Fibromuscular Type Research Articles

PD16-06 SHIFT CHANGE OF THE ACTIVATED COMPLEMENT PATHWAY IN THE FIBROTIC PROCESS ASSOCIATED WITH PROGRESSION OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022PD16-06 SHIFT CHANGE OF THE ACTIVATED COMPLEMENT PATHWAY IN THE FIBROTIC PROCESS ASSOCIATED WITH PROGRESSION OF BENIGN PROSTATIC HYPERPLASIA Junya Hata, Yusuke Kirihana, Tomoyuki Kumekawa, Hiroki Natsuya, Yusuke Hakozaki, Syunsuke Yoshioka, Hitomi Imai, Kanako Matsuoka, Tomoyuki Koguchi, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, and Yoshiyuki Kojima Junya HataJunya Hata More articles by this author , Yusuke KirihanaYusuke Kirihana More articles by this author , Tomoyuki KumekawaTomoyuki Kumekawa More articles by this author , Hiroki NatsuyaHiroki Natsuya More articles by this author , Yusuke HakozakiYusuke Hakozaki More articles by this author , Syunsuke YoshiokaSyunsuke Yoshioka More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002548.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In a previous study, we reported that complement activation by an autoimmune reaction was associated with the growth process of benign prostatic hyperplasia (BPH). On the other hand, BPH was reported to show a histological transition from smooth muscle-dominant type to fibrous-dominant type as it becomes more severe. Therefore, we hypothesized that activation of complement pathways might be associated with the fibrous process of BPH with progression. In this study, to clarify the activated complement pathway in the fibrous process of BPH with progression, we analyzed the histological severity and the expression of complement components using human fibrous BPH tissues. METHODS: The subjects were 56 histological BPH patients who underwent prostate needle biopsy due to high PSA levels in our institutions (mean age 68.6 ± 6.5 years). BPH patients were divided into two histological groups, fibromuscular type and fibrous type, by hematoxylin-eosin and elastica-Masson staining. Complement expression function analysis was performed by immunohistochemical staining using C3, factor B, and C5b-9 antibody, and the occupancy ratio of the stained region was calculated. RESULTS: Twenty-seven cases (48.2%) were classified as fibromuscular type, and 29 cases (51.8%) were classified as fibrous type. The proportion of fibrous components was significantly lower in the fibromuscular type than in the fibrous type (fibromuscular type 36.0 ± 12.9%, fibrous type 61.1 ± 11.7% (p<0.01)). In the expression analyses of complement components, factor B was not significantly different between the two groups, whereas C3 (fibromuscular type 10.7 ± 8.2%, fibrous type 16.4 ± 12.7%) and C5b-9 (fibromuscular type 15.9 ± 6.2%, fibrous type 17.6 ± 9.2%) were significantly upregulated in fibrous type compared to fibromuscular type (p = 0.04, p = 0.04). Furthermore, abundant infiltration of inflammatory cells was observed in the fibromuscular type (p = 0.03). CONCLUSIONS: In the fibrous process of BPH from fibromuscular type to fibrous type histologically, the inflammatory amplification loop enhancement by complement alternative pathway activation promotes the fibrosis of BPH, and finally shifts to fibrotic BPH. These results suggested that shift change to complement late pathway activation was involved in the progression of fibrous BPH. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e271 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junya Hata More articles by this author Yusuke Kirihana More articles by this author Tomoyuki Kumekawa More articles by this author Hiroki Natsuya More articles by this author Yusuke Hakozaki More articles by this author Syunsuke Yoshioka More articles by this author Hitomi Imai More articles by this author Kanako Matsuoka More articles by this author Tomoyuki Koguchi More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long-term follow-up of subvalvular aortic stenosis in children: a single-centre experience.

The aim of this study is to evaluate clinical and surgical outcomes of children with subaortic stenosis, to determine the risk factors for surgery and reoperation and to compare isolated subaortic stenosis and those concomitant with CHDs. The study involved 80 children with subaortic stenosis. The patients were first classified as isolated and CHD group, and the isolated group was further classified as membranous/fibromuscular group. The initial, pre-operative, post-operative and the most recent echocardiographic data, demographic properties and follow-up results of the groups were analysed and compared. The correlation of echocardiographic parameters with surgery and reoperation was evaluated. There was a significant male predominance in all groups. The frequency of the membranous type was higher than the fibromuscular type in the whole and the CHD group. The median time to the first operation was 4.6 years. Thirty-five (43.7%) patients underwent surgery, 5 of 35 (14%) patients required reoperation. The rate of surgery was similar between groups, but reoperation was significantly higher in the isolated group. The gradient was the most important factor for surgery and reoperation in both groups. In the isolated group besides gradient, mitral-aortic separation was the only echocardiographic parameter correlated with surgery and reoperation. Reoperation is higher in isolated subaortic stenosis but similar in membranous and fibromuscular types. Early surgery may be beneficial in preventing aortic insufficiency but does not affect the rate of reoperation. Higher initial gradients are associated with adverse outcomes, recurrence and reoperation.

