Case Report: Robotic pylorus-preserving pancreatoduodenectomy for periampullary rhabdomyosarcoma in a 3-year-old patient

Periampullary neoplasm is rare in pediatric patients and has constituted a strict indication for pancreatoduodenectomy (PD), which is a procedure sporadically reported in the literature among children. Robotic PD has been routinely performed for periampullary neoplasm in periampullary neoplasm, but only a few cases in pediatric patients have been reported. Here, we report the case of a 3-year-old patient with periampullary rhabdomyosarcoma treated with robotic pylorus-preserving PD and share our experience with this procedure in pediatric patients. A 3-year-old patient presented with obstructive jaundice and a mass in the pancreatic head revealed by imaging. A laparoscopic biopsy was performed. Jaundice progressed with abdominal pain and elevated alpha-amylase leading to urgent robotic exploration in which a periampullary neoplasm was revealed and pathologically diagnosed as rhabdomyosarcoma by frozen section examination. After pylorus-preserving PD, we performed a conventional jejunal loop following a child reconstruction, including an end-to-end pancreaticojejunostomy, followed by end-to-side hepaticojejunostomy and duodenojejunostomy. Delayed gastric emptying (DGE) presented with increasing drain from the nasogastric tube (NGT) a week after the surgery and improved spontaneously within 10 days. In a 13-month follow-up until the present, our case patient recovered well without potentially fatal complications, such as pancreatic fistula. Robotic PD in pediatric patients was safe and effective without intra- or postoperative complications.

Alterations of gut microbiota in infants with biliary atresia identified by 16S rRNA-sequencing

BACKGROUND

Biliary atresia (BA) is a severe neonatal disease with progressive intra- and extra-hepatic bile ducts inflammation and hepatic fibrosis. Characterization of gut microbiome profiles in infants with biliary atresia can provide valuable information and potential disease biomarkers. Our study aims to explore the relationship between gut microbiota and biliary atresia.

METHODS

16 S ribosomal RNA (rRNA) gene sequencing was carried out to identify the differences in composition and diversity of gut microbiota between infants with BA and healthy subjects. A total of 31 infants with biliary atresia and 20 healthy subjects were recruited.

RESULTS

The composition of gut microbiota in BA group was significantly different with the normal control group (P < 0.05) and the abundance ratio of Klebsiella/Bifidobacterium showed great potential for identification of BA (P < 0.01). In addition, the differential bacterial taxa were involved in lipid and vitamins metabolism.

CONCLUSION

Our results could provide potential non-invasive biomarker for identification of biliary atresia and contribute to the treatment in terms of ameliorating microbiota dysbiosis.

Diamond-shaped versus side-to-side anastomotic duodenoduodenostomy in laparoscopic management of annular pancreas in children: a single-center retrospective comparative study

Background

Annular pancreas is a rare congenital disorder that requires surgical management once diagnosed. Diamond-shaped and side-to-side duodenoduodenostomy are both popular worldwide nowadays in the surgical management of annular pancreas. Here we present our experience with laparoscopic management of annular pancreas in the last 5 years and compare the clinical results of the diamond-shaped versus side-to-side anastomotic techniques.

Methods

Fifty-two patients diagnosed with annular pancreas who underwent duodenoduodenostomy at our medical center between January 2016 and April 2021 were included in the study. Forty-four patients underwent laparoscopic diamond-shaped duodenoduodenostomy (DS group) and eight underwent laparoscopic side-to-side duodenoduodenostomy (STS group). Clinical data, including surgical indices and early outcomes after surgery, with at least 19 months of follow-up, were collected and analyzed.

Results

Of the 52 patients, 61.5% were prenatally diagnosed, and vomiting was the most common clinical manifestation after birth. The operative time and bleeding volume were 187.5 [interquartile range (IQR), 150-228)] min and 2 (IQR, 2-5) mL in the DS group, compared to 175 (IQR, 155-270) min and 2 (IQR, 2-4.25) mL in the STS group (P=0.89 and 0.32 respectively). The mean time from surgery to initial oral feeding and full oral feeding was 6 (IQR, 4-10) and 12 (IQR, 10-15) days in the DS group, compared to 8 (IQR, 4.75-11.25) and 14.5 (IQR, 13-16.75) days in the STS group (P=0.61 and 0.46 respectively). The mean hospital stay was 16 (IQR, 14-19) and 20 (IQR, 17.75-26) days in the DS and STS groups respectively (P=0.13). No severe complications such as anastomotic leakage, anastomotic stenosis, reoperation or unsuspected rehospitalization were noted in either group. Feeding intolerance was revealed in six cases in the DS group and two cases in the STS group, and there was no significant difference between the two groups (P=0.50).

Conclusions

Both laparoscopic diamond-shaped and side-to-side techniques showed good clinical results in treating annular pancreas. The surgical technique, trans-anastomotic tube and early feeding are not likely to increase the risk of postoperative feeding intolerance.

Early bile drainage improves native liver survival in biliary atresia without cholangitis

Objectives

To explore the outcomes and related factors in children without cholangitis after Kasai portoenterostomy (KPE).

