Effects of hyperbaric oxygen on GDNF expression and apoptosis in spinal cord injury

The effects of hyperbaric oxygen treatment on the progress of secondary damage following traumatic spinal cord injury were investigated. The early onset of hyperbaric oxygen treatment significantly diminished the number of apoptotic cells 1 day after the injury. However, hyperbaric oxygen did not influence the proliferation of macrophages or activated microglia. The gene expression of glial cell line-derived neurotrophic factor (GDNF) and inducible nitric oxide synthetase (iNOS) was significantly attenuated 1 day after the injury in the hyperbaric oxygen groups compared with the control group. The down-regulation was confirmed by immunohistochemical staining. Early hyperbaric oxygen treatment was shown to effectively suppress the progress of apoptosis perhaps via the inhibition of iNOS gene despite the down-regulation of the GDNF gene.     

Total laparoscopic wedge resection for an intramural ectopic pregnancy using an intraoperative ultrasound system: A case report

Intramural pregnancy is a rare form of ectopic pregnancy, and the optimal treatment remains uncertain. We describe a 33-year-old woman (gravida 2, para 0) who visited our hospital with suspected ectopic pregnancy. The patient was asymptomatic and hemodynamically stable. Transvaginal ultrasonography revealed pregnancy at 6 weeks of gestation and a gestational sac and fetal heartbeat in the anterior muscular layer of the uterus, away from the endometrium. The fetal sac measured 26 mm. The serum human chorionic gonadotropin (hCG) level had increased to 27 655 mIU/mL. Accordingly, the patient was diagnosed with an intramural ectopic pregnancy and underwent total laparoscopic wedge resection using intraoperative ultrasonography. The postoperative course was uneventful, and she was discharged after 4 days. Her serum hCG level normalized at 26 days postoperatively. This case indicates that intraoperative laparoscopic ultrasonography seems viable for treating intramural pregnancies.     

Immunohistochemical double staining with estrogen receptor and HER2 on primary breast cancer

Immunohistochemical double staining with estrogen receptor (ER) and epidermal growth factor receptor 2 (HER2) was conducted in tissue sample of 125 women with invasive breast cancer. The age at the time of surgery ranged from 28 to 82 years. The tumor size was 2 cm or less in 42 patients and larger than 2 cm in 83. Axillary lymph node status was positive in 53 patients and negative in 72. Estrogen receptor (ER) which was measured using enzyme immunoassay (EIA) was positive in 67 patients, negative in 50 and unknown in 8. Of the 125 patients evaluated, 83 (66.4%) were immunohistochemically positive for ER. ER by immunohistochemistry (IHC) (ER-IHC) was significantly (p<0.01) correlated with ER by EIA (ER-EIA). ER-EIA values in ER-IHC scores were 1.4 fmol/mg protein in score 0, 0.0 in score 1, 19.0 in score 3, 21.2 in score 4, 12.2 in score 5, 17.6 in score 6, 30.0 in score 7 and 114.8 in score 8. ER-EIA values in ER-IHC-score 8 were significantly higher than in scores 0, 2, 3, 4, 5, 6 and 7. Of the 125 patients, 35 (28%) were immunohistologically positive for HER2. HER2 expression was inversely correlated with ER expression. When evaluated even in ER-positive patients, HER2 overexpression was associated with lower ER levels. In this study, we conducted immunohistochemical double staining with ER and HER2, and demonstrated that low ER levels might be one factor in the relative resistance of HER2-positive and ER-positive tumors to hormonal therapy.     

Diagnostic value of abnormal Q waves for identification of preclinical carriers of hypertrophic cardiomyopathy based on a molecular genetic diagnosis.

AIMS: There are currently no established diagnostic criteria for the identification of abnormal Q waves in patients with hypertrophic cardiomyopathy (HCM), resulting in various definitions being applied in each previous study. The aim of this study was to determine the most accurate diagnostic definition of abnormal Q waves for HCM based on a molecular genetic diagnosis, and also to apply abnormal Q waves to the identification of preclinical carriers. METHODS AND RESULTS: We applied three different criteria used in previous reports for abnormal Q waves in 148 genotyped subjects. Of the three criteria, Criterion 3 (Q wave >3mm in depth and/or >0.04s in duration in at least two leads except aVR) showed the highest sensitivity (50% in the young, 29% in adults) while retaining a high specificity (90% in the young, 97% in adults), resulting in the highest accuracy (69% in the young, 52% in adults). Using Criterion 3, abnormal Q waves were present 27.6% of preclinical carriers, and in 5.4% of non-carriers (P<0.01). CONCLUSIONS: These findings suggest that Criterion 3 may be the most accurate diagnostic definition for HCM. Understanding the diagnostic value of abnormal Q waves may be useful in screening preclinical carriers of HCM.     

