Solid pseudopapillary neoplasm of pancreas in pregnancy treated with tumor enucleation: Case report and review of the literature

Solid pseudopapillary neoplasm of pancreas (SPN) during pregnancy is rare and presents a threat both to the mother and the fetus. We report a case of SPN in a 26-year-old woman diagnosed at 21 weeks of gestation. Tumor enucleation was successfully performed by a general surgeon. A healthy female infant was delivered at 39 weeks and 5 days of gestation vaginally without complications. Our report provides an example that tumor enucleation of SPN during the second trimester could be successfully performed during pregnancy. A multidisciplinary approach with respect to the pregnant patient's diagnosis, indications, and timing of surgery is necessary in ensuring the best possible outcomes for both the mother and the child.

Regulation of CD4⁺FOXP3⁺ T cells by CCL20/CCR6 axis in early unexplained recurrent miscarriage patients

Expression and function of CCR6/CCL20 in CD4(+)FOXP3(+) regulatory T cells (Tregs) was investigated in unexplained recurrent miscarriage (URM) patients. Flow cytometry, reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, western blots, and Transwell migration assays were used to analyze the expression and function of regulatory T cells in peripheral blood (PB) and decidual samples of women with URM and of healthy controls. Proportions of CD4(+)FOXP3(+) T cells and CCR6(+)CD4(+)FOXP3(+) T cells were lower in URM patients than in healthy controls for both PB lymphocytes and decidual samples (P < 0.05). Expression levels of FOXP3 and CCR6 mRNA were lower in URM patients than in control subjects for PB and decidual samples (P < 0.05). CCL20 protein levels were lower in URM patients than in controls (P < 0.05). An effect of Treg migration was significantly blocked (by 89.13%) using a neutralizing anti-CCL20 antibody in vitro. Furthermore, CCL20-stimulated Tregs exhibited a 3.21-fold increase in migration and this was blocked using a neutralizing anti-CCL20 antibody. IL-10 concentration in culture supernatants of CD4(+)CD25(+)CD127(dim/-) Tregs of URM patients was significantly lower than that in controls. Anti-CCL20 antibody inhibited IL-10 and IL-4 expression but increased IFN-r and IL-17 levels when there was cell-cell contact between PB CD4(+)CD25(+) T cells and CD4(+)CD25(-) T cells. No difference was detected when cell-cell contact was prevented by a semi-permeable Transwell membrane. CCL20-CCR6 could drive immune activity of CD4(+)FOXP3(+) Tregs, followed by their migration to the feto-maternal microenvironment. These results elucidated the mechanism by which Tregs exert this suppressive effect.

[Changes in proportion of decidua and peripheral blood CD(4)(+)CD(25)(+) regulatory T cells in unexplained recurrent spontaneous abortion patients]

OBJECTIVE

To study the changes in the percentage of CD(4)(+)CD(25)(+) regulatory T (Tr) cells in peripheral blood and deciduas in unexplained recurrent spontaneous abortion (URSA) patients, normal non-pregnant and pregnant women respectively.

METHODS

The percentage of CD(4)(+)CD(25)(+) Tr cells in deciduas and peripheral blood from 25 URSA patients, 22 normal non-pregnant (NNP) women, and 34 normal early pregnant (NP) women were measured by double-staining followed by flow cytometric analysis.

RESULTS

(1) The percentage of CD(4)(+)CD(25)(bright) T cells in peripheral blood in both URSA and NP [(1.55 +/- 0.77)%, (2.65 +/- 1.10)%, respectively] women were increased significantly than that in NNP women [(0.39 +/- 0.14)%, P < 0.05]. The percentage of CD(4)(+)CD(25)(bright) T cells in peripheral blood in URSA women was significantly lower than that in NP women (P < 0.05). (2) The percentage of CD(4)(+)CD(25)(bright) T cells in decidua in URSA women was significantly lower than that in NP women [(0.59 +/- 0.23)%, (1.24 +/- 0.55)%, respectively, P < 0.01]. There was no significant difference in the percentage of CD(4)(+)CD(25)(dim) T cells in decidua between URSA women and NP women [(4.23 +/- 1.52)%, (3.75 +/- 1.88)%, respectively, P > 0.05]. (3) The proportion of CD(4)(+)CD(25)(bright)/CD(4)(+) cells in deciduas was significantly higher than that in peripheral blood in NP women [(13.10 +/- 10.25)%, (5.59 +/- 2.62)%, respectively, P < 0.05]. However, a significant difference in the proportion of CD(4)(+)CD(25)(bright)/CD(4)(+) between decidua and peripheral blood was not found in URSA patients [(5.16 +/- 2.83)%, (4.64 +/- 2.07)%, respectively, P > 0.05)].

CONCLUSIONS

The number of CD(4)(+)CD(25)(+) Tr cells is increased in normal pregnancy and decreased in URSA. Therefore, CD(4)(+)CD(25)(+) Tr cells may play an important role in maintaining maternal-fetal tolerance and may be involved in the pathogenesis of URSA.

[Changes in T-lymphocyte subsets of peripheral blood in unexplained habitual abortion]

T-lymphocyte subsets of peripheral blood were examined by flow cytometry (FCM) in 20 cases of unexplained habitual abortion (UHA) before and after active immunization treatment, with 10 normal pregnant (NP) women and 20 normal nonpregnant (NNp) women as control.

THE RESULTS

there was no difference in the percentage of CD3 cells between the UHA cases and NNP. Before immunization the percentage of CD8 cells was significantly lower (P < 0.001) and the ratio of CD4/CD8 was increased (P < 0.05) in UHA as compared with the NNP. However, after immunization, the percentage of CD8 cells greatly increased (P < 0.05) and CD4/CD8 ratio decreased significantly (P < 0.05) nearly to that of NP. These findings suggest that: (1) the increase of CD4/CD8 ratio due to the decreasing CD8 cells is the underlying immunomechanism of UHA; (2) immunization may induce the proliferation of CD8 cells and the lowering of CD4/CD8 ratio. Therefore, CD8 cells might play an important role in maintaining the balance of fetal-maternal immunological relationship; (3) the ratio of CD4/CD8 may served as parameter for observing the clinical efficacy of immunization therapy.

[Effects of sodium vanadate on action potentials of guinea pig papillary muscles]

Sodium vanadate (NaVO3, 800 mumol/L) diminished the plateau phase and the action potential duration of the action potentials in guinea pig ventricular fibers (VF). 200 mumol/L also reduced the maximal rate of depolarization of slow action potentials in the partial depolarized VF under high K superfusion and inhibited the delayed after depolarization induced by adrenalin. It is suggested that NaVO3 may inhibit the slow channel current and does not reduce the sodium pump activity in VF significantly when it was used extracellularly.