[Long-term oncologic outcomes of localized high-risk prostate cancer undergoing brachytherapy combined with external-beam radiation therapy and maximal androgen blockade].

Objective: To investigate the oncologic outcome and PSA kinetics of localized high-risk prostate cancer (PCa) patients treated with combination strategy of radiation therapy (RT) and maximal androgen blockade (MAB). Methods: We retrospectively reviewed the clinical data of 320 localized PCa patients undergoing RT+ MAB from 2001 to 2015. And radiation treatment protocol consisted of permanent prostate brachytherapy (PPB) at 110 Gy and EBRT at 45 Gy/23 fractions. Results: The median follow-up time was 90 (range: 12-186) months. And 117 (36.6%) cases underwent MAB + external-beam radiotherapy (EBRT), and other 203 (63.4%) cases received MAB+ EBRT+ PPB. Multivariate Cox regression analyses showed that PSA kinetics were positive indicators of oncologic outcomes. Furthermore, PSA kinetics were aberrantly improved by supplemental PPB to MAB+ EBRT as following, PSA nadir (1.3±0.7)µg/L vs(0.11±0.06)µg/L, time of PSA decrease to nadir (7.5±1.8)months vs (3.2±2.1)months, PSA doubling time (15.6±4.2)months vs (22.6±6.1)months, PSA decreasing amplitude (84.6±6.2)%vs(95.8±3.4)%. Additionally, the median time of several important oncologic events in MAB+ EBRT+ PPB group were also prolonged than that in MAB+ EBRT group as following, overall survival (12.3 years vs 9.1 years, P<0.001), biochemical recurrence-free survival (9.8 years vs 6.5 years, P<0.001), skeletal-related event (10.4years vs 8.2 years, P<0.001), and cytotoxic chemotherapy (11.6 years vs 8.8 years, P=0.007). Conclusion: MAB+ EBRT+ PPB is extremely effective combination strategy for localized high-risk PCa patients, and PPB plays the important synergistic role in improving PSA kinetics, which are independent predictor for oncologic outcomes.

[Clinical manifestations and treatment of sweat gland carcinoma--analysis of 22 cases].

Twenty-two patients with sweat gland carcinoma treated during the past 8 years are reported. They constitute 4.4% of malignant lesions of the skin during the same period. Of these 22 patients, 2 were apocrine gland carcinoma, 15 eccrine carcinoma, 4 hidradenocarcinoma and 1 cylindroma. In 11 patients with distant metastasis, 90.9% had lymphatic metastasis and 36.3% had blood metastasis. Vascular disseminations were mainly to the bone, lung and skin in order of incidence. Sweat gland carcinoma is rare and of low malignancy with evident tendency of recurrence. Prognosis was mainly related to the presence of distant metastasis. It is believed that the enlarged local resection should be given to patients without metastasis. On the other hand, local resection plus regional dissection should be performed on patients with metastasis. Post-operative irradiation may be helpful to prevent distant metastasis.

Decreased circulating CD4+CD25highFoxp3+ T cells during acute rejection in liver transplant patients.

BACKGROUND: CD4(+)CD25(high)FoxP3(+) regulatory T (Treg) cells have been implicated to maintain immunologic tolerance. They have been investigated in acute renal allografts rejection episodes (ARE). This study was performed to examine the frequency of peripheral blood (PB) CD4(+)CD25(high)FoxP3(+) Treg cells among liver transplantation patients with prior benign end-stage liver diseases in relation to ARE. METHODS: This prospective analysis of 55 patients who underwent liver transplantation from 2004 to 2009 did not include prisoners either as donors or recipients. PB was obtained from liver transplant patients longitudinally: pretransplantation, posttransplantation within 1 year, and at the time of an episode of ARE to measure by flow cytometry circulating CD4(+)CD25(high)FoxP3(+) T cells. Blood samples were drawn during ARE with concomitant liver biopsies. The rejector group was defined in the 14/55 cases who suffered an ARE; in the other patients with stable liver function were classified as the nonrejector group. We compared the number of circulating CD4(+)CD25(high)FoxP3(+) T cells between the 2 groups. RESULTS: There was no difference in the levels of circulating CD4(+)CD25(high)FoxP3(+) T cells pretransplantation. Interestingly, circulating CD4(+)CD25(high)FoxP3(+) T cells were significantly lower among the rejector compared with the nonrejector (2.23 ± 0.54% vs 2.99 ± 0.86%; P < .01). Longitudinal analysis revealed circulating CD4(+)CD25(high)FoxP3(+) T cells of patients in the rejector group to be significantly lower during rejection than during quiescence (2.23 ± 0.54% vs 3.68 ± 0.70%; P < .0001). The frequency of circulating CD4(+)CD25(high)FoxP3(+) T cells negatively correlated with a Rejection Activity Index (r = -0.80; P < .01). CONCLUSION: Monitoring peripheral CD4(+)CD25(high)FoxP3(+) T cell levels may be useful to evaluate the immune state, potentially acting as a sensitive marker for ARE diagnosis among liver transplantation patients. Moreover, they may contribute to the mechanisms of Treg-mediated acceptance of liver transplantations.

Interleukin-23 promotes natural killer T-cell production of IL-17 during rat liver transplantation.

INTRODUCTION: Cytokine interleukin-17 (IL-17) is a key proinflammatory mediator promoting allograft cytokine and chemokine production. In addition to Th17 cells, natural killer T (NKT) cells have also been shown to be capable of rapidly producing IL-17 after activation. METHODS: The levels of IL-17 and IL-23 of liver allografts were determined using enzyme-linked immunosorbent assay (ELISA). IL-17-positive cells in CD1d CD4+ cells of grafts were detected using flow cytometry. RESULTS: High expression of IL-17 and IL-23 was observed in liver allografts. The ratios of NKT cells were dramatically increased in the allograft group compared with that in the control group (P < .01). In vitro, blockage of IL-23 using anti-IL-23 antibody can inhibit increasing expression of IL-17 (P < .01). CONCLUSION: NKT cells contribute to production of IL-17 mediated by IL-23 on a rat acute allograft rejection model of orthotopic liver transplantation (OLT).

Gastroduodenal arterial reconstruction of the pancreaticoduodenal allograft.

Simultaneous procurement of the pancreas and liver necessitates division of vessels supplying both organs. The integrity of the pancreatic arterial supply appears to be related to surgical complications after pancreas transplantation. We have described herein three cases of gastroduodenal artery (GDA) reconstruction during pancreas transplantation, and reviewed other options for GDA reconstruction. These techniques performed safely during bench reconstruction can be applied to various clinical situations.