Ventricular False Tendons in Human Hearts, an Autopsy Study of the Incidence, Morphology, Histology and Distribution in Basrah City

The left ventricular false tendons (LVFTs ) are fibrous or fibromuscular bands crossing the left ventricle in human hearts ,they arise mainly from the ventricular septum to the free wall or to a papillary muscle .They are considered as normal anatomical variant with different numbers, location and type. LVFTs had been associated with many clinical studies and discussions regarding their function . Literatures were reviewed and their incidence ,morphology , histology and clinical correlation were discussed .This study was intended to evaluate the existence LVFTs in Basrah city , and to compare the findings with other data verified in literatures. A prospective autopsy study of the prevalence and morphology of LVFTs in 215 cadaveric human hearts was performed to estimate the number ,types and location .of these bands .10 out of 215 samples were undergo routine histopathological processing to obtain 4 micrometer thickness slides stained with hematoxylin and eosin and examined for histological characteristics . LVFTs of varying number, types and different attachment were recorded in 62 ( 28.8% ) of 215 adult human cadaveric hearts studied. A complete morphologic assessments were done. No significant differences was found regarding age or gender. , Majority of LVFTs are single , commonly between the ventricular septum and papillary muscle .Fibrous and fibro muscular type is predominant . In our community false tendons are frequent anatomic variants of normal human LV which may be identified at routine examination and should not be mistaken as pathologic structures such as flail chordae tendineae or thrombi, further radiological and clinical studies are suggested to ensure their role and function

Morphological peculiarities of three-dimensional structure of tendinous cords of antrioventricular heart valves in human newborns

Objective — the aim of the study was to examine features of the structure of tendinous cords of atrioventricular valves in newborns by using optic lighting and reconstruction methods of investigation.Material and methods. Tendinous cords of the mitral and tricuspid valves were examined on 52 specimens atrioventricular heart valves, taken from 26 newborns who had died due to the causes which were not associated with pathology of the cardio-vascular system. During the study we used optical method, three-dimensional reconstruction and statistical analysis.Results. Results of microscopic studies have shown that tendinous cords consist of dense regular connective tissue, where between bundles of collagen fibers cells of fibroblastic range can be found. However, in thickness of 28% tendinous cords, except bundles of collagen fibers, bundles of cardiac muscle have been also found. With the help of three dimensional tendinous cords reconstructions, it was established that the subendothelial layer is a loose collagenous-elastic periphery with blood vessels inside. The central part is formed by collagen core.Conclusion. Therefore, the results of morphological studies have shown that 72% tendinous cords of atrioventricular heart valves in newborns belong to the fibrous, and 28% belong to fibro-muscular type of tendinous cords.

Left Ventricular False Tendons: Echocardiographic, Morphologic, and Histopathologic Studies and Review of the Literature

Left ventricular false tendons (LVFTs) are fibrous or fibromuscular bands stretching across the left ventricle (LV) from the ventricular septum to the papillary muscle or LV free wall but not connecting, like the chordae tendinae, to the mitral leaflet. LVFTs have become the focus of studies and discussions since the advent of echocardiography. We prospectively studied the prevalence of LVFTs by two-dimensional echocardiography in 476 infants and children referred to our institute for cardiac evaluation and cardiology workup. We also studied the morphology and histopathology of LVFTs in 68 congenital heart disease specimens and in 20 piglet hearts. The literature was reviewed and the clinical significance of LVFTs was discussed. LVFTs of varying size and different location were detected in 371 (77.9%) of 476 infants and children studied, in 42 (61.8%) of 68 congenital heart disease specimens, and in 19 (95.0%) of 20 piglet hearts. Of the 75 LVFTs from the congenital heart disease specimens, 33 (44.4%) were fibrous type, measuring less than 1.4mm; 38 (50.7%) were fibromuscular type, 1.5-2.4mm; and 4 (5.3%) were muscular type, 2.5mm or more in diameter. Of the 33 LVFTs from the piglet hearts, 23 (69.7%) and 10 (30.3%) were fibrous and fibromuscular, respectively, and none (0.0%) was muscular. LVFTs were detected partially or completely by modified two-dimensional echocardiography in both normal and abnormal hearts. LVFTs is a useful anatomical landmark of LV for the differentiation of morphological LV and right ventricle in segmental analysis of congenital heart disease. LVFTs are a cause of functional murmur. No pressure gradient was noted in the mid-LV or outflow tract. LVFTs could be a contributory factor in the generation of dysrhythmias during LV catheterization studies. LVFTs were more easily identifiable in neonates and young age patients because of a better delineation of images in echocardiography.

