Finger-like Projections Research Articles

Squamous papilloma treated with diode laser

Oral squamous papilloma is a benign tumor of unknown origin which arises from stratified squamous epithelium and appears as a cauliflower-like growth with finger-like projections seen on the tongue, palate, and other parts of oral cavity. The treatment modalities include surgery, cold steel excision, cryosurgery, and laser ablation. Here, we report a case of squamous papilloma on buccal mucosa treated with a diode laser.

Invasive micropapillary carcinoma breast: a rare entity

Invasive Papillary Carcinoma(IPC) is an uncommon breast disease, constituting 0.5% to 1% of all breast carcinomas. It is distinguished by the papillary structural design: proliferation characterized by finger-like projections or fronds composed of central fibrovascular cores covered by epithelium, without myoepithelial cell layer. The combination of a residual palpable mass and a frankly bloody aspirate at the fine needle aspiration is a strongest indicator of carcinoma. Clinical and Radiological manifestations of IPC are not specific. Papillary carcinomas may present as bloody nipple discharge, an abnormal mass, or radiographic abnormalities. Therapeutic management of IPC is still controversial. Treatment-related information for patients with papillary carcinoma is limited, and patterns noted in available series suggest a variable approach to this disease.

Long-term Progression of Type 1 Neovascularization in Age-related Macular Degeneration Using Optical Coherence Tomography Angiography

To analyze the long-term growth patterns of type 1 neovascularization (NV) in eyes with age-related macular degeneration (AMD) receiving anti-vascular endothelial growth factor (VEGF) therapy. Retrospective cohort study. Patients were enrolled from 2 eye centers and underwent optical coherence tomography angiography (OCTA) imaging with follow-up greater than 1 year. Choroidal neovascularization (CNV) was manually segmented on OCTA images and compared between time points. CNV growth was subdivided into 3 categories based on OCTA area measurement: CNV doubling, modest growth of less than 50%, and shrinkage. These growth rates were correlated with OCTA morphologic features. Forty-one eyes were analyzed. Mean CNV area was 1.60 ± 1.84mm2 at baseline and 1.80 ± 1.84mm2 at 1 year. Thirty-three eyes (80%) displayed an increase in CNV area at 1 year with a mean increase of 0.20 ± 0.38mm2 (P= .001). Eleven eyes (27%) underwent CNV doubling, 19 eyes (46%) illustrated modest growth, and 6 (15%) showed shrinkage. Anatomic features including a capillary fringe (odds ratio [OR]= 5.3, P= .036) and immature lesion morphology (OR= 4.2, P= .015) were significantly associated with CNV doubling. CNV growth occurred in 3 predominant patterns: "symmetric" growth, "asymmetric" growth, and "finger-like projections," which reflected the orientation of expansion of CNV. "Symmetric" and "asymmetric" growth together correlated with greater frequency of CNV doubling (OR= 15, P= .0048). OCTA provides noninvasive measurement of the area of neovascular lesions in AMD. Sustained growth of type 1 NV can be identified in the majority of lesions (80%) that display characteristic patterns of progression despite ongoing anti-VEGF therapy.

Phototaxis as a Collective Phenomenon in Cyanobacterial Colonies

Cyanobacteria are a diverse group of photosynthetic bacteria that exhibit phototaxis, or motion in response to light. Cyanobacteria such as Synechocystis sp. secrete a mixture of complex polysaccharides that facilitate cell motion, while their type 4 pili allow them to physically attach to each other. Even though cells can respond individually to light, colonies are observed to move collectively towards the light source in dense finger-like projections. We present an agent-based model for cyanobacterial phototaxis that accounts for slime deposition as well as for direct physical links between bacteria, mediated through their type 4 pili. We reproduce the experimentally observed aggregation of cells at the colony boundary as a precursor to finger formation. Our model also describes the changes in colony morphology that occur when the location of the light source is abruptly changed. We find that the overall motion of cells toward light remains relatively unimpaired even if a fraction of them do not sense light, allowing heterogeneous populations to continue to mount a robust collective response to stimuli. Our work suggests that in addition to bio-chemical signalling via diffusible molecules in the context of bacterial quorum-sensing, short-ranged physical interactions may also contribute to collective effects in bacterial motility.

