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Background Pseudomonas aeruginosa (PA) is a pathogenic bacterium that causes severe pneumonia in critically ill and immunocompromised patients. Peptidylarginine deiminase (PAD) 2, PAD4, and caspase-1 are important enzymes in mediating host response to infection. The goal of this study was to determine the interplay between PAD2, PAD4, and caspase-1 in PA pneumonia-induced sepsis. Methods Pneumonia was produced in wild-type, Pad2−/−, and Pad4−/− mice by intranasal inoculation of PA (2.5 × 106 colony-forming units per mouse), and survival (n = 15/group) was monitored for 10 days. Bone marrow-derived macrophages (BMDMs) were isolated for in vitro studies. Samples were collected at specific timepoints for Western blot, bacterial load determination, and flow cytometry analysis. Results Caspase-1-dependent inflammation was diminished in PA-inoculated Pad2−/− mice, contributing to reduced macrophage death and enhanced bacterial clearance. In addition, Pad2−/− mice exhibited improved survival and attenuated acute lung injury after PA infection. In contrast, Pad4−/− mice did not display diminished caspase-1 activation, altered bacterial loads, or improved survival. Conclusions Peptidylarginine deiminase 2 plays an essential role in the pathogenesis of pulmonary sepsis by mediating caspase-1 activation. This goes against previous findings of PAD4 in sepsis. Our study suggests that PAD2 is a potential therapeutic target of PA pneumonia-induced sepsis.

Background: Previous studies have independently validated the prognostic relevance of residual cancer burden (RCB) after neoadjuvant chemotherapy. We used results from several independent cohorts in a pooled patient-level analysis to evaluate the relationship of RCB with long-term prognosis across different phenotypic subtypes of breast cancer, to assess generalisability in a broad range of practice settings. Methods: In this pooled analysis, 12 institutes and trials in Europe and the USA were identified by personal communications with site investigators. We obtained participant-level RCB results, and data on clinical and pathological stage, tumour subtype and grade, and treatment and follow-up in November, 2019, from patients (aged ≥18 years) with primary stage I–III breast cancer treated with neoadjuvant chemotherapy followed by surgery. We assessed the association between the continuous RCB score and the primary study outcome, event-free survival, using mixed-effects Cox models with the incorporation of random RCB and cohort effects to account for between-study heterogeneity, and stratification to account for differences in baseline hazard across cancer subtypes defined by hormone receptor status and HER2 status. The association was further evaluated within each breast cancer subtype in multivariable analyses incorporating random RCB and cohort effects and adjustments for age and pretreatment clinical T category, nodal status, and tumour grade. Kaplan-Meier estimates of event-free survival at 3, 5, and 10 years were computed for each RCB class within each subtype. Findings: We analysed participant-level data from 5161 patients treated with neoadjuvant chemotherapy between Sept 12, 1994, and Feb 11, 2019. Median age was 49 years (IQR 20–80). 1164 event-free survival events occurred during follow-up (median follow-up 56 months [IQR 0–186]). RCB score was prognostic within each breast cancer subtype, with higher RCB score significantly associated with worse event-free survival. The univariable hazard ratio (HR) associated with one unit increase in RCB ranged from 1·55 (95% CI 1·41–1·71) for hormone receptor-positive, HER2-negative patients to 2·16 (1·79–2·61) for the hormone receptor-negative, HER2-positive group (with or without HER2-targeted therapy; p

Importance Residual cancer burden (RCB) distributions may improve the interpretation of efficacy in neoadjuvant breast cancer trials. Objective To compare RCB distributions between randomized control and investigational treatments within subtypes of breast cancer and explore the relationship with survival. Design, Setting, and Participants The I-SPY2 is a multicenter, platform adaptive, randomized clinical trial in the US that compares, by subtype, investigational agents in combination with chemotherapy vs chemotherapy alone in adult women with stage 2/3 breast cancer at high risk of early recurrence. Investigational treatments graduated in a prespecified subtype if there was 85% or greater predicted probability of higher rate of pathologic complete response (pCR) in a confirmatory, 300-patient, 1:1 randomized, neoadjuvant trial in that subtype. Evaluation of a secondary end point was reported from the 10 investigational agents tested in the I-SPY2 trial from March 200 through 2016, and analyzed as of September 9, 2020. The analysis plan included modeling of RCB within subtypes defined by hormone receptor (HR) andERBB2 status and compared control treatments with investigational treatments that graduated and those that did not graduate. Interventions Neoadjuvant paclitaxel plus/minus 1 of several investigational agents for 12 weeks, then 12 weeks of cyclophosphamide/doxorubicin chemotherapy followed by surgery. Main Outcomes and Measures Residual cancer burden (pathological measure of residual disease) and event-free survival (EFS). Results A total of 938 women (mean [SD] age, 49 [11] years; 66 [7%] Asian, 103 [11%] Black, and 750 [80%] White individuals) from the first 10 investigational agents were included, with a median follow-up of 52 months (IQR, 29 months). Event-free survival worsened significantly per unit of RCB in every subtype of breast cancer (HR-positive/ERBB2-negative: hazard ratio [HZR], 1.75; 95% CI, 1.45-2.16; HR-positive/ERBB2-positive: HZR, 1.55; 95% CI, 1.18-2.05; HR-negative/ERBB2-positive: HZR, 2.39; 95% CI, 1.64-3.49; HR-negative/ERBB2-negative: HZR, 1.99; 95% CI, 1.71-2.31). Prognostic information from RCB was similar from treatments that graduated (HZR, 2.00; 95% CI, 1.57-2.55; 254 [27%]), did not graduate (HZR, 1.87; 95% CI, 1.61-2.17; 486 [52%]), or were control (HZR, 1.79; 95% CI, 1.42-2.26; 198 [21%]). Investigational treatments significantly lowered RCB in HR-negative/ERBB2-negative (graduated and nongraduated treatments) andERBB2-positive subtypes (graduated treatments), with improved EFS (HZR, 0.61; 95% CI, 0.41-0.93) in the exploratory analysis. Conclusions and Relevance In this randomized clinical trial, the prognostic significance of RCB was consistent regardless of subtype and treatment. Effective neoadjuvant treatments shifted the distribution of RCB in addition to increasing pCR rate and appeared to improve EFS. Using a standardized quantitative method to measure response advances the interpretation of efficacy. Trial Registration ClinicalTrials.gov Identifier:NCT01042379

