Evaluation of the changes in signals from the spleen using ferucarbotran

Purpose Because superparamagnetic iron oxide is actively taken into the reticuloendothelial system, the signal intensity observed on T2-weighted images is reduced not only in the liver but also in the spleen. There is no difference in the reduction in signal intensity in the liver after contrast between the ferumoxides and ferucarbotran, but the reduction in signal intensity in the spleen is considerable. In the present study, we examined the efficacy of T2*-weighted imaging to compensate for the reduction in signal intensity in the spleen by administering ferucarbotran. Materials and methods We examined the images obtained from 35 patients who underwent MRI with ferucarbotran. T2-weighted images and T2*-weighted images were obtained before and after administration of ferucarbotran, and the changes in signal intensity in the liver and spleen were then analyzed. Results A reduction in signal intensity was observed in the liver by both T2- and T2*-weighted imaging. In the spleen, the signal intensity was reduced on T2-weighted images but was not reduced on T2*-weighted images. Conclusion The reduction in signal intensity due to administration of ferucarbotran is low in the spleen. Thus, it was considered necessary to approach the problem of diagnosing ectopic splenic tissue using ferucarbotran with caution.     

The forgotten organ: contrast enhanced sonography of the spleen

OBJECTIVE: Ultrasound contrast agents in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging in several organs. Contrast enhanced sonography (CES) of second-generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this review is to illustrate indications for the use of CES in patients with suspected (peri-)splenic pathology. METHODS: This review based on the experience of transcutaneous CES in 200 patients with (peri-)splenic pathology diagnosed by B-mode sonography at an internal medicine center. CES studies were performed with a contrast-devoted unit (Acuson, Sequoia, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (Sonovue, Bracco SpA, Milan, Italy) was injected. RESULTS: On our experience, there are several clinical conditions which may show an diagnostic advantage of CES in comparison to B-mode US. CES should be performed to investigate: (1) the perisplenic tumor to diagnose or exclude accessory spleen, (2) the small-sized spleen to diagnose functional asplenia/hyposplenia, (3) the inhomogenous spleen of unknown cause to diagnose focal lesions within the spleen, (4) the incidentally found hypoechoic splenic tumor to diagnose high vascular splenic hemangioma, (5) focal lesions suspect for splenic abscess, hematoma, infarction to confirme diagnosis, and (6) patients with abdominal trauma to diagnose or exclude splenic injury. CONCLUSION: CES is of diagnostic value in several clinical circumstances to diagnose accessory spleen, functional asplenia, small-sized splenic involvement, high vascular splenic hemangioma, and vascular splenic pathology like splenic infarction, splenic abscess, and splenic laceration.     

Iron medication-induced gastric mucosal injury

Severe gastrointestinal erosion, ulcer, necrosis and strictures after an acute iron overdose are well described. However, gastric mucosal injury in patients receiving therapeutic iron has received only scant recognition despite its wide use. We report a case of iron medication-induced gastric mucosal injury in a 76-year-old male who presented with iron deficiency anemia and had been taking ferrous sulfate tablet for 4 years. Esophagogastroduodenoscopy (EGD) revealed a pale, villous appearing flat lesion along the lesser curvature of gastric body. Histopathologic examination of EGD biopsies of the flat lesion showed brown crystalline materials deposited in the lamina propria of gastric mucosa, which was accompanied with fibrosis, chronic inflammation, and foreign body reaction. The crystalline materials were covered and admixed with gastric epithelium. Prussian blue iron stain confirmed that the brown crystalline materials were iron. The iron and hemosiderin accumulation was also seen in cytoplasm of epithelial cells and lumen of fundic gastric glands. The recognition and reporting by pathologists of iron-induced changes in EGD biopsies will alert clinicians to this underrecognized but easily correctable complication by alternative forms of iron therapy, such as liquid preparation.     

