Abnormal Tortuosity Research Articles

Unilateral cerebral arterial tortuosity: Associated with aneurysm occurrence, but potentially inversely associated with aneurysm rupture

PurposeTo investigate the association of tortuosity of the main cerebral arteries with intracranial aneurysm (IA) occurrence and rupture. To investigate the relationship between arterial tortuosity and aneurysm morphology as well as conventional risk factors of vascular diseases. MethodsThree subject groups were analyzed in this study: Patients with ruptured IAs, patients with unruptured IAs, and healthy subjects. The groups were matched by sex and age using tendency score matching. Their intracranial magnetic resonance angiography (MRA) images were collected retrospectively. The intracranial arterial structures were segmented from the MRA images. Arterial tortuosity was measured and statistically compared between the different subject groups and different vessels. Correlation analysis was conducted between arterial tortuosity and clinical risk factors as well as aneurysm morphology. Results120 patients were included in the study (average age: 67.5 years; 60% female), 40 for each group after matching. The tortuosity of the aneurysm-bearing artery was significantly greater than that of the contralateral artery in both the ruptured and unruptured IA groups (p < 0.001). There was no significant association between clinical risk factors (history of hypertension, hyperlipidemia, diabetes, smoking, and alcohol use) and arterial tortuosity. There were significant negative correlations between aneurysm-bearing artery tortuosity and aneurysm morphological features such as maximal diameter (p = 0.0011), neck diameter (p < 0.0001), maximum height (p = 0.0024), and size ratio (p = 0.0269). ConclusionThe occurrence of cerebral aneurysms correlates to increased unilateral arterial tortuosity, but the risk of aneurysm enlargement/rupturing decreases with greater arterial tortuosity. Abnormal tortuosity may be congenital as tortuosity has no clear connection with acquired common risk factors of vascular diseases.

Evaluation of cytokine profile of ejaculate in adolescents with varicocele

Varicocele is a vascular disease characterized by abnormal tortuosity and dilation of the veins in pampiniform plexus that drains the testis. Due to difficult outflow of blood via the altered veins, the intratesticular blood flow becomes impaired, leading to pathological changes in the testicular tissue caused by hyperthermia, ischemia, hypoxia and development of inflammatory reaction. Seminal plasma contains numerous proteins, molecules, a wide range of cytokines, chemokines, growth factors. Their properties and levels largely determine the stages of post-testicular maturation of spermatozoa. At the same time, cytokines are an integral part of the inflammatory effect and are synthesized by various immunocompetent cells present in the male reproductive tract. Increased cytokine levels in ejaculate may act as a marker of local inflammatory process, being a significant factor of male infertility. The purpose of our study was to assess cytokine profile of ejaculate in adolescents with varicocele.The level of cytokines IL-1β, IL-6, IL-8, TNFα, IL-4, IL-10, VEGF was determined in ejaculate of adolescents aged 17 years. The main group consisted of 100 adolescents with II-III degree varicocele; the comparison group included 30 adolescents without varicocele.Adolescents with varicocele have statistically higher levels of all studied pro-inflammatory cytokines, except of IL-8 and IL-10, which may suggest presence of a local inflammatory process. We did not find significant differences in the levels of cytokines between groups with grade II and III varicocele. However, the levels of pro-inflammatory IL-1β, IL-6 cytokines in ejaculate proved to be increased in the patients with grade III varicocele. When comparing the results between both groups, depending on the period after varicocelectomy and in the comparison group, statistically higher levels of IL-1β, IL-6, TNFα were detected in patients with more recent surgical correction and IL-10 levels in both subgroups with varicocele. This finding, given the progressive course of this disease, may be considered an unfavorable factor, since the pro-inflammatory status of testicular tissue returned, at later terms after surgery.In adolescentswith varicocele, increased levels of pro-inflammatory cytokineswere revealed in the ejaculate. There were no statistically significant differences in the level of cytokines in ejaculate of the patients with II and III degrees of varicocele. At the longer postsurgical period, an increased level of pro-inflammatory cytokines was revealed in the ejaculate samples.