The Finding of Pacific Transvenid Acanthocephalan in the Arabian Gulf, with the Description of Paratrajectura longcementglandatus N. Gen., N. Sp. from Perciform Fishes and Emendation of Transvenidae.

The acanthocephalan Paratrajectura longcementglandatus n. gen., n. sp. (Transvenidae) is described from specimens of 2 perciform fish species, Nemipterus japonicus Bloch (Nemipteridae) and Otolithes ruber Bloch and Schneider, collected in the marine territorial waters of Iraq and Iran in the Arabian Gulf. Metal analysis of hook tip, middle, and base is also described using energy disruptive analysis for X-ray. The new genus is distinguished from the closely related genus Trajectura Pichelin and Cribb, 2001 described from wrasses (Labridae) (Perciformes) in the Pacific off Australia and Japan by having a proboscis with apical epidermal cone, long rhadinorhynchid-like tubular cement glands, relatively short and lobulated lemnisci, all proboscis hooks with prominent roots, females with subterminal gonopore and a rounded projection on the antero-dorsal end of the trunk, and males with elongate pre-equatorial testes reaching proboscis receptacle. In Trajectura, the proboscis lacks apical epidermal cone, the cement glands are pyriform or ovoid, the lemnisci are digitiform and considerably longer than the receptacle, the posterior proboscis hooks are rootless, the females have prominent finger-like trunk projection and terminal gonopore, and males with equatorial testes that may not be elongate and may be distant from the receptacle. The importance of cement glands in the diagnosis of genera and families in acanthocephalan taxonomy is stressed. Other features especially the type and arrangement of hooks on the proboscis, but not hook roots, are comparable in the 2 genera. Diagnosis of the family Transvenidae is emended.

Revision of the family Carabodidae (Acari: Oribatida) XIII. Congocepheus camerunensis sp. nov. from Cameroon and Synkrotima zimbabwae gen. nov., sp. nov. from the Republic of Zimbabwe

Congocepheus camerunensis sp. nov. from Cameroon and Synkrotima zimbabwae gen. nov., sp. nov. from Zimbabwe are described using optical and Scanning Electron Microscopy (SEM). Congocepheus camerunensis is similar to C. heterotrichus, differentiated by: dissimilarity in shape and length of prodorsal, notogastral, epimeral, agenital, and adanal setae; placement, shape, and size of finger-like projection, bothridial ring and tutorium. Synkrotima zimbabwae gen. nov., sp. nov. is a distinctive species with a more or less flat elevated interlamellar process with longitudinal elevations and an anterior expansion; very complex ventral ornamentations with alternating depressed and elevated zones; genital neotrichy; absence of notogastral depression; the differences in shape and lengths of the prodorsal, notogastral, epimeral, genital, aggenital, adanal and anal setae in comparison to other species of the family Carabodidae.

Structure and functional morphology of the acid-secreting pygidial glands in the whipscorpion Mastigoproctus giganteus (Lucas, 1835) (Arachnida: Thelyphonida)

The order Thelyphonida (Chelicerata: Arachnida) contains more than 100 species of whipscorpions that live in warm tropical and xeric environments. All whipscorpions possess a pair of pygidial glands in their opisthosoma that secrete and actively discharge a defensive spray composed mostly of acetic acid, hence their common name, vinegaroon. To date, the structure of the glands remains poorly understood and has not been subject to detailed analysis for more than a century. Here, we provide the first description of gland structure in the North American vinegaroon, Mastigoproctus giganteus. We used paraffin histology to study general gland structure in juveniles (2nd instar) and adults. We supplement these observations with histochemical stains, confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). We found the glands to be composed of numerous long strips of multinucleated syncytium that rest on a basal lamina that lacks an external muscle coat. The gland syncytia contain abundant glycogen granules and secretion drops of different sizes and staining qualities. The adult epithelium is organized into three general patterns: as simple epithelia, as simple acinar glands, and as compound acinar glands. The juvenile gland epithelium is less distinctly organized. A cuticular intima lines the apical (lumenal) surface of adult and juvenile glands, is multilaminate, contains chitin, and may be permeated by irregular pores. The basal side of the intima consists of cuticular, finger-like projections that protrude into a subcuticular space. The underlying epithelium possesses an apical brush border of microvilli that appears to engage in Kurosumi’s type III extrusion, but the contents (cuticle or acids) of the vesicles are unknown. Curiously, the cells possess apical nuclei that also suggest a basal route of secretion, but details on this process are undetermined. Together, these results reveal that vinegaroon pygidial glands are unlike most other arachnid exocrine glands in their structure, methods of secretion, and mechanisms of discharge.

