[Clinical features, diagnosis and treatment of intraductal papillary neoplasm of the bile duct].

Objective: To study the clinicopathologic features of intraductal papillary neoplasm of the bile duct(IPNB) and to analyze the diagnostic and therapeutic patterns. Methods: The data of 46 patients with IPNB undergoing surgery in Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to November 2017 were retrospectively analyzed.There were 23 males and 23 females with age of (64±8)years.Patients were followed up by clinics and telephone inquiry.Categorical data were compared with χ(2) test or Fisher's exact test. Results: Abdominal pain(in 31 patients), fever (in 15 patients) and jaundice (in 11 patients) were the most common symptoms.Twenty-five patients were accompanied with cholangiolithiasis and 25 were accompanied with liver atrophy.Preoperative laboratory examination was mainly manifested as the abnormal liver function caused by biliary obstruction.Typical imaging findings included bile duct dilation (in 45 patients) and mass within bile duct (in 22 patients). All the patients were diagnosed as IPNB histopathologically.Among them, high-grade intraepithelial neoplasia and related adenocarcinoma were more common in mucus-hypersecretion IPNB ((13/15 vs. 51.6%(16/31))(χ(2)=5.331, P=0.021). Hepatectomy was performed in 25 patients, hepatectomy combined with biliary resection and reconstruction in 12 cases, biliary resection and reconstruction in 3 cases, pancreatoduodenectomy in 3 cases, hepatopancreaticoduodenectomy in 1 case, liver transplantation in 1 case and radiofrequency ablation in 1 case.Forty-one patients were followed up with a median of 30 (12, 41) months.Seven patients suffered recurrence and 6 died. Conclusion: IPNB is a rare disease with limited knowledge currently.Images are the main diagnositc means and surgery is the first choice.

Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis.

BACKGROUND: Pancreaticoduodenectomy combined with portal-superior mesenteric vein synchronous resection for cancer remains a hot debate topic. The present study used meta-analytical technique to provide update information and an evidence-based evaluation on both the perioperative benefit and long-term survival. METHODS: A meta-analysis was performed to evaluate studies comparing venous resection (VR) versus without venous resection (WVR) groups. 22 retrospective studies including 2890 patients were eligible for an analysis of perioperative morbidity, mortality, and long-term survival. Furthermore, subgroup analysis was made according to histopathology and resection margin status respectively for the purpose of survival assessment. RESULTS: There was no difference in perioperative morbidity, mortality and 1-year, 3-year survival between two groups, but showed differences in median tumor size (P < 0.001), R0 resection rate (P < 0.001), lymph node metastasis (P = 0.03), pancreatic fistula (P = 0.01), and 5-year survival (P = 0.03). In subgroup analysis, patients in venous resection group received R0 resection had a significantly better survival comparing with who received R1 resection both at 2-year (P < 0.001) and 5-year (P = 0.00002). In histopathology subgroup, patients in venous resection groups who had true tumor infiltration had a significantly bad survival comparing with whom only with inflammation pathology. CONCLUSION: Pancreaticoduodenectomy combined with venous resection can achieve equal perioperative morbidity and mortality as standard resection. However, in order to obtain an optimal survival outcome, surgeons should make an R0 resection as far as possible, especially in cases need synchronous venous resection.

Enhanced dissipation of PAHs from soil using mycorrhizal ryegrass and PAH-degrading bacteria.

The major aim of this experiment was to test the effects of a multi-component bioremediation system consisting of ryegrass (Lolium multiflorum), polycyclic aromatic hydrocarbons (PAHs)-degrading bacteria (Acinetobacter sp.), and arbuscular mycorrhizal fungi (Glomus mosseae) for cleaning up PAHs contaminated soil. Higher dissipation rates were observed in combination treatments: i.e., bacteria+ryegrass (BR), mycorrhizae+ryegrass (MR), and bacteria+mycorrhizae+ryegrass (BMR); than bacteria (B) and ryegrass (R) alone. The growth of ryegrass significantly (p<0.05) increased soil peroxidase activities, leading to enhanced dissipation of phenanthrene (PHE) and pyrene (PYR) from soil. Interactions between ryegrass with the two microbes further enhanced the dissipation of PHE and PYR. Mycorrhizal ryegrass (MR) significantly enhanced the dissipation of PYR from soil, PYR accumulation by ryegrass roots and soil peroxidase activities under lower PHE and PYR levels (0 and 50+50 mg kg(-1)). The present results highlighted the contribution of mycorrhiza and PAH-degrading bacteria in phytoremediation of PAH contaminated soil, however more detailed studies are needed.

