Temporal alterations in concentrations of sera cytokines/chemokines in sepsis due to group B streptococcus infection in a neonate

Group B streptococcus (GBS) is the most common pathogen in neonates and may induce the overproduction of cytokines. To further clarify temporal alterations in the levels of various cytokines/chemokines, we measured the concentrations of 16 types of these immunological responders in the serum of a neonate presenting with GBS infection. At birth, the concentrations of different cytokines/chemokines increased and that of granulocyte colony-stimulating factor remained high. Thus, these cytokines/chemokines might be associated with the pathophysiology of GBS infection.

[Intravenous leiomyomatosis with extension into the right atrium: differential diagnosis from right atrial myxoma by intraoperative transesophageal echocardiography]

Intravenous leiomyomatosis (IVL) is an uncommon neoplasm characterized by the growth of a benign-looking smooth muscle tumor into the venous system. Intracardiac extension of this tumor is rare and may be misdiagnosed as right atrial myxoma unless the extracardiac part of the tumor is fully evaluated. We report a case of a 76-year-old woman whose preoperative diagnosis was right atrial myxoma. Intraoperative transesophageal echocardiography (TEE) revealed that the tumor had an extracardiac origin, resulting in tumor removal from the heart chamber and a part of the inferior vena cava (IVC) under circulatory arrest. When the findings of no attachment of the tumor to the interatrial septum or the right atrial wall and the tumor extension through the IVC are obtained by TEE examination, IVL should be considered as a differential diagnosis.

Serum cytokine and chemokine profiles in neonates with meconium aspiration syndrome

OBJECTIVES

Various inflammatory cytokines and chemokines are thought to be associated with the pathophysiology of meconium aspiration syndrome. To clarify any such association, we compared various serum cytokine and chemokine profiles in patients with and without meconium aspiration syndrome.

PATIENTS AND METHODS

Using a highly sensitive fluorescence microsphere method, 17 types of cytokines and chemokines in sera were measured in 11 neonatal patients with meconium aspiration syndrome, 16 neonatal patients without meconium aspiration syndrome, and 9 healthy children.

RESULTS

The concentrations of 8 types of proinflammatory cytokines and chemokines were significantly higher in the meconium aspiration syndrome group than in healthy controls: interleukin-1beta, interleukin-6, interleukin-8, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, interferon-gamma, macrophage inflammatory protein-1beta, and tumor necrosis factor-alpha. Six types of proinflammatory cytokines and chemokines were significantly higher in the meconium aspiration syndrome group than in the nonmeconium aspiration syndrome group: interleukin-6, interleukin-8, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, interferon-gamma, and tumor necrosis factor-alpha. Serum concentrations of interleukin-10 (anti-inflammatory cytokine) in the meconium aspiration syndrome group were higher than those in both the nonmeconium aspiration syndrome group and healthy children group (P = .007 and 0.001, respectively).

CONCLUSIONS

Most types of proinflammatory cytokines and chemokines in sera of neonates with meconium aspiration syndrome were higher than those without meconium aspiration syndrome, giving support to the suggestion that elevated levels are associated with the pathogenesis of meconium aspiration syndrome.

The Wistar Bonn Kobori rat, a unique animal model for autoimmune pancreatitis with extrapancreatic exocrinopathy

The male Wistar Bonn/Kobori (WBN/Kob) rat is known to be a unique animal model for chronic pancreatitis with widely distributed fibrosis and degeneration of parenchyma because of the infiltration of lymphocytes. In this report, we show that female (but not male) rats develop dacryoadenitis at 3 months of age, and that both male and female WBN/Kob rats develop sialoadenitis, thyroiditis, sclerotic cholangitis and tubulointerstitial nephritis over 18 months of age. The infiltration of CD8+ cells and the deposits of tissue-specific IgG2b were observed in the injured pancreas and lachrymal glands. Furthermore, the number of regulatory T cells (defined as CD4+ Forkhead box P3+ cells) decreased in the periphery of both male and female WBN/Kob rats, suggesting that the onset of these diseases is attributable, at least, to the failure in the maintenance of peripheral immune tolerance. These features show clearly that WBN/Kob rats are a useful animal model for autoimmune pancreatitis and Sjøgren-like syndrome or multi-focal fibrosclerosis in humans. We also show that these autoimmune diseases can be prevented by a newly devised strategy of bone marrow transplantation (BMT) in which bone marrow cells are injected directly into the bone marrow cavity: intrabone marrow-BMT.

Elevation of high-mobility group box 1 concentration in asphyxiated neonates

BACKGROUND

In asphyxiated neonates, abnormal proinflammatory cytokine/chemokine production may be induced. High-mobility group box 1 (HMGB-1) protein is a new type of proinflammatory cytokine that induces abnormal inflammatory responses involving proinflammatory cytokine production. However, the physiological significance of HMGB-1 in asphyxia is poorly understood.

