Mixed ductal-endocrine carcinoma of the pancreas presenting as gastrinoma with Zollinger-Ellison syndrome: an autopsy case with a 24-year survival period

We report an autopsy case of mixed ductal-endocrine carcinoma of the pancreas presenting as gastrinoma with Zollinger-Ellison syndrome. A 38-year-old Japanese male was found to have Zollinger-Ellison syndrome and pancreatic gastrinoma, and gastrectomy and resection of the pancreatic tumor were performed. However, hypergastrinemia persisted, and the patient died of disseminated carcinomatosis at 62 years of age, 24 years after the onset of Zollinger-Ellison syndrome. At autopsy, the main tumor was present in the residual pancreas, and metastases were noted in many organs. In the pancreas and other organs, ductal and endocrine carcinoma areas were mixed and there was a gradual transition between the two. No acinar differentiation was noted. The ductal elements were positive for mucins and carcinoembryonic antigen but negative for neuroendocrine markers, while endocrine elements were positive for chromogranin A and synaptophysin and to a lesser extent for gastrin, but negative for mucins and carcinoembryonic antigen. The ductal elements comprised about 30% of the tumor cells, and endocrine elements 70%. According to the revised World Health Organization classification, our case was diagnosed as mixed ductal-endocrine carcinoma. Our case is rare because the tumor manifested as gastrinoma with Zollinger-Ellison syndrome and the patient survived for 24 years. To the best of our knowledge, no such case has been reported. Our case suggests that pancreatic endocrine tumors may evolve into mixed ductal-endocrine carcinomas. Received: 14 April 1999 / Accepted: 7 July 1999     

Optimal analysis of composite cytokine responses during alloreactivity

The one-way mixed lymphocyte reaction (MLR) is a useful model of the graft-vs.-host (GvH) response that occurs following bone-marrow transplantation (BMT). Previous studies of the MLR have shown high levels of type-1 cytokine production, such as IL-1, IL-6, IFN-γ and TNF-, but low or undetectable levels of type-2 cytokines, such as IL-4 and IL-10. Here, through establishing optimal conditions for the examination of levels and kinetics of a more definitive panel of type-1/type-2 cytokines (IL-4, IL-5, IL-10 and IL-13, IFN-γ, TNF- and the soluble IL-4 receptor) we show that, contrary to previously published data, the human alloresponse is truly heterogeneous, resulting in abundant type-2 as well as type-1 cytokine secretion. The kinetics of cytokine levels in the MLR show surprising complexity, suggesting a well-defined regulation as the alloresponse develops over time. Furthermore, each MLR responder:stimulator combination tested produces a composite cytokine profile that is intrinsic to that particular pairing. These combination-specific cytokine responses are reproducible when tested on multiple occasions over time. These data reveal a potential clinical application for the cytokine MLR in selecting donors for BMT with the least inflammatory cytokine profile. Additional analysis of this system reveals that the bulk of cytokine measured is both allospecific and T-cell-derived, with comparatively low levels produced through an autologous mechanism. Interestingly, although most of the cytokine detected is produced by CD45RO+ ‘mature/activated’ T cells, CD45RA+ ‘naive’ T cells are responsible for transient early production of IL-4. This novel finding suggests that naive T cells themselves could regulate type-1/type-2 developmental fate through an autocrine IL-4 mechanism.     

终末糖基化产物对培养的人脐静脉内皮细胞粘附分子表达的影响

目的：探讨终末糖基化产物在糖尿病动脉粥样硬化（AS）形成中的作用机理。 方法： 分离正常人脐静脉内皮细胞（HUVECs），将终末糖基化终产物（AGE）修饰的人血清白蛋白（AGE-HSA）、人血清白蛋白（HSA）与HUVECs在体外共同培养，并用荧光单克隆抗体染色，流式细胞仪定量检测细胞间粘附分子-1（ICAM-1）、血管细胞粘附分子-1（VCAM-1）的表达。 结果： 正常人HUVEC表达ICAM-1和VCAM-1。AGE-HSA能以时间和剂量依赖的方式上调ICAM-1、VCAM-1的表达（P<0.05），而HSA对HUVECs上述粘附分子的表达均无影响。 结论： AGE能上调HUVECs粘附分子的表达，从而促进AS时单核/巨噬细胞的浸润。     