CD28-specific antibody prevents graft-versus-host disease in mice.

The costimulatory molecules B7-1 and B7-2 regulate T cell activation by delivering activation signals through CD28 and inhibitory signals through CTLA4. Graft-vs-host disease (GVHD) is caused by activated donor T cells. Previously, we showed that CD28-deficient donor T cells induced less-severe GVHD than wild-type donor T cells, suggesting that CD28 signals exacerbate GVHD. In this paper we demonstrate that CTLA4 signals attenuate the severity of GVHD. Targeting the CD28 receptor with a specific mAb modulates the receptor in vivo, inhibits donor T cell expansion, and prevents GVHD. CTLA4 signaling was necessary for this effect because treatment with a soluble ligand that blocks binding of B7 to both CD28 and CTLA4 did not prevent GVHD as effectively as anti-CD28 mAb. These results support the current model of T cell costimulation in which CD28 signals amplify GVHD while CTLA4 signals inhibit GVHD, providing evidence that selective targeting of CD28 might be a better therapeutic strategy for inducing immunological tolerance than blocking the ligands for both CD28 and CTLA4.

Enhancement of susceptibility to Fas-mediated apoptosis of TH1 cells by nonmitogenic anti-CD3epsilon F(ab')2.

BACKGROUND: Anti-CD3epsilon F(ab')2 are nonmitogenic for naive T cells but can induce apoptosis of antigen-activated T cells in vitro and in vivo. We studied the mechanisms by which nonmitogenic anti-CD3epsilon F(ab')2 antibodies induce T cell death. METHODS: OVA-responsive T cell lines were generated by immunization in vivo and restimulation in vitro. Fas or Fas ligand (FasL) expression was tested by surface staining with specific mAbs. The apoptotic DNA and cell cycle phase were tested by staining DNA with propidium iodide. Interferon-gamma was measured by ELISA, whereas interleukin (IL)-2 and IL-4 were detected by bioassays. RESULTS: Restimulation with anti-CD3epsilon F(ab')2 induced apoptosis of antigen-activated wild-type T cells, but not Fas or FasL-defective T cells. Anti-CD3epsilon F(ab')2 induced death of cells expressing high levels of Fas and FasL, and preferentially deleted T helper (Th)1 cells but spared Th2 cells. Soluble anti-CD3epsilon F(ab')2 did not regulate Fas or induce FasL expression, indicating that the ability of anti-CD3epsilon F(ab')2 to induce T cell apoptosis depends on a distinct mechanism. T cells in S/G2 were found relatively resistant to Fas-mediated apoptosis, but anti-CD3epsilon F(ab')2 rendered those T cells exquisitely sensitive to Fas-mediated apoptosis. CONCLUSIONS: Anti-CD3epsilon F(ab')2 induces apoptosis of cycling CD4+ T cells through activation of the Fas/FasL pathway. Anti-CD3epsilon F(ab')2 does not regulate Fas or FasL expression but induces susceptibility to Fas-mediated apoptosis of cycling T cells. Anti-CD3epsilon F(ab')2 can induce death of polarized Th1 cells, but not Th2 cells, thus potentially skewing the repertoire of antigen-activated T cells toward the Th2 phenotype. These features predict that nonmitogenic anti-CD3epsilon F(ab')2-like antibodies can be useful to prevent or reverse pathogenic immune responses mediated by Th1 cells.

Role of CD28 in acute graft-versus-host disease.