With the accelerated growth of the number of electric vehicles, the frequent occurrence of electric vehicle charging safety accidents has brought some safety hazards to people. The fault diagnosis of on-board charger circuit has gradually become the focus of attention of scholars. This paper uses simulation software to conduct modeling simulation analysis, failure mode analysis and data acquisition for the on-board charger of electric vehicles, and establishes a fault diagnosis model based on BP neural network, which is applied to the fault diagnosis of on-board charger circuits. The optimal fault diagnosis model is obtained by continuously adjusting the number of neurons in the hidden layer of the BP neural network, and the open-circuit faults of diodes and MOSFETs are mainly analyzed experimentally. The simulation results show that the expected effect has been achieved in the fault diagnosis of the on-board charger circuit, and the established simple BP neural network model can be applied in practice. Some feasible solutions are provided for improving the charging safety of electric vehicles.

In recent years, Power electronic systems (such as DC/DC converters) have become more complex due to their needs. Under a series of harsh operating environments such as high temperatures, they are likely to fail, seriously endangering people’s property safety.This paper focuses on the research on the structure principle and fault diagnosis of the DC/DC converter system of electric vehicles, and introduces the structure principle of the electric vehicle DC/DC converter and the development of power electronic fault diagnosis.And the fault diagnosis method of DC/DC converter system is proposed. Finally, the research on fault diagnosis of DC/DC converters is summarized and prospected, hoping to provide new ideas and perspectives for the research and development of fault diagnosis of DC/DC converters for electric vehicles.

Peptidylarginine deiminases (PADs) are a family of calcium-dependent enzymes that are involved in a variety of human disorders, including cancer and autoimmune diseases. Although targeting PAD4 has shown no benefit in sepsis, the role of PAD2 remains unknown. Here, we report that PAD2 is engaged in sepsis and sepsis-induced acute lung injury in both human patients and mice. Pad2–/– or selective inhibition of PAD2 by a small molecule inhibitor increased survival and improved overall outcomes in mouse models of sepsis. Pad2 deficiency decreased neutrophil extracellular trap (NET) formation. Importantly, Pad2 deficiency inhibited Caspase-11–dependent pyroptosis in vivo and in vitro. Suppression of PAD2 expression reduced inflammation and increased macrophage bactericidal activity. In contrast to Pad2–/–, Pad4 deficiency enhanced activation of Caspase-11–dependent pyroptosis in BM-derived macrophages and displayed no survival improvement in a mouse sepsis model. Collectively, our findings highlight the potential of PAD2 as an indicative marker and therapeutic target for sepsis., Peptidylarginine deiminases 2 (PAD2) regulates neutrophil extracellular trap (NET) formation in sepsis and sepsis-induced acute lung injury.

Immune cell death caused by neutrophil extracellular traps (NETs), referred to as NETosis, can contribute to the pathogenesis of endotoxemia and organ damage. Although the mechanisms by which infection induces NETosis and how that leads to organ dysfunction remain largely unknown, NET formation is often found following citrullination of histone H3 (CitH3) by peptidylarginine deiminase (PAD). We hypothesized that lipopolysaccharide (LPS)-induced activation of PAD and subsequent CitH3-mediated NET formation increases endothelial permeability and pulmonary dysfunction and, therefore, that inhibition of PAD can mitigate damage and improve survival in lethal endotoxemia. Here, we showed that treatment with YW3–56, a PAD2/PAD4 inhibitor, significantly diminished PAD activation, blocked LPS-induced pulmonary vascular leakage, alleviated acute lung injury, and improved survival in a mouse model of lethal LPS-induced endotoxemia. We found CitH3 in the bloodstream 30 min after intraperitoneal injection of LPS (35 mg/kg) into mice. Additionally, CitH3 production was induced in cultured neutrophils exposed to LPS, and NETs derived from these LPS-treated neutrophils increased the permeability of endothelial cells. However, YW3–56 reduced CitH3 production and NET formation by neutrophils following LPS exposure. Moreover, treatment with YW3–56 decreased the levels of circulating CitH3 and abolished neutrophil activation and NET formation in the lungs of mice with endotoxemia. These data suggest a novel mechanism by which PAD-NET-CitH3 can play a pivotal role in pulmonary vascular dysfunction and the pathogenesis of lethal endotoxemia.

BACKGROUND The peptidylarginine deiminase (PAD) family converts arginine into citrulline through protein citrullination. PAD2 and PAD4 inhibitors can improve survival in hemorrhagic shock (HS). However, the impact of isoform-specific PAD inhibition in improving survival has not been studied. In this study, we utilize selective Pad2 knockout mice to elucidate loss of function of PAD2 leads to pro-survival effect in HS. METHODS HS: Pad2 and wild-type (WT) mice (n = 5/group) were subjected to lethal HS (55% volume hemorrhage). Survival was monitored over 7 days. Myocardial infarction (MI): Pad2 and WT mice (n = 9/group) were subjected to MI by permanent LAD ligation to examine the effect of ischemia on the heart. After 24 h cardiac function and infarct size were measured. RESULTS HS: Pad2 mice demonstrated 100% survival compared with 0% for WT mice (P = 0.002). In a sub-lethal HS model, cardiac β-catenin levels were higher in Pad2 compared with WT after 24 h. MI: WT mice demonstrated larger MI (75%) compared with Pad2 (60%) (P < 0.05). Pad2 had significantly higher ejection fraction and fractional shortening compared with WT (P

