Capillary Pattern Research Articles

Significance of Peritubular Capillary, Glomerular, and Arteriolar C4d Staining Patterns in Paraffin Sections of Early Kidney Transplant Biopsies

Although diffuse linear C4d deposition in peritubular capillaries (PTCs) is a well-established criterion of alloantibody-mediated kidney transplant rejection, the actual relevance of focal or granular C4d deposits or staining outside PTC (glomeruli and arterioles) has yet to be established. This study was designed to evaluate the diagnostic significance of such nontypical C4d staining patterns. A total of 539 early indication biopsies (329 kidney transplants) were analyzed by immunohistochemistry using a polyclonal anti-C4d antibody. We found a close interrelationship between diffuse or focal linear C4d deposition in PTC, linear endothelial deposition in glomeruli, and arteriolar C4d. These specific patterns were also related to transplant glomerulitis and recipient presensitization. No such associations, however, were observed for other patterns, such as granular C4d in PTC. Detection of diffuse but not focal linear C4d in PTC was found to be associated with adverse allograft survival (5-year death-censored graft survival: 48% vs. 82%, 89%, or 84% in patients with focal, minimal, or no C4d, respectively; P<0.0001). Univariate analysis also revealed inferior graft survival in recipients with linear C4d in glomeruli (P=0.02). Applying multivariate Cox regression analysis, however, only diffuse linear PTC staining was found to be predictive of graft loss (hazard ratio 3.95 [95% confidence interval 1.62-9.60]; P=0.002). There might be a relationship between humoral alloimmunity and distinct less established staining patterns, such as focal linear C4d in PTC, endothelial C4d in glomeruli, or arteriolar C4d. Nevertheless, our results reemphasize the prognostic value of diffuse linear PTC staining.

A comparative study of narrow-band imaging （NBI） with routine endoscopy and NBI with magnifying endoscopy for the diagnosis of colorectal neoplasia

Objective To compare the diagnostic efficacies of narrow-band imaging （NBI） in distinguishing neoplastic from non-neoplastic colorectal lesions with routine endoscopy and with magnifying endoscopy. Methods Patients with colorectal lesions detected by NBI from September 2008 to February 2010 were enrolled in the study. These lesions were classified by pit pattern and capillary pattern, which was then assessed by reference to histopathology. Results A total of 100 patients with colorectal lesions were enrolled, and the lesions were observed by NBI with ordinary endoscopy （n =64） and NBI with magnifying endoscopy （n =36）, respectively, and 7 cases （5 in NBI with ordinary endoscopy and 2 in NBI with magnifying endoscopy） which did not meet the diagnostic criteria were excluded. The overall diagnostic accuracy of NBI endoscopy in distinguishing neoplastic from non-neoplastic colorectal lesions was 91.4% （ 85/93 ）, in which NBI with ordinary endoscopy and magnifying endoscopy was 89. 8% （53/59） and 94. 1% （32/34）,respectively, with both significantly higher than that of conventional colonoscopy reported in the literature （79. 1% ） （P 〈 0. 05 ）. However, no significant difference was detected between 2 methods （ P 〉 0. 05 ）.Conclusion Similar with NBI magnifying endoscopy, NBI endoscopy without high magnification may also be useful to distinguish neoplastic from non-neoplastic colorectal lesions. Key words: Colonic neoplasns; Endoscopy ; Narrow-band imaging; Diagnosis

Correlation of Narrow Band Imaging with Magnifying Colonoscopy and Histology in Colorectal Tumors

Background/AimsNarrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion.MethodsBetween September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features.ResultsPit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01).ConclusionsObservation of capillary thickness and irregularity by NBI magnification is useful for correlating histological grade with carcinoma, especially with depth of submucosal invasion.

Imaging by Magnifying Endoscopy with NBI Implicates the Remnant Capillary Network As an Indication for Endoscopic Resection in Early Colon Cancer

Introduction. This study examined whether magnifying endoscopy with NBI observation (ME-NBI) could be useful selecting the appropriate treatment for submucosal invasive cancer (SM cancer). Patients and Methods. We analyzed 515 cases of colon tumors excised endoscopically or surgically. We classified capillary network pattern into four types according to the degree of dilatation, irregularity, and distribution of microcapillary features. Results. The comparison of capillary pattern and histological features revealed microcapillary networks by using confocal laser-scanning microscopy and ME-NBI in intramucosal lesion or SM cancer with remnant neoplastic glands at the superficial layer. In contrast, the network was absent in SM cancer with desmoplastic reactions, which invaded deeper into the submucosal layer. Conclusions. The remaining microcapillary network is designed to maintain the architecture of neoplastic glands. Consequently, loss of this network could correlate with depth of tumor invasion and desmoplastic reaction. Therefore, we can decide the appropriate treatment by using ME-NBI method.

