Flat Epithelium Research Articles

Supraclavicular-median sternotomy approach for a large neurilemmoma invading the thoracic outlet: a case report and review of the literature

BackgroundLarge mediastinum tumors invading the thoracic outlet have consistently been a challenge in thoracic surgery. Due to the large size of the tumor and its proximity to many important tissues, appropriate surgical approaches are crucial for a successful surgery.Case presentationsHere, we present a case of a large neurilemmoma that invaded the thoracic outlet that was resected by a supraclavicular-median sternotomy approach. The case was a 58-year-old woman with a large mass in the right chest cavity that had invaded the thoracic outlet. The preoperative biopsy showed a blood clot with a few fibrous connective tissues covered by a single layer of flat epithelium. There was insufficient evidence to diagnose the mass as a tumor, and imaging examinations suggested a diagnosis of solitary pleural fibroma. For good exposure of the cranial and caudal aspects of the large mass, we devised a median sternotomy combined with a supraclavicular approach and safely achieved complete resection. The patient recovered well and experienced no severe complications or functional restrictions of the upper extremity. The postoperative pathology diagnosis was a neurilemmoma.ConclusionsThe supraclavicular-median sternotomy approach could be an optional approach for the complete resection of large mediastinal tumors invading the thoracic outlet.

Cervical dysplasia, cervicitis and inflammatory bowel disease – is there a relationship? (Literature review)

The state of health of the female population of Ukraine is of particular concern due to the year-by-year increase in the frequency of precancerous and oncological diseases of the reproductive organs. Benign and precancerous pathologies of the cervix occupy an important place among gynecological diseases.The objective of this article is to review foreign literature and domestic data sources for assessment the risk of dysplasia and cervical cancer in patients with inflammatory bowel disease (IBD) and cervicitis.Early onset of sexual life and a large number of sexual partners are factors that increase the risk of contracting the human papillomavirus (HPV) and other sexually transmitted infections (STIs). Trauma to the cervical epithelium – mechanical one or caused by an STI – can cause HPV to enter the basal layer of the cervical epithelium. Cervical cancer (CC) is preceded by HPV lesions of the cervical epithelium, including low-grade and high-grade squamous intraepithelial lesions, which are usually diagnosed in women of reproductive age.Cervical intraepithelial neoplasia (CIN) is characterized by impaired maturation and differentiation of cells of the multilayered squamous epithelium and is the most frequent form of morphological precancer of the cervix. Up to 90% of CIN are localized at the border of single-layered cylindrical and multilayered flat epithelium (transformation zone). CIN of various degrees is a precancerous disease in which the index of malignancy (oncological transformation) can reach 50%.The clinical course of dysplastic changes in CIN is asymptomatic, and the patients have no specific complaints. During the infectious process in the vagina, CIN can be accompanied by an increase in the amount of vaginal discharges in the form of mucus or milky secretions. Therefore, in modern conditions timely diagnosis, effective treatment and prevention of precancerous processes, which include CIN of the cervix, is one of the important tasks of a gynecologist. Women of perimenopausal age, who are traditionally classified as a risk group, deserve special attention.Today, there is information in the literature that diseases of a multifactorial nature make up 90–95% of all diseases, which also includes CIN. Despite extensive research efforts and advances in screening and prevention strategies, CC remains an unsolved public health challenge, particularly in low- and middle-income countries. Every year in the world, more than half a million women are diagnosed with CC.The world scientific community pays great attention to the study of epidemiology, pathogenesis, treatment and development of methods of prevention of neoplastic processes in general and CC in particular. So far, this has not been thoroughly studied, and there are no large studies that take into account a variety of potential factors. Understanding the risk factors for the development of CC in patients with IBD and cervicitis may help develop screening and prevention strategies and ultimately improve treatment outcomes.