OBJECTIVES

We aimed to evaluate whether serum HMGB-1 levels were changed in asphyxia by measuring the serum concentration of HMGB-1 in both asphyxiated and normally delivered neonates at birth.

METHODS

Using enzyme-linked immunosorbent assay, we measured the concentration of HMGB-1 in sera obtained from 53 asphyxiated neonates and 32 normally delivered neonates immediately after birth.

RESULTS

The serum concentrations of HMGB-1 in asphyxiated neonates were significantly higher than those in normally delivered neonates without asphyxia (p = 0.033).

CONCLUSION

We suggest that the elevation of HMGB-1 might be associated with abnormal inflammatory responses involving the excessive production of proinflammatory cytokines in neonates with asphyxia.

Carboxyl terminus of the 34 kDa protein of Mycobacterium paratuberculosis shares homologous B-cell epitopes with Mycobacterium avium and Mycobacterium intracellulare

Monoclonal antibodies (mAbs) against a recombinant carboxyl terminus of the 34 kDa protein of Mycobacterium paratuberculosis were produced in mice. Two of the mAbs cross-reacted with Mycobacterium avium and Mycobacterium intracellulare in both an elisa and immunoblot. The recombinant protein also reacted with polyclonal sera produced in rabbits against all three mycobacteria, indicating the presence of cross-reactive epitopes in the protein. To determine the reactivity of cattle sera against epitopes recognised by the mAbs, competition assays between bovine sera and the mAbs were carried out. Two mAbs were significantly inhibited by sera from cattle that were naturally infected with M paratuberculosis. The results indicate that epitopes on the carboxyl terminus of the 34 kDa protein common to M paratuberculosis, M avium and M intracellulare readily induce antibody production in naturally infected cattle. These epitopes reduce the diagnostic specificity of the carboxyl terminus of the 34 kDa protein, which was originally thought to contain only M paratuberculosis-specific epitopes.

Th1 but not Th17 cells predominate in the joints of patients with rheumatoid arthritis

OBJECTIVES

Recent animal studies have revealed critical roles of interleukin (IL)17, which is produced by a newly identified subset of helper T cells, Th17 cells, in the development of autoimmune diseases including arthritis. However, in human rheumatoid arthritis (RA), detailed characteristics and the prevalence of Th17 cells are unclear.

METHODS

Peripheral blood mononuclear cells (PBMC) were obtained from 123 patients with RA and 28 healthy controls. Mononuclear cells were also prepared from synovial membrane or synovial fluid of 12 patients with RA. IL17 (IL17A) positive T cells were identified by a flow cytometer after ex vivo stimulation with phorbol myristate acetate and ionomycin. Disease activity was assessed with the 28-joint Disease Activity Score (DAS28).

RESULTS

IL17 positive cells were detected in CD45RO+ CD4 T cells. Most IL17 positive T cells produced neither interferon (IFN)gamma nor IL4, but tumour necrosis factor (TNF)alpha similar to murine Th17 cells. The frequency of Th17 cells was neither increased in RA nor correlated with DAS28. Unexpectedly, the frequency of Th17 cells was significantly decreased in the joints compared with PBMC of the same patients with RA, whereas Th1 cells were more abundant in the joints than in PBMC.

CONCLUSIONS

We could not obtain evidence that positively supports predominance of Th17 cells in RA. Further careful investigation is necessary before clinical application of IL17-targeting therapy.

Role of the appendix in the pathogenesis of ulcerative colitis

Although human appendix has been considered as a vestigial remnant, recent observations have focused attention on the role of the appendix in the pathogenesis of ulcerative colitis (UC). Many case-control studies suggest that previous appendectomy is rare in UC patients. This inverse relation is limited to patients who undergo appendectomy before the age of 20 years. Moreover, several investigators reported the improvement of UC after appendectomy, especially in young patients. In the appendix of UC patients, the CD4/CD8 ratio is significantly increased, and the proportion of CD4+CD69+ (early activation antigen) T cells, but not of CD4+HLA-DR+ (mature activation antigen) T cells, is also significantly increased. These findings suggest that the appendix may be a priming site in the development of UC. Further studies including analysis of CD4+ and CD8+ T cells are necessary to clarify the role of the appendix in the pathogenesis of UC.

Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer: a randomized controlled trial

BACKGROUND

The first step toward increasing the level of patient safety in endoscopic surgery is for all endoscopic surgeons to acquire fundamental skills, including psychomotor skills, in the preoperation stage of training. The current study aimed to evaluate the effectiveness of virtual reality (VR) simulator training and box training for training the fundamental skills of endoscopic surgery.

METHODS

For this study, 35 medical students at Kyushu University were divided into three groups: simulator (SIM) group (n = 20), box trainer (BOX) group (n = 20), and control group (n = 15). None of the students had any experience assisting with endoscopic surgery or any previous training for endoscopic surgery. The students in the SIM group underwent training using a VR simulator, the Procedicus MIST, 2 h per day for 2 days. The students in the BOX group underwent training using a box trainer 2 h per day for 2 days. The students in the control group watched an educational video for 30 min. The endoscopic surgical skills of all the students were evaluated before and after training with a task of suturing and knot tying using a box trainer.