Echocardiographic and hemodynamic changes in patients with high-grade varicocele.

Varicocele is abnormal tortuosity and dilatation of the pampiniform plexus veins within the spermatic cord. Varicocele is associated with testicular atrophy, hypogonadism, impaired semen analysis values, or decreased testosterone production. Varicocele is a progressive disease and should be treated because it may be a systemic disease that can be associated with cardiovascular abnormalities. We hypothesize in this study that cardiovascular and hemodynamic pathologies may occur in varicocele patients. In this prospective, multicentric, multidisciplinary study, patients diagnosed with high-grade left varicocele in the urology clinic underwent semen analysis, total testosterone determination, and scrotal Doppler ultrasonography. In addition, blood pressure measurement and echocardiographic evaluation were performed by blinded cardiologists in both the varicocele patients and the healthy control group. The study was carried out with 103 varicocele patients and 133 healthy individuals who formed the control group. Diastolic blood pressure (P = 0.016), left ventricular end diastolic (P < 0.001) and systolic diameter (P < 0.001), ejection fraction (P < 0.001), pulmonary arterial pressure (P < 0.001), and aortic distensibility (P < 0.001) values were significantly higher in varicocele patients compared with controls; interventricular septum wall thickness (P = 0.022), aortic systolic (P < 0.001) and diastolic diameter (P < 0.001), aortic systolic (P < 0.001) and diastolic diameter index (P < 0.001), and aortic stiffness index (P < 0.001) values were significantly lower in varicocele patients. The mean aortic distensibility of non-normozoospermic group was lower than that of normozoospermic group (P = 0.041). There was no statistically significant relationship between thickest vein diameter in spermatic cord and cardiological parameters. This study showed that symptomatic patients with high-grade varicocele had a higher risk of cardiovascular and hemodynamic disease. We recommend that men with high-grade symptomatic varicocele with impaired semen analysis undergo cardiovascular and hemodynamic evaluation regardless of their spermatic vein diameter.

Clinical and therapeutic aspects of laparoscopic varicocelectomy: a cross-sectional study in Douala, Cameroon

INTRODUCTION: Varicocele is an abnormal tortuosity of the pampiniform venous plexus and internal spermatic veins that drains the testicle. It is a well-recognized cause of decrease in testicular function, affecting approximately 15-20% of all males and 40% of infertile men globally. Principles of varicocele management consist of interrupting internal spermatic venous reflux while preserving the internal spermatic artery and the vas deferens. Treatment can be obtained through spermatic venous embolization or surgical, which could be performed by open or laparoscopic approach. The purpose of this study was to evaluate the clinical and therapeutic aspects of laparoscopic varicocelectomy in the city of Douala. METHODS: we report a descriptive cross-sectional study including a retrospective and prospective component. We reviewed files of patients who underwent laparoscopic varicocelectomy from January 2015 to May 2021. Clinical and diagnostic components of varicocele, indications and therapeutic outcomes were analyzed. RESULTS: we total of 71 patients were included in our study. The average age of patients was 34.34 years. Scrotal pain was the most represented clinical sign (46.48%). Varicocele was found on the left in 77.46% of patients. Scrotal pain represented 49.3% of the operative indications, and 81.70% of the patients had their spermatic arteries preserved. Vascular injury was the most common intraoperative complication with 5.63%, while peri-incisional pain (7.04%) was the most common post-operative complication. CONCLUSION: laparoscopic varicocelectomy is safe and beneficial with favorable outcome. However, there is limited availability of this approach in our setting, mainly due to lack of technical facilities and practitioners able to popularize it.

Role of microsurgical varicocelectomy in the management of non-obstructive azoospermia with varicocele: our tertiary care centre experience

BackgroundVaricocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele.MethodsThis was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele.ResultsA total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%).ConclusionsIn NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.

