Intracellular glutathione redox status in human dendritic cells regulates IL-27 production and T-cell polarization

BACKGROUND

Glutathione redox status, changes in intracellular reduced (GSH) or oxidized (GSSG) glutathione, plays a significant role in various aspects of cellular function. In this study, we examined whether intracellular glutathione redox status in human dendritic cells (DCs) regulates the polarization of Th1/Th2 balance.

METHODS

Human monocyte-derived DCs (MD-DCs) treated with glutathione reduced form ethyl ester (GSH-OEt) or L-buthionine-(S,R)-sulfoximine (BSO) were stimulated by lipopolysaccharide (LPS), and the levels of polarization cytokines were measured. Next, DCs matured by LPS or thymic stromal lymphopoietin (TSLP) were cocultured with allogeneic CD4(+) naive T cells and Th1/Th2 balance was evaluated by cytokine production from the primed T cells.

RESULTS

Monocyte-derived DCs exposed to GSH-OEt and BSO had increased and decreased intracellular GSH contents, respectively. Lipopolysaccharide-induced interleukin (IL)-27 production was enhanced by GSH-OEt and suppressed by BSO, but neither GSH-OEt nor BSO affected the expression of HLA-DR, CD80, CD83, or CD86. Mature GSH-OEt-treated MD-DCs enhanced interferon (IFN)-γ production from CD4(+) T cells compared with nontreated MD-DCs, and small interfering RNA (siRNA) against IL-27 suppressed the effect of GSH-OEt on IFN-γ production. Additionally, although human myeloid DCs activated by TSLP (TSLP-DCs) prime naïve CD4(+) T cells to differentiate into Th2 cells, treatment of TSLP-DCs with GSH-OEt reduced IL-13 production and enhanced IFN-γ production by CD4(+) T cells. Interleukin-27 siRNA attenuated the inhibitory effect of GSH-OEt on Th2 polarization.

CONCLUSION

Our results reveal that Th1 and Th2 responses are controlled by intracellular glutathione redox status in DCs through IL-27 production.

Meticillin-resistant Staphylococcus aureus and meticillin-susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings

OBJECTIVES

The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA).

METHODS

We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed.

RESULTS

Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p = 0.038, p = 0.007 and p = 0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p = 0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p = 0.002).

CONCLUSIONS

Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.

Radiological findings in acute Haemophilus influenzae pulmonary infection

OBJECTIVE

The aim of this study was to assess pulmonary thin-section CT findings in patients with acute Haemophilus influenzae pulmonary infection.

METHODS

Thin-section CT scans obtained between January 2004 and March 2009 from 434 patients with acute H. influenzae pulmonary infection were retrospectively evaluated. Patients with concurrent infection diseases, including Streptococcus pneumoniae (n=76), Staphylococcus aureus (n=58) or multiple pathogens (n=89) were excluded from this study. Thus, our study group comprised 211 patients (106 men, 105 women; age range, 16-91 years, mean, 63.9 years). Underlying diseases included cardiac disease (n=35), pulmonary emphysema (n=23), post-operative status for malignancy (n=20) and bronchial asthma (n=15). Frequencies of CT patterns and disease distribution of parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed by thin-section CT.

RESULTS

The CT findings in patients with H. influenzae pulmonary infection consisted mainly of ground-glass opacity (n=185), bronchial wall thickening (n=181), centrilobular nodules (n=137) and consolidation (n=112). These abnormalities were predominantly seen in the peripheral lung parenchyma (n=108). Pleural effusion was found in 22 patients. Two patients had mediastinal lymph node enlargement.

CONCLUSION

These findings in elderly patients with smoking habits or cardiac disease may be characteristic CT findings of H. influenzae pulmonary infection.

Localised right upper-lobe pulmonary oedema caused by extension of giant cell carcinoma to the mitral valve

Giant cell carcinoma of the lung is a very rare primary malignant tumour and localised right upper-lobe pulmonary oedema is also unusual. We report a case of giant cell carcinoma, which invaded the left atrium through the left pulmonary vein and caused localised right upper-lobe pulmonary oedema.

Pulmonary thin-section CT findings in acute Moraxella catarrhalis pulmonary infection

OBJECTIVE

Moraxella catarrhalis is an important pathogen in the exacerbation of chronic obstructive pulmonary disease. The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute M. catarrhalis pulmonary infection.

METHODS

Thin-section CT scans obtained between January 2004 and March 2009 from 292 patients with acute M. catarrhalis pulmonary infection were retrospectively evaluated. Clinical and pulmonary CT findings in the patients were assessed. Patients with concurrent infection including Streptococcus pneumoniae (n = 72), Haemophilus influenzae (n = 61) or multiple pathogens were excluded from this study.