Estramustine binding protein in human benign prostatic hypertrophy

Using a highly sensitive radioimmunoassay (RIA) of estramustine binding protein (EMBP) with the antibody raised against rat-EMBP, the concentration of EMBP in human benign prostatic hypertrophy (BPH) tissue was evaluated. Using mechanical separation procedure, EMBP was found significantly higher in the epithelium (10.7 ng/mg protein) than in the stroma (2.9 ng/mg protein). When human BPH was classified into glandular, fibromuscular and mixed type, the concentration of EMBP was the highest in glandular type (15.7 ng/mg protein) and the lowest in fibromuscular type (10.8 ng/mg protein).

Cholesterol-fed ovariectomized monkeys are good animal models for human atherosclerosis of postmenopausal women

Although it is well known that the incidence of atherosclerosis is markedly increased in postmenopausal women, antiatherosclerotic effects of estrogen replacement therapies are not clear. One of the reasons for this is due to the lack of appropriate animal models for atherosclerosis of postmenopausal women. Therefore, we attempted to develop an animal model for atherosclerosis of postmenopausal women and examined the antiatherosclerotic effects of estrogen replacement therapy. Adult ovariectomized Japanese monkeys were fed 2% cholesterol diet alone (C-group) or in combination with conjugated estrogen (CE-group) for 30 months. The serum estradiol-17beta levels of the CE-group were varied between 10 and 204.5 ng/dl during treatment. In the C-group, the serum total cholesterol levels were increased from 110 to 270 mg/dl, and atheroma was first observed after 3-months treatment with angioscopy. In the CE-group, the levels of the serum total cholesterol during treatment were 30% lower than those of the C-group, and the aortic lesions were first observed after 12-months treatment with angioscopy. The aortic intimal thickness of the CE-group was 58% of the C-group. This finding showed good agreement with the angioscopic observation. The aortic lesions were of a fibromuscular type in both groups. In conclusion, a cholesterol-fed ovariectomized monkey is an appropriate animal model for atherosclerosis of postmenopausal women. Furthermore, angiofiberscopic and histopathological observations suggested that estrogen replacement therapy was valid for atherosclerosis of postmenopausal women.

Development of Myocardial Infarction—Prone WHHL Rabbits, Histopathological and Immunohistochemical Examination

Ischemic heart disease is important in developed countries. However, there are few suitable animal models for myocardial infarction. To develop myocardial infarction (MI) -prone WHHL rabbits, we have carried out selective breeding by using coronary atherosclerosis-prone WHHL rabbits in our colony since 1994. We used following indices for the selective breeding; 1) vulnerable coronary plaque, 2) severe coronary stenosis greater than the lumen area stenosis with the mean value plus the standard error value of the parents' generation, 3) plasma cholesterol levels above 800 mg/dl at 12 months old, and 4) occurrence of myocardial infarction. During the selective breeding, housing condition was maintained constant and rabbits were fed standard rabbit chaw. We did not treat rabbits especially except the selective breeding. At 1999, after the selective breeding, myocardial infarction was observed in 94% of rabbits deceased up to 35 months old. Age of 35 months old in rabbits corresponds to approximately 44 years old in human by calculation of their life span (75 years old in humans and 60 months old in experimen-tal rabbits) . In histological examination, many rabbits after the selective breeding showed findings of acute myocardial infarction alone or in combination with findings of old myocardial infarction. Myocardial lesions of MI-prone WHHL rabbits were observed mainly at the subendocardial region circumf erentially, and about 60% rabbits showed transmural infarction in combination with subendocardial infarction. In some MI-prone WHHL rabbits, the profile of the electrocardiogram showed typical findings of myocardial infarction. The culprit coronary arteries had severe lumen area stenosis greater than 90% at about 20 serial sections prepared at 500μm interval. These findings of MI-prone WHHL rabbits resembled those of human multivessel disease. Atheromatous plaques of the coronary arteries of WHHL rabbits were changed from fibromuscular type to macrophage/extracellular lipid-rich type by the selective breeding. Many coronary plaques showed occlusion by macrophage accumulation at the superficial area of the plaque. In this case, denudation of the endothelial cells was observed. Some others showed thin fibromuscular cap with large lipid core. In this case, macrophages were detected at the border between the attenuated fibromuscular cap and the lipid core. This finding was considered as vulnerable plaque, which probably causes plaque rupture and consequent occlusive thrombus formation. However, we did not detect any plaque rupture or luminal thrombus in the coronary arteries. This suggests that we can examine which factors are important as trigger of plaque rupture by using MI-prone WHHL rabbits. We consider that MI-prone WHHL rabbits will contribute to studies of myocardial infarction.