Methods

We retrospectively analyzed the data of infants with type III BA who underwent KPE from June 2016 to December 2021. We compared and analyzed the difference in native liver survival (NLS) rates in different types of cholangitis. We also investigated the relationship between the absence of cholangitis and the effect of early bile drainage (EBD) as well as the related factors affecting EBD efficacy.

Results

A total of 145 children were included in this study. Among these children, 82 (56.6%, 82/145) had cholangitis, including 40 (48.8%, 40/82) with early cholangitis and 33 (40.2%, 33/82) with recurrent cholangitis. The median follow-up period was 29 months (range, 2-75 months). The NLS rates were 67.6%, 51.7%, 45.5% and 43.4% at 6 months, 1 year, 2 years and 5 years following KPE, while the NLS rates for infants without cholangitis after KPE were 68.3%, 50.8%, 46.0% and 46.0%, respectively. Higher gamma-glutamyl transferase (γ- GT) and total bile acid (TBA) before KPE were risk factors for cholangitis (P < 0.05). The NLS rate in recurrent cholangitis was significantly lower than that in occasional cholangitis (P < 0.01). Compared with the EBD-poor group, the NLS rate in the EBD-good group of infants was significantly increased (P < 0.001). EBD was significantly correlated with the occurrence and frequency of cholangitis (P < 0.05).

Conclusions

Recurrent cholangitis was an important factor affecting NLS. For children without cholangitis after KPE, early bile drainage was better, and the NLS was longer.

Management of pancreatic kaposiform hemangioendothelioma with sirolimus in a pediatric patient: a case report and literature review

BACKGROUND

Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular tumor. The pancreas is not a common site of KHE, especially in pediatric patients. Given that no guidelines are available for the treatment of KHE, management is currently based on expert opinions and clinical experiences. Here, we report a case of pancreatic KHE with obstructive jaundice, which was treated successfully with oral sirolimus instead of radical surgery. Additionally, a literature review on pancreatic KHE was performed to summarize prior clinical experiences and the available treatments.

CASE DESCRIPTION

A 10-month-old Chinese male infant presented with obstructive jaundice without any signs of fever, abdominal pain, or distention. A detailed consultation revealed an uneventful history. The obstructive jaundice worsened significantly during 3 weeks of conservative therapy. A pancreatic mass was identified via radiological evidence, and a laparoscopic biopsy of the tumor was performed, which confirmed the diagnosis of pancreatic KHE based on histological findings. Oral sirolimus 0.8 mg/m² twice daily was administered at a steady serum concentration of 5-15 ng/mL, which led to a shrinkage in tumor size and resolution of jaundice. The patient showed no evidence of recurrence after 1 year of follow-up and is still on sirolimus treatment, which has been tolerated well up to the time of this report.

CONCLUSIONS

The pancreas is a rare location of KHE, which is a locally aggressive vascular tumor. Diagnosis is based on histological findings, and therapy should be multidisciplinary and individualized. Although sirolimus has been very successful in the treatment of KHE even without radical surgery, the possible risks of tumor recurrence and adverse effects warrant some caution.

Clinical Characteristics of Gastric Duplication in Children

BACKGROUND

To investigate the clinical characteristics of gastric duplication (GD) in children.

METHODS

The clinical data of 17 children with GD who were treated in our hospital from July 2015 to June 2021 were analyzed retrospectively. There were 8 males and 9 females, aged from 2 months to 11 years. All children underwent laparoscopic GD resections and postoperative pathological diagnosis was GD. In addition, we searched and analyzed the literature on GD in children from 1 January 2011 to 31 December 2021 from the PubMed, EMBASE, and Cochrane Library databases.

RESULTS

Gastric duplication was more common in females, with the most common cystic type occurring in the greater curvature of the stomach. Vomiting is the most common clinical manifestation. Ultrasound is an effective method for the early screening of GD. In this study, one patient who had multiple GDs underwent laparoscopic cystectomy and mucosectomy, one patient was converted to open surgery, and all other children underwent laparoscopic cystectomies. The time to oral intake was 2.3 ± 1.0 days (range: 1-4 days), and the postoperative hospital stay was 5.7 ± 1.7 days (range: 2-9 days). All children were followed up for 6-77 months and had an uneventful recovery with the resolution of the preoperative symptoms.

CONCLUSION

Gastric duplication in children lacks specific clinical manifestations, and the preoperative diagnosis rate is not high, so surgical exploration combined with pathological examination is often needed to make a clear diagnosis. Laparoscopic cystectomy can achieve good therapeutic results.

Application of Embedding Hepaticojejunostomy in Children with Pancreaticobiliary Maljunction Without Biliary Dilatation

