Prevention of syngeneic graft-versus-host disease by recovery of thymic microenvironment after cyclosporine

Following a course of cyclosporine, syngeneic rat radiation chimeras consistently develop a GVHD-like syndrome. Correlation of the thymic immunopathology with conditions leading to syngeneic graft-versus-host disease (sGVHD) suggested the hypothesis that reconstitution of the normal thymic microenvironment after CsA is necessary for self-tolerance. When thymic regeneration is impaired, as in rats receiving previous mediastinal irradiation, then self-reactive effector cells are not regulated and proceed to damage the target tissues. Alternately, it could be argued that the observed thymic abnormalities are irrelevant to sGVHD. To test the primary hypothesis, post-CsA thymic reconstitution was prevented by total thymectomy in unirradiated rats. These rats consistently developed acute type sGVHD seen at 7 and 21 days post-CsA while rats from the CsA-treated sham thymectomy control group failed to develop sGVHD. Because thymectomy prior to CsA blocks sGVHD, most likely the peripheral effector cells in the post-CsA thymectomy group were derived from the CsA-altered thymus. The absence of sGVHD in the sham group indicates that the thymus led to active regulation of these cells after stopping CsA. If regeneration of the thymus restored only negative selection, then the sham thymectomy group should have also developed sGVHD. Flow cytometry and morphology of the spleen and lymph nodes demonstrated that the thymectomized rats, like CsA-treated radiation chimeras, experienced a significant delay in maturation of T cells following CsA. In contrast to the usual model in radiation chimeras, however, the post-CsA thymectomized rats did not convert to chronic type sGVHD. The importance of an abnormal thymus for this transition was confirmed in syngeneic radiation chimeras. Thymectomy after CsA in these rats also blocked the rapid transition to chronic sGVHD.

A PCR procedure to determine the sequence of large polypeptides by rapid walking through a cDNA library

A procedure that uses the PCR to make rapid successive steps through a random-primed cDNA library has been developed to provide a method for sequencing very long genes that are difficult to obtain as a single clone. In each successive step, the portions of partial clones that extend out from the region of known DNA sequence are amplified by two stages of PCR with nested, outward-directed primers designed approximately 50 bases in from the end of the known sequence, together with a general primer based on the sequence of the vector. This procedure has been used to determine the coding sequence of the cDNA for the beta heavy chain of axonemal dynein from embryos of the sea urchin Tripneustes gratilla. By starting from a single parent clone, whose translated amino acid sequence overlapped the microsequence of a tryptic peptide of the beta heavy chain, and making 3 such walk steps downstream and 14 walk steps upstream, we obtained a sequence of 13,799 base pairs that had an open reading frame of 13,398 base pairs. This sequence encodes a polypeptide with 4466 residues of Mr 511,804 that is believed to correspond to the complete beta heavy chain of ciliary outer arm dynein.

Treatment of small cell lung cancer

During a 28-year period, 110 patients with small cell lung cancer were treated at our hospital. Fifty-nine patients received surgery, and 58 patients (including 7 cases after exploratory thoracotomy) received chemotherapy and/or radiotherapy. The 5-year survival rate of the surgically treated group was 17%, while none in the non-surgical group survived for more than 5 years.

Midazolam as a main anesthesia induction agent--a comparison with thiopental and diazepam

A clinical randomized investigation was undertaken to determine the value of midazolam as a narcotic adjuvant for anesthetic induction. Thirty ASA I-II adult patients undergoing selective surgery were allocated randomly into two groups to receive one of the following agents: midazolam 0.3 mg/kg, thiopental 5 mg/kg, or diazepam 0.4 mg/kg. The induction time as measured from the onset of injection to loss of the eyelash reflex was shortest in the case of thiopental; while a lower frequency of apnea, lesser suppression of circulation, and lack of venous irritation were points favoring midazolam. However, further study is needed to clarify the moderate cardiovascular response seen during intubation in some cases as well as to elucidate any patient population differences.