Ovarian adult granulosa cell tumors are relatively rare low-grade malignant tumor. Metastasis of granulosa cell tumors often happens a long interval after initial surgical resections. This could lead to diagnostic difficulties due to loss of clinical follow up and lack of detailed clinical history. We present 2 cases of metastatic granulosa cell tumor to the lung, pleura, and mediastinum 11 and 25 years respectively after resection of primary tumors. The first case was a 67-year-old woman presented with a large mediastinal mass who underwent surgical resection with a clinical impression of thymoma. The tumor was largely necrotic, and focal viable tumor was composed of epithelioid cells with pale eosinophilic cytoplasm, irregular nuclei, and rare grooved nuclei. No typical Call-Exner body was identified. The histological differential diagnosis was broad, and a metastatic tumor was highly suspected. Additional clinical information was requested; it revealed a history of left ovarian mass with a diagnosis of adult granulosa tumor 11 years ago. The mediastinal tumor was confirmed to be adult granulosa cell tumor by immunohistochemistry. The second case involves a 74-year-old woman who presented with left pleural effusion and a large subpleural lung mass, with biopsy demonstrating classic histological features of adult granulosa cell tumor. She had bilateral salpingo-oophorectomy 25 years ago, so diagnostic details of the ovarian lesion were unavailable. Adult granulosa cell tumor can present as late metastasis at unusual locations. The possibility of metastatic granulosa tumors should always be kept in mind, and clinical history is critical to promote an accurate diagnosis of late onset metastatic granulosa cell tumor.

Intraductal proliferative disease of the breast is a group of very diverse lesions different in morphology, molecular changes, and risk of subsequent cancer risk. They tend to have similar clinical presentation, that is, no clinical symptom and mammographic findings unless they are associated with microcalcifications. Since they carry significantly different risk of subsequent development of invasive cancer, the clinical management is very different among them. Thus, understanding the clinical significance and making a correct diagnosis for each of these lesions are critical for all practicing pathologists.

We have found earlier that Tubastatin A (TubA), a selective inhibitor of histone deacetylase 6 (HDAC6), improves survival in a mouse model of lethal cecal ligation and puncture (CLP)-induced sepsis. However, the underlying mechanisms have not been fully established. This study sought to test the hypothesis that TubA could affect both lung and splenic function. C57BL/6J mice were subjected to CLP, and randomized to receive either TubA (70 mg/kg) dissolved in dimethyl sulfoxide (DMSO), or DMSO alone, 1 hour following CLP. Sham animals acted as a control. Twenty-four hours later, lung tissue was harvested for pathological examination, and splenic tissue was harvested for bacterial colonization. In a parallel study, the spleen was collected 48 hours following CLP, and single cell suspension was prepared. Splenocytes then underwent flow cytometry to analyze the immune cell population. RAW264.7 macrophages were treated with lipopolysaccharide (LPS) with or without the presence of TubA (10 μΜ) at 37°C for 3h to assess the effect on macrophage phagocytosis. We found that acute lung injury secondary to lethal sepsis was attenuated by TubA. Treatment with TubA restored the percentage of B lymphocytes, and significantly increased percentages of innate immune cells and macrophages compared to the vehicle-treated CLP group. Moreover, TubA significantly decreased the bacterial load in spleen, and improved the phagocytic ability of RAW264.7 murine macrophages in vitro. Such findings may help to explain the beneficial effects of TubA treatment in a model of lethal sepsis, as previously reported.

Hemorrhage is a common cause of death in the battlefield. Valproic acid (VPA) has been associated with improved outcomes in multiple models of trauma, when combined with isotonic fluid resuscitation. However, isotonic fluid administered in this setting is logistically impractical and may be associated with complications. In this study, we sought to evaluate the feasibility and immunologic impact of combining VPA treatment with low-volume hypertonic saline (HTS). In vivo: female Yorkshire swine were subjected to hemorrhage (40% total blood volume) and polytrauma (rib fracture and delayed liver injury). Animals were kept in shock for 30 minutes and resuscitated with (1) normal saline (NS, 3× hemorrhaged volume), (2) HTS (7.5% saline, 4 mL/kg), or (3) HTS + VPA (4 mg/kg; 150 mg/kg; n = 3/cohort). After 18 hours of observation, animals were euthanized and the lungs evaluated for acute injury and expression of myeloperoxidase (MPO) and caveolin-1 (Cav-1). In vitro: human umbilical vein endothelial cells (HUVECs) were exposed to anoxic conditions (5% CO2, 95% N2) for 16 hours in (1) normosmotic, (2) hyperosmotic (400 mOsm), or (3) hyperosmotic + VPA (4 mM) media. Immunohistochemistry and Western blots were performed to determine Cav-1 expression. Lungs from VPA-treated animals demonstrated decreased acute injury, MPO expression, and endothelial expression of Cav-1 when compared to lungs from animals resuscitated with NS or HTS alone. Similarly, HUVECs cultured in hyperosmotic media containing VPA demonstrated decreased expression of Cav-1. This study demonstrates that combined treatment with VPA and HTS is a viable strategy in hemorrhagic shock and polytrauma. Attenuation of lung injury following VPA treatment may be related to modulation of the inflammatory response.

Hemorrhagic shock (HS) can initiate an exaggerated systemic inflammatory response and multiple organ failure, especially if followed by a subsequent inflammatory insult ("second hit"). We have recently shown that histone deacetylase inhibitors can improve survival in rodent models of HS or septic shock, individually. In the present study, we examined whether valproic acid (VPA), a histone deacetylase inhibitor, could prolong survival in a rodent "two-hit" model: HS followed by septic shock from cecal ligation and puncture (CLP).Male Sprague-Dawley rats (250-300 g) were subjected to sublethal HS (40% blood loss) and then randomly divided into two groups (n = 7/group): VPA and control. The VPA group was treated intraperitoneally with VPA (300 mg/kg in normal saline [NS], volume = 750 μL/kg). The control group was injected with 750 μL/kg NS. After 24 h, all rats received CLP followed immediately by injection of the same dose of VPA (VPA group) or NS (vehicle group). Survival was monitored for 10 days. In a parallel study, serum and peritoneal irrigation fluid from VPA- or vehicle-treated rats were collected 3, 6, and 24 h after CLP, and enzyme-linked immunosorbent assay was performed to analyze myeloperoxidase activity and determine tumor necrosis factor α and interleukin 6 concentrations. Hematoxylin-eosin staining of lungs at 24-h time point was performed to investigate the grade of acute lung injury.Rats treated with VPA (300 mg/kg) showed significantly higher survival rates (85.7%) compared with the control (14.3%). Moreover, VPA significantly suppressed myeloperoxidase activity (marker of neutrophil-mediated oxidative damage) and inhibited levels of proinflammatory cytokine tumor necrosis factor α and interleukin 6 in the serum and peritoneal cavity. Meanwhile, the severity of acute lung injury was significantly reduced in VPA-treated animals.We have demonstrated that VPA treatment improves survival and attenuates inflammation in a rodent two-hit model.

