Interleukin-34 is present at the fetal-maternal interface and induces immunoregulatory macrophages of a decidual phenotype in vitro.

STUDY QUESTION: Is the newly discovered cytokine interleukin (IL)-34 expressed at the human fetal-maternal interface in order to influence polarization of monocytes into macrophages of a decidual immunoregulatory phenotype? SUMMARY ANSWER: IL-34 was found to be present at the fetal-maternal interface, in both fetal placenta and maternal decidua, and it was able to polarize monocytes into macrophages of a decidual phenotype. WHAT IS KNOWN ALREADY: IL-34 was shown to bind to the same receptor as macrophage-colony stimulating factor (M-CSF), which has an important immunomodulatory role at the fetal-maternal interface, for example by polarizing decidual macrophages to an M2-like regulatory phenotype. IL-34 is known to regulate macrophage subsets, such as microglia and Langerhans cells, but its presence at the fetal-maternal interface is unknown. STUDY DESIGN, SIZE, DURATION: The presence of IL-34 at the fetal-maternal interface was evaluated by immunohistochemistry (IHC) and ELISA in placental and decidual tissues as well as in isolated trophoblast cells and decidual stromal cells obtained from first trimester elective surgical terminations of pregnancy (n = 49). IL-34 expression was also assessed in third trimester placental biopsies from women with (n = 21) or without (n = 15) pre-eclampsia. The effect of IL-34 on macrophage polarization was evaluated in an in vitro model of blood monocytes obtained from healthy volunteers (n = 14). In this model, granulocyte macrophage-colony stimulating factor (GM-CSF) serves as a growth factor for M1-like polarization, and M-CSF as a growth factor for M2-like polarization. PARTICIPANTS/MATERIALS, SETTING, METHODS: First trimester placental and decidual tissues were obtained from elective pregnancy terminations. Placental biopsies were obtained from women with pre-eclampsia and matched controls in the delivery ward. Polarization of macrophages in vitro was determined by flow-cytometric phenotyping and secretion of cytokines and chemokines in cell-free supernatants by multiplex bead assay. MAIN RESULTS AND THE ROLE OF CHANCE: Our study shows that IL-34 is produced at the fetal-maternal interface by both placental cyto- and syncytiotrophoblasts and decidual stromal cells. We also show that IL-34, in vitro, is able to polarize blood monocytes into macrophages with a phenotype (CD14highCD163+CD209+) and cytokine secretion pattern similar to that of decidual macrophages. The IL-34-induced phenotype was similar, but not identical to the phenotype induced by M-CSF, and both IL-34- and M-CSF-induced macrophages were significantly different (P < 0.05-0.0001 depending on marker) from GM-CSF-polarized M1-like macrophages. Our findings suggest that IL-34 is involved in the establishment of the tolerant milieu found at the fetal-maternal interface by skewing polarization of macrophages into a regulatory phenotype. LIMITATIONS, REASONS FOR CAUTION: Although it is clear that IL-34 is present at the fetal-maternal interface and polarizes macrophages in vitro, its precise role in vivo remains to be established. WIDER IMPLICATIONS OF THE FINDINGS: The recently discovered cytokine IL-34 is present at the fetal-maternal interface and has immunomodulatory properties with regard to induction of decidual macrophages, which are important for a healthy pregnancy. Knowledge of growth factors related to macrophage polarization can potentially be translated to treatment of pregnancy complications involving dysregulation of this process. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by grants from the Medical Research Council (Grant K2013-61X-22310-01-04), the Research Council of South-East Sweden (FORSS), and the County Council of Östergötland, Sweden. No author has any conflicts of interest to declare.

Multiple variations in the paired arteries of the abdominal aorta.

Variations in the origin of arteries in the abdomen are very common. The arteries that show frequent variations include the celiac trunk, renal arteries, and gonadal arteries. We observed multiple variations in a 45-year-old male cadaver. The variations found on the left side were: one accessory renal artery, two testicular arteries, and middle suprarenal and inferior phrenic arteries that branched from the celiac trunk. On the right side, the inferior phrenic and middle suprarenal arteries arose from the right renal artery.