RESULTS

The study group comprised 109 patients (66 male, 43 female; age range 28-102 years; mean age 74.9 years). Among the 109 patients, 34 had community-acquired and 75 had nosocomial infections. Underlying diseases included pulmonary emphysema (n = 74), cardiovascular disease (n = 44) or malignant disease (n = 41). Abnormal findings were seen on CT scans in all patients and included ground-glass opacity (n = 99), bronchial wall thickening (n = 85) and centrilobular nodules (n = 79). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 99). Pleural effusion was found in eight patients. No patients had mediastinal and/or hilar lymph node enlargement.

CONCLUSIONS

M. catarrhalis pulmonary infection was observed in elderly patients, often in combination with pulmonary emphysema. CT manifestations of infection were mainly ground-glass opacity, bronchial wall thickening and centilobular nodules.

Acute Klebsiella pneumoniae pneumonia alone and with concurrent infection: comparison of clinical and thin-section CT findings

The purpose of this study was to identify the clinical and thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia (KPP) alone and with concurrent infection. We retrospectively identified 160 patients with acute KPP who underwent chest thin-section CT examinations between August 1998 and August 2008 at our institution. The study group comprised 80 patients (54 male, 26 female; age range 18-97 years, mean age 61.5) with acute KPP alone, 55 (43 male, 12 female; age range 46-92 years, mean age 76.0) with KPP combined with methicillin-resistant Staphylococcus aureus (MRSA) and 25 (23 male, 2 female; age range 56-91 years, mean age 72.7) with KPP combined with Pseudomonas aeruginosa (PA). Underlying diseases in patients with each type of pneumonia were assessed. Parenchymal abnormalities were evaluated along with enlarged lymph nodes and pleural effusion. In patients with concurrent pneumonia, underlying conditions such as cardiac diseases, diabetes mellitus and malignancy were significantly more frequent than in patients with KPP alone. The mortality rate in patients with KPP combined with MRSA or PA was significantly higher than in those with KPP alone. In concurrent KPP, CT findings of centrilobular nodules, bronchial wall thickening, cavity, bronchiectasis, nodules and pleural effusion were significantly more frequent with concurrent pneumonia than in those with KPP alone.

Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection

Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy. From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV-related cirrhosis, low platelet count (<==106 000/mm(3)) and splenomegaly (spleen size >==10 cm) underwent splenectomy. Platelet counts significantly increased at 4-8 weeks after splenectomy [pre: 64 200 +/- 6900/mm(3)vs post 209 000 +/- 40 600/mm(3) (P = 0.004)]. No severe operative complications were observed. All patients subsequently received antiviral therapy. Of the eight patients who were infected with HCV genotype 1 and had a high viral load (>==100 KIU/mL), four received combination therapy with pegylated IFNalpha-2b plus ribavirin, and the other four received standard IFNalpha-2b plus ribavirin. One patient infected with HCV genotype 2 and another with HCV genotype 1 and a low viral load (<100 KIU/mL) were treated with pegylated IFNalpha-2a. Six patients achieved sustained virologic response (SVR). Among four patients who failed to achieve SVR, one was given retreatment with pegylated IFN plus ribavirin, and the other three received low-dose long-term IFN therapy. Although this study was small, the treatment results were similar to those for patients without thrombocytopenia and suggested that splenectomy would not reduce the antiviral efficacy of IFNalpha-based treatment.

Decreased Interstitial FOXP3+ Lymphocytes in Usual Interstitial Pneumonia with Discrepancy of CXCL12/CXCR4 Axis

Regulatory T cells (Treg) play a critical role in immune homeostasis and expansion of Treg is controlled by chemokine receptors. The chemokine CXCL12 and its G-protein-coupled receptor (CXCR4) are involved in the development of idiopathic pulmonary fibrosis (IPF), but the association of Treg with the CXCL12/CXCR4 axis has not been documented. The aim of this study is to determine the distribution and extent of CXCL12/CXCR4 expression in idiopathic type of pulmonary fibrosis, and the relation of Treg expansion in the interstitium of pulmonary fibrosis patients to CXCL12/CXCR4 expression. CXCL12 expression was examined by immunostaining and ELISA in tissue specimens from patients with usual interstitial pneumonia (UIP, n=15), patients with fibrotic non-specific interstitial pneumonia (f-NSIP, n=4), and controls (n=6). CXCR4 expression was examined by in situ hybridization and immunoblotting. Expression of CD45, CD3, CD20, transcription factor forkhead box P3 (FOXP3), and CD25 was assessed by immunostaining. Fibrosis was evaluated by determining the established fibrosis (EF) score. The CXCL12/CXCR4 axis was upregulated in UIP and f-NSIP, and CXCL12 derived from lung tissue attracted CXCR4+ cells. CXCR4+ cells showed a CD3+ cell distribution pattern. The interstitial FOXP3+/CD3+ and CD25+/CD3+ cell ratios were lower in UIP than f-NSIP, but the CXCR4+/ CD3+ cell ratio was not different. The FOXP3+/CD3+ cell ratio and EF score were inversely correlated. These findings suggest that the CXCL12/CXCR4 axis contributes to inflammation in UIP and f-NSIP by promoting the accumulation CXCR4+ lymphocytes, and a decrease of Treg is correlated with the severity of fibrosis in UIP.