Background: To investigate the effect of embedded hepaticojejunostomy in children with pancreaticobiliary maljunction (PBM) without biliary dilatation. Materials and Methods: The clinical data of 10 patients with nondilated PBM from February 2017 to July 2020 were retrospectively analyzed. Perioperative liver function indexes were compared. Results: All patients were diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with intraoperative cholangiography. There were 5 cases of Komi type I and 5 cases of type II; the diameter of the common bile duct was 4-9 mm (median: 6 mm); and the length of the common channel was 5-15 mm (median: 9.25 mm). The procedure for one patient with common duct stones was converted to open surgery. Laparoscopic cholecystectomy, common bile duct resection, and embedded hepaticojejunostomy were successfully performed in all 10 cases. The average operation time was 225 ± 96.64 min, and the intraoperative blood loss was 2-5 mL. The mean time to oral intake was 3.5 ± 1.65 days (range: 2-5 days), and the mean hospitalization duration was 6.2 ± 2.44 days (range: 5-8 days). The differences in liver function indexes in the perioperative period were statistically significant (P < .05). The patients were followed-up for 13 to 54 months (median: 40 months). All patients grew well and there was no bile duct dilatation, calculus, or cirrhosis on B-ultrasound examinations. Conclusions: The clinical manifestations of nondilated PBM are often concealed, and preoperative MRCP was important for obtaining a diagnosis. Laparoscopic cholecystectomy, common bile duct resection, and embedded hepaticojejunostomy are feasible for treating nondilated PBM.

Knockdown of p66ShcA activates Nrf2 pathway to protect cardiomyocytes from oxidative stress and inflammation induced by H2O2

OBJECTIVE

Oxidative stress and inflammation are the most common causes of myocardial ischemia and hypoxia. This article focuses on the effect of p66ShcA on H2O2-induced cardiomyocytes.

MATERIALS AND METHODS

The p66ShcA knockdown model of H9c2 cells was constructed by plasmid transfection. After treatment of different groups with H2O2, oxidative stress-related factors and inflammatory factors were detected.

RESULTS

The expressions of SOD1, SOD2, GPX1, and GPX3 in H2O2 cells were significantly decreased, IL-1β and IL-6 expression were significantly increased, while p66ShcA siRNA negative group could promote the expression of SOD1, SOD2, GPX1, and GPX3, inhibit the expression of IL-1β and IL-6 significantly, and activates the Keap1/Nrf2 pathways.

CONCLUSIONS

Knockdown of p66ShcA can activate Keap1/Nrf2 pathway, which inhibits H2O2-induced oxidative stress and inflammation in H9c2 cells.

Parental Self-efficacy and Health-related Outcomes Among Children with Hirschsprung Disease: A Cross-sectional Study

PURPOSE

Little attention has been put to parental self-efficacy (PSE) on the home care management and its impact on the health-related outcome in children with Hirschsprung disease (HD) after surgery. The purpose of this study was to investigate the association between PSE and post-operative outcome and quality of life (QoL) in children with HD.

DESIGN AND METHODS

This study adopted a cross-sectional study design. Children diagnosed with HD who had surgery during 2015 and 2018, and their parents were included. Parental self-efficacy, children's post-operative fecal continence and QoL were evaluated with validated questionnaires; post-operative readmission and adverse events were extracted from electronic medical record system.

RESULTS

Of the eligible families, 69.6% (96/138) responded to the follow-up. The median children's age at surgery and current age were 16 (interquartile range: 10-32) and 45 (interquartile range: 39.7-57) months, respectively. The mean PSE score is 8.78 points, with the lowest score in the bowel habit training dimension (7.88 ± 2.28), followed by getting social support dimension (8.07 ± 2.64). Multivariable linear regression showed that PSE was associated with fecal continence (β = 0.043, 95% CI 0.013-0.072), pediatric QoL total score (β = 0.210, 95% CI 0.011-0.409) and social score (β = 0.273, 95% CI 0.022-0.525). No associations were observed between PSE and weight z-score, height z-score, readmission or adverse events.

CONCLUSIONS

PSE is correlated with fecal continence and QoL of children with HD.

PRACTICE IMPLICATIONS

PSE should be considered when designing a parental education program, with the focus on bowel habit training and getting social support.

[Comparative study on visual fatigue caused by watching liquid crystal display and projection display]

Objective: To explore the effect of different types of visual display terminals (VDT) on visual fatigue. Methods: A total of 68 subjects were enrolled and divided into flat screen group, metal screen group and glass bead screen group. The subjects watched a video in the same environment for 60 minutes. Before and after watching, they were asked to fill in a visual fatigue rating scale and underwent visual function examinations. The blink rate of subjects was recorded during the experiment. Results: After watching the video, for the metal screen, glass bead screen, and flat screen group respectively: (1)The median (interquartile range, IQR) of visual fatigue rating increased significantly (before: 1.0 (1.2), 1.3 (1.6), 0.5 (0.9); after: 2.1 (1.9), 2.1 (1.7), 1.2 (1.0); Z=-4.72, -4.83, -3.75; all P<0.05). (2) The median (IQR) of blink frequency increased significantly (before: 11.5 (10.6), 15.3 (11.9), 7.0 (13.0) times/minute; after: 15.0 (13.0), 17.0 (16.0), 15.0 (12.0) times/minute; Z=-2.64, -2.74, -4.12; all P<0.05). (3) The mean (±standard deviation) of critical flicker fusion frequency (CFF) decreased significantly [before: (35.76±2.98), (35.84±2.79), (35.44±2.21) Hz; after: (35.09±2.78), (34.94±2.67), (34.57±2.33) Hz; t=-2.64, -2.38, -4.12; all P<0.05). (4)The median (IQR) of near point of convergence (NPC) became significantly larger [before: 3.9 (2.6), 4.0 (2.5), 4.3 (2.7) cm; after 5.4 (3.8), 4.8 (2.7), 6.1 (3.9) cm; Z=-3.39, -2.27, -3.36; all P<0.05]. (5)The median of negative relative accommodation (NRA) reduced significantly [before: 2.00 (0.50), 2.00 (0.56), 2.00 (0.25) cm; after 1.75 (0.50), 1.75 (0.25), 1.75 (0.50) cm; Z=-1.98, -2.09, -2.53; all P<0.05]. Meanwhile, no significant changes were found for the positive relative accommodation (PRA), accommodative amplitude, accommodative response, negative relative vergence in all groups after watching the video. The comparisons between the three groups showed that, after watching the video, the participants in the two kinds of projection screen group (the metal and glass bead screen group) had more subjective visual fatigue than those in the flat screen group respectively (Z=-2.09, -2.21; all P<0.05), while there was no significant difference in subjective visual fatigue between the two projection screen groups (P>0.05). In addition, positive fusional vergence recovery point and break point decreased after watching the video in the metal screen and glass bead screen group, respectively (t=4.15, 2.07; all P<0.05). However, no such change was found in the flat screen group. Conclusions: Short-term and long-distance VDT operations have significant effects on visual fatigue, which may be due to the decreased positive convergence ability. VDT operations over projection screens may result in more visual fatigue than LED flat panel display, while the effect of different projection screen types have insignificant influences on visual fatigue. (Chin J Ophthalmol, 2019, 55:595-600).

