Diminished regulatory T cells in cutaneous lesions of thymoma-associated multi-organ autoimmunity: a newly described paraneoplastic autoimmune disorder with fatal clinical course

Thymoma-associated multi-organ autoimmunity is a rare, autoimmune disease that causes colitis, liver dysfunction and cutaneous graft-versus-host (GVH)-like skin damage. This paraneoplastic autoimmune disorder may be due to inadequate T cell selection in the tumour environment of the thymus. Although sporadic case reports have revealed its clinical features, little is known about its pathological mechanism. By comparing the skin-infiltrating T cell subsets with those of GVH disease (GVHD) and other inflammatory skin diseases, we sought to elucidate the pathological mechanism of thymoma-associated multi-organ autoimmunity. Histopathological and immunohistochemical analysis of skin biopsies was performed for three patients with thymoma-associated multi-organ autoimmunity. Histopathological findings of thymoma-associated multi-organ autoimmunity were indistinguishable from those of patients with acute GVHD, although the aetiologies of these diseases are completely different. The frequency of regulatory T cells (T(regs)) is reduced in cutaneous lesions and CD8+ cytotoxic T lymphocytes that massively infiltrate into the epidermis of patients with thymoma-associated multi-organ autoimmunity. Additionally, the ratio of T helper type 17 (Th17) cells to CD4+ cells in patients with thymoma-associated multi-organ autoimmunity and acute GVHD was higher than that in healthy controls, but similar to that in psoriasis vulgaris patients. Similarity of the skin-infiltrating T cell subsets with those of acute GVHD suggested that skin damage in patients with thymoma-associated multi-organ autoimmunity might be induced by self-reactive cytotoxic T lymphocytes under the diminished suppressive capacity of T(regs).

Conjoined twins pregnancies: experience with 36 cases from a single center

OBJECTIVE

To review a single center's experience in the management of twin pregnancies with conjoined fetuses.

METHODS

Retrospective study describing prenatal findings, delivery details, surgical treatment and perinatal outcome.

RESULTS

The study included 36 twin pregnancies with conjoined twins seen over a period of 12 years in a single tertiary hospital: 69.4% were thoracopagus, 13.9% parapagus, 8.3% omphaloischiopagus 5.6% omphalopagus and 2.8% cephalopagus. Cardiac defects were present in 91.6% of twin pairs and associated malformations were present in 61.8% of the cases: limb abnormalities in 36.1%, abdominal wall defects in 25.0%, cleft lip and/or palate in 13.9% and congenital diaphragmatic hernia in 5.5%. Surgical separation was considered not feasible and prognosis lethal in 30 (83.3%) cases. Termination of pregnancy was performed in 12 pregnancies of poor prognosis. Cesarean section was performed in all remaining cases. Five sets of twins underwent surgical separation and six children survived. Overall survival in our series was 8.3% and, among the livebirths, 13.6%.

CONCLUSION

Conjoined twin pregnancies should be referred to tertiary centers for detailed fetal anomaly and echocardiographic assessment to evaluate prognosis and determine the possibility of postnatal surgical separation.

Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor

Living-donor lobar lung transplantation (LDLLT) is one of the final options for saving patients with pulmonary complications after hematopoietic stem cell transplantation (HSCT). We retrospectively investigated 19 patients who had undergone LDLLT after HSCT in Japan. Eight patients underwent LDLLT after HSCT in which one of the donors was the same living donor as in HSCT (SD group), while 11 received LDLLT from relatives who were not the HSCT donors (non-SD group). In the SD group, three patients underwent single LDLLT. The 5-year survival rate was 100% and 58% in the SD and non-SD groups, respectively. In the SD group, postoperative immunosuppression was significantly lower than in the non-SD group. Two patients died of infection and one died of post-transplant lymphoproliferative disease (PTLD) in the non-SD group, while only one patient died of PTLD 7 years after LDLLT in the SD group. Hematologic malignancy relapsed in two patients in the non-SD group. For the three single LDLLTs in the SD group, immunosuppression was carefully tapered. In our study, LDLLT involving the same donor as for HSCT appeared to have advantages related to lower immunosuppression compared to LDLLT from relatives who were not the HSCT donors.