Gene expression profiling in rat liver treated with compounds inducing elevation of bilirubin

We have constructed a large-scale transcriptome database of rat liver treated with various drugs. In an effort to identify a biomarker for the diagnosis of elevated total bilirubin (TBIL) and direct bilirubin (DBIL), we extracted 59 probe sets of rat hepatic genes from the data for seven typical drugs, gemfibrozil, phalloidin, colchicine, bendazac, rifampicin, cyclosporine A, and chlorpromazine, which induced this phenotype from 3 to 28 days of repeated administration in the present study. Principal component analysis (PCA) using these probes clearly separated dose- and time-dependent clusters in the treated groups from their controls. Eighteen more drugs in the database, reported to elevate TBIL and DBIL, were estimated by PCA using these probe sets. Of these, 12 drugs, that is methapyrilene, thioacetamide, ticlopidine, ethinyl estradiol, alpha-naphthylisothiocyanate, indomethacin, methyltestosterone, penicillamine, allyl alcohol, aspirin, iproniazid, and isoniazid were also separated from the control clusters, as were the seven typical drugs causing elevation of TBIL and DBIL. The principal component 1 (PC1) value showed high correlation with TBIL and DBIL. In the cases of colchicine, bendazac, chlorpromazine, gemfibrozil, and phalloidin, the possible elevation of TBIL and DBIL could be predicted by expression of these genes 24 h after single administration. We conclude that these identified 59 probe sets could be useful to diagnose the cause of elevation of TBIL and DBIL, and that toxicogenomics would be a promising approach for prediction of this type of toxicity.

Serial pro-gastrin-releasing peptide and neuron specific enolase in predicting radiological response and overall survival of patients with small-cell lung cancer

e22144

Background: Pro-gastrin-releasing peptide (ProGRP: P) and Neuron specific enolase (NSE: N) are specific serological markers in patients (pts) with small-cell lung cancer (SCLC). The aim of this study was to investigate whether decreasing of these tumor markers correlate with radiological response and prognosis in pts with SCLC. Methods: Out of 194 newly diagnosed SCLC pts from September 2002- April 2008 at our institution, we retrospectively reviewed consecutive 118 pts who had measurable lesions and elevated baseline levels of P and N before initial therapy (IT) including chemotherapy or chemoradiotherapy, and survived more than one month. P and N were measured on the first day of the every treatment course and after the final course of IT. Computed tomography (CT) was documented on baseline and every 2 courses of IT. Results: Forty-six (38.9%) pts had limited stage disease (LD) and 72 (61.0%) pts had extensive stage disease (ED). Both P and N levels at baseline were significantly correlated with the sum of longest diameter (SLD) in baseline CT; Spearman's ρ was 0.34 (P=0.001) and 0.44 (p<0.0001), respectively. Also, the decreasing rate of P and N correlated with the decreasing rate of SLD, ρ= 0.45 (p<0.0001) and 0.21 (p=0.03), respectively. Furthermore, the normalization of both P (<46pg/ml) and N (<10ng/ml) levels after 3 courses of IT was significantly associated with radiological response (p=0.015) including partial and complete response assessed by the Response Evaluation Criteria in Solid Tumors. In Cox's multivariate analysis, the normalization of both P and N levels after 3 courses of the IT (p=0.03, hazard ratio: 0.47, 95% CI 0.23–0.93) was significantly associated with prolonged survival, when adjusted by age, PS, and disease extent (LD or ED). Conclusion: Levels of P and N at baseline, and decreasing rate of P and N in IT were both associated with radiological response. In addition, the normalization of both P and N levels might be meaningful in predicting prognosis of SCLC pts.

No significant financial relationships to disclose.

Colonoscopy quality assessment

AIM

Colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate.

MATERIAL AND METHOD

This is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results.

RESULTS

Indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99).

CONCLUSIONS

Quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.