Autoantibodies to killer cell immunoglobulin-like receptor 3DL1 in patients with systemic lupus erythematosus

A genetic variant of the killer immunoglobulin-like receptor 3DL1 (KIR3DL1) has been found in patients with systemic lupus erythematosus (SLE). Herein, we investigated the presence of autoantibodies to KIR3DL1 in a cohort of patients with SLE. We tested sera from 28 patients with SLE, 11 patients with rheumatoid arthritis (RA) and 17 healthy control subjects for anti-KIR3DL1 activity by an enzyme-linked immunosorbent assay (ELISA) using recombinant KIR3DL1-enhanced green fluorescent protein (EGFP) and EGFP proteins. Anti-KIR3DL1 antibodies were detected in 22 (79%) of the 28 patients with SLE, whereas they were present in only three (27%) of the 11 patients with RA examined. Notably, 10 (91%) of the 11 samples from patients with SLE prior to therapy had anti-KIR3DL1 antibodies. None of the samples from healthy donors were positive for the antibodies. Here, we report the presence of anti-KIR3DL1 antibodies in the sera of patients with SLE for the first time. Anti-KIR3DL1 autoantibodies may be involved in the pathogenesis of autoimmune diseases.     

Morphology and function of canine small intestinal auto grafts: With particular interest in the influence of ex vivo graft irradiation

The intestinal transplantation procedure obligates an early functional deficit in intestinal grafts Graft irradiation has been used to modulate post-transplant immune reactions; however, irradiation may cause further deterioration of the function of the transplanted intestine Using the canine model, we investigated the influence of the transplant procedures, with and without ex vivo graft irradiation, on early intestinal graft function and histopathology Outbred hound dogs underwent autointestinal transplantation with (n = 8) or without (n = 5)7 5 Gy ex vivo graft irradiation Mucosal cytochrome P450 and P-glycoprotein, routine immunohistopathology, and intestinal absorptive function were studied Weight gain was slow after surgery, but was comparable in the irradiated and nonirradiated groups During the early posttransplant period, both groups showed defects in intestinal absorption, associated with decreased cytochrome P450 3A4 activity and reduced P-glycoprotein expression, regardless of graft irradiation These changes returned to normal in both groups by day 28 Histopathologically, epithelial apoptosis showed a slight increase 1 hour after transplantation; however, there was no evidence of histopathologic abnormalities including arterial changes associated with irradiation In addition, the frequency of T and B lymphocytes in the lamina propria were not significantly influenced by the transplant surgery or ex vivo irradiation Thus, early after transplantation, intestinal function was impaired and effectiveness of orally administered immunosuppressive drugs was significantly altered Graft irradiation did not induce further defects in intestinal function or cause histopathologic abnormalities. Supported by grants DK 29961, R01 AI/DK 38899, and R01 DK54232 from the National Institutes of Health.     

Safety and feasibility of laparoscopic gastrectomy for gastric cancer patients with a history of abdominal surgery

Purpose

To assess the safety and feasibility of laparoscopic gastrectomy (LG) for gastric cancer patients with a history of abdominal surgery (HAS).

Methods

This retrospective study analyzed data collected from gastric cancer patients with HAS, who underwent LG between 2004 and 2015. We compared the clinicopathological features that correlated with conversion to open surgery and the development of severe postoperative complications (Clavien–Dindo classification of grade III or higher).

Results

Of the 41 patients identified, 6 (14.6%) required conversion to open surgery. The incidence of conversion to open surgery was associated with a history of lower gastrointestinal tract surgery (p?=?0.009), attempted laparoscopic total gastrectomy (p?=?0.002), and excessive blood loss (p?<?0.001). Severe postoperative complications developed in six patients (14.6%). Although the development of complications was associated with high postoperative serum C-reactive protein, the type of past abdominal surgery was not significantly correlated with severe complications.

Conclusions

LG was feasible for gastric cancer patients with a HAS, but for those with a history of lower abdominal surgery or those who require total gastrectomy, surgeons should carefully consider the indications for LG.

     

Impact of age at Kasai operation on short- and long-term outcomes of type III biliary atresia at a single institution

Purpose

We reevaluated the impact of age at Kasai operation on the short- and long-term outcomes of type III biliary atresia (BA).

Patients and Methods

From 1953 to 2009, 242 patients with type III BA underwent Kasai operation at ages ranging between 12 and 421 days (average, 79.7 days). The relationship between age at Kasai operation and jaundice disappearance rates (JDRs), and 10-, 20-, and 30-year native liver survival rates (NLSRs) were assessed retrospectively (JDR [%] = the number of patients in whom jaundice disappeared/the number of patients in each group × 100).

Results

Age at Kasai operation had a significant impact on the JDRs (P < .001). However, there was no statistical relationship between long-term NLSR of the patients in whom jaundice disappeared after Kasai operation and operative age. From the results of the cumulative NLSRs estimated by Kaplan-Meier method, each survival rate was quite dependent on the age at operation until 30 years after Kasai operation, but the difference became much smaller in the later period provided age at operation was 4 months or younger.

Conclusion

The operative age as a prognostic factor might be less significant in the long-term outcome than in the short-term outcome.