阿魏酸钠对糖尿病大鼠肾脏非酶糖基化和氧化的影响

目的:探讨阿魏酸钠(SF)对糖尿病(DM)大鼠肾脏非酶糖基化和氧化的影响。方法:对链脲佐菌素(STZ)诱导的DM大鼠灌胃给予SF 110 mg·kg^-1·d^-1,治疗8周,测定各组大鼠肾重／体重、肌酐清除率(Ccr)、24 h尿蛋白定量、血清和肾皮质果糖胺(FMN)、血清和肾皮质丙二醛(MDA)含量及抗氧化酶活性,并分别测定肾皮质糖基化终产物(AGEs)含量,观察肾脏病理改变。结果:糖尿病对照组(DM组)大鼠肾重／体重、Ccr、24 h尿蛋白定量、血清FMN、肾皮质FMN和AGEs显著高于正常对照组(N组);SF治疗组(SF组)肾重／体重、Ccr、24 h尿蛋白定量、血清FMN和肾皮质AGEs显著低于DM组;DM组大鼠肾皮质和血清超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性显著低于N组,MDA含量显著高于N组,SF治疗组大鼠肾皮质和血清SOD、CAT活性显著高于DM组,MDA含量显著低于DM组:DM组大鼠肾脏病理改变异常显著,SF组的肾脏病理学改变轻于DM组大鼠。结论: SF通过保护肾脏抗氧化酶,减轻氧化应激,抑制AGEs在肾脏的沉积对DM大鼠肾脏产生保护作用。     

Changes in myocardial capillary diffusion capacity during infusion of vasoactive drugs

The present study investigated how variations in coronary vascular resistance and metabolic demand affected myocardial capillary diffusion capacity. Hearts from Wistar rats were perfused with Krebs-Henseleit-albumin buffer in a Langendorff preparation, where heart rate (HR), contractility (dP/dt_max) and myocardial oxygen consumption (MVO₂) were recorded continuously. Myocardial capillary diffusion capacity was measured as the permeability surface area product (PS) for Cr-EDTA and vitamin B₁₂ by the single injection colorimetric indicator dilution method. After base-line recordings without drugs, angiotensin II + arginine-vasopressin was infused, which increased coronary vascular resistance by 90%, stimulated HR by 11%, decreased dP/dt_max by 21% and reduced MVO₂ by 4%. PS_Cr-EDTA and PS_B12, decreased by 24 and 27%, respectively, leaving the ratio PS_Cr-EDTA/PS_B12 unchanged indicating unaltered capillary permeability. Moreover, the reductions in MVO₂ and PS correlated significantly. During vasodilation: (1) nitroprusside-NA stimulated HR by 7% and decreased dP/dt_max by 14%; (2) adenosine reduced dP/dt_max by 37% and decreased MVO₂ by 9%; and (3) isoproterenol increased HR, dP/dt_max and MVO₂ by 53, 76 and 9%, respectively. However, all three vasodilators reduced PS_Cr-EDTA and PS_B12 in parallel by 7–25% leaving PS_Cr-EDTA/PS_B12 unchanged. Thus, maximal estimated diffusion capacities were obtained during spontaneous coronary vascular tone, most likely reflecting maximal capillary recruitment in the Krebs-Henseleit-albumin perfused heart. The derecruiting effects of the vasoconstrictors were partly overridden by metabolic factors, while the reductions of PS after vasodilation more likely were due to increased heterogeneity in coronary flow.     

急性有机磷中毒患者晚期氧化蛋白产物动态变化的临床研究

目的探讨晚期氧化蛋白（AOPP）在急性有机磷农药中毒（AOPP）患者中的临床意义。方法采用酶联免疫分析法（ELISA）动态检测90例有机磷农药中毒患者和30例健康对照者血清晚期氧化蛋白的含量，并探讨其与病情的相关性。结果AOPP患者血浆中晚期氧化蛋白含量发病后的第1天〉第3天〉第7天与健康对照组比较，P均〈0．01。血清CRP的含量在患者中毒后的第1天〉第3天〉第7天与健康对照组比较，P均〈0．01。在发病的第1天，AOPP患者血清晚期氧化蛋白和CRP的含量重度中毒组〉中度中毒组〉轻度中毒组与健康对照组比较，P均〈0．01。在第1天，AOPP患者的病情程度即MODS的评分值与血清晚期氧化蛋白和CRP的含量均呈明显的正相关性（r1=0．590和r2=0．627，P均〈O．01），而血清晚期氧化蛋白和CRP的含量之间也呈明显的正相关性（r3=0．792，P〈0．01）。结论晚期氧化蛋白的含量随急性有机磷农药中毒患者的病情和炎症反应加重而升高。晚期氧化蛋白可能参与了有机磷农药中毒患者发生多脏器功能障碍的病理生理过程。     