Bowel management program for pediatric postoperative fecal incontinence in China: A surgeon's experience

The purpose of this article is to report the status of the efficacy of and long-term adherence to the Bowel Management Program (BMP) for fecal incontinence (FI) postoperation in China.Children over 3 years of age with FI postoperation referred to our medical center were included in the study. Evaluations were performed before and 2 years after their clinic visit. The cost of bowel care, improvement in incontinence, health-related quality of life, and family functioning with the BMP were analyzed.A total of 48 children with FI were included in our study, of whom 38 were boys. The median treatment fee was 660.1 dollars. The complications included abdominal pain (4 patients, 8%), occasional vomiting (2 patients, 4%), and hypoglycemia (1 patient, 2%). The incontinence status and health-related quality of life improved significantly after the BMP. Despite the good outcome of the BMP, half of the patients discontinued the program.The BMP is an effective approach to manage FI and improve the patients' quality of life. Poor long-term adherence is currently the main challenge affecting the BMP application in China.

A thermal protective urethral heater applied to modulate the prostate cryoablation area

BACKGROUND

Urethral warmer and cryoheater are invented and applied in cryoablation to overcome urethral cryoinjury, but these devices cannot be fixed and precisely control the released heat which excessively reduces the effective ablation area. Current warmers enlarge the operation difficulty and decrease the precision in temperature control.

OBJECTIVE

A reformed catheter termed urethral heater aims to protect the urethra and simultaneously control the released heat so as to meet the aid of doctors' convenient operation in effective therapy, device fixation and precise heat controllability.

MATERIALS AND METHODS

In this paper, the temperature controller combined with temperature monitor was used to control the heating behavior of the urethral heater with the initial active temperature. The controllability and thermal protection of the urethral heater was simulated and tested, which compared with that of urethral warmer.

RESULTS

During the trials in vitro, the lowest temperature at the urethra surface is -3.7 degree C when one cryoprobe was introduced in the cryoablation for 15 min and -15.3 degree C with two cryoprobes. Above all, the effective cryoablation area increased with the decline of initial active temperatures.

CONCLUSION

The urethral heater is able to prevent the urethra from irreversible damage and modulate the ablation area. The delay of heat is a new way to decline the recurrence rate and facilitate the desire of aconuresis during the cryoablation.

Reversal of multidrug resistance of gastric cancer cells by down-regulation of ZNRD1 with ZNRD1 siRNA

The over-expression of a new zinc ribbon (ZNRD1) gene has been shown previously to promote a multidrug-resistant phenotype in gastric cancer cells through the up-regulation of permeability-glycoprotein (P-gp). In the present study, siRNA eukaryotic expression vectors of ZNRD1 are constructed and transfected into SGC7901/VCR cells to examine whether or not down-regulation of ZNRD1 increases cell sensitivity towards chemotherapeutic drugs. After transfection, ZNRD1 expression decreased dramatically in ZNRD1 siRNA transfectants compared with that in parental cells and empty vector control cells. Down-regulation of ZNRD1 significantly enhanced the sensitivity of SGC7901/VCR cells to vincristine, adriamycin and etoposide, but not to 5-fluorouracil and cisplatin. Cell capacity to efflux adriamycin decreased markedly in ZNRD1 siRNA transfectants, and correlation between ZNRD1 down-regulation and increased multidrug resistance 1 (MDR1) gene transcriptional activity was observed. These results suggest that the ZNRD1 siRNA constructs down-regulate the expression of ZNRD1 effectively and reverse the resistant phenotype of gastric cancer cells. Furthermore, ZNRD1 might influence transcription of the MDR1 gene and thus play an important role in multidrug resistance in gastric carcinoma.

Mitochondrial SIRT3 and its target glutamate dehydrogenase are altered in follicular cells of women with reduced ovarian reserve or advanced maternal age

STUDY QUESTION

Is the activity of sirtuin 3 (SIRT3) altered in granulosa and cumulus cells from young women with reduced ovarian reserve or women of advanced maternal age?