Narrow-band imaging endoscopy with and without magnification in diagnosis of colorectal neoplasia

To evaluate the diagnostic efficacies of narrow-band imaging (NBI) endoscopy with and without high magnification in distinguishing neoplasia from non-neoplasia colorectal lesions. A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study. These lesions were classified by pit pattern and capillary pattern, and then assessed by histopathology. Ten lesions not meeting the diagnostic criteria were excluded, the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2% (103/113), and that of NBI endoscopy with and without high magnification was 93.0% (40/43) and 90.0% (63/70), respectively. Both were significantly higher than that of conventional colonoscopy reported in the literature (P<0.05), but there was no significant difference between the two groups (P>0.05). Besides NBI magnifying endoscopy, NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.

COMPARISON OF MAGNIFYING CHROMOENDOSCOPY AND NARROW-BAND IMAGING IN ESTIMATION OF EARLY COLORECTAL CANCER INVASION DEPTH: A PILOT STUDY

Several previous studies have identified narrow-band imaging (NBI) with magnification as being useful in evaluating early colorectal cancer invasion depth, but comparative diagnostic accuracy of invasion depth between pit pattern analysis using magnifying chromoendoscopy and NBI remains unclear. The aim of this retrospective study was to compare NBI and pit pattern analysis using magnifying chromoendoscopy in estimating early colorectal cancer invasion depth and to assess interobserver agreement. We analyzed a total of 72 early colorectal cancers in 72 patients fulfilling the inclusion criteria. Each lesion image was subsequently reviewed by two experienced colonoscopists (A, B) and then classified clinically based on invasive/non-invasive pattern and Sano's capillary pattern classification with a five-point scale of confidence. In terms of diagnostic accuracy with confidence for A and B, the areas under the receiver operating characteristics curve were 0.84 and 0.81 for pit pattern analysis and 0.82 and 0.79 for NBI, respectively. Interobserver agreement for the diagnosis of submucosal deep (>1000 µm) invasion was evaluated for both modalities and indicated substantial agreement with pit pattern analysis (κ = 0.63) and moderate agreement with NBI (κ = 0.44). Estimating invasion depth of early colorectal cancer using NBI appeared to have been comparable to pit pattern analysis, but there was greater interobserver variability using NBI.

Changes in gastric mucosal patterns seen by magnifying NBI during H. pylori eradication

Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate changes in gastric mucosal patterns seen by magnifying NBI endoscopy after Helicobacter pylori eradication. Gastric mucosal patterns in non-pathological gastric corpus were observed by magnifying NBI endoscopy before and 12 weeks after H. pylori eradication in thirty patients. By using paired photographs of each case, changes in NBI mucosal patterns during H. pylori eradication were judged in a consensus manner by three blinded endoscopists. At 12 weeks after H. pylori eradication, 20 of 24 subjects who had been successfully treated showed remarkable changes in gastric mucosal patterns (sensitivity 83.3%, specificity 100%). In the specimens from these subjects, the patterns of enlarged or elongated pits were improved to small oval or pinhole-like round pits, and the density of fine irregular vessels was decreased. Histological assessment showed alleviation of chronic inflammation in all subjects (p < 0.0001), while such a change was not observed for four subjects showing severe gastric atrophy and intestinal metaplasia. When the subjects were divided according to the presence of severe gastric atrophy, the diagnostic efficacy of magnifying NBI for predicting the results of H. pylori eradication was excellent in subjects without severe gastric atrophy and intestinal metaplasia (sensitivity and specificity, 100%). However, no change in the NBI mucosal pattern was observed in subjects with severe gastric atrophy and intestinal metaplasia, regardless of the H. pylori eradication result. At least in subjects without severe gastric atrophy or intestinal metaplasia, successful H. pylori eradication treatment shows improvements in gastric mucosal patterns with the use of magnifying NBI endoscopy early after successful treatment.