Analysis of optical coherence tomography biomarker probability detection in central serous chorioretinopathy by using an artificial intelligence-based biomarker detector

AimTo adopt a novel artificial intelligence (AI) optical coherence tomography (OCT)-based program to identify the presence of biomarkers associated with central serous chorioretinopathy (CSC) and whether these can differentiate between acute and chronic central serous chorioretinopathy (aCSC and cCSC).MethodsMulticenter, observational study with a retrospective design enrolling treatment-naïve patients with aCSC and cCSC. The diagnosis of aCSC and cCSC was established with multimodal imaging and for the current study subsequent follow-up visits were also considered. Baseline OCTs were analyzed by an AI-based platform (Discovery® OCT Fluid and Biomarker Detector, RetinAI AG, Switzerland). This software allows to detect several different biomarkers in each single OCT scan, including subretinal fluid (SRF), intraretinal fluid (IRF), hyperreflective foci (HF) and flat irregular pigment epithelium detachment (FIPED). The presence of SRF was considered as a necessary inclusion criterion for performing biomarker analysis and OCT slabs without SRF presence were excluded from the analysis.ResultsOverall, 160 eyes of 144 patients with CSC were enrolled, out of which 100 (62.5%) eyes were diagnosed with cCSC and 60 eyes (34.5%) with aCSC. In the OCT slabs showing presence of SRF the presence of biomarkers was found to be clinically relevant (> 50%) for HF and FIPED in aCSC and cCSC. HF had an average percentage of 81% (± 20) in the cCSC group and 81% (± 15) in the aCSC group (p = 0.4295) and FIPED had a mean percentage of 88% (± 18) in cCSC vs. 89% (± 15) in the aCSC (p = 0.3197).ConclusionWe demonstrate that HF and FIPED are OCT biomarkers positively associated with CSC when present at baseline. While both HF and FIPED biomarkers could aid in CSC diagnosis, they could not distinguish between aCSC and cCSC at the first visit. AI-assisted biomarker detection shows promise for reducing invasive imaging needs, but further validation through longitudinal studies is needed.

Patterning and folding of intestinal villi by active mesenchymal dewetting

Tissue folds are structural motifs critical to organ function. In the intestine, bending of a flat epithelium into a periodic pattern of folds gives rise to villi, finger-like protrusions that enable nutrient absorption. However, the molecular and mechanical processes driving villus morphogenesis remain unclear. Here, we identify an active mechanical mechanism that simultaneously patterns and folds the intestinal epithelium to initiate villus formation. At the cellular level, we find that PDGFRA+ subepithelial mesenchymal cells generate myosin II-dependent forces sufficient to produce patterned curvature in neighboring tissue interfaces. This symmetry-breaking process requires altered cell and extracellular matrix interactions that are enabled by matrix metalloproteinase-mediated tissue fluidization. Computational models, together with invitro and invivo experiments, revealed that these cellular features manifest at the tissue level as differences in interfacial tensions that promote mesenchymal aggregation and interface bending through a process analogous to the active dewetting of a thin liquid film.

OCT risk factors for 2-year foveal involvement in non-treated eyes with extrafoveal geographic atrophy and AMD

PurposeTo assess the relationship of optical coherence tomography (OCT) findings and progression to foveal atrophy in a cohort of eyes with extrafoveal geographic atrophy (GA) and age-related macular degeneration (AMD) at inclusion.MethodsWe retrospectively analyzed 45 participants (45 eyes) with extrafoveal GA at baseline and with 2 years of regular follow-ups. Several OCT qualitative features (i.e., presence of foveal flat pigment epithelium detachment with a thin double layer sign [DLS] and reticular pseudodrusen, GA focality) and quantitative measurements (outer retinal layer thickness, retinal pigment epithelium [RPE] to Bruch’s membrane [BM] volume, minimum distance from the central foveal circle, and untransformed GA lesion size area) were assessed at baseline. Logistic regression analyses were carried out to identify independent significant predictors and compute odds ratios (ORs) for the risk of the development of atrophy.ResultsAt month 24, 26 eyes (57.8%) developed atrophy in the foveal central circle, while 11 eyes (24.4%) developed atrophy in the foveal central point. Significant independent predictive features for the development of atrophy in the foveal central circle included foveal outer retinal thickness (OR, 0.867; p = 0.015), minimum distance from the foveal central circle (OR, 0.992; p = 0.022), and foveal thin DLS (OR, 0.044; p = 0.036). The only independent predictive feature for the development of atrophy in the foveal central point was the presence of foveal thin DLS (OR, 0.138; p = 0.017).ConclusionsWe identified OCT risk factors for 2-year foveal atrophy in eyes with untreated extrafoveal GA at baseline.