RESULTS

Although no significant differences were found between the three groups in the total time taken to complete the evaluation task before training, there were significant improvements in the SIM and BOX groups after training compared with the control group. Box training increased errors during the task, but simulator training did not.

CONCLUSION

The findings showed that box training and VR training have different outcomes. The authors expect that the best curriculum for their training center would involve a combination that uses the merits of both methods.

[An intraoperative evaluation of the cerebral circulation using the ophthalmic artery Doppler method in a case of brachiocephalic trunk occlusion]

A 57-year-old man underwent left-right subclavian artery bypass for brachiocephalic trunk occlusion. The cerebral circulation was evaluated by ophthalmic artery Doppler method during the operation. Before the bypass, maximal flow velocity (Vmax) of the right ophthalmic artery was 6.09 cm x sec(-1), compared to 43.8 cm x sec(-1) of the left. The preoperative flow acceleration (FA) was 8.3 cm x sec(-2) and 500 cm x sec(-2) in the right and left, respectively. Both Vmax and FA of the right ophthalmic artery improved to 17.6 cm x sec(-1) and 96.7 cm x sec(-2) at the end of the bypass. Additional sutures were performed because of difficulty in stopping bleeding at the site of anastomosis. However, this additional procedure blunted the Doppler waveform, with decreases in Vmax to 8.69 cm x sec(-1) and FA to 33.1 cm x sec(-2) Re-anastomosis at the leftsubclavian artery was performed. Anaphylactic shock induced by transfusion was encountered at the end of re-bypass. Vmax of the right ophthalmic artery at that time was only 10.2 cm x sec(-1) However, the fact, that the Doppler waveform was no more blunt and FA had improved up to 116.4 cm x sec(-2), let us conclude that the cerebral circulation had recovered. In conclusion, the ophthalmic artery Doppler method is a useful tool for evaluation of the cerebral circulation.

Mapping and characterization of FLC homologs and QTL analysis of flowering time in Brassica oleracea

The FLC gene product is an inhibitor of flowering in Arabidopsis. FLC homologs in Brassica species are thought to control vernalization. We cloned four FLC homologs (BoFLCs) from Brassica oleracea. Three of these, BoFLC1, BoFLC3 and BoFLC5, have been previously characterized. The fourth novel sequence displayed 98% sequence homology to the previously identified gene BoFLC4, but also showed 91% homology to BrFLC2 from Brassica rapa. Phylogenetic analysis showed that this clone belongs to the FLC2 clade. Therefore, we designated this gene BoFLC2. Based on the segregation of RFLP, SRAP, CAPS, SSR and AFLP loci, a detailed linkage map of B. oleracea was constructed in the F(2) progeny obtained from a cross of B. oleracea cv. Green Comet (broccoli; non-vernalization type) and B. oleracea cv. Reiho (cabbage; vernalization type), which covered 540 cM, 9 major linkage groups. Six quantitative trait loci (QTL) controlling flowering time were detected. BoFLC1, BoFLC3 and BoFLC5 were not linked to the QTLs controlling flowering time. However, the largest QTL effect was located in the region where BoFLC2 was mapped. Genotyping of F(2 )plants at the BoFLC2 locus showed that most of the early flowering plants were homozygotes of BoFLC-GC, whereas most of the late- and non-flowering plants were homozygotes of BoFLC-Rei. The BoFLC2 homologs present in plants of the non-vernalization type were non-functional, due to a frameshift in exon 4. Moreover, duplications and deletions of BoFLC2 were detected in broccoli and a rapid cycling line, respectively. These results suggest that BoFLC2 contributes to the control of flowering time in B. oleracea.

TGF-β during human colorectal carcinogenesis: the shift from epithelial to mesenchymal signaling

Transforming growth factor-beta (TGF-beta) activates not only TGF-beta type I receptor (Tbeta RI) but also c-Jun N-terminal kinase (JNK), converting the mediator Smad3 to two distinct phosphoisoforms: C-terminally phosphorylated Smad3 (pSmad3C) and linker phosphorylated Smad3 (pSmad3L). While Tbeta RI/pSmad3C pathway inhibits growth of normal epithelial cells, the activated mesenchymal cells invade via JNK/pSmad3L pathway. During sporadic human colorectal carcinogenesis, TGF-beta signaling confers a selective advantage upon tumor cells by shifting from epithelial Tbeta RI/pSmad3C pathway to mesenchymal JNK/pSmad3L pathway. Loss of epithelial homeostasis and acquisition of a migratory, mesenchymal phenotype are essential for tumor invasion. In a future, specific inhibition of the JNK/pSmad3L pathway will become a therapy for human colorectal cancer that restores the lost tumor-suppressive function observed in normal colorectal epithelial cells at the expense of effects promoting the aggressive behavior.