Upregulation of transmembrane endothelial junction proteins in human cerebral cavernous malformations

Cerebral cavernous malformations (CCMs) are among the most prevalent cerebrovascular malformations, and endothelial cells seem to play a major role in the disease. However, the underlying mechanisms, including endothelial intercellular communication, have not yet been fully elucidated. In this article, the authors focus on the endothelial junction proteins CD31, VE-cadherin, and occludin as important factors for functional cell-cell contacts known as vascular adhesion molecules and adherence and tight junctions. Thirteen human CCM specimens and 6 control tissue specimens were cryopreserved and examined for the presence of VE-cadherin, occludin, and CD31 by immunofluorescence staining. Protein quantification was performed by triplicate measurements using western blot analysis. Immunofluorescent analyses of the CCM sections revealed a discontinuous pattern of dilated microvessels and capillaries as well as increased expression of occludin, VE-cadherin, and CD31 in the intima and in the enclosed parenchymal tissue compared with controls. Protein quantification confirmed these findings by showing upregulation of the levels of these proteins up to 2-6 times. A protocol enabling the molecular and morphological examination of the intercellular contact proteins in human CCM was validated. The abnormal and discontinuous pattern in these endothelial cell-contact proteins compared with control tissue explains the loose intercellular junctions that are considered to be one of the causes of CCM-associated bleeding or transendothelial oozing of erythrocytes. Despite the small number of specimens, this study demonstrates for the first time a quantitative analysis of endothelial junction proteins in human CCM.

A case report of recurrence of mixed cryoglobulinemic glomerulonephritis in a renal transplant recipient

Recurrence of glomerulonephritis (GN) is one of the major risk factors of long-surviving renal graft dysfunction. Cryoglobulinemic glomerulonephritis of hepatitis-C virus (HCV)-negative patient is a rare cause of end-stage renal disease. There is little case report of recurrent cryoglobulinemic glomerulonephritis in negative HCV recipients after renal transplantation. We represent a renal allograft recipient of an interesting recurrent cryoglobulinemic glomerulonephritis. The patient was diagnosed with mixed cryoglobulinemic glomerulonephritis by kidney biopsy at the age of 32 . He had no HCV, HBV nor liver dysfunction. He received immunosuppressive therapy, however, was introduced to hemodialysis treatment after 13 yr. He received a cadaveric renal transplantation at the age of 50, and immunosuppressive treatment was started with ciclosporin, prednisolone and mycophenolate mofetil (MMF). Four yr after transplantation, he developed fever and purpura of lower limbs. His serum creatinine level did not increase, however, proteinuria, hematuria, hypocomplementemia, positive rheumatoid factor and mixed cryoglobulinemia were noted. Detailed analysis failed to reveal the composition of mixed cryoglobulinemia. The renal allograft biopsy showed membranoproliferative-type GN with monocyte and polynuclear leukocyte accumulation of capillary loops and small cellular crescent. Immunofluorescent study showed C3, IgG and IgM deposition of mesangial and capillary pattern. Regardless of steroid pulse therapy, hypocomplementemia and positive rheumatoid factor did not improve. Ten yr after transplantation, he was affected by cellulitis and sepsis. Afterward, rising of serum creatinine and nephrotic range proteinuria developed. The allograft biopsy revealed advanced cryoglobulinemic glomerulonephritis with characteristic vascular lesions. Electron microscopy showed organized subendothelial deposits compatible with cryoglobulinemic glomerulonephritis and proteinaceous thrombus in arteriole.

Lymphatic and vascular invasion patterns in triple-negative breast cancer.

676 Background: Triple-negative breast cancer (TNBC) comprises of about 15%-20% of all breast cancer cases. Many studies have detected less lymph node metastasis in TNBC than sporadic breast cancers. In this study, we studied capillary and lymphatic invasion in tumors of TNBC patients. Methods: Two experienced pathologists blinded to clinical data evaluated capillary and lymphatic invasion patterns in 39 TNBC patients' tumor samples. Tumor samples were immunohistochemically stained with CD34 (endothelial cell marker) and D2-40 (podoplanin, a membrane protein, specific for lymphatic endothelium). The CD34 positive samples were categorized into two groups depending on their reaction with D2-40: lymphatic (D2-40 positive) and capillary (D2-40 negative) invasion. Results: We have detected vascular invasion in 15 out of 39 samples (38.5%) with CD34. Among those, capillary invasion was found in 14 (35.9%) and lymphatic invasion in 3 (7.7%) and both in 2 (5.1%) tumors. We did not find any significant correlations among capillary invasion, lymphatic invasion, vascular invasion, tumor grade, menopause status, history of cancer, and TNM. Conclusions: Capillary invasion is more commonly observed than lymphatic invasion in TNBC patients. This finding provides an explanation for more hematogenous metastasis (spreading) and less lymph node metastasis seen in TNBC patients. No significant financial relationships to disclose.