Inhibitory activity of a series of coumarins on leukocyte eicosanoid generation

Sixteen plant-derived or synthetic coumarins with different patterns of substitution were tested for their capacity to modify A23187-induced synthesis of leukotriene B₄ and thromboxane B₂ via the 5-lipoxygenase and cyclooxygenase pathways of arachidonate metabolism in rat peritoneal exudate leukocytes. Five of the 16 coumarins inhibited LTB₄ production: all containortho-dihydroxy substitutions (approximate IC₅₀ values 8–100 M). The mechanism is likely to depend upon a combination of the coumarins' iron-chelating and iron ion-reducing abilities, properties which also confer beneficial activities of these compounds as scavengers of reactive oxygen species (Payá et al., Biochem. Pharmacol.44, 205–214 (1992)). Inhibition of the cyclooxygenase pathway was only demonstrated by one compound, 5,7-dihydroxy-4-methylcoumarin, which did not inhibit 5-lipoxygenase, indicating that the cyclooxygenase inhibitory mechanism is different. Similar effects of the active coumarins were obtained using arachidonic acid as substrate for rat leukocyte eicosanoid generation, confirming that they act at the 5-lipoxygenase/cyclooxygenase level. The same profile of activity was also shown when the coumarins were tested against 5-lipoxygenase in human polymorphonuclear neutrophils. Taken together, these antioxidant and anti-eicosanoid properties of coumarins could be exploited for the design of potentially valuable non-toxic anti-inflammatory agents for treating diseases in which eicosanoid generation and the production of reactive oxygen species are involved.     

长程体外反搏对高胆固醇血症猪高级氧化蛋白产物和高敏C反应蛋白的影响

目的探讨长程体外反搏对高胆固醇血症猪血清中高级氧化蛋白产物(AOPP)和高敏C反应蛋白(hs-CRP)的影响.方法 18头雄性乳猪随机分为正常饲养组(n=6)、高脂饲养组(n=6)及高脂饲养+体外反搏组(n=6).后2组通过高脂饲养复制高胆固醇血症猪模型并对高脂饲养+体外反搏组进行36 d共36 h的长程增强型体外反搏.分别于分组饲养前、反搏前、反搏中期和反搏结束时留取3组动物静脉血,采用分光光度法检测血清AOPP浓度,采用乳胶凝集反应法检测血清hs-CRP浓度.结果高脂饲养组和高脂饲养+体外反搏组经高脂饲养后血清总胆固醇和低密度脂蛋白明显升高(P<0.05).血清AOPP和hs-CRP浓度在分组饲养前组差异无统计学意义(P>0.05).反搏前、反搏中期和反搏结束时,高脂饲养组与高脂饲养+体外反搏组血清AOPP和hs-CRP浓度较正常饲养组同时期均有显著增高(P<0.05);而反搏中期和反搏结束时高脂饲养+体外反搏组血清AOPP浓度较高脂饲养组显著降低[(95.38±12.66)μmol/L比(128.46±12.55)μmol/L;(85.78±10.33)μmol/L比(158.22±16.32)μmoL/L,P<0.05];且反搏中期和反搏结束时高脂饲养+体外反搏组血清hs-CRP浓度较高脂饲养组也有显著降低[(0.47±0.14)mg/L比(0.62±0.32)mg/L;(0.47±0.16)mg/L比(0.59±0.43)mg/L,P<0.05].结论 AOPP和hs-CRP参与了高胆固醇血症猪的发病过程.长程体外反搏可能通过减轻机体体内氧化应激和微炎性反应过程,从而阻止高胆固醇血症的病理生理进程.