Quantitative image analysis of histopathology slides is becoming an important technology in diagnostic pathology. To this end, it is essential to combine a robust image analysis software with the most commonly used immunohistochemical staining methods. In this investigation, we describe a practical application of NIH ImageJ software for quantitative vascular image analysis for diaminobenzene chromogen-based CD34 immunostain in breast cancer. CD34 immunostain is in a unique position to identify lymphangiogenesis and angiogenesis simultaneously in a given tumor tissue. This investigation aims at establishing a practical quantitative vascular image analysis solution for diagnostic pathologists by using ImageJ, and CD34 immunostain.Tissue microarray slides containing breast cancer tissue were immunostained for CD34 for simultaneous identification of lymphatic endothelial cells (LEC) and blood vessel endothelial cells (BEC). Digital images were analyzed using NIH ImageJ software. A CD34 score was quantified for each tissue core as a percentage (CD34-positive area/area of tissue core). The mean CD34 scores were 0.24%, 0.40%, 1.30%, 2.33%, 2.64%, and 3.44% for normal breast tissue, in stage IIA, IIB, IIIA, IIIB, and IIIC breast cancer tissue cores, respectively (p0.0001). The mean CD34 scores were 0.70% and 2.21% for lymph node-negative and lymph node-positive breast cancer patients, respectively (p0.0001).ImageJ software seems to be an attractive quantitative image analysis tool for diagnostic pathology for immunohistochemistry-based applications because of its capabilities, availability, and ease of use with most image formats. Our results show the feasibility, versatility, and ease of use of ImageJ and CD34 immunohistochemistry for vascular image analysis in breast pathology. Given the prospects of novel lymphatic and vascular endothelium-targeting therapeutics in breast oncology, the practical analysis of combined LEC and BEC density described in this report could enable diagnostic pathologists to apply quantitative vascular image analysis easily in their pathology practice and translational research.

The walls of angiogenic blood vessel capillaries are composed of two principal cell types, blood vessel endothelial cells (BEC) and pericytes (PC), whereas the walls of lymphatic capillaries are composed of lymphatic endothelial cells (LEC). In this investigation we describe a practical application of NIH ImageJ software for quantitative image analysis for pericytes and endothelial cells in prostate cancer. We used a tissue microarray that contained 49 tissue cores (normal prostate tissue or prostatic carcinomas with Gleason scores of 6 through 10). These prostate cancer samples represented AJCC prognostic stages II, III, and IV. Slides were immunostained with anti-PDGFR-β antibody for identification of PC, and quantified as microvascular pericyte density (MVPD); they were also immunostained with anti-CD34 antibody for identification of LEC and BEC simultaneously, and quantified as microvascular endothelial density (MVED). CD31 and D2-40 immunostains were used to quantify BEC and lymphatic endothelial cells, respectively. Our results showed higher MVPD and MVED in prostate cancers with higher Gleason scores and higher stages, suggesting the prognostic utility of vascular image analysis in prostate pathology. This investigation demonstrates the feasibility, versatility, and ease of use of ImageJ software and pericyte-specific and endothelial-specific immunohistochemistry for quantitative image analysis in prostate pathology.

BACKGROUND We recently discovered that Tubastatin-A, a histone deacetylase (HDAC6) inhibitor, can improve survival in a rodent model of hemorrhagic shock (HS), but mechanisms remain poorly defined. In this study, we investigated whether Tubastatin-A could protect intestinal tight junction (TJ) in HS. METHODS In an in-vivo study with Wistar-Kyoto rats, the rats underwent HS (40% blood loss) followed by Tubastatin-A (70 mg/kg) treatment, without fluid resuscitation. The experimental groups were (1) sham (no hemorrhage, no treatment), (2) control (hemorrhage, without treatment), and (3) treatment (hemorrhage with Tubastatin-A administration). Six hours after hemorrhage, ileum was harvested. Whole cell lysate were analyzed for acetylated α-tubulin (Ac-tubulin), total tubulin, acetylated histone 3 at lysine 9 (Ac-H3K9), β-actin, claudin-3 and zonula occludens 1 (ZO-1) proteins by Western blot. Histological effects of Tubastatin-A on small bowel were examined. In an in-vitro study, human intestinal epithelial cells (Caco-2) were divided into three groups: (1) sham (normoxia), (2) control (anoxia, no treatment), and (3) treatment (anoxia, treatment with Tubastatin-A). After 12 hours in an anoxia chamber, the cells were examined for Ac-tubulin and Ac-H3K9, cellular viability, cytotoxicity, claudin-3 and ZO-1 protein expression, and transwell permeability study. RESULTS Tubastatin-A treatment significantly attenuated HS-induced decreases of Ac-tubulin, Ac-H3K9, ZO-1 and claudin-3 proteins in small bowel in-vivo (p < 0.05). In cultured Caco-2 cells, anoxia significantly decreased cellular viability (p < 0.001) and increased cytotoxicity (p < 0.001) compared to the sham group, while Tubastatin-A treatment offered significant protection (p < 0.0001). Moreover, expression of claudin-3 was markedly decreased in vitro compared to the sham group, whereas this was significantly attenuated by Tubastatin-A (p < 0.05). Finally, anoxia markedly increased the permeability of Caco-2 monolayer cells (p < 0.05), while Tubastatin-A significantly attenuated the alteration (p < 0.05). CONCLUSION Inhibition of HDAC6 can induce Ac-tubulin and Ac-H3K9, promote cellular viability, and prevent the loss of intestinal tight junction proteins during HS and anoxia.

