. However, little is known about the anti-inflammatory effect of zinc on hepatitis C virus (HCV)-related chronic liver disease (CLD). We therefore examined the effects of zinc administration on inflammatory activity and fibrosis in the liver of patients with HCV-related CLD. Material and methods. Polaprezinc, a complex of zinc and l-carnosine, was administrated at 225 mg/day for 6 months to 14 patients with HCV-related CLD, in addition to their ongoing prescriptions. Peripheral blood cell counts, liver-related biochemical parameters, serological markers for liver fibrosis, HCV-RNA loads, and serum levels of zinc and ferritin were evaluated before and after zinc administration. Results. Serum zinc concentrations were positively correlated with hepatic reserve before zinc supplementation. A significant increase in serum zinc level was observed after zinc supplementation (64±15 versus 78±26 mg/dl, p=0.0156). Treatment with polaprezinc significantly decreased serum aminotransferase levels (aspartate aminotransferase (AST): 92±33 versus 63±23 IU/l, p=0.0004; alanine aminotransferase (ALT): 106±43 versus 65±32 IU/l, p=0.0002), whereas alkaline phosphatase levels were significantly increased (305±117 versus 337±118 U/l, p=0.0020). Serum ferritin levels were significantly decreased by treatment with polaprezinc (158±141 versus 101±80 ng/ml, p=0.0117). The reduction rate of ALT levels by polaprezinc was positively correlated with that of ferritin (r2=0.536, p=0.0389). There was a tendency toward a decrease in serum type IV collagen 7S levels after treatment with polaprezinc. However, administration of polaprezinc did not affect peripheral blood cell counts, other liver function tests, or HCV-RNA loads. Conclusions. These findings suggest that polaprezinc exerts an anti-inflammatory effect on the liver in patients with HCV-related CLD by reducing iron overload.

This letter reports a method for displacement measurement of the depth migration of transparent cells. This proposed optical spatial filtering method allows visualization of the transparent cells and determination of depth migration as a horizontal displacement positive or negative first order diffracted light on the detector surface. When the sample is displaced upward or downward from the focal plane, first and negative first order diffracted light form images at a different point as a light circle. The coordinates of these two light circles on the detector surface change places when the displacement of depth migration moves to the opposite direction.

AIMAlthough the pathogenic mechanism underlying autoimmune hepatitis (AIH) remains unclear, the immune system is thought to be critical for the progression of the disease. Cellular immune responses may be linked to the hepatocellular damage in AIH. Recently, much attention has been focused on the critical functions of costimulatory molecules expressed on mononuclear cells in the generation of effective T cell-mediated immune responses. Analysis of costimulatory molecule expressed on mononuclear cells from the patients with AIH may give us insight into the pathogenic mechanism of hepatocellular damage in AIH.METHODSPeripheral blood mononuclear cells (PBMC) were taken from the patients with AIH (34 cases) and healthy controls (25 cases). Liver infiltrating mononuclear cells (LIMCs) were taken from the patients with AIH (18 cases), the patient with chronic hepatitis C (CH-C) (13 cases) and the patients with fatty liver (2 cases). Using flow cytometry, the cells were analyzed for the expression of costimulatory molecules, such as CD80, CD86, and CD152 (CTLA-4). The results were compared with clinical data such as the level of gammaglobulin, histological grade, presence or absence of corticosteroids administration and the response to corticosteroids.RESULTSThe levels of CD80+, CD86+ and CD152+ PBMC were significantly reduced in the patients with AIH as compared with healthy controls. By contrast, those cells were significantly higher in LIMC than in PBMC of the patients with AIH. Especially, the level of CD86+ LIMC showed a marked increase irrespective of the degree of disease activity in the patients with AIH, although CD86+ cells were rarely present in PBMC. The levels of CD86+ cells were present in significantly higher frequency in patients with AIH than in the patients with CH-C. Furthermore, the patients with AIH with high levels of CD86+ LIMC showed good responses to corticosteroids, whereas 2 cases of AIH with low levels of CD86+ LIMC did not respond well.CONCLUSIONThese results suggest that LIMC over-expressing costimulatory molecules such as CD80 and CD86 appears to play a role in the pathogenesis of AIH. Especially, CD86 molecule expressed on the LIMC may be useful for the diagnosis of AIH and for the prediction of the therapeutic effects of corticosteroids on AIH.