Varicoceles

A varicocele is an abnormal venous dilatation and/or tortuosity of the pampiniform plexus in the scrotum. The exact pathophysiology of varicoceles is not very well understood, including whether there is any effect on male infertility. They can, however, be uncomfortable or painful and may result in testicular growth arrest during and prior to puberty. Varicocoeles can cause significant anxiety in patients about infertility, testicular cancer, or appearance. This article will not only discuss how to diagnose, when to investigate, and how to treat varicoceles, but also when to leave them alone.

AN EPIDEMIOLOGICAL STUDY OF VARICOCELE

Background: Varicocele, an abnormal dilatation and tortuosity of the pampiniform plexus of veins is found in about 15% of the general population with a marked left sided predominance. However this incidence rises to 35% in men with primary infertility and 70 to 80% in men with secondary infertility.&#x0D; Methods: Hospital based prospective study conducted on 100 cases reporting to General surgery department within the study duration and eligible as per inclusion criteria was included in study.&#x0D; Results: In our study out of Out of 100 patients maximum 42.00% patients were farmer followed by 22.00% patients were Coolies and Rickshaw Pullers, 17.00% patients were students, 10.00% were laborer and 9.00% were policemen.&#x0D; Conclusion: It conclude that Varicocele epidemiology remains incompletely understood. We need well‑designed, large‑scale studies that include evaluation of important clinical factors to comprehend fully the epidemiological aspects of this condition.

Plus Disease in Retinopathy of Prematurity: Convolutional Neural Network Performance Using a Combined Neural Network and Feature Extraction Approach.

PurposeRetinopathy of prematurity (ROP), a leading cause of childhood blindness, is diagnosed by clinical ophthalmoscopic examinations or reading retinal images. Plus disease, defined as abnormal tortuosity and dilation of the posterior retinal blood vessels, is the most important feature to determine treatment-requiring ROP. We aimed to create a complete, publicly available and feature-extraction-based pipeline, I-ROP ASSIST, that achieves convolutional neural network (CNN)-like performance when diagnosing plus disease from retinal images.MethodsWe developed two datasets containing 100 and 5512 posterior retinal images, respectively. After segmenting retinal vessels, we detected the vessel centerlines. Then, we extracted features relevant to ROP, including tortuosity and dilation measures, and used these features in the classifiers including logistic regression, support vector machine and neural networks to assess a severity score for the input. We tested our system with fivefold cross-validation and calculated the area under the curve (AUC) metric for each classifier and dataset.ResultsFor predicting plus versus not-plus categories, we achieved 99% and 94% AUC on the first and second datasets, respectively. For predicting pre-plus or worse versus normal categories, we achieved 99% and 88% AUC on the first and second datasets, respectively. The CNN method achieved 98% and 94% for predicting two categories on the second dataset.ConclusionsOur system combining automatic retinal vessel segmentation, tracing, feature extraction and classification is able to diagnose plus disease in ROP with CNN-like performance.Translational RelevanceThe high performance of I-ROP ASSIST suggests potential applications in automated and objective diagnosis of plus disease.

Ureterosciatic Hernia Treated with Laparoscopic Intraperitonization of the Ureter.

Background: Ureterosciatic hernia (USH) is a rare benign disease. We report a case of USH treated with laparoscopic intraperitonization of the ureter. Case Presentation: A 70-year-old woman was admitted to our hospital with right abdominal pain lasting for 2 months. CT showed right hydronephrosis and invagination of the right ureter into the right sciatic foramen. She underwent retrograde ureterography, which revealed abnormal tortuosity of the right lower ureter, and was found to have USH. We performed laparoscopic intraperitonization of the ureter and she presented good postoperative course. Conclusion: Laparoscopic intraperitonization of the ureter can be a useful treatment for USH.

