[Clinical and pathological characteristics and outcome of 46 children with autoimmune hepatitis].

Objective: To review and analyze the clinical and pathological data of children with autoimmune hepatitis (AIH). Methods: Medical records of 46 patients hospitalized in Pediatric Liver Diseases Treatment and Research Center, Fifth Medical Center, General Hospital of People's Liberation Army(PLA) from April 2012 to April 2018 were extracted. Medical data included type of AIH, clinical manifestations, biochemical parameters, liver biopsy results, and outcomes of treatment were analyzed retrospectively. Among 46 children, 19 were males and 27 were females. The age of onset was 10.1(1.4-18.0) years old. Chi-Square test, Rank sum test or t test were used for inter-group comparison. Results: There were 32 (70%)AIH-I cases and 14 (30%)AIH-Ⅱ cases (χ(2)=12.565, P=0.000). Among the 46 patients, there were 5 modes of onest: 17 cases (37%) had acute viral hepatitis-like presentation, 2 cases (4%) had fulminant hepatic failure, 9 cases (20%) had insidious onset, 5 cases (11%) showed cirrhosis and portal hypertension, and 13 cases (28%) were incidentally found to be due to elevated hepatic aminotransferases. Comorbidities including primary sclerotic cholangitis (n=3), primary biliary cholangitis (n=1), systemic lupus erythematosus (n=1) and inflammatory bowel disease (n=2), were all seen in AIH-Ⅰ cases. The elevated biochemical parameters of these patients were as follows: alanine aminotransferase (n=46), aspartate transminase (n=46), total bilirubin (n=35) γ-glutamyl transpeptadase (n=39), γ-globulin (n=32) and IgG (n=33). The γ-globulin and IgG levels were significantly higher in AIH-Ⅰ patients than those with AIH-Ⅱ((32±9)% vs. (23±8)%, t=3.217, P=0.002,(27±10) vs. (18±8)g/L, t=3.193, P=0.003, respectively). Thirty-nine patients received liver biopsy, among whom 22 (56%) with inflammation grade (G)≥3, 26(67%) with fibrosis stage (S) ≥3, and 7 with hepatic cirrhosis (S4) according to pathological analysis. Typical histopathological changes of AIH included: 36 cases of interfacial hepatitis (92%), 23 cases of lymphocyte/plasma cell infiltration (59%), 3 cases of rosette (8%). Forty patients received prednisolone monotherapy or combined with azathioprine after diagnosis. Complete remission was seen in 29 (72%) patients, partial remission in 10 (25%) patients and no response in 1 (3%) patient. Among complete remission patients, 15 (52%) had relapse in the process of prednisolone reduction. Repeated liver biopsy performed in 8 patients after treatment showed that hepatic inflammation and fibrosis were both improved in 6 patients, only inflammation was alleviated without fibrosis improvement in 1 patient, and neither inflammation nor fibrosis was improved in 1 case. The length of follow-up was 3.3 (0.3-10.5) years, and none of the 39 prednisolone-responded cases discontinued treatment successfully. Adverse effect of long-term prednisolone therapy included bilateral cataract (n=6), spinal fracture accompanied with delayed bone age development (n=1). Conclusions: AIH-Ⅰ is more common than AIH-Ⅱ in children, with diverse clinical characteristics. Most cases have progressive liver inflammation and fibrosis when diagnosed. Prednisolone monotherapy or combined with azathioprine could achieve both biochemical and pathological improvement, but relapse is inevitable during drug tapering, hence long-term treatment is essential.

Oral administration of short chain fatty acids could attenuate fat deposition of pigs.