Norepinephrine contents of human prostatic hyperplasia: differences between pathological subtypes.

Tissue norepinephrine content in benign prostatic hyperplasia (BPH) was evaluated to detect possible histological differences in BPH subtypes and to investigate the correlation between norepinephrine levels and age, prostatic weight and clinical symptom score, respectively. Specimens were obtained from 28 patients who underwent transurethral resection of the prostate. Pathologically, 18 out of 28 specimens were classified as fibromyoadenomatous hyperplasia and the remaining 10 as fibromuscular type. Norepinephrine content in the fibromyoadenomatous type was 133.1 +/- 23.1 ng/g, whereas it was 340.3 +/- 60.5 ng/g in the fibromuscular type. Norepinephrine level in the former group was significantly lower than that in the latter group (p < 0.001). In both groups, there was no correlation between norepinephrine content, age and clinical symptom score, while the norepinephrine content had a reverse correlation with prostatic weight only in the former group (p < 0.05). In conclusion, norepinephrine levels were dependent upon histological differences, especially upon the amount of smooth muscle elements, in the evaluated specimen. Severity of prostatism and patients' age showed no correlation with tissue norepinephrine content.

Increase of plasma renin activity at renal blood flow estimations with the xenon133 wash-out technique in patients with renal artery stenosis.

Eleven patients with hypertension and renal artery stenosis of fibromuscular type were investigated with renal blood flow estimations with Xenon133 wash-out technique before and after alpha-receptor blockade with infusion of phenoxybenzamine in the stenosed renal artery. During the whole investigation frequent blood samples for renal vein renin estimations were drawn from both kidneys. Immediately after the Xenon injection renal vein renin elevations on the investigated side were observed in 9/11 patients. The renin peak was reached in 10 min and the mean increase for all patients was 152%. The mean duration of the peak was 19.25 min. A neurogenic renin release mechanism triggered by renal chemoreceptors and mediated by beta-adrenergic fibres was suggested. This finding with renin release stimulation at Xenon133 infusion in the renal artery is of great importance in judging results of investigations concerning renal blood flow and renin when the Xenon wash-out technique is used. Blood samples for renin estimations should not be taken within 25 min after intrarenal Xenon133 infusions.

Discrete subaortic stenosis: the value of cross-sectional sector echocardiography in evaluating different types of obstruction.

The value of cross-sectional sector echocardiography in the visualization of discrete subaortic stenosis (DSS) was investigated using an 80 degrees phased-array sector scanner with simultaneously derived M-mode outputs. Thirty-three patients (including 22 postoperative patients) with proven DSS were investigated and divided into two groups: group I--discrete membranous type; and group II--diffuse fibromuscular type. In group I (15 patients), two isolated subaortic ridges were identified as discrete linear echoes in the long axis of the outflow tract in five patients. A single distinct and isolated linear echo was observed in three patients, whereas in another five the ridges appeared to be attached to the ventricular septum and/or to the base of the anterior mitral leaflet. In two patients with mild DSS, a false-negative diagnosis was made. Only 2 out of 12 patients in this group showed a short remnant of the ridge after surgical revision. In group II, a more generalized or long-segment narrowing was present in 18 patients; in 14 of them the ridges were continuous with the walls of the outflow tract. Eight out of ten patients reexamined following resection of fibromuscular tissue still had residual obstruction. Analysis of the simultaneous M-mode recordings revealed that the transient appearance of the ridge in the outflow tract depended on the normal movement of the heart within the chest, on the lengthening of the membrane itself, and on the angle between the ultrasound beam and the membrane during different cardiac cycles. Our study shows that a spectrum of one- and two-dimensional patterns exists depending on the nature of the obstructing lesion. Cross-sectional sector echocardiography provides more direct visualization and characterization of various types of DSS than M-mode echocardiography does.

Special technics in renovascular surgery.

Apart from the critical selection of patients, surgical results in renovascular surgery depend mainly on technical problems. To overcome most frequent technical handicaps, such as a deep abdominal cavity, intervening structures, additional distal stenoses and limited ischemic tolerance time, several technical principles may be recommended. An anterior transperitoneal approach usually ensures an optimal exposure. The 'one-field repair' and the 'partial ex situ repair', include the advantage of excellent exposure and a superficial operating field. Particularly in cases of renal artery stenosis of the fibromuscular type, the routinely performed distal 'run-off control' by mechanical dilatation of the arterial branches, allows a high degree security. As in other fields of surgery, renovascular interventions should be directed to the principle of technical simplicity. Following this surgical concept there is only limited indication for the use of 'total ex situ repair' with heterotopic kidney replantation. We feel that this major time-consuming procedure has only a very small place in renovascular surgery, but a very real place in the correction of intrarenal lesions.