Prognostic significances of tumor-infiltrating S-100 positive dendritic cells and lymphocytes in patients with hepatocellular carcinoma

BACKGROUND/AIMS: To investigate the prognostic significances of dendritic cells and lymphocytes infiltration in hepatocellular carcinoma. METHODOLOGY: The clinicopathological and follow-up data of 44 patients with hepatocellular carcinoma, who underwent curative resection of tumor in our hospital from January 1995 to July 1996, were collected. Immunohistochemical staining was employed to detect the S-100 positive dendritic cells in the tumor tissue, and lymphocytes infiltration was evaluated simultaneously. The relationship of the tumor-infiltrating dendritic cells and lymphocytes to the postoperative recurrence-free time and survival rate was analyzed. RESULTS: Either the tumor-infiltrating dendritic cells or the tumor-infiltrating lymphocytes alone had no significant relationship to the postoperative recurrence-free time and survival rate. By taking into consideration both tumor-infiltrating dendritic cells and lymphocytes simultaneously, the patients were classified into two groups. Group A included patients having dendritic cell counts > or = 20 cells/10 high power fields together with positive lymphocytes infiltration (n = 17), and group B consisted of patients having dendritic cell count > or = 20 cells/10 high power fields but with negative lymphocytes infiltration or dendritic cell count < 20 cells/10 high power fields with either positive or negative lymphocytes infiltration (n = 27). There were no significant differences in clinicopathological features between two groups. The recurrence-free time was markedly longer in group A as compared with group B, with a median time of 21.6 months for group A and 4.1 months for group B (P < 0.05). The 1-, 3-, 4-year survival rates were significantly greater in group A than those in group B, being 83.5% vs. 42.2%, 61.8% vs. 28.4% and 48.7% vs. 23.0%, respectively (P < 0.01). CONCLUSIONS: Marked infiltration of dendritic cells together with lymphocytes in tumor tissue was closely related to the improved clinical prognosis in patients with hepatocellular carcinoma, and represented as an independent prognostic factor.     

Alterations of intestinal mucosa structure and barrier function following traumatic brain injury in rats

AIM: Gastrointestinal dysfunction is a common complication in patients with traumatic brain injury (TBI). However, the effect of traumatic brain injury on intestinal mucosa has not been studied previously. The aim of the current study was to explore the alterations of intestinal mucosa morphology and barrier function, and to determine how rapidly the impairment of gut barrier function occurs and how long it persists following traumatic brain injury.METHODS: Male Wistar rats were randomly divided into six groups (6 rats each group) including controls without brain injury and traumatic brain injury groups at hours 3,12, 24, and 72, and on day 7. The intestinal mucosa structure was detected by histopathological examination and electron microscopy. Gut barrier dysfunction was evaluated by detecting serum endotoxin and intestinal permeability. The level of serum endotoxin and intestinal permeability was measured by using chromogenic limulus amebocyte lysate and lactulose/mannitol (L/M) ratio, respectively.RESULTS: After traumatic brain injury, the histopathological alterations of gut mucosa occurred rapidly as early as 3 hours and progressed to a serious state, including shedding of epithelial cells, fracture of villi, focal ulcer, fusion of adjacent villi, dilation of central chyle duct, mucosal atrophy,and vascular dilation, congestion and edema in the villous interstitium and lamina propria. Apoptosis of epithelial cells,fracture and sparseness of microvilli, loss of tight junction between enterocytes, damage of mitochondria and endoplasm, were found by electron microscopy. The villous height, crypt depth and surface area in jejunum decreased progressively with the time of brain injury. As compared with that of control group (183.7±41.8 EU/L), serum endotoxin level was signnificantly increased at 3, 12, and 24 hours following TBI (434.8±54.9 EU/L, 324.2±61.7 EU/L and 303.3±60.2 EU/L, respectively), and peaked at 72 hours (560.5±76.2 EU/L), then declined on day 7 (306.7±62.4 EU/L,P＜0.0L). Two peaks of serum endotoxin level were found at hours 3 and 72 following TBI. L/M ratio was also significantly higher in TBI groups than that in control group (control,0.0172±0.0009; 12 h, 0.0303±0.0013; 24 h, 0.0354±0.0025;72 h, 0.0736±0.0105; 7 d, 0.0588±0.0083; P＜0.01).CONCLUSION: Traumatic brain injury can induce significant damages of gut structure and impairment of barrier function which occur rapidly as early as 3 hours following brain injury and lasts for more than 7 days with marked mucosal atrophy.     