Silent period and H reflex from soleus muscle as an index in a neuro-muscular function after reconstruction of anterior cruciate ligament

To clarify that the mixed nerve silent period (SP) and H reflex from soleus muscle may become an index expressed neuro-muscular function after reconstruction of anterior cruciate ligament (ACL), we studied the alteration of SP and H reflex from the soleus muscle in the patient with ACL reconstruction. Subjects were three patients with after ACL reconstruction, who were two male athletes (case A and B) and a female aerobics instructor (case C). Recording of SP and H reflex was performed longitudinally from one month post operation to six months post operation. As a result of this study, in case A, following findings were appeared; shortening of duration of SEP increasing the coefficient of variation of SP and increasing the amplitude ratio of H/M in non-operative side at the same time when his overusing activity of non-operative side. With case B, an appearance of long latency reflex (LLR) and an increase of coefficient of variation of SP in the operative side were verified in the period when many assists were required in order to correct motion image in rehabilitation. Concretely, from after the reconstruction over 5 months, LLR was appeared in SP of operative side, and increases of coefficient of variation was most remarkably in 4 months after the reconstruction, amplitude H/M ratio of operative side showed high value in 4 months after the reconstruction. With case C, remarkable problematical point was not found at the time of activity of daily life (ADL) acquisition and occupation return. So, with case C, feature findings of both SP and H reflex were not appeared. The results suggested that SP and H reflex from soleus muscle have become an index expressed neuro-muscular function of lower extremity and supra-spinal function in the patient after reconstruction of ACL.

Primary malignant lymphoma of the gallbladder: a case report and literature review

Primary malignant lymphoma of the gallbladder is extremely rare and the associated radiological findings are not well described in the literature. We report a case of malignant lymphoma in the gallbladder wall of a 78-year-old woman. Pre-operative CT and MRI showed homogeneous submucosal thickening of the gallbladder wall with a preserved mucosal surface. These unique radiological findings may be useful for diagnosing malignant lymphoma of the gallbladder.

CXCR4+FOXP3+CD25+ Lymphocytes Accumulate in CXCL12-Expressing Malignant Pleural Mesothelioma

CXCL12 is a chemokine that binds to a G-protein-coupled receptor (CXCR4). CXCL12 is expressed in various tumors and is considered as playing an important role in tumor growth and invasion. The aim of this study is to investigate the expression of CXCL12 in human malignant mesothelioma (MM), the chemotactic effect of CXCL12 derived from MM, and the expression of CXCR4 in MM tissues in relation to regulatory T cells. CXCL12 expression was examined by immunostaining of tissue specimens from malignant pleural mesothelioma (MPM) and malignant peritoneal mesothelioma (MPEM). The MM group comprised 6 patients (4 men/2 women, MPM=4, MPEM=2, aged 56.0 ± 12.4 years) and the control (non-mesothelioma) group also had 6 patients (4 men/2 women aged 65.0 ± 6.7 years). CXCL12 mRNA expression was also examined by RT-PCR in MPM cell lines (H28, H2052, and H2058), while CXCR4 mRNA expression was examined by in situ hybridization in MPM tissue. CXCL12 was expressed in the cytoplasm of MM cells from all patients, but was not expressed in the control group. H2052 and H2058 cells expressed CXCL12 mRNA, but H28 cells did not. CXCL12 in MM tissue homogenate supernatant had a chemotactic effect on CXCR4-expressing THP-1 cells. CXCR4 mRNA was expressed by a part of LCA+CD3+ Foxp3+CD25+ T cells that were located adjacent to the border of CXCL12-expressing epithelioid MPM. These findings suggest that CXCL12 contributed to tumor-related inflammation by inducing the accumulation of CXCR4-expressing cells with regulatory T cell markers around MM.

The effect of cortical bone thickness on the stability of orthodontic mini-implants and on the stress distribution in surrounding bone

Cortical bone thickness (CBT) was evaluated at mini-implant placement sites in 65 orthodontic patients and was found to be directly proportional to the success rate of the mini-implant. The success rate of the mini-implant was significantly greater at sites with CBT> or =1.0mm. To examine the biomechanical effects of CBT, finite element models were made for CBT from 0.5 to 1.5mm, at 0.25-mm intervals. Cortical bone models without cancellous bone were constructed to examine the biomechanical influence on cortical bone after cancellous bone resorption. CBT influenced the stresses in the cancellous bone, but could not directly influence the stresses in the cortical bone. For CBT<1mm, the cancellous bone models exhibited von Mises stresses exceeding 6MPa, and the cortical bone models without cancellous bone showed von Mises stresses exceeding 28MPa. Greater CBT values were associated with higher mini-implant success rates. This morphometric study and mathematical simulation verify that a clinical CBT threshold of 1mm improves the success rate of mini-implants.