[A study of protein engineering for human cardionatrin. II. Construction of two new human cardionatrin analog genes, RH-2 & RH-3 by intragenic recombination in vitro]

Two new analog genes of the alpha-human atrial natriuretic polypeptide (alpha-hANP) were constructed by accurate intragenic recombination of analog RH-1 gene with ANP gene in vitro, both of which had been synthesized and reported. One recombined analog gene, RH-2, was designed to contain an equivalent of the alpha-hANP gene, capping the peptidase inhibitor SQ20881 sequence at its 5'end. The other analog gene, RH-3, was designed to contain an equivalent of the alpha-hANP gene, wedging in two proline codons CCG & CCG at the 3' end. The recombinants bearing the genes, bacteriophage RH-2/M13mp18 & RH-3/M13mp18, were identified by DNA domain combination analysis--in situ hybridization and dot blotting with three probes matching three specific DNA domains, and by restriction analysis. The DNA sequences of RH-2 and RH-3 were confirmed by the dideoxynucleotide chain termination method.

[The report of 2 cases of thyroid cancer with intratracheal growth]

From 1961-1987, 28 patients were operated upon for tracheal tumor, including 2 cases of thyroid cancer with intratracheal growth. Operative findings showed that in these cases a small intraluminal cancer mass and large extraluminal cancer mass were fixed together. Intratracheal growth was secondary to extratracheal thyroid cancer. Evidence of cancer from aberrant intratracheal thyroid tissues was not found. Differential diagnosis of tracheal tumor from thyroid cancer with intratracheal growth is difficult. Palliative resection with post-operative irradiation was used in these two cases because of the generally poor condition of the patients.

Pleural plaques do not predict asbestosis: high-resolution computed tomography and pathology study

Pleural plaques can be caused by asbestos exposure, but their predictive value in diagnosing pulmonary asbestosis is uncertain. Similarly, although high-resolution computed tomography (HRCT) can accurately detect parenchymal lung lesions, its ability to detect asbestosis is unknown. In a test of the predictive value of pleural plaques and HRCT, lungs of 29 autopsied patients with bilateral parietal pleural plaques were compared with lungs from 29 age- and sex-matched controls without pleural plaques. Significantly more of the patients with pleural plaques had histories of asbestos exposure (P less than 0.01). One lung from each patient was inflation fixed and air dried. HRCT of the lungs did not show significantly more thickening, lines, or densities in patients with pleural plaques than did controls; and HRCT did not predict a significantly greater likelihood of asbestos-related parenchymal disease in the study group. Gross and histologic examinations showed no significant intergroup differences in the frequency or severity of several forms of emphysema and fibrosis. Average asbestos fiber counts were not significantly higher in the lungs with pleural plaques. We conclude that pleural plaques do not predict asbestosis, and that high-resolution computed tomography accurately detects interstitial and parenchymal lung disease but cannot reliably diagnose asbestosis.

Accelerated arteriosclerosis in heart transplant recipients is associated with a T-lymphocyte-mediated endothelialitis

Accelerated arteriosclerosis has emerged as a major life-threatening complication in long-term survivors of heart transplantation. It has been proposed that accelerated arteriosclerosis is an immune-mediated complication of rejection. We observed a striking endothelialitis in the coronary arteries of two explanted hearts obtained from patients with severe transplant-related accelerated arteriosclerosis. This finding prompted us to review the pathologic changes in the coronary arteries of 23 autopsied patients who had received heart transplants. The infiltrate in these vessels was characterized using immunohistochemical stains for lymphocytes (CD45), macrophages (MAC-387), T lymphocytes (CD45RO), B lymphocytes (L-26), and smooth muscle cells (actin). In addition, a full panel of monoclonal antibodies was used on the fresh-frozen tissue available from one of the two explanted hearts. Ten of the eleven recipients with accelerated arteriosclerosis had a moderate to marked lymphocytic endothelialitis compared to 3 of 14 without transplant-related arteriosclerosis (P less than 0.005). Immunohistochemical staining of the paraffin-embedded material demonstrated that most of the lymphocytes in the subendothelial space of these vessels were T lymphocytes and that this infiltrate was associated with an accumulation of macrophages and a proliferation of smooth muscle cells in the intima. In the explanted heart from which fresh-frozen tissue was available for more detailed cell typing, the T cells marked predominantly as cytotoxic T lymphocytes (CD8+, CD2+). These results suggest that accelerated arteriosclerosis may be mediated, in part, by a cytotoxic T-lymphocyte-directed endothelialitis.