Short chain fatty acids (SCFAs) are the main products of indigestible carbohydrates that are fermented by microbiota in the hindgut. This study was designed to investigate the effects of oral SCFAs administration on the lipid metabolism of weaned pigs. A total of 21 barrows were randomly allocated into three groups, including control group (orally infused with 200 mL physiological saline per day), low dose SCFAs group (orally infused with 200 mL SCFAs containing acetic acid 20.04 mM, propionic acid 7.71 mM and butyric acid 4.89 mM per day), and high dose SCFAs group (orally infused with 200 mL SCFAs containing acetic acid 40.08 mM, propionic acid 15.42 mM and butyric acid 9.78 mM per day). The results showed that the average daily feed intake of SCFAs groups were lower than that of control group (P<0.05). Oral administration of SCFAs decreased the concentrations of triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol and insulin (P<0.05), and increased the leptin concentration in serum (P<0.05). The total fat, as well as TC and TG levels in liver, was decreased by oral SCFAs administration (P<0.05). In addition, SCFAs down-regulated the mRNA expressions of fatty acid synthase (FAS) and sterol regulatory element binding protein 1c (P<0.05), and enhanced the mRNA expression of carnitine palmitoyltransferase-1α (CPT-1α) in liver (P<0.05). SCFAs also decreased FAS, acetyl-CoA carboxylase (ACC) and peroxisome proliferator activated receptor σ mRNA expressions in longissimus dorsi (P<0.05). And in abdominal fat, SCFAs reduced FAS and ACC mRNA expressions (P<0.05), and increased CPT-1α mRNA expression (P<0.05). These results suggested that oral administration of SCFAs could attenuate fat deposition in weaned pigs via reducing lipogenesis and enhancing lipolysis of different tissues.

Involvement of PKA signalling in anti-inflammatory effects of chitosan oligosaccharides in IPEC-J2 porcine epithelial cells.

Weaning is characterized by intestinal inflammation, which is a big challenge in pig industry. Control of intestinal inflammation is important for improvement of growth performance and health. Therefore, the study was focused on the anti-inflammatory activity of low-molecular-weight chitosan oligosaccharide (LCOS) in a porcine small intestinal epithelial cell line (IPEC-J2). The results showed that TNF-α, as inflammation inducer, significantly upregulated the mRNA expression of IL-8 and MCP-1. Afterwards, LCOS significantly attenuated mRNA expression of IL-8 and MCP-1 induced by TNF-α in the cells. Mannose (MAN), as ligand of mannose receptor, had no effect on the anti-inflammatory activity of LCOS, which suggested that mannose receptor may not involve in the anti-inflammatory activity of LCOS in IPEC-J2 cells. Interestingly, N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide 2HCl hydrate (H89), as PKA (protein kinase A)-specific inhibitor, reversed the mRNA expression of IL-8 when co-cultured with LCOS. Furthermore, LCOS concentration dependent downregulated the mRNA expression of claudin-1 compared with TNF-α treatment. However, the trans-epithelial electric resistance (TEER) was not affected by LCOS when co-cultured with TNF-α in 3 hr. In conclusion, LCOS have a potent anti-inflammatory activity, and as a feed additives, may be useful for the inhibition of inflammatory process in weaning period of pigs with intestinal inflammation occurring.

Excess of dietary montmorillonite impairs growth performance, liver function, and antioxidant capacity in starter pigs.

