CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

BACKGROUND

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative surgical approach for the treatment of massive hepatocellular carcinoma (HCC), the key to successful planned stage 2 ALPPS is future liver remnant (FLR) volume growth, but the exact mechanism has not been elucidated. The correlation between regulatory T cells (Tregs) and postoperative FLR regeneration has not been reported.

AIM

To investigate the effect of CD4⁺CD25⁺ Tregs on FLR regeneration after ALPPS.

METHODS

Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4⁺CD25⁺ Tregs to CD4⁺ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4⁺CD25⁺ Treg proportion and clinicopathological information and liver volume.

RESULTS

The postoperative CD4⁺CD25⁺ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and kinetic growth rate (KGR) of the FLR after stage 1 ALPPS. Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion (P = 0.006); patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion (P = 0.043). The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume, proliferation rate, and KGR were all greater than 0.70.

CONCLUSION

CD4⁺CD25⁺ Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients’ livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Pulmonary nocardiosis with bloodstream infection diagnosed by metagenomic next-generation sequencing in a kidney transplant recipient: A case report

BACKGROUND

Pulmonary nocardiosis is difficult to diagnose by culture and other conventional testing, and is often associated with lethal disseminated infections. This difficulty poses a great challenge to the timeliness and accuracy of clinical detection, especially in susceptible immunosuppressed individuals. Metagenomic next-generation sequencing (mNGS) has transformed the conventional diagnosis pattern by providing a rapid and precise method to assess all microorganisms in a sample.

CASE SUMMARY

A 45-year-old male was hospitalized for cough, chest tightness and fatigue for 3 consecutive days. He had received a kidney transplant 42 d prior to admission. No pathogens were detected at admission. Chest computed tomography showed nodules, streak shadows and fiber lesions in both lung lobes as well as right pleural effusion. Pulmonary tuberculosis with pleural effusion was highly suspected based on the symptoms, imaging and residence in a high tuberculosis-burden area. However, anti-tuberculosis treatment was ineffective, showing no improvement in computed tomography imaging. Pleural effusion and blood samples were subsequently sent for mNGS. The results indicated Nocardia farcinica as the major pathogen. After switching to sulphamethoxazole combined with minocycline for anti-nocardiosis treatment, the patient gradually improved and was finally discharged.

CONCLUSION

A case of pulmonary nocardiosis with an accompanying bloodstream infection was diagnosed and promptly treated before the dissemination of the infection. This report emphasizes the value of mNGS in the diagnosis of nocardiosis. mNGS may be an effective method for facilitating early diagnosis and prompt treatment in infectious diseases, which overcomes the shortcomings of conventional testing.

A retrospective cohort study of geographic differences in the semen of 1,012 sperm donors in China

Background

Male reproductive health has become a serious public health concern, and semen quality is essential to male reproduction. We aimed to investigate geographical differences in the semen quality of sperm donors from northern and southern China by enrolling donors across the country.

Methods

A total of 1,012 sperm donors were enrolled in this study between 2015 and 2019. Donors were first divided into two parts based on their birthplace according to the "Qinling-Huaihe" line, and secondly, by their residential latitude. Finally, donors were re-classified into two groups (typically north and south) which contained 667 samples.

Results

Statistically significant differences in sperm concentration were observed among men from different latitudes in China (P=0.04). The sperm concentrations of males from 18° to 27° north latitude were significantly lower than those from 36° to 45° and 45° to 54° [median 131, 134, and 146, respectively, P=0.021 (18° to 27° vs. 36° to 45°) and P=0.01 (18° to 27° vs. 45° to 54°)].

Conclusion

We hypothesize environmental pollution and mental stress due to the increased population size may be the main factors underlying differences in the sperm quality of men in northern and southern China.

Change of tumor-infiltrating lymphocyte of associating liver partition and portal vein ligation for staged hepatectomy for hepatocellular carcinoma

BACKGROUND

The role of tumor-infiltrating lymphocytes (TILs) in the growth and progression of hepatocellular carcinoma (HCC) has attracted widespread attention.

AIM

To evaluate the feasibility of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for massive HCC by exploring the role of TIL in the tumor microenvironment.

METHODS

Fifteen massive HCC patients who underwent ALPPS treatment and 46 who underwent hemi-hepatectomy were selected for this study. Propensity score matching was utilized to match patients in ALPPS and hemi-hepatectomy groups (1:1). Quantitative analysis of TILs in tumor and adjacent tissues between the two groups was performed by immunofluorescence staining and further analyses with oncological characteristics. In the meantime, trends of TILs in peripheral blood were compared between the two groups during the perioperative period.

RESULTS

Continuous measurement of tumor volume and necrosis volume showed that the proportion of tumor necrosis volume on the seventh day after stage-I ALPPS was significantly higher than the pre-operative value (P = 0.024). In the preoperative period of stage-I ALPPS, the proportion of tumor necrosis volume in the high CD8⁺ T cell infiltration group was significantly higher than that in the low group (P = 0.048).