Mammary Paget disease (MPD) is considered an intraepidermal manifestation of an underlying mammary carcinoma. In contrast to extramammary Paget disease, invasion of mammary Paget cells into the dermis (invMPD) has not been reported, except for 2 cases described in Rosen's textbook. Our study was designed to identify the presence of dermal invasion of mammary Paget cells and characterize the associated clinicopathologic features. Slides from 146 MPD patients were retrieved. Six cases of invMPD were identified. One case of invMPD was not associated with an underlying breast cancer, 1 was associated with invasive ductal carcinoma (IDC), 1 with ductal carcinoma in situ (DCIS) with microinvasion, and 3 with DCIS only. The underlying breast carcinomas was separate from the area of invMPD. The depth of invasion, measured from the dermal-epidermal junction to the focus of deepest invasion, ranged from 0.02 to 0.9 mm. The horizontal extent ranged from 0.01 to 4.0 mm. Lymph node with isolated tumor clusters was present in case 1, which had no underlying carcinoma but had the greatest extent of invasion, and in case 3, which had DCIS with microinvasion. One patient (case 1) died of unrelated causes 2 years later, and the remaining patients were alive without disease at last follow-up. In summary, we describe 6 cases of MPD with invasion of Paget cells into the dermis and provide histopathologic criteria for the diagnosis of this rare and underrecognized entity. Further studies are required to determine whether invasion in MPD has clinical significance.

520Background: I-SPY2 is a multicenter phase 2 trial in high risk stage II/III breast cancer (BC) using adaptive randomization within biomarker subtypes to evaluate novel treatment agents added to ...

Sepsis, a systemic inflammatory response syndrome caused by severe infection, is still a tremendous burden for health-care systems and results in more than 225,000 deaths annually in the United States1. No pharmacological agents have been shown to effectively change the outcomes2. Acetylation of histone is an important epigenetic mechanism that governs amplitude of the immune signaling by controlling the chromatin structure, accessibility of transcription factors to DNA, and gene transcription. Regulation of this process needs the opposing actions of two families of enzymes: histone acetyltransferases (HATs) and histone deacetylases (HDACs). It is found that dysregulated HDAC activity is linked to the pathogenesis of inflammatory and autoimmune diseases3. So far, 18 HDAC isoforms have been identified in humans and mice and grouped into four classes 4. Classical HDACs (class I, II and IV) are Zn2+ dependent hydrolases, while the class III sirtuins are NAD+-dependent. Class I HDACs (HDAC1, 2, 3 and 8) play a role in cell survival and proliferation. Class II HDACs, subdivided into class IIa (HDAC4, 5, 7 and 9) and IIb (HDAC6 and 10) based on domain organization 5, may have tissue-specific roles 6. Recently, HDAC6 has become an important target for anti-cancer drug development, and inhibition of HDAC6 was also shown to have therapeutic potential to ameliorate injury of central nervous system7. MS-275 is a HDAC class I inhibitor with selectivity for HDAC1, 2, and 3. Tubastatin A is a newly synthesized selective inhibitor of HDAC class IIb with high selectivity for HDAC6 8. Suberoylanilide hydroxamic acid (SAHA, vorinostat) is a broad-spectrum histone deacetylase inhibitor (HDACI) with a selectivity for HDAC1, 2, 3 and 6 9. Our laboratory has previously demonstrated that administration of SAHA improves survival in rodent models of lipopolysaccharided (LPS)-induced endotoxemia and cecal ligation and puncture (CLP)-induced septic shock 10, 11. However, this HDACI was also found to increase host susceptibility to bacterial infection due to cell apoptosis 12. We hypothesized that targeting different HDACs could have different effect on animal survival in a mouse model of cecal ligation and puncture (CLP)-induced sepsis. In the present study, we first determined that inhibitor of HDAC6 (Tubastatin A) rather than that of HDAC1, 2, and 3 significantly prolonged animal lives in the CLP model. We then assessed impact of HDAC6 inhibition on production of some key pro-inflammatory cytokines, organ (liver) injury, and immune cell apoptosis. Our findings suggested that selective inhibition of HDAC6 has a substantial advantage for sepsis treatment.

Juxtaglomerular cell tumor is a rare renal neoplasm arising from the juxtaglomerular apparatus. Approximately 70 cases have been reported in the English literature since it was first described by Robertson et al in 1967. This tumor has been considered benign and resection has so far been curative. In this paper, we report the first metastatic juxtaglomerular cell tumor. The 15-cm tumor occurred in the right kidney of a 46-year-old man. It invaded the renal vein, and was treated by radical nephrectomy in 1995. The diagnosis at that time was renal cell carcinoma. The patient was well for 6 years and then developed bilateral lung masses, which were resected. Microscopically, the tumors from the kidney and the lungs were similar, consisting of solid sheets of uniformly round-to-polygonal cells intermixed with abundant delicate vasculature. Both renal and pulmonary tumors were positive for vimentin, renin, and only focally to CD34. Electron microscopic studies performed on the paraffin-embedded renal tumor and formalin-fixed lung tumor revealed the typical rhomboid crystals of proto-renin. In consideration of the characteristic morphologic features, immunohistochemistry, and the presence of rhomboid crystals of proto-renin, the diagnosis was modified to malignant juxtaglomerular cell tumor.