Expression of Atoh1, Gfi1, and Pou4f3 in the mature cochlea reprograms nonsensory cells into hair cells

Mechanosensory hair cells of the mature mammalian organ of Corti do not regenerate; consequently, loss of hair cells leads to permanent hearing loss. Although nonmammalian vertebrates can regenerate hair cells from neighboring supporting cells, many humans with severe hearing loss lack both hair cells and supporting cells, with the organ of Corti being replaced by a flat epithelium of nonsensory cells. To determine whether the mature cochlea can produce hair cells in vivo, we reprogrammed nonsensory cells adjacent to the organ of Corti with three hair cell transcription factors: Gfi1, Atoh1, and Pou4f3. We generated numerous hair cell-like cells in nonsensory regions of the cochlea and new hair cells continued to be added over a period of 9 wk. Significantly, cells adjacent to reprogrammed hair cells expressed markers of supporting cells, suggesting that transcription factor reprogramming of nonsensory cochlear cells in adult animals can generate mosaics of sensory cells like those seen in the organ of Corti. Generating such sensory mosaics by reprogramming may represent a potential strategy for hearing restoration in humans.

Морфофункциональная оценка слизистой оболочки надтубарного кармана и переднего эпитимпанального синуса

Based on autopsy and biopsy material, a morpho-functional assessment of the mucous membrane of the anatomical spaces of the medial wall of the tympanic cavity — separated by fold of the tensor tympani muscle —was carried out. It has been shown that in most cases samples of the mucous membrane of the supratubal recess are represented by multirow or pseudostratified epithelium with loose connective tissue of the lamina propria. On the other hand, the mucous membrane of the anterior epitympanic recess in most cases is represented by flat epithelium with compact connective tissue of the lamina propria, which determines the high gas-absorbing capacity of the mucous membrane. Establishing the boundary of the mucous membrane with a high gas-absorbing capacity in practical terms determines the formation of the tympanic segment when performing open-type tympanoplasty.

Combinatorial Atoh1, Gfi1, Pou4f3, and Six1 gene transfer induces hair cell regeneration in the flat epithelium of mature guinea pigs

Flat epithelium (FE) is a condition characterized by the loss of both hair cells (HCs) and supporting cells and the transformation of the organ of Corti into a simple flat or cuboidal epithelium, which can occur after severe cochlear insults. The transcription factors Gfi1, Atoh1, Pou4f3, and Six1 (GAPS) play key roles in HC differentiation and survival in normal ears. Previous work using a single transcription factor, Atoh1, to induce HC regeneration in mature ears in vivo usually produced very few cells and failed to produce HCs in severely damaged organs of Corti, especially those with FE. Studies in vitro suggested combinations of transcription factors may be more effective than any single factor, thus the current study aims to examine the effect of co-overexpressing GAPS genes in deafened mature guinea pig cochleae with FE. Deafening was achieved through the infusion of neomycin into the perilymph, leading to the formation of FE and substantial degeneration of nerve fibers. Seven days post neomycin treatment, adenovirus vectors carrying GAPS were injected into the scala media and successfully expressed in the FE. One or two months following GAPS inoculation, cells expressing Myosin VIIa were observed in regions under the FE (located at the scala tympani side of the basilar membrane), rather than within the FE. The number of cells, which we define as induced HCs (iHCs), was not significantly different between one and two months, but the larger N at two months made it more apparent that there were significantly more iHCs in GAPS treated animals than in controls. Additionally, qualitative observations indicated that ears with GAPS gene expression in the FE had more nerve fibers than FE without the treatment. In summary, our results showed that co-overexpression of GAPS enhances the potential for HC regeneration in a severe lesion model of FE.