MicroRNA-mediated downregulation of mTOR/FGFR3 controls tumor growth induced by Src-related oncogenic pathways

The tyrosine kinase c-Src is upregulated in various human cancers, but the molecular mechanisms underlying c-Src-mediated tumor growth remain unclear. Here we examined the involvement of microRNAs in the c-Src-mediated tumor growth. Microarray profiling revealed that c-Src activation downregulates a limited set of microRNAs, including miR-99a, which targets oncogenic mammalian target of rapamycin (mTOR) and fibroblast growth factor receptor 3 (FGFR3). Re-expression of miR-99a suppressed tumor growth of c-Src-transformed cells, and this effect was restored by the overexpression of mTOR. The downregulation of miR-99a was also observed in epidermal growth factor- and Ras-transformed cells, and it was suppressed by inhibiting the mitogen-activated protein kinase (MAPK) pathway. Furthermore, miR-99a downregulation is associated with mTOR/FGFR3 upregulation in various human lung cancer cells/tissues. The tumorigenicity of these cells was suppressed by the introduction of miR-99a. These findings suggest that the miR-99a-mTOR/FGFR3 pathway is crucial for controlling tumor growth in a wide range of human cancers that harbor upregulation of the Src-related oncogenic pathways.

Electron Holographic Nano-Characterization of Gold Catalyst at Interface

The catalytic properties of nanostructured gold catalyst are known to depend on the size of the gold particles and to be activated when the size decreases to a few nanometers. We investigated the size dependence of the three-dimensional nanostructure on the mean inner potential of gold catalysts supported on titanium oxide using electron holography and high-resolution electron microscopy (HREM). The contact angle of the gold particles on the titanium oxide tended to be over 90° for gold particles with a size of over 5 nm, and below 90° for a size of below 2 nm. This decreasing change in the contact angle (morphology) acts to increase the perimeter and hence the area of the interface between the gold and titanium oxide support, which is considered to be an active site for CO oxidation. The mean inner potential of the gold particles also changed as their size decreased. The value of the inner potential of gold, which is approximately 25 V in bulk state, rose to over 40 V when the size of the gold particles was less than 2 nm. This phenomenon indicates the existence of a charge transfer at the interface between gold and titanium oxide. The 3-D structure change and the inner potential change should be attributed to the specific electronic structure at the interface, owing to both the “nano size effect” and the “hetero-interface effect.”

Mean Inner Potential of Nanostructured Noble Metal Catalysts - Pt/TiO2 Catalyst -

Catalytic properties of noble metal catalysts are often caused by their nanostructures. Gold catalysts are typical cases. It is especially interesting that the catalytic property of gold suddenly changes to resemble that of platinum when the mean size of gold dispersed on certain oxides is <2nm. This phenomenon should be owing to the change of the local electronic structure of the gold particle or the interface between the gold and the oxides, however its detail has not been cleared yet. We measured the mean inner potential of gold particles supported on TiO2 using electron holography and HREM, and found that the mean inner potential of gold depend largely on the size of the gold particles. When the size is >5nm, the mean inner potential is the same as the reported values of bulk gold (experimental: 21–23V, calculated: 25–30V). When the size is <5nm, it begins to increase >30V, and it begins to increase suddenly >40V at the size <2nm. It indicates that the electronic structure of the gold particle varies from that of the bulk state as the size of the gold reduces due to the nano-size effect or the interaction at the interface, since the mean inner potential is sensitive to the electronic state of the outer valence electron. On the other hand, the behavior of the platinum catalysts is different from that of gold catalysts. When the size of the platinum particle on the TiO2 support is >1.5nm, the mean inner potential of platinum is the same as that of the bulk (∼25V). In case of the particle with the size <1.5nm, it begins to increase and the increase rate is lower than that of the gold particles with the size <2nm. It is suggested to be due to the difference of the interaction with TiO2.