We study on the imaging technology of three-dimensional distribution for sugar chain on single living cell-membrane. This technology can observe the entire cell surface. To observe the cell surface, the local area image of cell-membrane is taken by TIRF (total internal reflection fluorescence) microscopy. And by scanning the whole cell surface area, we can obtain the image of the entire cell membrane. These observed local area images can be converted into an entire surface image by the pattern matching processing. For this scanning technology, we propose the proximal two beam optical tweezers to rotate the single floating cell. This proximal two beam optical tweezers can rotate the floating single cell in the nutrient medium by light pressure. Two beams illuminate the single cell at proximal two points from below and above. The cell is trapped at the center of these two focal points. At the same time, light pressures that are generated at two focal points are made to act as rotational torque. Conventionally TIRF microscope is well known as the observation technology for the cell-membrane using the evanescent light as the exciting light. We can observe the local area images of the fluorescently labeled sugar chain that binds the glycoprotein. Using the proposed optical system, we can obtain the fluorescent distribution images on the cell-membrane.

This letter describes the spectroscopic measurements of fluorescently stained cells. Variable phase-contrast fluorescence spectrometry was used on fluorescently stained cells to achieve high two-dimensional spatial resolution. Phase shift interferometry by autocorrelation interference made it possible to measure fluorescence spectra in the field of view without the separation of wavelengths, as in the case of a conventional dispersive spectrometer. In this letter, the authors describe the experimental characteristics of fluorescence spectra generated from fluorescently stained cells and verify that the fluorescence spectra of the stained area in the cells can be measured by our method.

Because the underlying mechanism of hepatocellular damages in autoimmune hepatitis (AIH) still remains unclear, analysis of CD28 and bcl-2 molecules, which are critical for T cell activation and survival, was performed in patients with AIH. The number of CD28(+)CD4(+) peripheral blood mononuclear cells (PBMC) in corticosteroid (CS)-treated patients was comparable to normal control individuals but decreased in untreated AIH patients. In contrast, the number of CD28(+)CD8(+) PBMC was decreased in both CS-treated and untreated AIH patients. Analysis of liver-infiltrating mononuclear cells (LIMC) showed that the number of CD28(+)CD4(+) and CD28(−)CD8(+) LIMC were positively correlated with the histology activity index score. Bcl-2(+)CD4(+) LIMC were observed in the portal area of the liver and the numbers fluctuated with disease activity during the time course after CS administration. By contrast, CD8(+) LIMC were shown not to express bcl-2. Taken collectively, these results suggest that bcl-2(+)CD28(+)CD4(+) and bcl-2(−)CD28(−)CD8(+) cells may play critical and distinct roles in hepatocellular damage in AIH.

A three-dimensional phase-contrast imaging technique that does not involve fluorescent labeling has been developed for observing floating cells. In this method, a single floating cell is made to rotate and images are acquired at several orientations of the cell using a phase-contrast microscope. From these two-dimensional phase-contrast images, three-dimensional cross-sectional images are obtained using the conventional computed tomography algorithm. This proposed method enabled successful rotation of a floating cell (a breast cancer cell line) and reconstruction of three-dimensional phase-contrast images. In these reconstructed three-dimensional images, the distribution of cell organelles is obtained and the cell nucleus is clearly distinguishable.