Montmorillonite (MMT) is widely used as a mycotoxin adsorbent in animal feeds, but its safety remains unclear. This study was conducted to investigate the safety of MMT supplementation in diets fed to starter pigs. A total of 120 32-d-old piglets (initial weight, 8.0 ± 0.9 kg) were randomly allotted into dietary treatments with graded MMT levels (0 [FS 0], 0.5% [FS 0.5], 1.0% [FS 1.0], 2.5% [FS 2.5], and 5.0% [FS 5.0]) with 6 replicate pens per treatment and 4 pigs per pen. All diets were fed for 28 d. As the MMT level increased, ADG and G:F changed in a linear and quadratic manner, while ADFI was linearly decreased ( > 0.05). Compared with FS 0, ADG, ADFI, and G:F of pigs in FS 1.0 increased ( < 0.05). However, the ADFI in pigs of FS 5.0 was lower than that in pigs of FS 0 ( < 0.05). The relative liver weight activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) changed in a linear and quadratic manner ( < 0.05). Compared with FS 0, pigs in FS 2.5 and FS 5.0 had a greater serum ALT ( < 0.05), while AST activity significantly increased in pigs of FS 5.0 ( < 0.05). Dietary MMT supplementation decreased serum Mg content in a linear and quadratic manner ( < 0.05), while Zn and Cu contents were linearly decreased ( < 0.05). Serum Zn and Cu contents of pigs in FS 0.5, FS 2.5, and FS 5.0 groups were lower than those in the control. Pigs fed with 2.5% and 5% MMT showed hepatic histopathological changes, including swelling, granular and vesicular degeneration, and apparent vacuolar degeneration. In addition, the content of serum total antioxidant capacity (T-AOC) and activity of glutathione peroxidase (GSH-PX) decreased in a linear and quadratic manner ( < 0.05). Compared to the control, 5.0% MMT significantly increased piglets' serum malondialdehyde (MDA) concentration and decreased GSH-PX activity ( < 0.05). T-AOC concentration in the pigs fed 2.5% and 5.0% MMT was lower than that in the control group ( < 0.05). Serum superoxide dismutase (SOD) activity changed in a quadratic manner ( < 0.05). Piglets in FS 1.0 showed a higher SOD activity when compared with the control ( < 0.05). These results indicate that supplementation of MMT higher than 1.0% can negatively affect liver structure and serum mineral content, and 5.0% MMT supplementation would also decrease feed intake, aggravate liver damage, and reduce the antioxidant capacity of starter pigs. Therefore, excess supplementation of MMT is not safe in starter pigs.

The addition of protein-bound amino acids in low-protein diets improves the metabolic and immunological characteristics in fifteen- to thirty-five-kg pigs.

This study was to evaluate the effects of supplementation of AA form (crystalline vs. protein bound) in low-protein diets on growth, metabolic, and immunological characteristics of pigs. A total of 80 barrows (PIC 327 × 1050; 15.57 ± 0.13 kg BW and 48 ± 2 d of age), housed in 4 pigs per pen with 5 pens per treatment, were assigned to 4 dietary treatments of 17, 15, and 13% CP and 13% CP plus casein for 28 d. The crystalline AA were supplemented to meet the requirement of indispensable AA in pigs. Results showed that pigs fed the 13% CP diet or the 13% CP plus casein diet had lower ( < 0.01) ADG and ADFI and a greater ( < 0.01) feed:gain ratio than pigs fed the 17% CP or 15% CP diets over the 4-wk study period. Compared with other diets, pigs fed the 13% CP diet had decreased concentrations of plasma urea nitrogen, albumin ( < 0.01), and mRNA expressions of Toll-like receptor 4 (), nuclear factor kappa B (; < 0.05), and Toll-interacting protein (; < 0.01) in the ileum and also increased activity of plasma glutamate-pyruvate transaminase ( < 0.05) and concentrations of IL-1ß ( < 0.05) and tumor necrosis factor-α ( < 0.01); however, these characteristics were partly normalized by feeding the 13% CP plus casein diet. Furthermore, the plasma concentration of insulin-like growth factor 1 (IGF-1; < 0.01) and mRNA expressions of protein kinase B (), mammalian target of rapamycin (), and ribosomal protein S6 kinase () in longissimus muscle were increased ( < 0.05) in pigs fed the 13% CP plus casein diet relative to pigs fed the 17% CP or 15% CP diets. In summary, reducing dietary CP level from 17% to 15% had no effect on growth, metabolic, and immunological characteristics of 15- to 35-kg pigs. A further reduction of dietary CP level up to 13% would lead to poor growth performance, but metabolic and immunological characteristics were partly normalized using protein-bound AA to replace synthesized AA in the 13% CP diet.

[A retrospective study on HBsAg clearance rate after antiviral therapy in children with HBeAg-positive chronic hepatitis B aged 1-7 years].