Hemorrhagic shock (HS) is the foremost etiology of early deaths in trauma patients, whereas infections remain the leading cause of late morbidity and mortality. Patients who survive the initial hemorrhage often pass through periods of systemic inflammatory response syndrome (SIRS) and immune dysfunction where they die of infectious complications.1 This combined (“two-hit”) insult creates an exaggerated injury pattern that can lead to multiple-organ failure.2 Goal-directed resuscitation remains important in the management of these patients, but what exactly is the most appropriate early resuscitation strategy remains controversial.3,4 Although fluids are capable of restoring intravascular volume, they have been implicated in worsening of the postshock inflammatory response.4–6 Compared with conventional isotonic crystalloids (such as isotonic sodium choride solution [ISCS]), hypertonic saline (HTS) has several theoretical advantages, including more effective expansion of intravascular volume and a blunting of the inflammatory response.3–5,7,8 However, the largest and the most recent randomized clinical trial has failed to show an overall survival advantage in the patients that were resuscitated with hypertonic fluid.9 In fact, this trial was stopped ahead of schedule owing to an increase in early deaths in the hypertonic group.10 The pathophysiology of sepsis is classically attributed to hyperinflammatory responses that mediate the excessive production of cytokines, which can lead to cellular injury and organ dysfunction.11 We now know that trauma, even in the absence of sepsis, can cause inflammation through multiple mechanisms.12,13 This sterile inflammation/SIRS is often clinically indistinguishable from its infectious counterpart (sepsis and septic shock).14 Traditional treatment strategies have largely been supportive, but recent research has focused on developing more specific treatments that normalize the underlying affected pathways.15 We have shown that shock alters the acetylation status of the cell, which in turn impairs gene transcription and the function of multiple cell survival pathways.16 Acetylation is a rapid and reversible posttranslational protein modification that is controlled by two opposing enzyme families, histone deacetylases (HDACs) and histone acetyl transferases. The balance of acetylation in a cell can be therapeutically altered by a class of drugs called HDAC inhibitors (HDACIs). HDACs remove acetyl groups from lysine residues of the target proteins, and treatment with their inhibitors (HDACIs) can tilt the balance in favor of histone acetyl transferases. This results in increased acetylation, which has been shown to regulate numerous biologic functions, including inflammation and immune responses.15,16 At the molecular level, it has been reported that both hemorrhage and sepsis lead to an imbalance in protein acetylation and that treatment with HDACIs can restore this balance and improve outcomes.17,18 Recently, our team has demonstrated that treatment with a large dose (300 mg/kg) of valproic acid (VPA), which works as an HDACI, can significantly decrease inflammation and improve survival in a lethal two-hit rodent model of hemorrhagic and septic shock (data presented at the 92nd annual meeting of the New England Surgical Society, September 2011). Although effective, this high dose of VPA is associated with increased chances of toxicity, which has prompted us to explore various strategies that could lower the effective dose of the drug. One such approach is to combine VPA with another anti-inflammatory agent, such as HTS, to see if the prosurvival benefits could be achieved at a lower dose. In the present study, we tested the hypothesis that VPA and HTS would work synergistically to attenuate inflammation and improve survival in a rodent two-hit model: HS followed by septic shock from cecal ligation and puncture (CLP).

The walls of angiogenic blood vessel capillaries are composed of two principal cell types, blood vessel endothelial cells (BEC) and pericytes (PC), whereas the walls of lymphatic capillaries are composed of lymphatic endothelial cells (LEC). In this investigation we describe a practical application of NIH ImageJ software for quantitative image analysis for pericytes and endothelial cells in prostate cancer. We used a tissue microarray that contained 49 tissue cores (normal prostate tissue or prostatic carcinomas with Gleason scores of 6 through 10). These prostate cancer samples represented AJCC prognostic stages II, III, and IV. Slides were immunostained with anti-PDGFR-β antibody for identification of PC, and quantified as microvascular pericyte density (MVPD); they were also immunostained with anti-CD34 antibody for identification of LEC and BEC simultaneously, and quantified as microvascular endothelial density (MVED). CD31 and D2-40 immunostains were used to quantify BEC and lymphatic endothelial cells, respectively. Our results showed higher MVPD and MVED in prostate cancers with higher Gleason scores and higher stages, suggesting the prognostic utility of vascular image analysis in prostate pathology. This investigation demonstrates the feasibility, versatility, and ease of use of ImageJ software and pericyte-specific and endothelial-specific immunohistochemistry for quantitative image analysis in prostate pathology.

Ozone-induced lung injury in rats is focal, with the primary target sites being the distal trachea and the central acinus. In both areas, ozone causes cellular injury and necrosis after shortterm exposures, but the areas become tolerant to further injury after long-term exposure. To investigate the role of antioxidant enzymes in the resistance of the lung to injury from long-term ozone exposure, we measured activities of three antioxidant enzymes in airway samples microdissected from specific sites within the lung: distal trachea, lobar bronchi, major daughter axial bronchi, minor daughter bronchi, distal bronchiole, and parenchyma. Fischer 344 rats were exposed to 0, 0.5, and 1 ppm ozone 6 hr/day, 5 days/week for 20 months, or to 0, 0.12, and 1 ppm for 90 days. Glutathione transferase, glutathione peroxidase, and superoxide dismutase activities were measured at the end of the exposure periods. Data were normalized for DNA content (Units/mg DNA). For both the 90-day and 20-month exposures, the activities of all three enzymes were significantly elevated in a concentration-dependent fashion in the distal bronchioles. Compared to controls, animals exposed to 1.0 ppm ozone had superoxide dismutase activities 1.6× (90 days) and 2× (20 months) greater; glutathione peroxidase had activities 1.4× (90 days) and 1.6× (20 months) greater; and glutathione S -transferase had activities 1.5× (90 days and 20 months) greater. In animals exposed for 90 days, superoxide dismutase activity was lower in major daughter bronchi and greater in minor daughter bronchi and glutathione peroxidase activity was lower in major daughter bronchi. After 20 months of exposure, superoxide dismutase activity was significantly elevated in a dose-dependent fashion in the distal trachea; glutathione peroxidase activity decreased in the major daughter bronchi and increased in the minor daughter bronchi; and glutathione S -transferase activity decreased in the major daughter bronchi. There were no changes in antioxidant enzyme levels in other subcompartments. Superoxide dismutase activity increased in a concentration-dependent fashion in the whole lung homogenate of animals exposed for 90 days, but no differences were detected in whole lung homogenates of any other exposure groups. We conclude that (1) antioxidant enzyme activities are altered on a site-specific basis in response to long-term exposure to ozone; (2) the antioxidant enzymes respond differently in different lung subcompartments; (3) activities determined for the whole lung do not reflect changes in subcompartments with variable susceptibility to injury; and (4) changes in antioxidant enzyme activities are concentration-dependent and altered by length of exposure.

Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of extranodal diffuse large Bcell lymphoma with only a few more than 300 cases reported. It is characterized as lymphoma cells confined to the lumina of small vessels, so patients usually do not present with masses or lymphadenopathy. Clinical presentations of these patients are non-specific and the pathologic changes may be subtle, which often leads to delayed diagnoses and, in many instances, a postmortem diagnosis. IVLBCL can essentially involve the vessels of any organ, but it is quite rare for the gallbladder to serve as the initial presenting site; there are only four such cases reported in the English literature. Furthermore, IVLBCL of the gallbladder with peripheral blood involvement is even less common. We report a recent case of IVLBCL presenting as acute cholecystitis and pancytopenia. The patient underwent a simple cholecystectomy. Examination of the gallbladder showed clusters of large lymphoma cells within lumina of small vessels in the gallbladder wall. These cells were positive for CD5/CD20 and negative for CD3, CD10, and TdT. Based on these findings, a diagnosis of IVLBCL was made. Coincidently, circulating lymphoma cells were identified in the peripheral blood and confirmed by flow cytometric analysis (positive for CD19/CD20/CD5, without light chain expression). The patient was started on chemotherapy but subsequently died of chemotherapy related multi-organ failure 10 days after the initial diagnosis.

Epstein-Barr virus (EBV) - associated smooth muscle tumors (EBV-SMT) are a rare, recently recognized distinct group of mesenchymal tumors that develop exclusively in patients with immunosuppression. It is believed that tumorigenesis is, at least in part, through the activation of the Akt/mammalian target of rapamycin (mTOR) signal pathway. We describe the clinicopathologic and immunohistochemical features of a multifocal hepatic EBV-SMT in a 34-year-old acquired immunodeficiency syndrome (AIDS) patient and investigate the activation status of the mTOR signal pathway in this tumor. In addition, we provide a review of the literature on the clinicopathologic findings of hepatic EBV-SMT in adult AIDS patients, and discuss their biologies and possible therapeutic strategies.

Antioxidant enzymes including catalase, superoxide dismutase, glutathione peroxidase, and glutathione S-transferases are thought to be the primary cellular defense against reactive oxygen species. Since pulmonary injury produced by oxidant air pollutants like ozone is highly focal, involving primarily the trachea and centriacinar areas of the lung, measurements of alterations in antioxidant enzyme activities in whole lung may substantially underestimate changes occurring in target areas of the respiratory tract. We have applied a technique for preparation of lung specimens from well-defined anatomic locations to determine whether the focal injury associated with ozone exposure is related to an uneven distribution of antioxidant enzyme activity in the respiratory tract. Our study compared enzyme activities in rat and monkey, species which differ considerably in sensitivity to ozone-induced injury (monkey > rat). The activities of glutathione S-transferase varied less than twofold between different airway subcompartments for both the rat and monkey. Pulmonary veins had approximately 50% of the activity of airways in both species. Glutathione peroxidase activity was slightly higher in proximal compared to distal airways of the rat but was evenly distributed at all airway levels in the monkey. In both species, activity in pulmonary veins was lower than that in airways. The activity of superoxide dismutase was similar in rat and monkey and marked differences were not observed in the various subcompartments studied. Similarly, catalase activity was relatively evenly distributed in rat airways but, in the monkey, the distal bronchiole and lobar bronchus had marginally higher activity than the trachea. We conclude that: (1) measurement of antioxidant enzyme activities in anatomic subcompartments within the lung is feasible using microdissected specimens, (2) antioxidant enzyme activity can vary in different subcompartments of the lung of the same species, (3) the pattern of variation in enzyme activity differs by the enzyme and by species, and (4) species and subcompartment differences in ozone injury are not due primarily to differences in the distribution of antioxidant enzyme activity.

Human papilloma virus (HPV) infection of the uterine cervix is linked to the pathogenesis of cervical cancer. Preclinical in vitro and in vivo studies using HPV-containing human cervical carcinoma cell lines have shown that the mammalian target of rapamycin (mTOR) inhibitor, rapamycin, and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor, erlotinib, can induce growth delay of xenografts. Activation of Akt and mTOR are also observed in cervical squamous cell carcinoma and, the expression of phosphorylated mTOR was reported to serve as a marker to predict response to chemotherapy and survival of cervical cancer patients. Therefore, we investigated: a) the expression level of EGFR in cervical squamous cell carcinoma (SCC) and high-grade squamous intraepithelial lesions (HSIL) versus non-neoplastic cervical squamous epithelium; b) the state of activation of the mTOR pathway in these same tissues; and c) any impact of these signal transduction molecules on cell cycle. Formalin-fixed paraffin-embedded tissue microarray blocks containing 20 samples each of normal cervix, HSIL and invasive SCC, derived from a total of 60 cases of cervical biopsies and cervical conizations were examined. Immunohistochemistry was utilized to detect the following antigens: EGFR; mTOR pathway markers, phosphorylated (p)-mTOR (Ser2448) and p-p70S6K (Thr389); and cell cycle associated proteins, Ki-67 and S phase kinase-associated protein (Skp)2. Protein compartmentalization and expression were quantified in regard to proportion (0-100%) and intensity (0-3+). Mitotic index (MI) was also assessed. An expression index (EI) for pmTOR, p-p70S6K and EGFR, respectively was calculated by taking the product of intensity score and proportion of positively staining cells. We found that plasmalemmal EGFR expression was limited to the basal/parabasal cells (2-3+, EI = 67) in normal cervical epithelium (NL), but was diffusely positive in all HSIL (EI = 237) and SCC (EI 226). The pattern of cytoplasmic p-mTOR and nuclear p-p70S6K expression was similar to that of EGFR; all showed a significantly increased EI in HSIL/SCC versus NL (p