Microarchitecture of the tsetse fly proboscis

BackgroundTsetse flies (genus Glossina) are large blood-sucking dipteran flies that are important as vectors of human and animal trypanosomiasis in sub-Saharan Africa. Tsetse anatomy has been well described, including detailed accounts of the functional anatomy of the proboscis for piercing host skin and sucking up blood. The proboscis also serves as the developmental site for the infective metacyclic stages of several species of pathogenic livestock trypanosomes that are inoculated into the host with fly saliva. To understand the physical environment in which these trypanosomes develop, we have re-examined the microarchitecture of the tsetse proboscis.ResultsWe examined proboscises from male and female flies of Glossina pallidipes using light microscopy and scanning electron microscopy (SEM). Each proboscis was removed from the fly head and either examined intact or dissected into the three constituent components: Labrum, labium and hypopharynx. Our light and SEM images reaffirm earlier observations that the tsetse proboscis is a formidably armed weapon, well-adapted for piercing skin, and provide comparative data for G. pallidipes. In addition, the images reveal that the hypopharynx, the narrow tube that delivers saliva to the wound site, ends in a remarkably ornate and complex structure with around ten finger-like projections, each adorned with sucker-like protrusions, contradicting previous descriptions that show a simple, bevelled end like a hypodermic needle. The function of the finger-like projections is speculative; they appear to be flexible and may serve to protect the hypopharynx from influx of blood or microorganisms, or control the flow of saliva. Proboscises were examined after colonisation by Trypanosoma congolense savannah. Consistent with the idea that colonisation commences in the region nearest the foregut, the highest densities of trypanosomes were found in the region of the labrum proximal to the bulb, although high densities were also found in other regions of the labrum. Trypanosomes were visible through the thin wall of the hypopharynx by both light microscopy and SEM.ConclusionsWe highlight the remarkable architecture of the tsetse proboscis, in particular the intricate structure of the distal end of the hypopharynx. Further work is needed to elucidate the function of this intriguing structure.

Revision of the Neotropical moth genus Ptychotrichos Schaus (Lepidoptera, Erebidae, Arctiinae, Arctiini, Ctenuchina)

Ptychotrichos Schaus, 1894 is revised and redescribed based on external and genitalia characters. The genus is now characterized by the following autapomorphic characters: forewing more than twice as long as hindwing, hairbrush on dorsal surface of inner margin of hindwing, vinculum sigmoid, uncus bilobed, and valva with a proximal finger-like projection. Ptychotrichos is comprised of two species, P. zeus Schaus, 1894 (type-species) and P. elongata Schaus, 1905, which differ from each other in fore- and hindwing patterns, coloration of abdominal tergites and male and female genitalia. Both species of Ptychotrichos are redescribed and illustrated, and maps of their geographical distribution are provided, with a discussion on the unusual distribution of P. zeus. A new combination for Ptychotrichos [sic] fenestrifer Zerny, 1931 is also proposed: Heliura fenestrifer comb. nov.

Tulasnella tubericola (Tulasnellaceae, Cantharellales, Basidiomycota): a new Rhizoctonia-like fungus associated with mycorrhizal evergreen oak plants artificially inoculated with black truffle (Tuber melanosporum) in Spain

A new Rhizoctonia-like fungus associated with ectomycorrhizal tips of evergreen oak inoculated with Tuber melanosporum is described. Tulasnella tubericola sp. nov. is characterized by its particular habitat, apparently not associated with the roots of any orchid species, its fast-growing rate in plate culture, the creamy-white to pale orange tones of the colonies, the production of both typical globose monilioid cells together with terminal, finger-like monilioid projections and the absence of true sclerotia. In addition, phylogenetic analyses based on the sequences of the internal transcribed spacer (ITS) region of the ribosomal DNA (rDNA) showed that the different isolates that define the new species constitute an isolated, monophyletic lineage within the genus. The fungus is exclusively isolated from mycorrhizal roots of Quercus ilex subsp. ballota, being absent both in the culture substrate or in the natural soil employed in the mycorrhization processes. No sexual fruiting bodies have been observed or induced in the laboratory for this fungus.