hepatitis or prolonged exposure to environmental toxins predisposes liver cells to mutations of the genes critical in the control of hepatocyte growth.In fact, both activation of cellular oncogenes and inactivation of tumorsuppressor genes are involved in the development of HCC.Activation of oncogenes by hepatitis virus integration has been shown in the woodchuck animal model [2] , although the significance of this finding in human hepatocarcinogenesis is still under investigation.Tyrosine kinases, though a minor class of cellular protein, represent a major class of oncogenes.These tyrosine kinases are classified into two major groups [3,4] .The first is receptor-type protein tyrosine kinases, the second is non-receptor type tyrosine kinases.The main representatives of the latter group are non-receptor-linked and membrane-associated Src family tyrosine kinases.At least nine Src-related tyrosine kinases have been identified thus far, including c-Yes, c-Src, c-Lck, c-Fyn, c-Hck, c-Lyn, c-Blk, c-Fgr and c-Yrk protooncogene products.The cellular oncogene c-Yes, a member of the Src family, encodes a 62-kilodalton, cytoplasmic and membrane-associated protein-tyrosine kinase [5] .c-Yes expression and its kinase activity have been shown to be increased in colorectal cancer [6,7] , melanoma [8] and metastatic liver cancer [9] .However, the activation of c-Yes in human HCC has not yet been investigated at all.In the present study, we determined the activity of c-Yes both in the normal liver (NL) tissues and in chronic hepatitis (CH), tumorous (T) and adjacent nontumorous (N) cirrhotic liver tissues.This is the first report on the activity of c-Yes in various liver diseases including HCC.Tissue samples, including the tumorous and surrounding nontumorous cirrhotic tissues, were obtained during surgery from 9 patients with HCC (7 males and 2 females; mean age, 68.2 ± 4.4 years; range, 59-73 years).All the patients were positive for hepatitis C virus (HCV), as determined by the reverse-transcriptase polymerase chain reaction method (Amplicor, Roche Diagnostics Ltd).The number of patients with well-, moderately-and poorlydifferentiated HCC was 2, 5 and 2, respectively.The fibrosis stage of the surrounding liver tissues was assessed as cirrhosis in all the HCC cases.Liver tissue samples from three patients with HCV-induced CH were obtained by liver biopsy.During surgery, two normal liver tissue samples were also obtained from patients with liver metastases of colon cancer.The serum samples of these patients with NL were negative for HCV and hepatitis B virus (HBV).

A precise method to rotate single cells is reported. In this method, the light pressure in the optical axis direction is harnessed as a rotating torque. Two proximal points in each cell are illuminated from different directions using two beams, and a light pressure is created that acts as a rotating torque. Using this proposed method, we could control the rotational direction of a microsphere regardless of the refractive index distribution in a noncontact operation. The microsphere could be rotated using proximal two-beam optical tweezers, and the rotational velocity could be controlled by changing the light intensity. (c) 2006 American Institute of Physics.

Technology for the attitudinal manipulation of medical equipment for local dosing to single living cells is presented. The authors developed a “juggling probe” which can manipulate a bacillary probe with multiple degrees of freedom and high accuracy without physical contact by using light pressure. With this technology, the authors cause two beams to focus on the probe from both the top and bottom faces. When the two focal points coincide, the probe becomes trapped immediately in a stable fixed attitude. Furthermore, the probe remains at rest in an arbitrary tilted attitude simply by controlling the distance between the two focal points.

To examine the feasibility of liver-directed in vivo gene therapy, we administered recombinant adenoviruses carrying a reporter lacZ gene retrogradely into the common bile duct of rats, as well as antegradely into the portal vein. Transduction efficiency of the lacZ gene in the liver was estimated not only histochemically by X-gal staining, but also quantitatively by a chemiluminescent reporter gene assay. Retrograde infusion of adenoviruses into the common bile duct was shown to successfully induce transgene expression in the liver. Transduction efficiency induced by intrabiliary adenoviral administration was not significantly different from that induced by intraportal adenoviral administration. Although transgene expression induced not only by intraportal, but also by intrabiliary adenoviral administration was observed predominantly at periportal areas, a considerable number of cells expressing the transgene were detectable even in lobular and centrilobular areas. Mild infiltration of inflammatory cells into the liver and mild hyperplastic changes of hepatocytes were observed after intrabiliary and intraportal adenoviral administration. However, hepatic damage estimated pathologically was not substantial. Furthermore, although intrabiliary and intraportal adenoviral administration resulted in very mild elevation of liver-related serum biochemical parameters, apparent complications were not observed in any rats. Our results demonstrated in the present study suggest that retrograde administration of adenoviruses into the common bile duct can induce efficient transgene expression in the liver without causing severe adverse effects, supporting the feasibility of adenovirus-mediated gene transfer into the liver in clinical settings by means of endoscopic retrograde cholangiography.