SUMMARY ANSWER

SIRT3 mRNA and active protein in granulosa and cumulus cells were decreased in women with reduced ovarian reserve and advanced maternal age.

WHAT IS KNOWN ALREADY

Young women with reduced ovarian reserve or women of advanced maternal age have reduced oocyte viability, possibly due to altered granulosa and cumulus cell metabolism. The mitochondrial SIRT3 protein may be implicated in these processes as it is able to sense the metabolic state of the cell and alter mitochondrial protein function post-translationally.

STUDY DESIGN, SIZE, DURATION

This is a prospective cohort study, in which women (n = 72) undergoing routine IVF/ICSI were recruited and allocated to one of three cohorts based on age and ovarian reserve (as assessed by serum anti-Mullerian hormone level). Women were classified as young (≤35 years) or of advanced maternal age (≥40 years).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Granulosa and cumulus cells were collected. SIRT3 mRNA and protein levels and protein activity was analysed in granulosa and cumulus cells via quantitative PCR, immunohistochemistry and western blotting, and deacetylation activity, respectively. Activity of the glutamate dehydrogenase (GDH) enzyme, a known target of SIRT3, was assessed, and acetylated proteins in mitochondria isolated from granulosa and cumulus cells were separated by immunoprecipitation and acetylation of GDH assessed by western blotting. Data for women with good prognosis (young women with normal ovarian reserve) were compared with those from young women with reduced ovarian reserve and those of advanced maternal age.

MAIN RESULTS AND THE ROLE OF CHANCE

SIRT3 mRNA and active protein were present in granulosa and cumulus cells and co-localized to the mitochondria. SIRT3 mRNA in granulosa cells was decreased in young women with reduced ovarian reserve and advanced maternal age versus young women with normal ovarian reserve (P < 0.05). SIRT3 mRNA in cumulus cells was decreased in women of advanced maternal age versus young women with normal ovarian reserve only (P < 0.05). Granulosa cell GDH activity was decreased in young women with reduced ovarian reserve and in women of advanced maternal age (P < 0.05), whereas cumulus cell GDH activity was reduced in the advanced maternal age group only (P < 0.05). The acetylation profile of GDH in mitochondria revealed increased acetylation of GDH in granulosa and cumulus cells from women of advanced maternal age (P < 0.05) while young women with reduced ovarian reserve had increased GDH acetylation in granulosa cells only (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

Although patients were allocated to groups based on maternal age and ovarian reserve and matched for BMI, other maternal factors may also alter the 'molecular health' of ovarian cells.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggest that SIRT3 post-translational modification of mitochondrial enzymes in human granulosa and cumulus cells may regulate GDH activity, thus altering the metabolic milieu surrounding the developing oocyte. Owing to the association between the decline in oocyte quality and pregnancy rates in women of advanced maternal age and the possible association with reduced ovarian reserve, knowledge of perturbed SIRT3 function in granulosa and cumulus cells may lead to novel therapies to improve mitochondrial metabolism in the oocyte and follicular cells in women undergoing IVF treatment.

STUDY FUNDING/COMPETING INTEREST(S)

No conflicts of interest to declare. Research was funded by an NHMRC project grant.

Clonal Status and Clinicopathological Features of Langerhans Cell Histiocytosis

Some studies have demonstrated that Langerhans cell histiocytosis (LCH) is a neoplastic hyperplasia of Langerhans cells, however some researchers consider that clonality should be assessed in more patients with LCH, both at disease presentation and during the disease course. Monoclonality is a major characteristic of most tumours, whereas normal tissue and reactive hyperplasia are polyclonal. To elucidate the nature of Langerhans cells further, the present study investigated the clinicopathological features and clonality of three cases of LCH in female patients using laser microdissection and a clonality assay, based on X-chromosomal inactivation mosaicism in somatic tissues and polymorphism of the androgen receptor gene. The results indicated that LCH was composed of Langerhans cells with a characteristic morphological appearance, eosinophils, giant cells, neutrophils and foamy cells. Immunohistochemically, the Langerhans cells were positive for CD1a, S-100 protein and vimentin. The clonality assay demonstrated that the Langerhans cells formed a monoclonal population, showing that LCH is neoplastic. We conclude that LCH is characterized by clonal proliferation, although additional studies with larger sample sizes are required to prove this conclusively.

Overexpression of PrPC and its antiapoptosis function in gastric cancer

Cellular prion protein (PrP(C)), a glycosylphosphatidylinositol-anchored membrane protein, was found in our lab to be widely expressed in gastric cancer cell lines. In order to evaluate its biological significance in human gastric cancer, we investigated its expression in a large series of gastric tissue samples (n = 124) by immuno histochemical staining with the monoclonal antibody 3F4. Compared with normal tissues, gastric adenocarcinoma showed increased PrP(C) expression, correlated with the histopathological differentiation (according to the WHO and Lauren classifications) and tumor progression (as documented by pTNM staging). To better understand the underlying mechanism, we introduced the PrP(C) and two pairs of RNAi into the poorly differentiated gastric cancer cell line AGS and found that PrP(C) suppressed ROS and slowed down apoptosis in transfected cells. Further study proved that the apoptosis-related protein Bcl-2 was upregulated whereas p53 and Bax were downregulated in the PrP(C)-transfected cells. A reverse effect was observed in PrP(C) siRNA-transfected cells. These results strongly suggested that PrP(C) might play a role as an effective antiapoptotic protein through Bcl-2-dependent apoptotic pathways in gastric cancer cells. Further study into the mechanism of these relationships might enrich the knowledge of PrP, better our understanding of the nature of gastric carcinoma, and further develop possible strategies to block or reverse the development of gastric carcinoma.