Disruptive colouration in reef fish: does matching the background reduce predation risk?

Animals use disruptive colouration to prevent detection or recognition by potential predators or prey. Highly contrasting elements within colour patterns, including vertical or horizontal bars, are thought to be effective at distracting attention away from body form and reducing detection likelihood. However, it is unclear whether such patterns need to be a good match to the spatial characteristics of the background to gain cryptic benefits. We tested this hypothesis using the iconic vertically barred humbug damselfish, Dascyllus aruanus (Linneaus 1758), a small reef fish that lives among the finger-like projections of branching coral colonies. Using behavioural experiments, we demonstrated that the spatial frequency of the humbug pattern does not need to exactly match the spatial frequency of the coral background to reduce the likelihood of being attacked by two typical reef fish predators: slingjaw wrasse, Epibulus insidiator (Pallas 1770), and coral trout, Plectropomus leopardus (Lacépède 1802). Indeed, backgrounds with a slightly higher spatial frequency than the humbug body pattern provided more protection from predation than well-matched backgrounds. These results were consistent for both predator species, despite differences in their mode of foraging and visual acuity, which was measured using anatomical techniques. We also showed that a slight mismatch in the orientation of the vertical bars did not increase the chances of detection. However, the likelihood of attack did increase significantly when the bars were perpendicular to the background. Our results provide evidence that fish camouflage is more complex than it initially appears, with likely many factors influencing the detection likelihood of prey by relevant predators.

Fragility of foot process morphology in kidney podocytes arises from chaotic spatial propagation of cytoskeletal instability.

Kidney podocytes’ function depends on fingerlike projections (foot processes) that interdigitate with those from neighboring cells to form the glomerular filtration barrier. The integrity of the barrier depends on spatial control of dynamics of actin cytoskeleton in the foot processes. We determined how imbalances in regulation of actin cytoskeletal dynamics could result in pathological morphology. We obtained 3-D electron microscopy images of podocytes and used quantitative features to build dynamical models to investigate how regulation of actin dynamics within foot processes controls local morphology. We find that imbalances in regulation of actin bundling lead to chaotic spatial patterns that could impair the foot process morphology. Simulation results are consistent with experimental observations for cytoskeletal reconfiguration through dysregulated RhoA or Rac1, and they predict compensatory mechanisms for biochemical stability. We conclude that podocyte morphology, optimized for filtration, is intrinsically fragile, whereby local transient biochemical imbalances may lead to permanent morphological changes associated with pathophysiology.

Three-Dimensional HyCoSy With Perfluoropropane-Albumin Microspheres as Contrast Agents and Normal Saline Injections Into the Pelvic Cavity for Morphological Assessment of the Fallopian Tube in Infertile Women.

To apply the three-dimensional (3D) hysterosalpingo-contrast sonography (HyCoSy) with perfluoropropane-albumin microspheres as contrast agents and normal saline injections into the pelvic cavity for assessment of the tubal patency and adhesions of fimbrial parts. Fifty-five infertile female patients were recruited to undergo 3D HyCoSy with normal saline injected into the pelvic cavity, in which the tubal patency was observed by visualizing the spillage of contrast agents from the fimbriae, and the fimbrial adhesion was confirmed by the finger-like projections of the fimbriae and their floating and moving status. Of the 55 patients, bilateral tubal patency was observed in 44 (80.0%), unilateral tubal patency and the other partial occlusion in 7 (12.7%), unilateral partial occlusion and the other complete occlusion in 3 (5.4%), and bilateral complete occlusion in 1 (1.8%). The fimbrial parts were observed in 105 fallopian tubes, among which 101 were seen with the finger-like fimbriae floated and moved in the pelvic cavity, whereas 4 tubes were not because of adhesion to the pelvic cavity (n = 3) or the ovary and intestine (n = 1). More than three visible, quite long, and distributed evenly finger-like projections were present for the patent fimbrial parts; however, fewer, flat, and not evenly distributed finger-like projections were present for the adhesive tubes. No serious complications occurred during or after this procedure. Combination of 3D HyCoSy with normal saline injected into the pelvic cavity may be a feasible and safe procedure to assess tubal patency and adhesions of the fimbrial parts.