AN EPIDEMIOLOGICAL STUDY OF VARICOCELE

Background: Varicocele, an abnormal dilatation and tortuosity of the pampiniform plexus of veins is found in about 15% of the general population with a marked left sided predominance. However this incidence rises to 35% in men with primary infertility and 70 to 80% in men with secondary infertility.&#x0D; Methods: Hospital based prospective study conducted on 100 cases reporting to General surgery department within the study duration and eligible as per inclusion criteria was included in study.&#x0D; Results: In our study out of Out of 100 patients maximum 42.00% patients were farmer followed by 22.00% patients were Coolies and Rickshaw Pullers, 17.00% patients were students, 10.00% were laborer and 9.00% were policemen.&#x0D; Conclusion: It conclude that Varicocele epidemiology remains incompletely understood. We need well‑designed, large‑scale studies that include evaluation of important clinical factors to comprehend fully the epidemiological aspects of this condition.

Diagnostic imaging features of Menkes disease

Objective To analyze the imaging features of Menkes disease in children, and in order to identify the diagnostic value and improve the knowledge of it. Methods The imaging findings of 9 Menkes disease patients confirmed by the clinical and laboratory examinations were retrospectively analyzed. All the patients were male aged from 2.0 to 7.0 months with a median age of 3.0 months. The clinical manifestations including seizures, psychomotor retardation, dystonia accompanied with light complexion and curly hair. The laboratory examinations showed low serum copper and ceruloplasmin levels. All the patients were performed with plain MR scan and MR angiography, 7 cases were performed with chest X-ray examinations and 4 cases were performed with bone X-ray examinations and 1 were performed with hand X-ray examinations. Results The plain MR scan showed white matter lesions in 8 cases, abnormality signal intensity of basal ganglia in 4 cases, subdural effusion in 2 cases. 8 cases had cerebral and cerebellar atrophy at different degrees. The MR angiography showed abnormal tortuosity of the main intracranial arteries. The chest X-ray of 5 in 7 cases showed that the front end of bilateral ribs were spherical and enlarged. 4 cases were performed with bone X-ray presenting, 3 out of 4 cases showed the widened metaphysis of tibia, fibula, femoral, humerus ulna and radius with the shape like cup-mouth and the formation of bony spur locally. The X ray examination of 1 case with connecting palm showed symphysodactylia. Conclusion Brain MR, X-ray of chest and bone showed imaging features of Menkes disease. MR angiography finding was the most distinctive feature, which has important value in the diagnosis of Menkes disease. Key words: Menkes disease; Magnetic resonance imaging; Copper

Expression of claudin‑11 in a rat model of varicocele and its effects on the blood‑testis barrier.

Varicocele (VC) is an abnormal tortuosity and venous distension of the pampiniform plexus in the spermatic cord. VC is the most common surgically correctable cause of male infertility. The purpose of the present study was to investigate the effects of VC on the tight junctions and the blood-testis barrier (BTB) of Sertoli cells in the bilateral testes of rats. A model of VC was established by left renal vein narrowing in Sprague-Dawley rats; control rats underwent dissection of the vein without narrowing. The bilateral testes were harvested at 4, 6 and 8 weeks after the operation. The relative expression of claudin-11 and transforming growth factor (TGF)-β in the testis was determined by reverse transcription-polymerase chain reaction analysis and immunohistochemistry (IHC). The expression level of claudin-11 was prominently downregulated in the VC model group compared with the control group, while the level of TGF-β in the testes was higher in the VC group. IHC examination demonstrated that VC led to destruction of the integrity of the BTB, and the degree of destruction increased with time. Furthermore, it was also observed that unilateral VC affected contralateral testicular function. In conclusion, the present study partially explained the molecular mechanisms underlying the pathogenesis of VC and provided grounds for further research into the treatment of male infertility.