Objective: To investigate the HBsAg clearance rate after antiviral therapy in children with HBeAg-positive chronic hepatitis B (CHB) aged 1-7 years. Methods: A retrospective analysis was performed for the HBsAg clearance rate in 293 children who were hospitalized in 302 Hospital of PLA from June 2006 to December 2013, met the inclusion criteria, received antiviral therapy, and were followed up for at least 6 months after the withdrawal of antiviral therapy. The t-test or the rank sum test was applied according to the distribution of continuous data, and the chi-square test was used for comparison of categorical data. Results: The HBsAg positive rate of children's mothers was 91.1%. In the age groups of >1-≤2 years, >2-≤3 years, >3-≤4 years, >4-≤5 years, >5-≤6 years, and >6-≤7 years, the HBsAg clearance rates were 66.1%, 65.5%, 45.7%, 41.3%, 20.6%, and 27.6%, respectively. There were significant differences in HBsAg clearance rate between the age groups of >1-≤3 years and >3-≤5 years, >1-≤3 years and >5-≤7 years, and >3-≤5 years and >5-≤7 years (P = 0.001, 0.000, and 0.008). Of all children, 64.8% were boys, among whom 41.1% achieved HBsAg clearance, and 35.2% were girls, among whom 61.2% achieved HBsAg clearance; there was a significant difference in HBsAg clearance rate between boys and girls (P = 0.001). The children with pretreatment alanine aminotransferase (ALT) levels of ≤80 IU/L, > 80 IU/L, ≤200 IU/L, and > 200 IU/L had HBsAg clearance rates of 40.7%, 51.2%, 47.6%, and 49.4%, respectively; there were no significant differences in HBsAg clearance rate between the ALT ≤80 IU/L and ALT > 80 IU/L groups and the ALT ≤200 IU/L and ALT > 200 IU/L groups (P = 0.101 and 0.778). There was no significant difference in HBsAg clearance rate between the pretreatment HBV DNA load < 1×107 IU/ml and ≥1×107 IU/ml groups (54.9% vs 46.7%, P = 0.286). Of all children, 14.2% had genotype B and an HBsAg clearance rate of 57.1%, and 85% had genotype C and an HBsAg clearance rate of 39.5%; there was no significant difference in HBsAg clearance rate between the genotype B group and the genotype C group (P = 0.051). Of all children, 90.4% underwent liver biopsy, among whom 10.9% had severe liver fibrosis (F≥3) and liver cirrhosis, as well as an HBsAg clearance rate of 31%; the non-severe liver fibrosis/liver cirrhosis group had an HBsAg clearance rate of 49.2%, and there was no significant difference in HBsAg clearance rate between these two groups (P = 0.065). There was no significant difference in HBsAg clearance rate between the liver inflammation grade (G) < 2 group and the G ≥ 2 group (39.5% vs 50.9%, P = 0.084). Of all children, 58.7% received interferon antiviral therapy alone and had an HBsAg clearance rate of 48.8%, and 41.3% received interferon alone for 6 months followed by lamivudine antiviral therapy and had an HBsAg clearance rate of 47.1%; there was no significant difference between these two groups (P = 0.770). Conclusion: In children with HBeAg-positive CHB aged 1-7 years who receive antiviral therapy, HBsAg clearance rate is correlated with age and sex, and the children aged < 5 years can achieve a higher HBsAg clearance rate.

[A retrospective study on the liver pathological characteristics and the effect of antiviral treatment for 1 to 7 years old children with heptitis B e antigen negative chronic hepatitis B].