Senescence and apoptosis are two key mechanisms that protect against cancer development. Many cell cycle regulators, such as p14(ARF), p15(INK4b) and p16(INK4a), are important in G1 cell cycle arrest and oncogene-induced senescence. The bcl-2 protein is one of the key components that control apoptosis, while the p53 protein plays key roles in both mechanisms. The genes of these key regulator proteins are often mutated or deleted in various malignancies. It is unknown how senescence and apoptosis are regulated in one of the most common tumors of the female genital tract, cervical squamous cell carcinoma (SCC). In this study the, expression of senescence, apoptosis and proliferation markers in normal cervical epithelium, cervical intraepithelial neoplasia (CIN) and SCC are characterized via immunohistochemical staining for p14(ARF), p15(INK4b), p16(INK4a), bcl-2, p53 and Ki-67 in tissue microarray blocks containing 20 samples each of normal cervix, moderate-to-severe cervical dysplasia (CIN II-III) and invasive SCC. Samples are derived from 60 total cases of cervical biopsies and cervical conizations. Results showed that the proliferation marker, Ki-67, is markedly increased, and the senescence markers, p15(INK4b), p16(INK4a) and p14(ARF) are overexpressed in both dysplasia and carcinoma. P53 immunostain is negative in all normal cervical tissue, and positive in dysplasia and carcinoma. Although the expression of bcl-2 is increased in dysplasia, this marker is negative in approximately half of SCC cases. These results suggest that some senescence pathways are activated and are still maintained in cervical dysplasia and carcinoma. However proliferation is increased and carcinogenesis is not thwarted, leading to eventual development of cervical cancer. Other mechanisms, such as those that account for the apparent overexpression of p53 and paradoxical loss of bcl-2 expression in some SCC cases, as well as additional senescence and apoptotic pathways, may play key roles carcinogenesis of cervical SCC.

regulated expression of cyclin D1, a downstream target of Wnt signaling. In contrast, Wnt agonist treatment restored beta-catenin and cyclin D1 levels in the lungs and liver. This was associated with a reduction of myeloperoxidase (MPO) activity and IL-6 mRNA in the lungs following treatment (Table), as well as an improvement in a lung histologic injury index. Also, Wnt agonist treatment increased Bcl-2 expression, while it inhibited the degradation of caspase-3 in the lungs.

The current studies were designed to test two hypotheses: (1) differences in steady-state reduced glutathione levels are responsible for subcompartment differences in susceptibility to acute ozone injury, and (2) elevation of reduced glutathione concentrations accounts for the tolerance to further injury produced by repeated ozone exposure. Glutathione was measured in well-defined subcompartments of the lung of both rats and monkeys to compare alterations occurring in both target (distal trachea and terminal bronchiole) and nontarget areas (lobar bronchus, major daughter, minor daughter bronchus, and parenchyma) of the lung in species that differ in sensitivity to ozone exposure (rat is less susceptible than monkey). Glutathione concentrations were decreased in trachea of rats exposed to 0.4 ppm ozone for 2 h and increased in lobar bronchus and distal bronchiole after 2 h exposure at 1 ppm. In monkey, glutathione levels in most subcompartments were not altered by either 0.4 or 1.0 ppm ozone exposure for 2 h. The exceptions were the major daughter subcompartment (200% of control at 0.4 ppm exposure) and the distal bronchiole (55% of control at 1 ppm exposure). Ninety day ozone exposures (6 h/day x 5 days/week) in rats produced an elevation in glutathione (164% of control value) only in distal bronchiole at the 1 ppm exposure level. In a similar manner, glutathione levels in the distal bronchiole of monkeys exposed for 90 days to 1 ppm O3 were 165% of the corresponding control values. These results suggest the following: glutathione levels in target and nontarget areas of the lung and in susceptible versus less susceptible species are not the primary determinant in the differences observed in ozone toxicity; the response of lung subcompartments to short-term ozone exposure varied depending on airway subcompartment and species; increased glutathione levels may be one reason for adaptation of some airway epithelial cells from rats and monkeys exposed to O3 for long periods; and use of well-defined segments of the lung provides a means of assessing changes in target areas of the lung without dilution from nontarget areas.

The prevalence of malignant paragangliomas is approximately 10% and is defined by the presence of metastases. Differential diagnosis includes hepatic tumors, alveolar soft part sarcoma, melanoma, glomus tumors, vascular neoplasms, and primary or metastatic carcinomas with endocrine or nonendocrine phenotype. Increasingly, fine-needle aspiration (FNA) is being used to evaluate primary and potential metastatic lesions. We describe a recent case …

e15538 Background: Ovarian cancer is one of the leading causes of increased morbidity and mortality worldwide. The fluid content of the cystic ovarian tumors has never been thoroughly analyzed. It is hypothesized that the fluid contents of the ovarian cystic tumors have procoagulant effects. Methods: Under an institutionally approved protocol, cystic fluids from ovarian neoplasms were collected (n=28) and analyzed to determine their procoagulant potential. Assays such as Thrombelastography (TEG, Helige, Germany), Platelet aggregometry (BioData, Horsham, PA), Fibrinopeptide A (FPA, Dade Behring, Marburg, Germany), Thrombin Antithrombin Complex (TAT, Dade Behring), and Zymuphen Platelet Microparticle Activity Assay (Hyphen BioMed, Neuville-Sur-Oise, France). Cerebral Array II (Randox, Crumlin, CO) was used to determine the levels of C-reactive protein (CRP), D-Dimer, Neuron Specific Enolase (NSE), Neutrophil Gelatinase-Associated Lipocalin (NGAL), soluble Tumor Necrosis Factor Receptor I (TNFRI) and Thrombomodulin. Results: The TEG parameters such as r- time, rk-time, k-time, MA, and angle were measured to be 17 , 22 , 5 , 54 mm, 55° with clear cell carcinoma, 18 , 24 , 6 , 58 , 54° with benign serous cyst compared to saline control values of 23 , 30 , 7 , 41 mm and 48° respectively. Platelet aggregometry showed increased aggregations when cystic fluids were supplemented in donor platelet rich plasma. The levels of Fibrinopeptide A were in the range of 24.1 and 56.6 ng/ml compared to a control value of 1.8 ng/ml. The TAT complexes were in the range of 6.7- 175 µg/ml compared to a control value of 0.7 ug/ml. The platelet microparticle measurements were markedly increased and were in the range of 10-45 nM for benign and malignant cystic fluids, compared to control values in the range of 2.3-6.6 nM. The results of CRP, D-Dimer, NSE, NGAL, TNFRI and TM were 9.28 mg/m (Normal=5.03) , >2000 ng/ml (N=227.34) , >120 ng/ml (N=10.50), >1229 ng/ml (N=228.16), 3.98 ng/ml (5.91) and 13.55 ng/ml (N=13.55) respectively. Conclusions: Benign ovarian tumors have prothrombogenic activity as much as the malignant tumors. Early surgical evaluation of clinically silent benign ovarian tumors should be considered.