Anomaly of Haughton type D left cervical aortic arch in combination with type B dissection: case report and literature review

BackgroundThe anomaly of cervical aortic arch is a rare phenomenon first described by Reid in 1914 and categorized by Haughton in 1975. The left cervical aortic arch Type D consisting of an ipsilateral descending aorta and coarctation or aneurysmatic formation of the arch demonstrates a complicated form requiring surgical management. Because of its rarity and unspecific symptoms only few cases are documented with the focus on surgical management.Case presentationA 43-year old, asymptomatic woman presented with a mediastinal mass overlapping the aortic arch region in a routine x-ray. For verification, a computed tomography was performed and revealed incidentally a type B dissection originating from an aneurysm of a left cervical arch with a maximum diameter of 6 cm. Because of the huge diameter and the potential risk of rupture, an urgent surgical repair was planned. Surgical access was performed through median sternotomy and an additional left lateral thoracic incision through the fourth intercostal space. Simultaneously to the preparation, partial cardiopulmonary bypass was installed in the left groin. After preparation of the recurrent and phrenic nerve and the supraaortic branches, the descending aorta was clamped. Before the distal anastomosis to a straight graft, we performed a fenestration of the dissection membrane about a length of 5 cm to preserve the perfusion of both lumina. Then, the straight graft was sutured to the proximal part of descending aorta. The left axillary artery originated directly from the aneurysm and was dissected and reimplanted with a separate 8 mm sidegraft to the straight graft between the distal arch and proximal descending aorta. The patient was extubated on first postoperative day and recovered well.ConclusionThe left cervical aortic arch type D is a rare disease, which is prone to aneurysm formation due to abnormal flow patterns and tortuosity of the aorta. The difficulty lays in the identification of the pathology, especially in the physical examination, since a pulsating mass or cervical murmur seem to be the most specific symptoms in the majority of young, female patients. If diagnosed, surgical therapy with resection of the aneurysm and reimplantation of the axillary artery under cardiopulmonary bypass demonstrates the treatment of choice.

Effect of selenium on testicular damage induced by varicocele in adult male Wistar rats

ProjectVaricocele is an abnormal tortuosity and distension of the veins of the pampiniform plexus in the spermatic cord. It is the most common surgically correctable cause of male infertility. Several studies have revealed the effects of increased oxidative stress on serum, semen, and testicular tissues in patients with varicocele or in animal models. The aim of this study was to investigate the effects of sodium selenite on testicular damage induced by experimental left varicocele in male Wistar rats. ProcedureIn the present study, the effects of oral administration of sodium selenite (at doses of 0.05, 0.1, 0.2, and 0.4mg/kg bw) were assessed in normal and varicocelized rats. ResultsThe varicocelized control rats showed decrease in sperm quality parameters, decreased activity of testes CAT, GPX and SOD, increased levels of MDA, and damage in testicular architecture. Administration of sodium selenite significantly reduced these changes to nearly normal levels, but did not change these parameters in normal rats. Histopathological studies further confirmed the protective effects of sodium selenite on varicocele-induced testicular damage in rats. Administrations of sodium selenite did not change these parameters in normal rats. ConclusionsTaken together, the results of this study suggest that sodium selenite treatment may have beneficial effect on the testes of varicocelized rats.

Evaluation of microvascular findings of deeply invasive colorectal cancer by endocytoscopy with narrow-band imaging.

Background and study aims: Magnifying narrow-band imaging (NBI) is useful for examination of colorectal lesions, and endocytoscopy (EC) allows diagnostic evaluation of structural atypia, nuclear atypia, and vascular structures of colorectal tumors. The aim of this study was to examine surface microvessels in deep invasive colorectal cancer using EC with a new NBI video processor system. Patients and methods: We retrospectively assessed 132 colorectal neoplastic lesions: 81 adenomas, 18 intramucosal cancers, 4 submucosal slightly invasive cancers, and 29 submucosal deep invasive cancers. Detailed vascular findings commonly seen in submucosal deep invasive carcinomas included > 2-fold vasodilatation seen in adenomas, abnormal tortuosity and branching, loss of the micro-network pattern, caliber change in > 2 places in a single blood vessel, and blood vessels not visible in a line because they appear like a string of beads (beaded sign). Results: Univariate analysis revealed 4 vascular findings that were strongly predictive of submucosal deep invasion: vasodilatation (odds ratio [OR] 9.31; 95 % confidence interval [CI] 3.57 – 24.30), loss of the micro-network pattern (OR 61.60; 95 % CI 17.87 – 212.29), caliber change (OR 35.7; 95 % CI 9.16 – 139.14), and the beaded sign (OR 45.90; 95 % CI 5.50 – 382.73). Conclusions: Detailed assessment of ultra-magnified microvessels could improve the diagnostic performance for submucosal deep invasive cancer. Study registration: UMIN-CTR000014033