OBJECTIVE: To investigate the liver pathological characteristics and the clearance rate of hepatitis B surface antigen (HBsAg) with antiviral treatment for 1 to 7 years old children with heptitis B e antigen(HBeAg)-negative chronic hepatitis B. METHOD: A total of 49 cases with HBeAg-negative chronic hepatitis B were treated with interferon (IFN) or IFN treatment for 6 months added with lamivudine, and were followed up for at least 6 months.Retrospective analysis was performed on the liver pathological characteristics, the efficacy of antivirus treatment and its influencing factors of the HBsAg clearance rate in the cases from June 2006 to December 2013 in the 302 Hospital of People's Liberation Army.The χ(2) test was used to compare the rates. RESULT: (1)The median age of cases was 3 years old(1-7 years old), 38 children were male(78%). Cases in the age group 1-2, >2 -3, >3 -4, >4-5, >5-6 and >6-7 were 7, 8, 14, 6, 6 and 8 respectively. HBsAg was 100% positive in mother of the cases. (2)There were 7 children whose pre-treatment alanine aminotransferase (ALT) were ≤80 U/L and pre-treatment ALT>200 U/L in 25 children. There were 24 children whose pre-treatment HBVDNA ≥1×10(7) U/ml. Genetype analysis was detected in 43 children, 3 children were B genotype, 38 were C genotype, 2 were B and C genotype. (3)Liver biopsy was performed in all children. The degree of liver inflammation ≥2 was seen in 48 (98%) children.Severe liver fibrosis and cirrhosis were found in 21(43%) children. (4)In the age group 1-2, >2-3, >3-4, >4-5, >5-6 and >6-7 years old , the clearance of HBsAg was 5, 6, 2, 1, 0 and 0 respectively. The HBsAg clearance rate between 1-3 years old group and 3-7 years old group has significant difference ((73%(11/15) vs. 9%(3/34), χ(2)=18.180, P=0.000). (5)The clearance of HBsAg in male group was 11, but 3 in female group.It showed no significant difference between two groups (χ(2)=0.073, P=0.787). (6) The clearance rate of HBsAg were 0, 24%(4/17) and 40%(10/25) in the groups of pre-treatment ALT ≤80 U/L, 80200 U/L, respectively. There were no significant difference between the groups of ALT≤200 U/L and ALT > 200 U/L(χ(2)=2.223, P=0.136). In the groups with pre-treatment HBV DNA <1×10(7)U/ml and HBV DNA≥1×10(7)U/ml, the clearance rate of HBsAg was 28%(7/25) and 29%(7/24). There were no significant elifference between two groups(χ(2)=0.008, P=0.928). (7)The clearance rate of HBsAg was 33%(7/21) in children with severe liver fibrosis and cirrhosis, while 25%(7/28) in children who had no severe liver fibrosis and cirrhosis.There were no significant difference between two groups(χ(2)=0.408, P=0.523). CONCLUSION: There are obvious liver injuries and severe liver fibrosis in 1-7 years old children with HBeAg-negative chronic hepatitis B. The HBsAg clearance rate in the children with antiviral treatment correlated with age, among those who received antiviral treatment before 3 years old, the HBsAg clearance rate is relatively higher.

Dietary spray-dried chicken plasma improves intestinal barrier function and modulates immune status in weaning piglets.

The objective of this study was to evaluate the effects of dietary addition of spray-dried chicken plasma (SDCP) as a replacement for spray-dried porcine plasma (SDPP) on serum biochemistry, intestinal barrier function, immune parameters, and the expression of intestinal development-related genes in weaning pigs. One hundred and forty-four 25-d-old weaning piglets with BW of 6.43 ± 0.39 kg were randomly allotted to 1 of 4 dietary treatments: 1) CON (basal diet; control), 2) SDPP (containing 5% SDPP), 3) SDPP + SDCP (containing 2.5% SDPP and 2.5% SDCP), and 4) SDCP (containing 5% SDCP). After a 28-d trial, 6 pigs from each treatment were randomly selected to collect serum and intestinal samples. On d 14 after the initiation of the trial, pigs in the SDPP, SDPP + SDCP, and SDCP groups had an increase ( < 0.05) in serum concentrations of total protein and IgG and a decrease ( < 0.05) in activities of alanine aminotransferase and diamine oxidase compared with the CON group. In the jejunum, supplementation with SDPP and SDCP reduced ( < 0.05) the concentration of tumor necrosis factor-α (TNF-α) and upregulated ( < 0.05) the mRNA levels of zonula occludens 1 (ZO-1), zonula occludens 2 (ZO-2), occludin (OCLN), Toll-like receptor 2 (TLR2), glucagon-like peptide 2 (GLP2), and IGF-1 compared with the CON group. In the ileum, feeding SDPP, SDPP + SDCP, and SDCP decreased ( < 0.05) the concentrations of TNF-α and secretory IgA (sIgA) and upregulated ( < 0.05) the mRNA levels of claudin 1 (CLDN-1) and TLR2 compared with feeding CON. However, there were no differences among the SDPP, SDPP + SDCP, and SDCP groups. Furthermore, supplementation with SDCP reduced ( < 0.05) the concentration of IL-10 and upregulated ( < 0.05) the mRNA levels of GLP-2, mucin 2 (MUC2), and trefoil factor family 3 (TFF3) in the ileum compared with feeding CON. Collectively, the current results indicate that dietary addition of SDCP has a beneficial influence on the health condition of weaning pigs by alleviating liver damage, promoting intestinal development, improving intestinal barrier function, and reducing overstimulation of immune response. The efficacy of SDCP is comparable to that of SDPP.