Congenital Cyst of Pancreas in a Newborn: A Rare Presentation

Pancreatic cysts are rare lesions in newborns. Prenatal diagnosis of true congenital pancreatic cyst is rare and many times cystic lesion on prenatal scans confused with mesenteric cyst, ovarian cyst, and left renal cyst. Here we report a newborn presented with antenatally detected upper abdominal cystic lesion. The cystic mass was located in the left upper side of the abdomen, and total cystectomy was performed without any intra or post-operative complication. Histopathological examination demonstrated presence of pancreatic tissues in the wall of cyst with foci of inflammation and cystically dilated ducts, lined by flattened epithelium. Features suggestive of congenital true pancreatic cyst with pancreatic fluid as its predominant content.

Efficiency of using deflu silver nose in patients with acute rhinosinusitis

ABSTRACT. Acute rhinosinusitis is one of the most common diseases that affects up to 15% of the world's population every year and can occur at any age. The provisions of EPOS 2020 do not provide for the appointment of antibiotics in acute viral and acute post-viral rhinosinusitis. Thus, there is a need to find medicines to improve the well-being of patients, speed up recovery and prevent complications. One of such promising means of combating viral and bacterial infection of the ENT organs is the use of drugs with silver nanoparticles. Purposes. The purpose of this work was to study the effectiveness of using Deflu Silver Nose in the treatment of patients with acute rhinosinusitis. There was a study of its influence on the clinical course of the disease and parameters of local immunity.Materials and methods. Two groups of patients with acute rhinosinusitis were under our observation. The first group (main) consisted of 32 patients who, together with traditional symptomatic therapy (saline solution intranasally for 2 injections 3 times a day, multivitamins) received the aid Deflu Silver Nose (intranasally for 2 injections 3 times a day for 7 days). The drug was used from the 3rd day after the onset of the disease. The second group (comparison group) consisted of 30 patients who received similar therapy, except for Deflu Silver Nose.Clinical examinations and studies of local immunity were carried out before and after the start of therapy (on the 3rd and 7th day, on the 6th and 10th day of the disease). The results of the examination of 10 healthy people were used as an indicator of the norm. Rhinocytograms (cytological studies of scrapings from the nasal mucosa) were studied.Immunoglobulins, lysozyme, and cationic proteins were carried out in oropharyngeal secretions. Results. Clinical observations showed that under the influence of Deflu Silver Nose, patients with acute rhinosinusitis on the 3rd day from the start of treatment had a noticeable reduction or complete disappearance of the clinical symptoms of the disease. On the 3rd day of treatment, in the rhinocytograms, in the patients of the main group, there was a decrease in the nasal mucosa of destroyed cells and the percentage of lymphocytes in the scraping of cells of the flat and prismatic epithelium. On the 7th day of using Deflu Silver Nose, the level of all antimicrobial factors in nasal secretions in patients of group 1 decreases to normal levels.During this period, the inflammatory process was stopped and excessive swelling of the nasal mucosa was not observed in the vast majority of patients in the main group. No such positive changes were observed in the 2nd group of patients. Conclusion. Intranasal use of Deflu Silver Nose has a positive effect on the clinical course of acute rhinosinusitis, contributes to the prevention of bacterial complications, and increases the local immunoreactivity of the body. Under the influence of the nasal spray, the duration of the disease is reduced and the quality of life of patients improves.