CLINICAL AND GENETIC ASPECTS OF ABNORMAL TORTUOSITY OF PRECEREBRAL ARTERIES IN ISCHEMIC STROKE

Background: Inherited connective tissue pathology is the most frequent genetic abnormality. Weakness of connective tissue in this group of disorders is manifested not only by excessive joint mobility, but also by abnormalities in other organs and systems, including vessels. In inherited connective tissue disorders brain artery aneurysms and abnormal vascular tortuosity is found that can be a risk factor for stroke. Aim: To study frequency of abnormal tortuosities of brachiocephalic vessels in post-ischemic stroke patients, as well as efficacy of secondary stroke prevention in such patients. Materials and methods: One hundred and seventy two adult patients with ischemic stroke were examined. Neurological deficiency was assessed with the National Institute of Health Stroke Scale (NIHSS) and with the modified Rankin scale. Abnormalities of precerebral arteries were found by ultrasound dopplerography and duplex scanning. To diagnose any abnormalities of connective tissue, clinical and genetic analysis, dermatoglyphic assessment and scoring of excessive joint mobility (Beyton scale) were used. Results: Abnormal tortuosity of precerebral arteries is found in 47% of patients with ischemic stroke. The screening performed in 25 of such patients showed connective tissue disorders in one third of them (in 2 patients, Ehlers-Danlos syndrome, in 2 patients, connective tissue dysplasia, in 4 patients, mild symptoms of abnormal connective tissue, such as excessive joint mobility scoring to 1–2). In patients without inherited syndromes, some dermatoglyphic traits were found, i.e., distal shift of the axial palmar triradius, higher frequency of patterns on the skin of the thenar, lower pattern frequency on the skin of the hypothenar, higher frequency of simple digital patterns (A and T), lower frequency of complex patterns, such as whorls (W), lower palmar and digital ridgecounts. The results of secondary stroke prevention with antiplatelet agents, antihypertensives and cholesterol-lowering agents depended on patient compliance to medical recommendations. The odds ratio for a repeated stroke in the groups who were regularly taking these agents, compared to the groups who were not, was 0.116 for treatment with antiplatelet agents (p < 0.05) and 0.043 for antihypertensive therapy (p < 0.005). Conclusion: Dysplasia of connective tissue can lead to formation of tortuous precerebral arteries and become an additional risk factor for strokes. Conventional antiplatelet, antihypertensive and cholesterol-lowering prophylaxis is effective in patients with tortuous precerebral arteries, but its results depend on patient compliance.

Abstract WMP107: Arterial Tortuosity: an Imaging Biomarker of Perinatal Stroke Pathogenesis?

Background: Perinatal stroke causes cerebral palsy and lifelong disability. Specific diseases are definable but pathophysiological mechanisms are unknown. Arterial tortuosity may reflect inherent vascular biology. We recently demonstrated an association between abnormal tortuosity and specific arteriopathies in childhood stroke. Hypothesis: As fetal periventricular infarction (PVI) has been associated with genetic connective tissue disease, we hypothesized that tortuosity would be increased in PVI compared to other perinatal stroke diseases and controls. Methods: Subjects were recruited from the Alberta Perinatal Stroke Project (APSP), a population-based research cohort. Inclusion criteria were MRI-classified perinatal stroke syndrome and 3D time-of-flight MR angiography (MRA). A validated imaging software method calculated cerebral arterial tortuosity using source images. Mean tortuosity scores (ANOVA) and variances (Levene’s test) were compared across arterial ischemic, hemorrhagic, and PVI strokes and controls. Effects of age and gender were examined. Results: A total of 130 children were studied (61 arterial, 30 PVI, 15 hemorrhagic, 24 controls). Tortuosity scores and variances were consistent with validation studies. Tortuosity was not associated with age at imaging (including infants versus older children) or gender. Variance in tortuosity was much greater in all perinatal stroke groups compared to controls (p&lt;0.0008) with no differences between specific stroke types found. There was no difference in mean tortuosity scores across groups. Conclusion: Children with perinatal stroke have an abnormally wide range of arterial tortuosity, suggesting inherent differences in vascular biology. This is consistent with genetic connective tissue disorders associated with PVI while suggesting novel mechanisms for other perinatal stroke diseases.