Spreading and breakup of nanodroplet impinging on surface

The normal impinging of nanoscale water droplets on the solid surface is investigated through molecular dynamics simulations. A wide regime of impinging from spreading to breakup is studied. The overestimations of dissipation and surface free energy in literature are modified with a more accurate assumption on flow fields. The refined model fits well with the simulation results by introducing the linear distribution of radial velocity gradient. Two modes of breakup are observed during the nanodroplet impinging on the surface: (1) touch-bottom of the surface of the liquid film and (2) propagation of finger-like projections on the flow frontier. The touch-bottom breakup is possibly the dominant mode in cases with large We and small Re. The criterion is proposed to be that the amplitude of the capillary wave is larger than the average height of the droplets at the maximum spreading state. This criterion gives a well prediction comparing to the results obtained in molecular dynamics simulations.

SD-OCT and Adaptive Optics Imaging of Outer Retinal Tubulation.

ABSTRACTPurposeTo investigate outer retinal tubulation (ORT) using spectral domain optical coherence tomography (SD-OCT) and an adaptive optics scanning laser ophthalmoscope (AOSLO). To document the frequency of ORT in atrophic retinal conditions and quantify ORT dimensions versus adjacent retinal layers.MethodsSD-OCT images were reviewed for the presence of retinal atrophy, scarring, and/or exudation. The greatest width of each ORT was quantified. Inner and outer retinal thicknesses adjacent to and within the area of ORT were measured for 18 patients. AOSLO imaged ORTs in five subjects with direct and scattered light imaging.ResultsORT was identified in 47 of 76 subjects (61.8%) and in 65 eyes via SD-OCT in a wide range of conditions and ages, and in peripapillary atrophy. ORTs appeared as finger-like projections in atrophy, seen in the en face images. AOSLO showed some ORTs with bright cones that guide light within atrophic areas. Multiply scattered light mode AOSLO visualized variegated lines (18–35 μm) radiating from ORTs. The ORTs’ width on OCT b-scan images varied from 70 to 509 μm. The inner retina at the ORT was significantly thinner than the adjacent retina, 135 vs.170 μm (P = .004), whereas the outer retina was significantly thicker, 115 vs. 80 μm (P = .03).ConclusionsORTs are quite common in eyes with retinal atrophy in various disorders. ORTs demonstrate surviving photoreceptors in tubular structures found within otherwise nonsupportive atrophic areas that lack retinal pigment epithelium and choriocapillaris.

Clinicopathological study of crateriform verruca: Crateriform epithelial lesions histopathologically distinct from keratoacanthoma.

Keratoacanthoma (KA) is a distinct clinicopathological entity, but it is often confused with other crateriform tumors. This study re-examined the clinicopathological features of 380 crateriform epithelial tumors with a central keratin plug. Seventy-six tumors (20%) had histopathological features that differed from solitary KA and were more verruca-like, and we designated these lesions as crateriform verruca (CFV). We performed clinicopathological re-examination of these neoplasms with a crateriform architecture and epithelial lip-like structures similar to KA, which also displayed histopathological features reminiscent of verruca vulgaris, such as finger-like exophytic projections with hyperkeratosis and acanthosis, focal hypergranulosis and arborization. Clinical data on CFV were also summarized. The main histopathological differences from KA were that CFV showed proliferation of keratinocytes with a similar size and regular arrangement, and the base of CFV was well demarcated without endophytic growth. Interestingly, some CFV were partly composed of epithelial cells with large pink cytoplasm in the upper malpighian layer between papillomatous projections. Furthermore, areas of trichilemmal-like keratinization without formation of the granular layer were seen in some lesions. These types of CFV were hardly distinguishable from KA, unless it is recognized that CFV may contain trichilemmal keratinization-like areas accompanied by large epithelial cells with eosinophilic cytoplasm. We have proposed the term CFV for these verrucous neoplasms to differentiate them from KA.