Erg and AP-1 as determinants of glucocorticoid response in acute lymphoblastic leukemia.

Glucocorticoids (GCs) are among the most widely prescribed medications in clinical practice. The beneficial effects of GCs in acute lymphoblastic leukemia (ALL) are based on their ability to induce apoptosis, but the underlying transcriptional mechanisms remain poorly defined. Computational modeling has enormous potential in the understanding of biological processes such as apoptosis and the discovery of novel regulatory mechanisms. We here present an integrated analysis of gene expression kinetic profiles using microarrays from GC sensitive and resistant ALL cell lines and patients, including newly generated and previously published data sets available from the Gene Expression Omnibus. By applying time-series clustering analysis in the sensitive ALL CEM-C7-14 cells, we identified 358 differentially regulated genes that we classified into 15 kinetic profiles. We identified GC response element (GRE) sequences in 33 of the upregulated known or potential GC receptor (GR) targets. Comparative study of sensitive and resistant ALL showed distinct gene expression patterns and indicated unexpected similarities between sensitivity-restored and resistant ALL. We found that activator protein 1 (AP-1), Ets related gene (Erg) and GR pathways were differentially regulated in sensitive and resistant ALL. Erg protein levels were substantially higher in CEM-C1-15-resistant cells, c-Jun was significantly induced in sensitive cells, whereas c-Fos was expressed at low levels in both. c-Jun was recruited on the AP-1 site on the Bim promoter, whereas a transient Erg occupancy on the GR promoter was detected. Inhibition of Erg and activation of GR lead to increased apoptosis in both sensitive and resistant ALL. These novel findings significantly advance our understanding of GC sensitivity and can be used to improve therapy of leukemia.

The concentration of antibiotic in fresh-frozen bone graft.

We investigated the antibiotic concentration in fresh-frozen femoral head allografts harvested from two groups of living donors. Ten samples were collected from patients with osteoarthritis of the hip and ten from those with a fracture of the neck of the femur scheduled for primary arthroplasty. Cefazolin (1 g) was administered as a pre-operative prophylactic antibiotic. After storage at -80 degrees C for two weeks the pattern of release of cefazolin from morsellised femoral heads was evaluated by an in vitro broth elution assay using high-performance liquid chromatography. The bioactivity of the bone was further determined with an agar disc diffusion and standardised tube dilution bioassay. The results indicated that the fresh-frozen femoral heads contained cefazolin. The morsellised bone released cefazolin for up to four days. The concentration of cefazolin was significantly higher in the heads from patients with osteoarthritis of the hip than in those with a fracture.Also, in bioassays the bone showed inhibitory effects against bacteria.We concluded that allografts of morsellised bone from the femoral head harvested from patients undergoing arthroplasty of the hip contained cefazolin, which had been administered pre-operatively and they exhibited inhibitory effects against bacteria in vitro.

The determination of in vitro pingyangmycin hydrochloride plasma protein binding by microdialysis.