Supporting-cell vs. hair-cell survival in the human cochlea: Implications for regenerative therapies

Animal studies have shown that the supporting-cells surviving in the organ of Corti after cochlear insult can be transdifferentiated into hair cells as a treatment for sensorineural hearing loss. Clinical trials of small-molecule therapeutics have been undertaken, but little is known about how to predict the pattern and degree of supporting-cell survival based on audiogram, hearing loss etiology or any other metric obtainable pre-mortem. To address this, we systematically assessed supporting-cell and hair cell survival, as a function of cochlear location in 274 temporal bone cases from the archives at the Massachusetts Eye and Ear and compared the histopathology with the audiograms and hearing-loss etiologies. Results showed that supporting-cell survival was always significantly greater in the apical half than the basal half of the cochlea, that inner pillars were more robust than outer pillars or Deiters’ cells, and that total replacement of all supporting cells with a flat epithelium was rare outside of the extreme basal 20% of the cochlea. Supporting cell survival in the basal half of the cochlea was better correlated with the slope of the audiogram than with the mean high-frequency threshold per se: i.e. survival was better with flatter audiograms than with steeply down-sloping audiograms. Cochlear regions with extensive hair cell loss and exceptional supporting cell survival were most common in cases with hearing loss due to ototoxic drugs. Such cases also tended to have less pathology in other functionally critical structures, i.e. spiral ganglion neurons and the stria vascularis.

Influence of soft tissue elements on the reparative abilities of the jaw bone tissue

BACKGROUND: Treatment of patients with jaws bone defects requires the elimination of the defect, restoration of the dentition and long-term support of the functional state of the dental system. However, dental damages reduce the reparative capabilities of the jaw bone tissue. Therefore, when developing ways to optimize the reparative osteogenesis of such defects, an important task is to determine the proportion of soft tissue medium in the biology of a bone defect.
 AIMS: to study the effect of soft-tissue elements on the reparative abilities of jaw bone tissue.
 MATERIALS AND METHODS: The study included 98 people with acquired combined jaws bone defects. To study the tissue environment and the characteristics of the transformation of the tissues surrounding the defect, material was taken during the surgical intervention. The obtained samples were sent for histological examination.
 RESULTS: Microscopic examination of histological sections obtained from the area of jaws bone defects revealed the proliferation of a multilayer flat non-corneating epithelium with "creeping" and massive ingrowth of the epithelium into the area of the bone defect. The advance of the epithelium into the underlying bone led to atrophy and destruction of the bone over the entire area of the defect, an increase in the volume of the defect. The epithelial-connective tissue complex lined the bone surface of the defect, replacing the periosteum.
 CONCLUSIONS: The morphology of the tissues surrounding the area of the bone defect suggests a decrease in the sources of cambial bone elements. Treatment of jaws bone defects requires the elimination of the soft-tissue environment that fills the bone defect, followed by the operation of " Guided bone regeneration" using granular osteoconductive material and a resorbable collagen membrane.

Neomycin-induced deafness in neonatal mice

BackgroundHearing impairment is a rising public health issue, and current therapeutics fail to restore normal auditory sensation. Animal models are essential to a better understanding of the pathophysiology of deafness and developing therapeutics to restore hearing. New MethodsWild-type CBA/CaJ neonatal mice P2–5 were used in this study. Neomycin suspension (500 nl of 50 or 100 mg/ml) was micro-injected into the endolymphatic space. Cochlear morphology was examined 3 and 7 days after injection; hair cell (HC) loss, supporting cell morphology, and neurite denervation pattern were assessed with whole-mounts. At 2 and 4 weeks post-injection, the spiral ganglion neuron (SGN) density was analyzed with cryostat sections. Audiometric responses were measured with auditory brain response (ABR) at 4 weeks. ResultsRapid and complete degeneration of the inner and outer HCs occurred as early as 3 days post-injection. Subsequently, time- and dose-dependent degeneration patterns were observed along the axis of the cochlear membranous labyrinth forming a flat epithelium. Likewise, the SGN histology demonstrated significant cell density reduction at 2 and 4 weeks. The ABR threshold measurements confirmed profound deafness at 4 weeks. Comparison with existing methodsCompared to previously described local and systemic aminoglycoside injections, this method provides a reliable, robust, and rapid deafening model with a single infusion of neomycin in neonatal mice. This model also allows for investigating the effects of inner ear damage during auditory maturation. ConclusionsA single injection of neomycin into the endolymphatic space induces robust HC loss and denervation in neonatal mice.