Comparative analysis of protein expressions in primary and metastatic gastric carcinomas

Because metastatic cancers are derived from their primary counterparts, their molecular profiles could reasonably be expected to be similar to those of primary cancers. However, this expectation has been proven to be untrue in several human cancers. To explore protein expressional differences in primary and metastatic gastric carcinoma, we evaluated the expressions of 32 tumor-associated proteins in 250 pairs of primary and metastatic gastric carcinoma tissues by immunohistochemistry using tissue array slides. In metastatic gastric carcinomas, the expressions of epidermal growth factor receptor, c-erbB2, and trefoil factor 1(TFF-1) were higher and those of beta-catenin, E-cadherin, fragile histone triad gene (FHIT), glutathione S transferase-pi (GST-pi), kangai 1 (KAI1), and nuclear factor-kappaB (NF-kappaB) were lower than in primary gastric carcinomas. Furthermore, the expressions of beta-catenin, E-cadherin, KAI1, and NF-kappaB were associated with an advanced T and combined stage. In addition, the loss of E-cadherin expression during lymph node metastasis or E-cadherin immunonegativity in metastatic lesions and epidermal growth factor receptor expression in primary gastric carcinomas were independently associated with a poor prognosis by multivariate analysis. In conclusion, the expression of some tumor-associated proteins and their prognostic significance in metastatic gastric carcinomas differ from those in primary tumors. Consequently, analysis of both metastatic gastric carcinomas and their primary counterparts may be required to fully determine the molecular characteristics of node-positive gastric carcinoma.     

SARS患者脾内IL-6、IFN-β和IP-10的免疫组织化学观察及定量分析

目的 通过对严重急性呼吸综合征(SARS)患者脾内白细胞介素6(IL-6),干扰素β(IFN-β)和干扰素γ诱导蛋白10(IP-10)的免疫组织化学结果分析,深入探讨SARS患者脾组织的病理变化及其发病机制. 方法 通过免疫组织化学技术观察6例SARS死亡患者脾和6例意外死亡者正常脾组织细胞内IL-6、IFN-β和IP-10的表达情况,并进行图像分析.结果 SARS患者脾红髓内含大量IL-6阳性细胞,阳性产物呈团块状分布于细胞质和细胞核.图像分析结果显示,SARS患者脾红髓内IL-6阳性细胞的平均吸光度值(AA)与正常对照组比较,有显著性差异(P<0.05);SARS患者脾红髓内阳性细胞的细胞核、细胞质呈IFN-β阳性,阳性产物呈棕黄色团块状,图像分析结果显示,SARS患者脾组织内IFN-β阳性细胞的AA值与正常对照组比较,有显著性差异(P<0.05);SARS患者脾红髓内含大量IP-10阳性细胞,阳性产物呈棕黄色团块状,分布于细胞核和细胞质.图像分析结果显示,SARS患者脾组织内IP-10阳性细胞的AA值与正常对照组比较,有显著性差异(P<0.05).3种细胞因子在SARS患者残存的脾白髓内均呈阴性. 结论 SARS患者脾内细胞的IL-6、IFN-β和IP-10反应均相对增强,提示SARS患者脾组织的病理性损伤以及免疫功能缺陷可能与上述促炎症因子、免疫抑制因子及趋化因子的相对增多有关.     

Effects of HIF-1α on human gastric cancer cell apoptosis at different CO2 pressures

The effects and potential molecular mechanisms underlying carbon dioxide (CO₂) pneumoperitoneum on gastric cancer cell apoptosis are not fully understood. In this study, we assessed the effects of CO₂ pneumoperitoneum on the apoptosis of MKN-45 gastric cancer cells. Additionally, we investigated the role of HIF-1α in CO₂ pneumoperitoneum-induced apoptosis of gastric cancer cells. MKN-45 cells were cultured in CO₂ or air pneumoperitoneum at 0, 12 and 15 mmHg pressures for 4 h. We observed a change in cells morphology and increasing apoptotic ratios in MKN-45 cells when they were put into a 15 mmHg CO₂ pneumoperitoneum environment. However, there was no significant difference between the 0, 12 mmHg CO₂ pneumoperitoneum and the control groups. Exposure to 15 mmHg CO₂ pneumoperitoneum significantly enhanced the expression levels of HIF-1α and Bax, while it attenuated Bcl-2 expression levels. When we inhibited HIF-1α by small interfering RNA (siRNA), we found that the apoptotic ratio of MKN-45 cells decreased in 15 mmHg CO₂ pneumoperitoneum. This treatment markedly elevated Bcl-2 levels and decreased Bax expression. These data suggest that CO₂ pneumoperitoneum may accelerate the apoptosis of MKN-45 cells at higher pressures. HIF-1α is a crucial factor that affects gastric cancer cell apoptosis by downregulating the Bcl-2/Bax ratio.     