Near-infrared kinetic spectroscopy of the HO2 and C2H5O2 self-reactions and cross reactions

The self-reactions and cross reactions of the peroxy radicals C2H5O2 and HO2 were monitored using simultaneous independent spectroscopic probes to observe each radical species. Wavelength modulation (WM) near-infrared (NIR) spectroscopy was used to detect HO2, and UV absorption monitored C2H5O2. The temperature dependences of these reactions were investigated over a range of interest to tropospheric chemistry, 221-296 K. The Arrhenius expression determined for the cross reaction, k2(T) = (6.01(-1.47)(+1.95)) x 10(-13) exp((638 +/- 73)/T) cm3 molecules(-1) s(-1) is in agreement with other work from the literature. The measurements of the HO2 self-reaction agreed with previous work from this lab and were not further refined. The C2H5O2 self-reaction is complicated by secondary production of HO2. This experiment performed the first direct measurement of the self-reaction rate constant, as well as the branching fraction to the radical channel, in part by measurement of the secondary HO2. The Arrhenius expression for the self-reaction rate constant is k3(T) = (1.29(-0.27)(+0.34)) x 10(-13)exp((-23 +/- 61)/T) cm3 molecules(-1) s(-1), and the branching fraction value is alpha = 0.28 +/- 0.06, independent of temperature. These values are in disagreement with previous measurements based on end product studies of the branching fraction. The results suggest that better characterization of the products from RO2 self-reactions are required.

Minimum effective dose of spinal ropivacaine with and without fentanyl for postpartum tubal ligation

BACKGROUND

Ropivacaine may be the ideal spinal anesthetic for postpartum tubal ligation due to its medium duration of action, low incidence of side effects and possibly reduced post-anesthetic care unit (PACU) stay.

METHODS

Two prospective up-down sequential allocation studies were performed using hyperbaric spinal ropivacaine via a combined spinal-epidural anesthetic technique for patients undergoing postpartum tubal ligation. The first study was performed using an initial dose of 12.5 mg hyperbaric ropivacaine, which was adjusted in testing intervals of 0.5 mg. The second study used an initial dose of 16 mg hyperbaric ropivacaine, a testing interval of 1.0mg, and a fixed dose of fentanyl 10 μg. The need to supplement the block with intravenous or epidural agents was defined as a failure. Failures were treated with epidural lidocaine.

RESULTS

The first and second studies recruited 24 and 17 patients, respectively. The median effective dose (ED50) for hyperbaric spinal ropivacaine was 16.4 mg (95% CI 13.7-19) with an ED95 estimate of 21.9 mg. The median effective dose of spinal ropivacaine with fentanyl 10 μg was 17.0 mg (95% CI 15.4-18.7) with an ED95 estimate of 21.3 mg. When data were combined, the overall ED50 for ropivacaine was 16.7 mg (95% CI 15.1-18.4) with an ED95 estimate of 22.5 mg (95% CI 16.3-28.8). A T8 block was not achieved in 4 patients receiving spinal ropivacaine alone, and 1 patient receiving spinal ropivacaine with fentanyl. The majority (82%) of patients who did not receive epidural local anesthetic supplementation had recovery of motor block within 60 min following PACU admission.

CONCLUSION

Spinal hyperbaric ropivacaine 22 mg with or without fentanyl 10 μg could be used for postpartum tubal ligation surgery.

Sonographic appearance of gestational trophoblastic disease evolving into epithelioid trophoblastic tumor

Epithelioid trophoblastic tumor is a distinctive but rare trophoblastic tumor. It derives from intermediate trophoblastic cells of the chorion laeve and is usually associated with a previous gestational event. We report the case of a patient who had undergone dilatation and curettage for a missed miscarriage. Three months later gestational trophoblastic disease was suspected because of persistent vaginal bleeding and high levels of beta-human chorionic gonadotropin (beta-hCG). Transvaginal ultrasound revealed irregular echolucent lacunae within the myometrium, some of them filled with low-resistance, turbulent blood flow on Doppler examination, emphasizing the diagnosis of gestational trophoblastic disease. The patient was treated with 12 courses of multiagent chemotherapy. After a 2-year remission, a low rise in serum beta-hCG was observed. Transvaginal ultrasound revealed a well-circumscribed echogenic lesion with a diameter of 1.8 cm in the uterine fundus, with no detectable blood flow on Doppler imaging. A diagnosis of tumor of intermediate trophoblastic cells was suspected and total hysterectomy was performed. On pathological examination, the histological and immunohistochemical features were characteristic of epithelioid trophoblastic tumor. Most reported cases of epithelioid trophoblastic tumor have solitary nodules with sharp margins, which is consistent with our ultrasound findings. Ultrasound may be helpful in differentiating epithelioid trophoblastic tumor from placental-site trophoblastic tumor, another tumor of intermediate trophoblastic cells, which shows infiltrative growth insinuating between muscle fibers.