Amiodarone pulmonary toxicity: CT findings in symptomatic patients

The computed tomographic (CT) chest scans of 11 patients who developed respiratory or constitutional symptoms while receiving amiodarone therapy were reviewed. CT findings indicative of significant amiodarone exposure included (a) high-attenuation parenchymal-pleural lesions in eight of the 11 patients (73%), and (b) increased liver and/or spleen attenuation in 10 of the 11 patients (91%). Nonspecific pulmonary infiltrates were identified in nine of the 11 patients (82%). Four patients had interstitial infiltrates, four had mixed alveolar and interstitial disease, and one had a conglomerate mass. CT findings of high-attenuation parenchymal-pleural abnormalities are thought to be related to the iodinated chemistry of the drug and its prolonged half-life within the lung. These unique properties of the drug and the use of CT to discriminate attenuation levels provide a means of identifying patients with significant pulmonary accumulation of amiodarone.

Three-dimensional CT-volumetric reconstruction and display of the bronchial tree

We applied a refined version of our volumetric rendering technique for three-dimensional (3-D) computed tomographic (CT) imaging to display the cadaveric lung and the major components of the bronchial tree. We report details of the technical aspects of 3-D imaging of the lung, and four representative case studies of lung specimens from our initial experience.

Hemorrhagic infarction of hilar lymph nodes associated with combined heart-lung transplantation

The histologic changes in lymph nodes transplanted during combined heart-lung transplantation were examined. We studied at autopsy nine patients who had received a total of 10 heart-lung transplants. Hemorrhagic infarction of hilar nodes was found in eight of the 10 transplanted lungs. Pulmonary parenchymal pathologic changes associated with lymph node infarction included acute rejection (two cases), chronic rejection with bronchiolitis obliterans (two cases), and pneumonia (four cases). In one of the transplants without lymph node infarction there was chronic rejection with bronchiolitis obliterans and in another there was evidence of bronchopneumonia. The hemorrhagic lymph node infarction seen in the recipients of combined heart-lung transplant's may be directly attributable to the interruption of bronchial arteries and veins by the surgical procedure. At present the possible contribution of node infarction to postoperative morbidity or mortality is unknown.

Inflation-fixed lungs: pathologic-radiologic (CT) correlation of lung transplantation

Pulmonary infections and lung rejection are the two major complications of lung transplantation. Although the therapies for these two processes differ greatly, they often cannot be differentiated using standard radiography. We applied high resolution CT (HRCT) to seven lung specimens that were obtained from patients who had received a heart-lung transplant. The lungs were fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. We found: (a) that in contrast to the extensive changes present microscopically, acute lung allograft rejection was characterized by only minor changes on HRCT; (b) that bronchiolitis obliterans, the hallmark of chronic lung allograft rejection, was not reliably identifiable on HRCT; (c) that bronchiectasis with associated peribronchial inflammation and fibrosis, a common finding in lung allograft rejection, was identifiable on HRCT, but that the HRCT appearance of this lesion was not specific for rejection; and (d) that pulmonary infections were often identifiable as a mixed airway-interstitial process on HRCT.

[A study of protein engineering for human cardionatrin. I. Synthesis, cloning and expression of a gene analog of human atrial natriuretic polypeptide in E. coli]

An analog of the alpha-human atrial natriuretic polypeptide (alpha-hANP) gene, articulated with a peptidase inhibitor SQ20881 at its N-terminal and two prolines at the C-terminal was expressed in E. coli by cloning the reconstituted plasmid pRHL-1 in vivo. This gene analog, RH-1, comprising 154 base pairs in total, was designed to contain an equivalent of the alpha-hANP gene, capping the peptidase inhibitor SQ20881 at its 5' end with a glutamic acid codon GAA to facilitate enzymatic cleavage of the expressed end product by endoproteinase Glu-C, wedging in two proline codons CCG & CCG before the double terminal codons TGA TAG at the 3' end to retard hydrolysis of the expressed product by exopeptidase, and adding 3 restriction sites to both ends. Synthesis of the RH-1 gene was effected enzymatically by joining in predicted order the ten segments of oligodeoxynucleotides which had been chemically synthesized by the solid-phase phosphite-triester method. The synthetic gene was cloned into vector M13mp18. Phage bearing the gene analog was identified by dot blotting and restriction endonuclease mapping. Nucleotide sequence of the gene was determined by the dideoxynucleotide chain termination method.(ABSTRACT TRUNCATED AT 250 WORDS)