Microdialysis sampling was used to study the binding of pingyangmycin hydrochloride (PYM) to plasma proteins in canis familiaris blood. In vitro plasma protein binding fractions were evaluated in a series of PYM concentration. The results showed decreased protein binding with increased concentration. The data was analyzed using the Scatchard analysis and Klotz plot. The results showed that the Scatchard plot and Klotz plot were linear with good correlation coefficient, indicating a good agreement of the experimental data to the theoretical equation.

Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis.

BACKGROUND: Laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST) was compared with laparoscopic exploration of the common bile duct (LCBDE) for cholecystocholedocholithiasis in an attempt tried to find the best mini-invasive treatment for the cholelithiasis and choledocholithiasis. METHODS: For this study, 234 patients with cholelithiasis and choledocholithiasis diagnosed by preoperative B-ultrasonography and intraoperative cholangiogram were divided at random into an LC-LCBDE group (141 cases) and an LC-IOEST group (93 cases). The surgical times, surgical success rates, number of stone extractions, postoperative complications, retained common bile duct stones, postoperative lengths of stay, and hospital charges were compared prospectively. RESULTS: There were no differences between the two groups in terms of surgical time, surgical success rate, number of stone extractions, postoperative complications, retained common bile duct stones, postoperative length of stay, and hospital charge. CONCLUSION: Both LC-IOEST and LC-LCBDE were shown to be safe, effective, minimally invasive treatments for cholecystocholedocholithiasis.

[3,3'-[2,2'-(ethylenedioxy)dibenzylidene]bis(S-methyl dithiocarbazate)]-nickel](II).

The tetradentate N(2)S(2) Schiff base ligand 3,3'-[2,2'-(ethylenedioxy)dibenzylidene]bis(S-methyl dithiocarbazate) (H(2)L), prepared by the condensation of S-methyl dithiocarbazate with 1,4-bis(2-formylphenyl)-1,4-dioxabutane in a 1:2 molar ratio, reacts with nickel acetate to form the title neutral metal complex, [Ni(C(20)H(20)N(4)O(2)S(4))]. The X-ray structure of the complex shows a distorted square-planar geometry around the Ni atom. The monomeric units are weakly associated into dimers via a long Ni.S interaction [3.569 (1) A]. These dimeric units are then linked by C-H.S intermolecular contacts to form a polymeric chain along the a axis.

Filling the gap: equity and access to oral health services for minorities and the underserved.

BACKGROUND AND OBJECTIVES: Family physicians and other primary care providers play a pivotal role in preventing oral disease, especially among minority and underserved populations who have limited access to dental services and poorer oral health status. Oral diseases/conditions, such as caries, baby bottle tooth decay, gingivitis, periodontitis, oral pharyngeal malignancies, and orofacial trauma, are prevalent and costly, yet largely preventable. Given their role in promoting and protecting overall health and their historical role in serving minority and underserved families, family physicians occupy a unique position to assure equity, access, and improvement in oral health for all Americans.

AIDS -- a modern hydra.

PIP: So far, AIDS has not been a major problem in Taiwan. Only 79 people have tested HIV-seropositive, and only 6 have been stricken by the disease. The government has allocated money for AIDS research; blood screening is mandatory in all hospitals; confidential AIDS testing is widely available; and doctors are advised to administer azidothymidine to anyone who tests positive. Azidothymidine is not a cure, but it can prevent the virus from destroying more cells. Nevertheless, a climate of irrational fear of and ignorance about AIDS pervades Taiwan. Many people believe that AIDS can be transmitted by casual contact, and people who are HIV-seropositive are treated as social outcasts. One student at the University of Taipei, only a few credits from graduation, has been refused readmission to the university because he tested HIV-positive. Sex education in the schools is not a good route for AIDS education because sex and especially homosexuality are simply not mentioned in public in Taiwan. Activists, including gay-rights representative, Chi Chia-Wei, have turned to the mass media, especially television as a vehicle for AIDS education, and several programs on AIDS have been shown since 1986.^ieng