Modeling the long-term outcomes and costs of HIV antiretroviral therapy using HIV RNA levels: application to a clinical trial

A model was developed to gain insight into the potential clinical and economic impact of antiretroviral therapy for HIV-infected patients. Observed HIV RNA levels and CD4 cell counts are used in the model to estimate the probability that an individual progresses from asymptomatic infection to the first AIDS-defining illness and death and to estimate the total net cost of care and long-term cost-effectiveness of antiretroviral therapy. The model was applied to patients in a clinical trial (Merck protocol 035) that compared the surrogate marker response to triple therapy with indinavir (IDV; 800 mg every 8 hr) plus zidovudine (ZDV; 200 mg every 8 hr) plus lamivudine (3TC; 150 mg twice a day) to double therapy with ZDV+3TC. The model projected that for an individual without AIDS who received triple therapy the progression to AIDS and death would be delayed more than for a patient who received double therapy with ZDV+3TC if no other treatment options were offered. Because of this delay in disease progression, the total discounted cost over the initial 5-year period was projected to be $5100 lower for patients who received triple therapy compared with double therapy if suppression with triple therapy lasts up to 3 years. If suppression with triple therapy lasts up to 5 years, costs were projected to be higher with the triple combination, but 81% of the cost is offset by lower disease costs as a result of fewer patients progressing to AIDS. Over 20 years, total discounted cost was projected to be higher for the triple-therapy regimen primarily because of a longer estimated survival time. At 20 years, the incremental cost per life-year gained by adding IDV to a ZDV+3TC regimen was estimated at $13,229, which is well within the range of other widely accepted medical interventions.     

Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation

There is no gold standard for the measurement of pulmonary regurgitation (PR) severity. Two-dimensional (2D) transthoracic echocardiography is most commonly used to quantify PR severity using color Doppler criteria for aortic regurgitation. However, this method is limited by visualization of only one or two dimensions of the proximal PR jet or vena contracta (VC) precluding accurate assessment of its shape or size. This limitation would be expected to be obviated by three-dimensional (3D) transthoracic echocardiography, which could provide a more accurate quantitative assessment of PR severity. This study evaluated 82 adult patients with PR using 2D and 3D. PR VC area by 3D was obtained by planimetry by positioning the cropping plane exactly parallel to the VC, which was viewed en face by cropping of the 3D data set. Regurgitant volumes were calculated by 2D (assuming a circular VC) and by 3D as a product of the VC and velocity time integral obtained by color Doppler-guided conventional Doppler interrogation of the PR jet.The 3D VC area correlated with 2D jet width (JW)/right ventricular outflow tract (RVOT) width (r = 0.71) and 2D VC area (r = 0.79). 3D JW/RVOT width correlated with 2D JW/RVOT (r = 0.87). 3D regurgitant volumes also correlated with 2D regurgitant volumes (r = 0.76). The 3D VC values of <0.20, 0.20-0.45, 0.46-1.15, and >1.15 cm(2) and regurgitant volumes of <15 ml, 15-50 ml, 51-115 ml, and >115 ml were effective as cutoffs for grades 1, 2, 3, and 4 PR, respectively. In conclusion, quantification of 3D VC area and regurgitant volumes correlate reasonably well with the current 2D methods for measurement of PR. Since 3D visualizes PR VC in three dimensions, it would be expected to provide a more accurate and more quantitative assessment of PR severity as compared to 2D.     

A human-derived protein SBP (HBsAg-binding protein) can bind to hepatitis B virus surface antigen (HBsAg) and enhance the immune response to hepatitis B virus (HBV) vaccine

A high titer of antibody to HBsAg (Hepatitis B virus surface antigen) (anti-HBs) is a requisite for the prevention of HB (Hepatitis B), and adjuvants generally play a great role in eliciting special anti-HBs to HB vaccine. However, adjuvants still need to be improved because of their shortages such as unremarkable efficacy, undesirable side effect or poor security. In this study, we used HBsAg separated from HB patient sera to screen a human liver cDNA expression library, and found a novel HBsAg-binding protein (SBP), which is located at the human chromosome 14q32.33 and is similar to human IgG heavy chain in structure. Western blot demonstrated that SBP existed in both healthy human sera and HB patient sera. Furthermore, SBP could bind to HBsAg by its N-terminal domain. Notably, we confirmed that SBP could promote dendritic cells (DC) to phagocytize HBsAg more effectively and enhance the immunogenicity of HB vaccine, when SBP was mixed proportionally with HBsAg and the resulting mixture was infused into mice. These results suggest that SBP could be developed into a safe and promising adjuvant of HB vaccine.     

Penile aseptic abscess in the cavernous body at the base of the penis:a case report

We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resection of the abscess wall,with the incisions closed layer by layer with primary suture.In addition,we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema;the incision would not be covered with dressings from the third day after the operation,so as to keep the incision site dry in an open way.During the period of indwelling of the catheter after the operation,we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections.Finally,the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis.The patient recovered well after surgery and was discharged 1 week later.At 1.5 years after the operation,the shape of the penis returned to normal,and the erectile function was normal.It was seen that good nursing concept is of great help for prognosis,which could avoid infection and edema,and is conducive to wound healing.     

Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.