CONCLUSION

TIL infiltration level maintained a dynamic balance during the preoperative period of ALPPS. Compared with right hemi-hepatectomy, the ALPPS procedure does not cause severe immunosuppression with the decrease in TIL infiltration and pathological changes in immune components of peripheral blood. Our results suggested that ALPPS is safe and feasible for treating massive HCC from the perspective of immunology. In addition, high CD8⁺ T cell infiltration is associated with increasing tumor necrosis in the perioperative period of ALPPS.

[Application of tracheotomy in the treatment of severe cases of COVID-19]

Objective: To discuss the the effects, indications and protective measures of tracheotomy for severe cases of coronavirus disease 2019 (COVID-19) patients. Methods: A retrospectively analysis was conducted to explore the clinical data of COVID-19 patients who received tracheotomy in February to March 2020, and descriptive statistics were used to analyze the indication of tracheotomy, particularity of intraoperative treatment and protective measures. Results: A total of 4 cases were included in this article. All patients were successfully operated. One case had postoperative incision continuous bleeding, there were not other complications and nosocomial infection among the medical staff. The patient's condition was relieved in different degrees after the operation, who remained hospitalized. Conclusion: Tracheotomy for severe cases of COVID-19 can achieve certain curative effect, but the occurrence of tracheotomy related complications and nosocomial infection should be effectively controlled, and the risk benefit ratio of tracheotomy should be carefully weighed before surgery.

[Application of tracheotomy in the treatment of severe cases of COVID-19]

Objective: Todiscuss the the effects, indications and protective measures of tracheotomy for severe cases of 2019 novel corona virus disease(COVID-19)patients. Methods: A retrospectively analyze was conducted to explore the clinical data of ofCOVID-19 patients who received tracheotomy in February to March 2020,descriptive statistics were used to analyze the indication of tracheotomy, particularity of intraoperative treatment and protective measures. Results: A total of 4 cases were included in this article, 3 cases were successfully operated, 1 case of postoperative incision continuous bleeding, there were not other complications and nosocomial infection among the medical staff.the patient's condition was relieved in different degrees after the operation, who remain hospitalized. Conclusion: Tracheotomy for severe cases of COVID-19 can achieve certain curative effect, but the occurrence of tracheotomy related complicationsand nosocomial infection should be effectively controlled, and the risk benefit ratio of tracheotomy should be carefully weighed before surgery.

[Expression and significance of polymeric immunoglobulin receptor in nasal polyps]

Objective:To explore the expression of polymeric immunoglobulin receptor in nasal polyps of patients with chronic rhinosinusitis with nasal polyps, and to investigateits relationship with the pathogenesis of nasal polyps. Method:Thirty-six specimens of nasal polyps were harvested patients were selected for the control group who had operation of nasal septal construction in the corresponding time period. The pIgR and IgA expression in nasal polyps and normal nasal inferior turbinate mucosa were detected by immunohistochemistry，and the real-time reverse transcription（RT-PCR） were used to detect the level of pIgR，IgA，RORc and Foxp3 mRNA expression in nasal polyps and normal nasal inferior turbinate mucosa. The association between pIgR mRNA and their association with the number of EOS，RORc mRNA，Foxp3 mRNA were analyzed，respectively． Result:The expression of pIgR in the nasal polyps was significantly lowerer than that in control group, and the result was statistically significant(P<0.05)；Compared with nasal polyps with no eosinophils, the expression levels of pIgR in the nasal polyps with eosinophils was lower\, and the result was statistically significant(P<0.05).The expression of IgA in the nasal polyps was significantly higherthan that in control , and the result was statistically significant(P<0.05).Compared with control, the mRNA expression of pIgR and Foxp3 in the nasal polyps were significantly lower，while the expression levels of IgA mRNA and Foxp3 mRNA in the nasal polyps was significantly higher compared to controls, and the result was statistically significant(P<0.05).In nasal polyps ,pIgR mRNA expression was correlated with RORc mRNA (P<0.05，r=-0.79)，and there was no correlation between pIgR mRNA and Foxp3 mRNA（P>0.05，r=0.36）. Conclusion:It was proved that pIgR down-regulation play an important role in the development of nasal polyps．.

[Pressor effect of substance P applied to the pressor area of ventral surface of medulla oblongata and the underlying mechanism in rabbits]

Experiments were performed on urethane anesthetized and artificially ventilated rabbits. The results were as follows. Application of substance P (SP) to the pressor area of ventral surface of medulla oblongata (VSMp) elicited a dose-dependent increase in blood pressure (BP), but no significant change in heart rate. The pressor response of SP was blocked by pretreatment with SP receptor antagonist (DSP) in VSMp. Application of DSP alone to VSMp elicited a significant decrease in BP. The pressor response of SP was attenuated when VSMp was pretreated with phentolamine or prazosine, whereas pretreatment with yohimbin or propranolol was without effect. Application of SP to VSMp elicited an increase in renal sympathetic nerve discharge (RSND) in association with pressor response; both these responses were blocked by pretreatment with DSP in VSMp. Application of DSP alone to VSMp elicited a significant decrease in RSND and BP. The above results indicate that SP has a pressor effect in VSMp due to activation of SP receptor mediated by alpha 1-receptor. The pressor effect of SP may be mainly due to an increase of peripheral vascular resistance induced by the augmented sympathetic nerve activity. In summary, it appears that endogenous SP in VSMp plays an important role in maintaining sympathetic tone and BP level.