Use of narrow-band imaging bronchoscopy in detection of lung cancer

Narrow-band imaging (NBI) is a new endoscopic technique designed for detection of pathologically altered submucosal and mucosal microvascular patterns. The combination of magnification videobronchoscopy and NBI showed great potential in the detection of precancerous and cancerous lesions of the bronchial mucosa. The preliminary studies confirmed supremacy of NBI over white-light videobronchoscopy in the detection of premalignant and malignant lesions. Pathological patterns of capillaries in bronchial mucosa are known as Shibuya’s descriptors (dotted, tortuous and abrupt-ending blood vessels). Where respiratory endoscopy is concerned, the NBI is still a ‘technology in search of proper indication’. More randomized trials are necessary to confirm the place of NBI in the diagnostic algorithm, and more trials are needed to evaluate the relation of NBI to autofluorescence videobronchoscopy and to white-light magnification videobronchoscopy. Considering the fact that NBI examination of the tracheo–bronchial tree is easy, reproducible and clear to interpret, it is certain that NBI videobronchoscopy will play a significant role in the future of lung cancer detection and staging.

Videocapillaroscopy in postburn scars: In vivo analysis of the microcirculation

Objective The aim of the study was the evaluation in vivo of the differences between the microcirculatory characteristics of the postburn scar and the healthy skin. Methods Twelve patients with postburn scars were included in the study, evaluating fifteen scar areas and twelve healthy skin areas by means of contact optical probe videocapillaroscopy. The examined areas for each patient were the right and the left upper limb. Capillary density, length and diameter, together with capillary distribution pattern (punctiform, reticular, directional) and the presence of microhaemorrhages and neoangiogenesis were studied. Results The results were obtained by two different researchers using the capillaroscope's software. Capillary loop diameter and length, capillary distribution pattern and presence of neoangiogenesis were found to be significantly increased in postburn scars compared with controls. There were also significant differences between hypertrophic tissue in the active phase and the one in the remission phase for capillary diameter and presence of neoangiogenesis. Conclusion Videocapillaroscopy showed “in vivo” a change in local microcirculation architecture using a microscope. Patients with hypertrophic burn scars showed a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, dilated capillaries and neoangiogenetic phenomena. This methodology is highly likely to be of value in the assessment and prognostication of burn outcome.

M1581: Change in Gastric Mucosal Patterns Seen by Magnifying NBI Endoscopy During H. Pylori Eradication

Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate the change in gastric mucosal patterns seen by magnifying NBI endoscopy during H. pylori eradication.

Protein Fractionation of Cowpea (Vigna unguiculata (L.) Walp) Leaf, Flower and Seed by Capillary Electrophoresis and Its Potential for Variety Identification

AbstractThe proteins of different faction of cowpea [Vigna unguiculata (L.) Walp] were fractionated by capillary electrophoresis (CE). The extracting solvent system was one of the most critical factors in the optimization exercise. To improve reproducibility, seed samples needed to be defatted with chloroform/methanol (V:V=2:1) as preferred prior to protein extraction. Proteins were extracted from seeds, leaves and flowers with 50% aqueous 1‐propanol and separated on a 50 (m×20 cm fused silica capillary column using a UV detector at 200 nm. Separation was conducted at constant voltage (10 kV, 40°C), using iminodiacetic acid (pH 2.5) containing 0.05% hydroxypropylmethylcellulose (HPMC) and 20% acetonitile. The results showed that proteins extracted from all fraction of cowpea were successfully separated by CE in less than 20 min. Seed extracts provided the greatest number of eluted protein peaks, followed by flower and leaf, respectively. The seed‐protein extracts provided unique CE patterns for different varieties; hence the seed was the tissue chosen as being most suitable for variety identification. As a result, an optimized procedure was developed to provide rapid identification of cowpea varieties, based on capillary electrophoregram patterns.