Mid-Esophageal Food Bolus Impaction Associated with Prominent, Segmental Esophageal Papillomatosis and Squamous Cell Carcinoma

AIM: To describe a case of esophageal food bolus impaction associated with esophageal papillomatosis and a superficial squamous cell carcinoma (SCCa). CASE REPORT: A 62 yo male with a history of hypertension, hyperlipidemia and early stage (F1 disease by biopsy in 2009) type 1a hepatitis C infection, presented to the emergency room with an esophageal food bolus impaction. He sensed mid retrosternal bolus impaction since beginning a meal of pork 3 hours previously. After informed consent was obtained, EGD under moderate sedation revealed a very large pork bolus (2.5X4 cm) which was impacted in the mid esophagus. The food bolus was extracted per os with the use of a friction fit adapter which was attached to a standard video gastroscope. The underlying esophageal mucosa in the mid esophagus was decidedly abnormal (from 28 to 34 cm from the incisors) in a confluent fashion. Over this mid esophageal segment, the lumen was mildly narrowed and there were prominent macroscopic findings consistent with verrucous change (see Figure 1). Biopsies on 2 occasions revealed only esophageal papillomatosis without dysplasia and were negative for HPV. The patient was briefly followed expectantly. Recommendations to masticate food thoroughly, eat slowly and drink plenty of liquids with meals were reinforced. Given the unusual nature of the process, a second opinion was sought at a local tertiary care center. A third EGD was performed and extensive esophageal biopsies were again performed. A small nodular area was noted and biopsies of this region revealed invasive SCCa. Staging PET CT was negative for metastatic spread and it revealed positive uptake in the mid esophagus. Numerous treatment options were considered during multidisciplinary review and in the end, he underwent esophagectomy. The final esophageal resection specimen revealed a 2.0 X 0.5 cm moderately differentiated SCCa (T1a) against a background of papillomatosis.Figure 1CONCLUSION: Histologically, esophageal papillomasare benign tumors composed of fingerlike projections of lamina propria covered by hyperplastic squamous epithelium. Gastroesophageal reflux and HPV have been implicated as possible pathogenic factors. In this case, intense, segmental esophageal papillomatosis caused esophageal lumenal narrowing and led to esophageal food bolus impaction. The finding of a small superficial SCCa was thought to be fortuitous and coincidental.

A Case of HPV Induced Extensive Esophageal Papillomatosis

Introduction: Esophageal papillomas are benign epithelial raised lesions characterized histologically by fingerlike projections of tissue lined by an increased number of squamous cells and a core of connective tissue that contains small blood vessels. Incidence of esophageal papillomas has ranged from 0.01 to 0.45% of cases with male/female ratio of 3:1. 70% of the papillomas are located in the distal esophagus. Although esophageal papillomas are uncommon findings, extensive Papillomatosis is an extremely rare condition with only few reported cases. Case Report: A 52-year old male with long standing history of esophageal achalasia s/p Heller myotomy presented to the clinic with complaints of worsening dysphagia of solids and night sweats. Laboratory tests were normal. Esophagogram showed esophageal narrowing at the gastro esophageal junction with dilatation of the distal esophagus. EGD was performed which showed dilated esophagus and thick whitish plaques extending over distal third of esophagus which demonstrated appearance of keratinized squamous papilloma. Biopsies obtained from distal esophagus showed superficial strips of squamous mucosa with hyperkeratosis and parakeratosis with no evidence of dysplasia or malignancy. Follow up EGD which was performed a year later showed dilated esophagus with whitish plaques suggestive of parakeratosis. Biopsies were taken and HPV in situ hybridization studies for HPV 16 and 18 were found to be positive. As there are no guidelines for management and follow up of patients with Papillomatosis, we discussed close surveillance versus esophagectomy with the patient. He opted for close surveillance with repeat EGD every 6 months. Discussion: HPV induced Esophageal Papillomatosis is a rare entity. The etiology and pathogenesis of this condition appear to be a mechanical or chemical irritation of the mucosa in addition to the presence of human papillomavirus (HPV), important agent in the evolution to a squamous carcinoma, especially HPV types 16 and 18. HPV is found in 40% of patients with papillomas or Papillomatosis. Herein we describe a case of Esophageal Papillomatosis associated with HPV 16 and 18 DNA.Figure 1Figure 2