CT of inflation-fixed lungs: wedge-shaped density and vascular sign in the diagnosis of infarction

To evaluate the role of high resolution CT (HRCT) in the diagnosis of pulmonary infarcts, we selected 83 postmortem lung specimens with subpleural densities from a collection of 180 lungs that had been prepared by a method which allows for a direct radiologic-pathologic correlation. Twelve of the lungs had pulmonary infarcts and 71 lungs had other disorders that had produced a subpleural shadow on HRCT. Lungs were evaluated for the presence of wedge-shaped pleural-based densities and for the presence of an associated vascular sign. There was no significant difference in the incidence of wedge-shaped densities on HRCT between lungs with pulmonary infarcts and lungs with pulmonary hemorrhage, pneumonia, tumor, or edema (p greater than 0.05). A vascular sign associated with a subpleural density was, however, more common (p less than 0.01) in lungs with pulmonary infarcts. We suggest that the vascular sign associated with a wedge-shaped density may be of importance in diagnosing pulmonary infarcts by HRCT.

Fulminant pulmonary calcification complicating renal transplantation: CT demonstration

The authors report a case of fulminant, metastatic lung calcification leading to progressive respiratory failure in a patient who underwent unsuccessful renal transplantation. Premortem computed tomographic (CT) examination of the lung demonstrated the presence of high-attenuation (greater than 100 HU) parenchymal consolidation, compatible with metastatic calcium deposition. By depicting significant pulmonary calcification not seen on conventional radiographs, CT facilitated identification of an important contributing factor to the patient's respiratory failure and death.

Computed tomography of inflation-fixed lungs: the beaded septum sign of pulmonary metastases

Radiographic identification of pulmonary metastases has proved to be a challenging problem. We applied high resolution CT (HRCT) to 180 post-mortem lung specimens prepared by a method that allows for direct one-to-one pathologic-radiologic correlation. Of the 180 lungs, 32 had pulmonary metastases. The location, number, size, and interstitial changes were evaluated in 32 cases with pulmonary metastases. The pulmonary metastases were peripheral lesions in 94% of these 32 patients, and multiple tumors were found in 91% of these cases. The metastases were less than 1 cm in diameter in 78%. Twenty-two of the 32 cases (69%) had obvious interstitial changes. In 19 of these 22 cases the interstitial change was characterized by the appearance of a "beaded septum" on HRCT. This beaded septal change corresponded directly to tumor growth in pulmonary capillaries and lymphatics and the septal interstitium. This sign was not noted in any of the specimens with pulmonary edema or fibrosis or in normal lungs. We believe that detection of the beaded septum sign on HRCT is highly suggestive of pulmonary metastases.

[B-cell differential factor (IL-6) in peripheral mononuclear cells in viral hepatitis B infections]

B-cell differential factor (BCDF) activities were determined in 58 patients with various types of hepatitis B. In comparison with normal subjects, BCDF activities were significantly increased in patients with FH and CAH (P less than 0.01), markedly decreased in HBsAg carriers (P less than 0.01) and presented no change in patients with CPH and AH. It is interesting that there was a significant positive correlation between BCDF activity and serum titer of anti-HBC or serum globulin levels. No correlation was observed between BCDF activity and serum anti-HBs levels. It is suggested that abnormal BCDF activity might attribute to aberration of immunoregulation of HBV infections.

[Treatment of 100 patients with small cell lung cancer]

100 patients with small cell lung cancer were treated in Peking Union Medical College Hospital from 1963 through 1987. The five year survival rate in patients received combined treatment (resection + chemotherapy+radiotherapy, resection+chemotherapy or resection+radiotherapy,) was 18.52% (5/27). It was better than patients received nonsurgical treatment (chemotherapy,radiotherapy or chemotherapy+radiotherapy, 58 patients). And also it was better than patients received surgical resection only (11 patients). This advantage was especially marked in patients with lesion of IIIa stage. The five year survival rate in this group was 26.31%(5/19). It was suggested that combined method (resection+chemotherapy+radiotherapy) is the first choice for the treatment of small cell lung cancer.

Computed tomography of rounded atelectasis

High resolution CT of a fixed-inflated air-dried lung was obtained from a patient with rounded atelectasis. The dense periphery of the mass was shown to correspond to an invagination of the pleura, and the central lucency to slightly aerated atelectatic lung parenchyma.