S1557: Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms

S1557: Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms

S1543: Simultaneous Evaluation of the Pit and Capillary Patterns of Colorectal Lesions on Routine Colonoscopy - Prime Time for Optical Biopsy

The endoscopic in vivo observation of microscopic superficial details of colorectal lesions is now possible. The differential diagnosis of small colorectal polyps and characterization of neoplastic lesions is crucial for a better screening colonoscopy and in choosing the right therapy for each colorectal lesion. Kudo et al. have proposed the pit pattern classification of colorectal lesions. Last year, we have developed an original endoscopic classification of the capillary pattern of colorectal lesions and reported its high accuracy rate in the diagnosis of colorectal lesions (GIE 2009).

W1576: Single-Operator Experience in Detecting Gastritis, Helicobacter Pylori Infection, Gastric Intestinal Metaplasia, and Dysplasia Before and After Training in Narrow-Band Imaging

Narrow-band imaging (NBI) is an optical technology that provides real-time endoscopic information about the surface capillary pattern and mucosa of the GI tract. NBI may enable endoscopic diagnosis of gastric pathology and targeting of gastric biopsies. The light-blue crest (LBC) sign, seen on NBI, may enable identification of gastric intestinal metaplasia (IM).

Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms

BackgroundCapillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms.MethodsA series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI.ResultsThere were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 μm) from pSM2-3 (≥1000 μm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: κ = 0.68, 0.67, 0.72. Intraobserver agreement: κ = 0.79, 0.76, 0.75ConclusionIdentification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.

Implanted Myoblast Survival Is Dependent on the Degree of Vascularization in a Novel Delayed Implantation/Prevascularization Tissue Engineering Model

In in vivo tissue engineering, many implanted cells die because of hypoxic conditions immediately postimplantation. The aim of this study was to determine whether delayed myoblast implantation, at day 4 or 7, improves myoblast survival compared with implantation at day 0 in an in vivo arterio-venous loop (AB loop) chamber model. In adult inbred Sprague-Dawley rats, an AB loop was inserted into a plastic chamber (day 0). In Group I, day 0, two million DiI-labeled (neonatal inbred) myoblasts were implanted around the AB loop. In Groups II and III, day 0, the AB loop was created and inserted into a novel delayed cell seeding chamber, and 4 (Group II) or 7 days (Group III) later the delay chamber was seeded with 2 million DiI-labeled myoblasts. Constructs were harvested 7-day postmyoblast implantation, for morphometric determination of DiI/DAPI-positive myoblasts/mm(2), and percent vascular volume on Griffonia simplicifolia lectin (endothelial cell marker)-labeled tissue sections. Control (nonmyoblast seeded) and experimental (myoblast seeded) constructs demonstrated similar capillary and tissue growth patterns. DiI/DAPI-labeled myoblasts/mm(2) appeared in similar numbers in constructs implanted at days 0 and 4, but increased markedly in day-7 implanted constructs. The percent vascular volume increased significantly (p = 0.03) over time. A positive correlation existed between myoblast survival and construct vascularity (p = 0.017). In conclusion, delaying myoblast implantation to 7-day postconstruct assembly, when new capillary growth is well established, significantly correlates with increased myoblast survival and indicates that cell seeding in regenerative procedures should always occur into an established vascular bed.

Study of Pattern Collapse for Freezing Free Litho-Litho-Etch Double Patterning

Pattern collapse becomes one of the serious issues for critical patterning process below 45nm half pitch. Many reports have been published in recent days to investigate pattern collapse mechanism. There are factors such as capillary force, hardness, swelling, and pattern profile that can cause pattern collapse.On the other hand, Litho-Litho-Etch (LLE) without freezing process has been recognized as a promising candidate because of its cost effectiveness among double patterning processes. The materials using 2nd resist formulation is totally different from the one on 1st resist because it is necessary that 2nd resist solution doesn't dissolve 1st resist during 2nd litho process. Therefore, pattern collapse mitigation on freezing free LLE process can pose considerable challenges.In this report, the improvement of pattern collapse on 2nd resist will be discussed by focusing on the surface free energy and the swelling during its development process.