A 54-year-old male with hepatocellular carcinoma (HCC) underwent transcatheter arterial embolization (TAE) at a nearby hospital. He was then referred to our hospital for the purpose of additional treatment of HCC. Because TAE was not a complete therapy and HCC was growing and protruding from the left lobe of the liver, laparoscopic radio-frequency ablation (RFA) was chosen for the treatment of HCC. After inserting a laparoscope into the abdominal cavity, it was observed that HCC unexpectedly adhered to the mesentery as a result of TAE performed previously. After cutting off the adhered mesentery and removing it from the tumor, the combination therapy of percutaneous ethanol injection and RFA (PEI-RFA), developed at our department, was performed on the tumor. The tumor was successfully abrogated by PEI-RFA and the sufficient safety margin was confirmed by computed tomography after the treatment.

AIM:In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount of ethanol injected into HCC.METHODS:The volume of coagulated necrosis, total energy requirement and energy requirement for coagulation of per unit volume were examined in the groups of PEI-RFA and RFA alone using the Cool-tip RF system.RESULTS:The results showed that the volume of coagulated necrosis induced was significantly larger in PEI-RFA group than in routine RFA group, when the total energy administered was comparable in both groups. In PEI-RFA, enlargement of coagulated necrosis was admitted in 3 dimensions and the amount of energy requirement per unit volume of coagulated necrosis was negatively correlated with the amount of ethanol injected into HCC.CONCLUSION:These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated necrosis. Thus, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.

Percutaneous radiofrequency ablation (RFA) is able to destroy hepatocellular carcinoma (HCC) in a few sessions without major complications. We have previously shown that not only the combined use of percutaneous ethanol injection and RFA (PEI-RFA) but also injection of mixture of ethanol and lipiodol (PELIT) was useful for the treatment of HCC. In the present study, we further developed the combined use of PELIT and RFA through percutaneous or laparoscopic approach (PELI-RFA or LELI-RFA) and evaluated its usefulness. Nineteen nodules in 18 cases were treated with PELI-RFA or LELI-RFA. In the cases treated with LELI-RFA, no bleeding and no spilling milky fluid containing tumor cells were observed from the surface of ablated tumors. In the cases sufficiently treated with PELI-RFA or LELI-RFA, the mixture of ethanol and lipiodol was accumulated in the entire region of the tumor and low-density area was observed around the lipiodol deposit by computed tomography (CT). These delineations of coagulated area were helpful to evaluate the precise area of safety margin around the tumor treated with PELI-RFA or LELI-RFA. Furthermore, the total volume of coagulated necrosis significantly and positively correlated with the product of energy requirement for ablation and the volume of ethanol injected by PELI-RFA or LELI-RFA. Among the cases treated with PELI-RFA or LELI-RFA, local recurrence emerged only in one case in whom enough safety margin could not be achieved by PELI-RFA. Therefore, it is critical to evaluate whether enough safety margin could be obtained with RFA therapy, and PELI-RFA and LELI-RFA are helpful in visualizing the safety margin area.

The pathogenic mechanism for hepatocellular damage in hepatitis C virus (HCV) infection has not been clearly understood. Analysis of costimulatory molecules on lymphocytes may give us insight into the pathogenic mechanism of hepatocellular damage in HCV infection. Peripheral blood mononuclear cells (PBMCs) and liver infiltrating mononuclear cells (LIMCs) isolated from the HCV-infected patients were analyzed with antibodies directed against a variety of costimulatory molecules by flow cytometry. Blocking experiment against HLA-A24-restricted HCV-specific CTLs and immunohistochemical analysis were also performed. PBMCs expressing CD8, CD28, CD80, or CD154 were significantly reduced in HCV-infected patients compared with the healthy controls. CD28(+)CD8(+) PBMCs in the patients inversely correlated with ALT levels. Conversely, levels of CD28(−)CD8(+) LIMCs correlated with ALT levels. HCV-specific CTL activity was blocked by the treatment with anti-CD8 antibody, but not with anti-CD4 or anti-CD28 antibody. Immunohistochemical analysis revealed the accumulation of CD28(+) cells around the portal area in the liver of a patient with chronic active hepatitis C. These results suggest that CD28(+)CD8(+) T cells leave the circulation, move to the livers, and are activated in the portal area in proportion to the extent of liver diseases. CD28(−)CD8(+) T cells may finally function as effector T cells causing the hepatocellular damage in HCV infection.