Islet cell autoimmunity in youth onset diabetes mellitus in Northern India

We characterised a consecutive cohort of 132 youth onset diabetic individuals (age at onset<30 years, mean duration of disease 5.5+/-6.0 years) from North India, by serological determination of the determination of the islet cell autoantibodies, GAD(65) and IA2, and clinically for coexisting autoimmune thyroid disease, malnutrition and pancreatic calcification. Five types of diabetes were delineated: Type 1 (37%), ketosis resistant (32%), Type 2 (13%), fibrocalculous pancreatopathy (11%) and autoimmune polyglandular syndrome (7%). C-peptide response to glucagon was assessed in a representative subset of 50 patients with Type 1, ketosis resistant, and autoimmune polyglandular syndrome. A total of 22.4% of Type 1 and 30% of autoimmune polyglandular syndrome subjects showed both GAD(65) plus IA-2 autoantibody positivity, significantly more than the 4.7% positivity shown by the ketosis resistant type. However, GAD(65) antibody positivity alone was seen in 38% of ketosis resistant subjects which was significantly more than the 14.2 and 10% positivity seen in Type 1 and autoimmune polyglandular groups, respectively. The fibrocalculous pancreatopathy group showed GAD(65) plus IA-2 autoantibody positivity in 14.2% and GAD(65) autoantibody alone positivity in 7.1%. 26 and 60%, respectively, of the Type 1 and autoimmune polyglandular syndrome groups had thyroid microsomal autoantibody positivity. Type 1 showed significantly less C-peptide response to glucagon when compared to the ketosis resistant and autoimmune polyglandular syndrome groups. The controls and Type 2 diabetic individuals tested negative for islet cell autoimmunity markers. These findings demonstrate a role of islet cell autoimmunity in the pathogenesis of four out of the five clinical types of youth onset diabetes seen in North India.

[The effect of calponin and caldesmon in regulation of the gastrointestinal motility during pathophysiological adaptation]

OBJECTIVE

To investigate the expression of calponin (CaP) and caldesmon (CaD) in the gastrointestinal tract and their effect in regulating gastrointestinal motility during physiological and pathological adaptation.

METHODS

Models of chronic gastrointestinal motility hyperfunction in mice were induced by intragastric administration of senna extraction and models of chronic gastrointestinal motility hypofunction in rats were established with carbon tetrachloride induced cirrhosis, CaP and CaD were detected in the gastrointestinal tract of different model groups using SDS-PAGE and Western blot. The color development of Western blots was scanned using densitometric scanning. The relative contents of gastrointestinal CaP and CaD were compared with control animals with different state of gastrointestinal motility.

RESULTS

Animal models of abnormal gastrointestinal motility were established in mice and rats. Densitometric quantification of CaP and CaD blots by CP1 and C98 mAbs showed that normal animal colon contained higher amounts of h1-CaP and CaD. In normal mice and rats, the content of CaP and CaD was successively in this order :colon > stomach > small intestine. The content was reduced in mice of chronic gastrointestinal motility hyperfunction, but the expression of CaP and CaD was promoted in rats with cirrhosis and declined to normal level after treatment with L-NAME.

CONCLUSION

There is close relation between expression of CaP and CaD and state of gastrointestinal motility. CaP and CaD may inhibit gastrointestinal motility. These suggest that CaP and CaD may play a role in the regulation of gastrointestinal motility during physiological and pathological adaptation.

Phosphorylation of protein phosphatase inhibitor-1 by Cdk5

Protein phosphatase inhibitor-1 is a prototypical mediator of cross-talk between protein kinases and protein phosphatases. Activation of cAMP-dependent protein kinase results in phosphorylation of inhibitor-1 at Thr-35, converting it into a potent inhibitor of protein phosphatase-1. Here we report that inhibitor-1 is phosphorylated in vitro at Ser-67 by the proline-directed kinases, Cdk1, Cdk5, and mitogen-activated protein kinase. By using phosphorylation state-specific antibodies and selective protein kinase inhibitors, Cdk5 was found to be the only kinase that phosphorylates inhibitor-1 at Ser-67 in intact striatal brain tissue. In vitro and in vivo studies indicated that phospho-Ser-67 inhibitor-1 was dephosphorylated by protein phosphatases-2A and -2B. The state of phosphorylation of inhibitor-1 at Ser-67 was dynamically regulated in striatal tissue by glutamate-dependent regulation of N-methyl-d-aspartic acid-type channels. Phosphorylation of Ser-67 did not convert inhibitor-1 into an inhibitor of protein phosphatase-1. However, inhibitor-1 phosphorylated at Ser-67 was a less efficient substrate for cAMP-dependent protein kinase. These results demonstrate regulation of a Cdk5-dependent phosphorylation site in inhibitor-1 and suggest a role for this site in modulating the amplitude of signal transduction events that involve cAMP-dependent protein kinase activation.

Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2beta predict immune-mediated (Type 1) diabetes in relatives

We report here our prospective study of 15,224 non-diabetic, first-degree relatives of probands with immune-mediated (type 1) diabetes (IMD), of which 135 were found to eventually develop diabetes. We determined islet cell, insulin, GAD65, insulinoma-associated antigen-2 and 2beta autoantibodies (ICA, IAA, GAD65A, IA-2A and IA-2betaA), on the first available serum samples. The latter three autoantibodies were however assayed on subsets of the relatives with and without ICA, IAA and/or GAD65A, plus most of the relatives who developed diabetes. Of the relatives who progressed to diabetes, 94% had at least one of these autoantibodies on the first screening, while ICA proved to be the most sensitive single marker (sensitivity 74%). Risk of diabetes was however negligible when ICA was found in the absence of the others (5-year risk=5.3%), but increased dramatically whenever two or more autoantibodies were present (5-year risk=28.2% and 66.2%, respectively). The most predictive combination of markers was ICA plus IA-2A and/or IA-2beta A. Loss of first phase insulin release to IVGTT also occurred only in those ICA-positive relatives who had one or more of the other autoantibodies. The data suggests that significant beta-cell damage is seen only when the underlying autoimmunity has spread to multiple antigenic islet cell determinants. Combinations of the autoantibodies occurred most often in relatives with the highest risk HLA-DR/DQ phenotypes. These data document that only relatives positive for at least two or more of these five autoantibodies are at significant risk of diabetes themselves. Intervention trials for the prevention of type 1 diabetes could be designed based on testing for these autoantibodies alone, without the need for HLA typing and IVGTT testing.

The influence of diabetes on free flap transfer: II. The effect of ischemia on flap survival

Insulin-dependent diabetes mellitus causes microangiopathic changes in many tissues, including skin and muscle. It is not known if such changes are detrimental to free flap transfer, particularly after extended ischemia. To address this issue, we used an experimental design by using a syngeneic rat strain (Lewis) for free groin flap and muscle flap transplantations from streptozotocin-induced diabetic rats (2 month's duration of symptoms) to normal rats. Flaps from age-matched normal donors were transplanted to normal recipients for control comparisons. Groin flaps were stored ischemically for 12 or 18 hours at room temperature, or for 48 hours in the cold (4 degrees C) before transplantation. Flap survival and vascular patency were assessed at 7 days. Cutaneous maximus muscle flaps were transplanted to the groins of recipients after 6 hours of room temperature ischemia. Vascular patency, muscle viability, flap weight change (edema), and dehydrogenase activity were assessed after 2 days of reperfusion. Seventy percent, 67%, and 73% of diabetic groin flaps survived after 12, 18, or 48 (cold) hours of ischemia, respectively, in comparison with 90%, 73%, and 87% of normal flaps undergoing the same respective ischemia periods. The differences were not significant, even when the data were pooled (p greater than 0.1). Muscle flaps also showed no significant differences for the parameters studied. These results support the use of microvascular reconstructive surgery in diabetic patients, suggesting that moderate ischemic challenges do not compromise free flap transfer or extremity replantation.

Microvascular salvage procedures with adjuvant antithrombotic therapy for restitution of patency in a rat model

Thrombosis following microvascular anastomosis requires further surgical intervention, involving anastomotic resection and reanastomosis or interpositional vein grafting. This study was undertaken to investigate different methods of salvaging thrombosed vessels, using a rat-vein model of error-induced thrombosis. Vessels were reconstructed 4 hr after the onset of thrombosis, using one of three methods: Group 1--removal of the erroneously placed stitch; Group 2--anastomotic resection and re-anastomosis; and Group 3--resection and replacement with a vein graft. Adjuvant antithrombotic therapy was simultaneously evaluated, assessing the influence of systemic Iloprost or heparin. Patency rates at one day postoperatively were 0 percent, 12.5 percent and 37.5 percent for Groups 1, 2, and 3, respectively. Following Iloprost infusion, these rates increased to 25 percent, 25 percent, and 56.3 percent, respectively and, following heparin administration, to 50 percent, 68.8 percent, and 81.8 percent, respectively. Significant increases were found for vein grafting (Group 3), and for the heparin-treated subgroups using all three methods. Effective levels of both Iloprost and heparin were confirmed by increases noted in rat-tail bleeding times. Significant rates of recanalization by three days following one-day occlusion were found in Groups 1 and 2. These results support the application of vein-graft replacement for thrombosed veins, concurrently with systemic heparinization. This study further confirms the high rate of recanalization seen in thrombosed rat femoral veins.

[Effects of semen Ziziphis Spinosae oil and Ziziphis Spinosae extract on the decrease of serum lipoprotein and inhibiton of platelet aggregation]

Our experiments have shown that oral administration of Semen Ziziphis Spinosae oil(SZSO) or Ziziphis Spinosae extract (ZSE) given to quails for 53 days can significantly reduce their TC, LDL and TG and markedly subdue the fatty degeneration in their livers. Also, SZSO pressed into the stomach of rats for five days can conspicuously inhibit their platelet aggregation, while ZSE cannot.