Endocuff Improves Polyp Detection by GI Fellows Across Multiple Stages of Training

Introduction: The Endocuff (EC) is a cap with soft, finger-like projections designed to flatten colonic folds during withdrawal to improve polyp detection. We previously showed that use of Endocuff in GI fellow-performed procedures is assoc with higher polyp detection rate (PDR) and number of polyps per procedure (PPP). This study was designed to assess how level of training affects these variables. Methods: Colonoscopy quality data was collected prospectively at our center beginning in June 2012. EC was implemented in Aug 2014 and utilized at the discretion of the colonoscopists. For this study, the dataset included all colonoscopies performed by GI fellows since initiation of database, inclusive of all indications. A total of 2465 colonoscopies, including 1841 conventional (CC) and 624 Endocuff-assisted colonoscopies (EC), were included. Procedures were grouped by performing fellow's level of training at that time, i.e. 0-12 mo. (1st yr), 13-24 mo. (2nd yr), or 25-36 mo. (3rd yr). CC and EC in each group were compared with respect to procedure times, PDR, ADR, PPP and APP. All polyps were removed by forceps, snare or EMR. Significance was determined by two-tailed T-test. Results: Compared to CC, EC was assoc with a higher PDR among 1st (0.78 vs. 0.64, p=0.003) and 2nd yr fellows (0.87 vs. 0.67, p < 0.0005). Benefit of EC was marginal among 3rd yr fellows (0.82 vs. 0.71, p=0.06). ADR was highest in 2nd yr fellows (0.62 vs. 0.43, p < 0.0005), but did not reach statistical significance for the 1st and 3rd yr fellows (see table). Similarly, PPP and APP, respectively, were significantly higher among 1st (2.87 vs. 1.77, p=0.003; 1.35 vs. 0.92, p=0.004) and 2nd yr fellows (3.43 vs. 2.13, p=0.0005, 1.69 vs. 1.15, p=0.007). Insertion time was significantly reduced with EC in 1st and 2nd yr fellows (16.6 vs. 19.6min, p=0.03, 11.8 vs. 16.7min, p=0.02). Despite the increased number of polyps in EC cases, withdrawal and total times were not increased. Conclusion: Among our fellows, use of EC increased the detection rate and numbers of polyps and adenomas found and removed, especially in the first 2 years of training. This benefit occurs without affecting total time of procedure. Our findings suggest that use of EC by fellows increases polypectomies, which should improve patient outcomes by reducing risk of interval colorectal cancer. While our study was not randomized and is therefore subject to bias, our findings encourage expanded use of assistive devices such as Endocuff by GI fellows.Table 1: Results, by Training Year

Sperm head shaping in ratites: New insights, yet more questions.

Head shaping in mammalian sperm is regulated by a number of factors including acrosome formation, nuclear condensation and the action of the microtubular manchette. A role has also been suggested for the attendant Sertoli cells and the perinuclear theca (PT). In comparison, relatively little information is available on this topic in birds and the presence of a PT per se has not been described in this vertebrate order. This study revealed that a similar combination of factors contributed to head shaping in the ostrich, emu and rhea, although the Sertoli cells seem to play a limited role in ratites. A fibro-granular structure analogous to the mammalian PT was identified, consisting of sub- and post-acrosomal components. The latter was characterized by stage-specific finger-like projections that appeared to emanate from the cytoplasmic face of the nuclear envelope. They were particularly obvious beneath the base of the acrosome, and closely aligned, but not connected to, the manchette microtubules. During the final stages of chromatin condensation and elongation of the sperm head the projections abruptly disappeared. They appear to play a role in stabilizing the shape of the sperm head during the caudal translocation of the spermatid cytoplasm.