免疫性血小板减少性紫癜患者脾脏T淋巴细胞亚群的变化

目的 探讨免疫性血小板减少性紫癜(ITP)患者脾脏T淋巴细胞亚群的变化及其临床意义.方法 收集2005年12月至2008年5月本科室收治的ITP患者47例,分为激素依赖(SD)组29例和激素抵抗(SR)组18例,以急诊外伤性脾破裂行脾切除术者12例作为对照组.免疫组化法检测脾脏组织标本CD3~+、CD4~+和CD8~+细胞的表达情况,观察脾脏组织动脉周围淋巴鞘(PALS)中染色阳性细胞的百分数,并计算CD4~+与CD8~+细胞的比值.分析3组CD3~+、CD4~+,CD8~+细胞百分数和CD4~+/CD8~+比值的差异. 结果3组间PALS中CD3~+、CD4~+细胞百分数差异均无统计学意义(均P>0.05).对照组PALS中CD8~+T淋巴细胞百分数低于SD组和SR组(28.70±22.19比43.80±20.77,49.27±14.10,均P<0.05),而CD4~+/CD8~+比值高于SD组和SR组(6.27±4.64比0.95±0.93,0.89±0.51,均P<0.05).SD组和SR组PALS中CD8~+细胞百分数及CD4~+/CD8~+比值的差异均无统计学意义(均P>0.05).结论 ITP患者脾脏细胞免疫存在异常.术前激素治疗反应性与脾脏T淋巴细胞亚群百分数的改变无明显关联.     

Involvement of aquaporin-5 in differentiation of human gastric cancer cells

Litttle is known about the function of aquaporin (AQP) water channels in human gastric cancer. In the upper or middle part of human stomach, we found that expression level of AQP5 protein in intestinal type of adenocarcinoma was significantly higher than that in accompanying normal mucosa. AQP5 was localized in the apical membrane of the cancer cells. On the other hand, both AQP3 and AQP4 were not up-regulated in the adenocarcinoma. To elucidate the role of AQP5 in cancer cells, AQP5 was exogenously expressed in a cell line of poorly differentiated human gastric adenocarcinoma (MKN45). The AQP5 expression significantly increased the proportion of differentiated cells with a spindle shape, the activity of alkaline phosphatase, a marker for the intestinal epithelial cell type of cancer cells, and the expression level of laminin, an epithelial cell marker. Treatment of the MKN45 cells stably expressing AQP5 with HgCl₂, an inhibitor of aquaporins, significantly decreased the proportion of differentiated cells and the activity of alkaline phosphatase. Our results suggest that up-regulation of AQP5 may be involved in differentiation of human gastric cancer cells. T. Watanabe and T. Fujii have equally contributed to this work.     

The cellular niche of Listeria monocytogenes infection changes rapidly in the spleen

The spleen is an important organ for the host response to systemic bacterial infections. Many cell types and cell surface receptors have been shown to play role in the capture and control of bacteria, yet these are often studied individually and a coherent picture has yet to emerge of how various phagocytes collaborate to control bacterial infection. We analyzed the cellular distribution of Listeria monocytogenes (LM) in situ during the early phase of infection. Using an immunohistochemistry approach, five distinct phagocyte populations contained LM after i.v. challenge and accounted for roughly all bacterial signal in tissue sections. Our analysis showed that LM was initially captured by a wide range of phagocytes in the marginal zone, where the growth of LM appeared to be controlled. The cellular distribution of LM within phagocyte populations changed rapidly during the first few hours, decreasing in marginal zone macrophages and transiently increasing in CD11c⁺ DC. After 4–6 h LM was transported to the periarteriolar lymphoid sheath where the infective foci developed and LM grew exponentially.     

胃癌分子靶向治疗的临床研究进展

分子靶向治疗联合化疗为晚期胃癌治疗带来了新的希望.针对晚期胃癌靶向治疗进行的几个国际多中心随机对照Ⅲ期临床研究,包括ToGA、EXPAND、LOGIC、AVAGAST、REAL3、GRANITE-1等确立了胃癌靶向治疗的地位.