A 5-HT(4)-receptor activation-induced neural plasticity enhances in vivo reconstructs of enteric nerve circuit insult

BACKGROUND

It was recently reported that some 5-HT(4)-receptor agonists increased neuronal numbers and length of neurites in enteric neurons developing in vitro from immunoselected neural crest-derived precursors. We aimed to explore a novel approach in vivo to reconstruct the enteric neural circuitry that mediates a fundamental distal gut reflex.

METHODS

The neural circuit insult was performed in guinea pigs by rectal transection and subsequent end-to-end one layer anastomosis. A 5-HT(4)-receptor agonist, mosapride citrate (10-100 micromol L(-1)) (applied for a patent) was applied locally at the anastomotic site.

KEY RESULTS

Mosapride promoted the regeneration of the neural circuit in the impaired myenteric plexus and the recovery of the defecation reflex in the distal gut. Furthermore, mosapride generated neurofilament (NF)-, 5-HT(4)-receptor- and 5-bromo-2'-deoxyuridine (BrdU)-positive cells and surprisingly formed neural network in the newly formed granulation tissue at the anastomotic site 2 weeks after enteric nerve circuit insult. Possible neural stem cell markers, anti-distal less homeobox 2 (DLX2)- and p75-positive and NF-positive cells increased during the same time period. All actions by mosapride were inhibited by the specific 5-HT(4)-receptor antagonist, GR113808 (10 micromol L(-1)).

CONCLUSIONS & INFERENCES

These results indicate that activation of enteric neural 5-HT(4)-receptors promotes reconstruction of an enteric neural circuit leading to the recovery of the defecation reflex in the distal gut, and that this reconstruction involves possibly neural stem cells. These findings indicate that treatment with 5-HT(4) agonists could be a novel therapy for generating new enteric neurons to rescue aganglionic gut disorders.

Flavivirus encephalitis: pathological aspects of mouse and other animal models

Encephalitic flaviviruses are important arthropod-borne pathogens of humans and other animals. In particular, the recent emergence of the West Nile virus (WNV) and Japanese encephalitis virus (JEV) in new geographic areas has caused a considerable public health alert and international concern. Among the experimental in vivo models of WNV and JEV infection, mice and other laboratory rodents are the most thoroughly studied and well-characterized systems, having provided data that are important for understanding the infectious process in humans. Macaca monkeys have also been used as a model for WNV and JEV infection, mainly for the evaluation of vaccine efficacy, although a limited number of published studies have addressed pathomorphology. These animal models demonstrate the development of encephalitis with many similarities to the human disease; however, the histological events that occur during infection, especially in peripheral tissues, have not been fully characterized.

The effect of gantry and collimator angles on leaf limited velocity and position in dynamic multileaf collimator intensity-modulated radiation therapy

The purpose of the study is to evaluate the limiting velocity (LV) of a multileaf collimator and the leaf position in various collimator and gantry angles. Both leading leaves and trailing leaves began to move with a constant acceleration from 0 to 4 cm s(-1). When the beam hold occurred, the leaf velocity was defined as the leaf LV. Dynamic irradiation was performed at eight gantry angles of every 45 degrees with three different collimator angles. The analysis of the LV and the leaf position was performed with a log file from a leaf motion controller. The mean LVs for Varian Clinac 21EX (21EX) ranged from 2.51 to 3.10 cm s(-1). The mean LVs for Clinac 600C ranged from 2.91 to 3.12 cm s(-1). When only central 5 mm leaves of 21EX moved, LVs were significantly higher than those when all 60 pairs of leaf moved, while the leaf position inconsistencies of the two accelerators were within 1 mm at the leaf velocities from 0.5 to 2.0 cm s(-1). It was recognized that the LV was affected by gravity. This measurement method can be utilized as routine quality assurance for a dynamic multileaf collimator (DMLC) is and easily reproducible.