Varicocele-Induced Infertility in Animal Models.

Varicocele is characterized by abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord. Although several reports show the mechanisms by which the varicocele exerts its infertility impact, the exact pathophysiology for varicocele-induced inflammation and its relationship with testicular endocrine disruption remain largely unknown. This review article will update previous findings by discussing the pathophysiology of long term-induced varicocele in rats. Testicular endocrine disruption in experimentally-induced varicocele, new findings related to biochemical alterations in germinal epithelium, and sperm cells apoptosis are highlighted. Recent observations show that varicocele down-regulates first and second maturation divisions, results in Leydig and Sertoli cell inflammation, and increases immune cell infiltration in the testes of the rat as an animal model. Ultimately, previous findings of our laboratory have revealed that varicocele decreased sperm motility, viability and severe DNA damage. Damage in sperm significantly lowers the animal's fertility potential. Varicocele not only exerts its pathologic impact by lowering the testicular antioxidant capacity but it also down-regulates first and second maturation divisions by exerting biochemical alterations such as reducing the intracytoplasmic carbohydrate ratio in germinal epithelium.

Expression and Subcellular Localization of Retinoic Acid Receptor-α (RARα) in Healthy and Varicocele Human Spermatozoa: Its Possible Regulatory Role in Capacitation and Survival.

Varicocele, an abnormal tortuosity and dilation of veins of the pampiniform plexus, is the most common identifiable and correctable cause of male infertility. It is now becoming apparent that signaling through vitamin A metabolites, such as all-trans retinoic acid (ATRA), is indispensable for spermatogenesis and disruption of retinoic acid receptor-α (RARα) function may result in male sterility and aberrant spermatogenesis. Herein, we investigated by Western blot and immunogold electron microscopy the expression profiles and subcellular localization of RARα in healthy and varicocele human sperm; in addition, we analyzed the effects of ATRA on cholesterol efflux and sperm survival utilizing enzymatic colorimetric CHOD-PAP method and Eosin Y technique, respectively. In varicocele samples, a strong reduction of RARα expression was observed. Immunogold labeling evidenced cellular location of RARα also confirming its reduced expression in "varicocele" samples. Sperm responsiveness to ATRA treatment was reduced in varicocele sperm. Our study showed that RARα is expressed in human sperm probably with a dual role in promoting both cholesterol efflux and survival. RARα might be involved in the pathogenesis of varicocele as its expression is reduced in pathologic samples. Thus, ATRA administration in procedures for artificial insemination or dietary vitamin A supplementation might represent a promising therapeutic approach for the management of male infertility.

Automatic Evaluation of Plus Disease in Retinopathy of Prematurity

Abnormal dilation and tortuosity of retinal blood vessels are the primary signs of plus disease in retinopathy of prematurity. Timely prognosis could help reduce the delay in treatment and the risk of retinal detachment. Our objectives is to determine whether tortuosity and dilation sufficient for plus disease could be assessed most accurately by considering only arterioles, venules, or both. Tortuosity estimation and width measurement is done using previously proposed methods. Image preprocessing is applied before the two features namely, tortuosity and width of blood vessels are estimated to supply as input parameters for classification using K-means clustering technique. The results are validated by comparing with expert ophthalmologists ground truths. Performance is evaluated based on measures as sensitivity, specificity, predictive values and accuracy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy values obtained when considering both the arteriolar tortuosity and venous dilation are 85.86%, 90.74%, 88.76%, 88.28% and 88.50% respectively.