Because CD28-mediated T-cell costimulation has a pivotal role in the initiation and maintenance of T-cell responses, we tested the hypothesis that CD28 is critical for the development of graft-versus-host disease (GVHD). We compared the in vivo effects of CD28(-/-) T cells transplanted from B6 donor with the CD28 gene deleted by homologous recombination with those of CD28(+/+) T cells transplanted from wild-type C57BL/6 (B6) donor. Fifty million CD28(-/-) or CD28(+/+) splenocytes from B6 mice were transplanted into unirradiated (B6 x DBA/2)F1 (BDF1) recipients. Unlike CD28(+/+), CD28(-/-) T cells from B6 mice had lower levels of proliferation and interleukin-2 production, had a limited ability to generate cytotoxic T lymphocytes against the recipient, and did not induce immune deficiency, despite survival in the recipient for at least 28 days. The ability to prevent rejection was reduced by the absence of CD28, because as many as 1.0 x 10(7) CD28(-/-) CD8(+) cells were needed to prevent rejection of major histocompatibility complex (MHC) class-I incompatible marrow in sublethally irradiated (550 cGy) bm1 recipients, whereas 8.0 x 10(5) CD28(+/+) CD8(+) T cells were sufficient to produce a similar effect, indicating that CD28 on donor CD8(+) cells helps to eliminate host immunity. Two million CD4(+) CD28(-/-) or CD28(+/+) T cells were transplanted into sublethally irradiated (750 cGy), MHC class-II incompatible (B6 x bm12)F1 recipients. With CD28(-/-) cells, 44% of the recipients died at a median of 20 days compared with 94% at a median of 15 days with CD28(+/+) cells (P < .001). Two million CD8(+) CD28(-/-) or CD28(+/+) T cells were transplanted into sublethally irradiated (750 cGy), MHC class-I incompatible (B6 x bm1) F1 recipients. With CD28(-/-) cells, 25% of the recipients died at a median of 41 days compared with 100% at a median of 15 days with CD28(+/+) cells (P < . 001). (B6 x bm12)F1 and (B6 x bm1)F1 mice surviving after transplantation of CD28(-/-) cells recovered thymocytes, T cells, and B cells in numbers and function comparable with that of irradiation-control F1 mice. We conclude that CD28 contributes to the pathogenesis and the severity of GVHD. Our results suggest that the severity of GVHD could be decreased by the administration of agents that block CD28 function in T lymphocytes.

Induction of apoptosis by anti-CD3 epsilon F(ab')2 in antigen receptor transgenic murine T cells activated by specific peptide.

Peripheral T cell tolerance can be achieved through deletion of mature CD4+ cells activated by high dose Ag. We tested whether apoptosis of peripheral CD4+ cells could be induced by a stimulatory dose of Ag plus a soluble ligand to the nonpolymorphic epsilon-chain of the TCR-associated CD3 complex. CD4+ T cells from the DO10 mouse express a transgenic TCR-alphabeta specific for OVA peptide 323-339 presented by I-A(d). OVA alone induced clonal activation and expansion of peripheral CD4+/TCR transgene+ cells. Simultaneous exposure to specific Ag plus soluble anti-CD3 Fos, a nonmitogenic anti-CD3epsilon genetically engineered F(ab')2-like Ab, blocked expansion and induced death of CD4+/TCR transgene+ cells, but not CD4+/TCR transgene- T cells. In contrast, a mitogenic anti-CD3epsilon Ab induced polyclonal activation and nonselective T cell death. Sequential stimulation by Ag followed by anti-CD3 Fos also induced death of TCR transgene+ cells, whereas stimulation by anti-CD3 Fos followed by Ag did not affect cell viability or function. Anti-CD3 Fos-induced death was associated with DNA fragmentation characteristic of apoptosis, was facilitated by IL-2, and was initiated by stimulation during the S-G2 phases of the cell cycle. Anti-CD3 Fos could induce deletion of Ag-activated T cells by apoptosis in vivo. Thus, a soluble, non-Fc-binding anti-CD3 Ab can induce programmed cell death of Ag-activated peripheral CD4+ T cells by CD3epsilon cross-linking during S or G2. Peripheral T cell deletion by activation-driven apoptosis is under cell cycle control and can be exploited to achieve selective immunosuppression by nonmitogenic anti-CD3epsilon Abs.