Rat femoral vein-to-vein grafts as a microvascular practice model: factors that influence patency

The rat femoral vein has become a standard model for microvascular anastomosis practice as well as for research investigations into various manipulative influences upon venous patency. Although vein grafts to the rat artery are the focus of many experimental studies, few reports have investigated vein-to-vein grafts. This study examines the short-term patency (1-3 days) of vein grafts interpositioned to the rat femoral vein. Several factors are studied for their ability to alter the patency rate. The results indicate that patency is difficult to achieve following the creation of a second serial anastomosis (construction of a vein-to-vein graft). Systemic heparin consistently improves patency rates, and trends toward increased patency are seen for reduction in longitudinal tension of the repaired vessel. It is also implied that a deeper understanding of venous hemodynamics and thrombotic events may lead to improved methodologies in the clinical applications of microvenous repairs. These results indicate that rat vein-to-vein grafts may provide a challenging microvascular training model, while introducing the novice microsurgeon to some of the complicating factors encountered with microvascular grafting.

Common denominators in the etiology and pathology of visceral lesions of cystic fibrosis and Keshan disease

The common denominator of a unique disseminated multi-focal miliary myocardial hyaline necrosis and fibrosis in Keshan disease (KSD) and cystic fibrosis (CF) and a commonality of the affected age groups of fetuses and preschool children led to the review of existing KSD autopsy material to search for pancreatic and hepatic lesions considered pathognomonic for CF. Pancreatic lesions considered pathognomonic for CF were found in 595, or 35% of 1700 documented cases of KSD. The pancreatic lesions were limited to tissues of fetuses and preschool children. Adults dying of KSD had diagnostic lesions limited to the cardiovascular system, liver, and skeletal muscle. Varying degrees of focal biliary cirrhosis were identified in 850, or 50% of the KSD autopsies, and 85, or 5% developed severe lobular cirrhosis. The common denominator in CF and KSD appears to be a primary or induced secondary selenium deficiency in age-susceptible humans, prenatally at or around 22 wk of fetal life, during early postnatal life, or during the rapid-growth preschool years. The basic difference between the natural history of CF and KSD is that the selenium deficiency is totally environmental in KSD and appears to be the result of a maternal malabsorptive syndrome or an abnormality of selenium transfer in CF.

Laser-assisted microsurgical anastomoses in traumatized blood vessels

Technological advances have made CO2 laser-assisted microvascular anastomoses (LAMA) feasible. This study seeks to compare results of LAMA versus CSMA (conventional suture microsurgical anastomosis) in traumatized vessels. Using a rat model, femoral arteries and veins were either crushed and transected or divided by avulsion and then repaired by either LAMA or CSMA. LAMA resulted in higher patency rates than CSMA at early postoperative observation periods. With time, the patency rates improved in both groups and, by the end of the study, the patency rates were equivalent. These findings indicate that the laser technique may be a better option when working with traumatized vessels because of the critical nature of early patency rates. The improved results may be due to a reduction of suture material at the anastomotic site when using the laser technique. Some physiologic aspects of vessel thrombosis, recanalization, and the role of collateral circulation are discussed.

The laser-assisted end-to-side microvascular anastomosis

A simple method of performing the laser-assisted end-to-side microvascular anastomosis was devised. This technique was tested on 150 Sprague-Dawley rats in two separate series of experiments. In the first, end-to-side anastomoses were performed on the iliac artery under the normal tension due to the elastic recoil of severed vessels. Four stay sutures were placed 90 degrees apart, and the intervals were "spot welded" with a low-wattage CO2 microsurgical laser unit. The patency rate (96 percent) was equivalent to that found in a control group utilizing the conventional all-suture method (92 percent), but there was a significantly higher aneurysm rate (44 versus 11 percent). In a second model, an arterial bypass with very low anastomotic tension was performed around an obstruction created in the carotid artery. This model resulted in turbulent flow but low anastomotic tension. Here the laser-anastomosis patency rate was 98 percent, versus 42 percent for the conventional all-suture method. The placement of fewer sutures in association with turbulent flow in this model may account for the improved patency rate. The avoidance of excessive tension at the anastomotic site reduced the incidence of aneurysms to a negligible level.

Bursting strength in CO2 laser-assisted microvascular anastomoses

Iliac artery end-to-end anastomoses were performed in 42 Sprague-Dawley rats, divided into seven groups, to determine the welding effects of CO2 laser radiation in microvascular anastomoses. Conventional suture techniques were performed on right iliac arteries, and left iliac arteries were anastomosed with a laser-assisted technique. Bursting strength and diameters of the anastomotic sites were measured at different intervals (from one day to five weeks) post surgery. The anastomotic patency rate was 100 percent in both groups, and the aneurysm rate was only 2 percent in the laser group. Bursting strength was low at one and three days post surgery in both groups; then, it increased gradually until both groups could withstand higher than physiologic pressures. Results of high patency rates, low aneurysm formation, and the ability to withstand pressures higher than physiologic, suggest that the laser-assisted anastomotic technique can play an important role in microvascular surgery.