Coexisting tuberculosis and carcinoma of the colon.

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 +/- 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P less than 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 +/- 11 years vs 34 +/- 10 years, P less than 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.

Jejunogastric intussusception as a technique for in situ resection.

A technique for resection of irreducible, gangrenous jejunogastric intussusception is presented. In comparison with previously described resection procedures involving division of the stoma, dismantling of the gastrojejunostomy or higher gastrectomy, in situ resection is simple and safe.

Jejunogastric intussusception: therapeutic options.

Acute jejunogastric intussusception is a rare complication of gastric surgery. It presents considerable difficulties in diagnosis unless the index of suspicion is high. Four cases of acute retrograde jejunogastric intussusception are reported. They were managed surgically after diagnosis had been confirmed by upper gastrointestinal contrast studies. In situ resection of the distal portion of gangrenous intussusceptum was performed in one case, while the intussusception could be reduced manually in the other three cases. The importance of early diagnosis in preventing avoidable morbidity and mortality has been stressed. In situ resection is recommended as the method of choice for the management of irreducible, gangrenous intussusception.

A study on laboratory diagnosis of liver abscess in Pondicherry.

A study was carried out to evaluate the role of laboratory investigations for diagnosis of liver abscess from the year 1976 to 1981. Bacteriological, parasitological, serological, haematological, histopathological studies and liver function tests were carried out in 240 confirmed cases of liver abscess during the study period. Out of 219 cases, pus culture for pyogenic bacteria was positive in 68 cases (including 27 cases of secondary bacterial infection of amoebic liver abscess) and sterile in 151 cases. Ent histolytica was demonstrated in pus of 24 cases. The diagnostic titre of 1:128 and above was detected in 137 sera by isohaemagglutination test. The liver function tests were of limited value. Albumin globulin ratio was altered in 91.25% cases and there was moderate increase in the levels of alkaline phosphatase. Histopathological studies demonstrated Ent histolitica in 2 cases only. Changes characteristic of pyogenic liver abscess were observed in 6 cases. Rest showed no specific changes.

Management of 240 cases of liver abscess.

The clinical features and surgical management of 240 cases of liver abscess admitted during a period of five years are presented. Incidence of liver abscess was 0.20 per cent of hospital admissions. A peak age incidence in the 4th decade, male preponderance, pain and fever were the striking features. The majority of the abscesses were localised to a single lobe (90.0%). The abscess was sited in the right lobe in 75.1 per cent, in the left lobe in 18.3 per cent and in both lobes in 6.7 per cent. Elevation and limitation of movement of the right dome of the diaphragm was present in 89.5 per cent of cases. Depending upon therapeutic response, aspiration or/and surgical drainage was undertaken. Aspiration was done in 169 patients and surgical drainage in 63 patients. Management of pyogenic liver abscess included early operative intervention preceded by appropriate antibiotic therapy. Surgical intervention is required less often in amoebic abscess and is recommended only after amoebicidal therapy. Open drainage is recommended for the cases associated with complications, left lobe abscess and big abscess.

Effect of halothane anaesthesia on salivary elimination of paracetamol.

The effect of halothane anaesthesia on paracetamol elimination was studied in 6 male patients undergoing short surgical procedures. Seven males operated on for the same indications under epidural anaesthesia served as the control group. Paracetamol concentration in saliva was measured at intervals on the day before and after surgery. Paracetamol t1/2 significantly decreased from 2.1 to 0.96 h and clearance rate (CL) significantly increased from 8.7 to 17.0 ml min-1 kg-1, when compared with the preoperative values. The control group also showed a significant but smaller alteration in the parameters. The results suggest that halothane anaesthesia per se may enhance the hepatic metabolism of paracetamol.

Non-chromaffin, non-functioning retroperitoneal paragangliomas: a report of three additional cases with a review of the literature.

A review of the literature has revealed only 24 cases of retroperitoneal non-functional paraganglioma recorded up to the present date. This report presents three additional cases, in two of which metastasis had occurred at the time of surgery. The clinical presentation and the biological behaviour of these tumours are reviewed in detail, as also are recommendations regarding therapy.