A long-term culture system for the expansion of hematopoietic stem cells from embryonic yolk sac with the capacity to seed erythroid and lymphoid development in vitro and to reconstitute the lymphoid compartment in severe combined immunodeficient mice.

We have established a long-term culture system under which hematopoietic stem cells derived from the embryonic yolk sac may be maintained for long periods. Evidence for the persistence of stem cells in this culture is provided by three experimental observations. First, erythroid progenitors, as evidenced by morphological, functional, and phenotypical analysis, may be generated from these yolk sac cultures after more than 7 months in culture. The yolk sac derived erythroid progenitors are distinct from those of bone marrow derived cells both qualitatively and quantitatively. This is evidenced by the high colony plating efficiency, large colony size, different growth factor requirements, increased sensitivity to Epo and other cytokines, as well as significant and prolonged expansion capability, suggesting that the yolk sac derived progenitors are both more proliferative and more primitive than their bone marrow derived analogs. Second, under different conditions, lymphoid progenitors may also be derived from these long term yolk sac cultures in the presence of the appropriate cytokines. Third, preliminary data suggest the engraftment of these yolk sac cells and reconstitution of at least some compartments of the hematopoietic system of host animals. This long-term culture system will provide a useful model for the study of early embryonic hematopoiesis, and the cells derived from this culture system may also have the potential of serving as donor cells for hematopoietic cell transplantation.

[Observations on serum digoxin-like immunoreactive substances in patients with cor-pulmonale].

The level of endogenous digoxin-like immunoreactive substances (DLIS) was determined with RIA in 27 patients with cor-pulmonale and 10 normal subjects as controls. The results showed that the concentration of serum DLIS was 0.51 +/- 0.18 ng/ml in the controls, 0.82 +/- 0.24 (P < 0.05), 1.45 +/- 0.51 (P < 0.001), and 2.31 +/- 1.22 ng/ml (P < 0.001) in the patients groups with cardiac function grade II (9 cases), III (10 cases) and IV (8 cases) respectively. It has been reported that both endo- and exogenous digoxin-like substances have the same function. Cor-pulmonale patients with heart failure who are treated with digoxin tend to have toxic reactions. We consider the increase in serum endogenous DLIS as the cause. It is suggested that the dosage of digoxin, if it must be used, should be individualized and the serum level monitored if possible, so as to achieve best therapeutic effects with smaller doses.

[Preliminary report of the treatment of luteal phase defect by replenishing kidney. An analysis of 53 cases].

53 patients with Luteal phase defect (LPD) were treated with different Chinese medicinal herbs at different phases of menstrual cycle. On the 5th day of the menstrual cycle, the treatment was implemented with the rationale of "nourishing the Kidney Yin, invigorating the Spleen and replenishing the Qi, promoting the blood circulation and enriching the Blood" which might promote follicular development. The principle for the postovulatory treatment was that "invigorating the Kidney and strengthening the Yang" might enhance the development of corpus luteum and maintain its function. The patients were treated for three menstrual cycles. There were significant improvement in the luteal phase of endometrium, and prolonged basal body temperature elevation in progestational stage with a tendency for normalization of the wave forms and its amplitude after the treatment. In the mid-progestational stage, the level of serum LH and PRL were reduced (P < 0.05) and that of serum progestin (P) rose significantly (P < 0.01), as compared with those before the treatment. The findings suggested that Chinese herbal medicines capable of replenishing the Kidney could regulate the hypothalamus-pituitary-ovarian axis and thus improve the luteal function. Among the 53 cases, 22 (41.5%) conceived but 68.18% of them required other measures to preserve the pregnancy.

[Lymphatic metastasis of breast cancer and selection of operation].

Studies of 169 cases of breast carcinoma showed that lymphatic metastasis was closely related to biological behavior of the cancer. Modified radical operation or modified extended radical operation were performed in cases of TNM stage I and II by pre- and intraoperative estimation of the tumor less than or about 5 cm in diameter, limited within mammary gland, and of expansion type. Histological typing and grading, degree of infiltration, condition of ER and lymphatic metastasis were used to plan postoperative adjuvant therapy. The importance of investigation of ER status of the lesions lies in proper arrangement of combined therapy and prediction of prognosis.