Rhythmological features of the nasal mucociliary system functioning in healthy children and children with bronchial asthma

Introduction. The circadian rhythms of the nasociliary system of children with bronchial asthma have not been practically studied.Objective. To evaluate seasonal variations of circa-annual rhythms of the nasociliary system in healthy children and children with year-round bronchial asthma.Materials and methods. 134 children were examined; the main group consisted of 99 children aged 1.5–7 years with mild and moderate bronchial asthma, the control group was represented by 45 healthy children of the same age. The biorhythms of the nasociliary system were studied for three years, 4 times during each year (in October, January, April, July): smears-prints from the nasal mucosa were studied with the calculation of the specific gravity of neutrophils, eosinophils, cylindrical and squamous epithelium as a percentage, the calculation of the cytolysis index of cells and the average destruction index for each type of cell. To study the near-seasonal rhythms, the KOSINOR program and the computer system of intra-laboratory control “VlCC” were used.Results. The presence of seasonal changes in cytological parameters of the nasal mucosa with the maximum values of the average values of the average destruction of the flat, cylindrical epithelium, neutrophils in January and acrophases in January was revealed. If eosinophils on the nasal mucosa were not detected in healthy children, then the presence of this type of cells was noted in children with asthma throughout the year. The period of fluctuations of the average destruction index in the flat epithelium (1.7 months) was 4 times shorter, and in the cylindrical epithelium (21.6 months) – 3.5 times longer in children with asthma compared with healthy children. The periods, amplitude and mesor of the average neutrophil destruction index in children with asthma and healthy peers did not differ significantly. Acrophases and bathyphases of the average index of destruction of the flat, cylindrical epithelium, neutrophils in patients with asthma and healthy children were recorded at different times.Conclusions. The study showed that in children with AD there are no patterns of rhythmological organization in the work of the nasociliary system, characteristic of healthy children.

Sodium deoxyribonucleate effects on the status of cervical cancer patients after radiotherapy

Background. Apart from surgery and medications, radiation therapy is one of the main treatment methods for malignant tumors of the cervix. However, its use is associated with high incidence of urological complications. In addition, the need for long-term treatment, reduced level of patients’ quality of life promote the necessity to minimize the frequency of urological complications and justify search and study of the most adequate methods of their prevention.Aim. To evaluate the effect of radioprotector sodium deoxyribonucleate on clinical characteristics and quality of life of patients with cervical cancer after radiation treatment.Materials and methods. 80 patients with cervical cancer treated in A.I. Kryzhanovsky Krasnoyarsk Regional Clinical Oncology Dispensary. Patients received chemoand radiotherapy with the 3D conformal radiotherapy method in combination with intracavity gamma therapy sources of high dose with subsequent application of radioprotector and without it.Results. On the 3rd visit it was found that in patients with cervical cancer using a radioprotector, reduced red blood cells and flat epithelium cells content in the urine sediment, it may be due to the reparative and cytoprotective sodium deoxyribonucleate properties. In the assessment of the life quality after combined therapy completion with radioprotector, 60 % of patients’ responses to the health assessment questions of the last week differed from the comparison group. Undesirable phenomena associated with sodium deoxyribonucleate therapy not observed in cervical cancer patients during radiotherapy and subsequent observation period.Conclusion. Conformal external beam radiation therapy in combination with long-term intramuscular administration of a radioprotector has advantages compared to 3D conformal radiation therapy. This method reduces the severity of post-radiation side effects, increases time to development of hematological toxicity in the context of combination chemoradiotherapy, and reduces urothelial damage caused by chemoradiotherapy.

Parameatal cyst: A presentation of a rare case and literature review

Parameatal cysts are very rare in clinical practice due to their asymptomatic course. This article presents one such case. A 25-year-old male patient with a formed spherical cystic tumor measuring 0.7 cm in the area of the external opening of the urethra. Total resection of the cystic formation, suturing of the resulting imperfections was carried out. According to the results of histology, the cyst is formed by a flat and cylindrical epithelium. After 3 months of follow-up, good results were established without relapse and cosmetic appearance.

MICRO- AND ULTRAMICROSCOPIC STRUCTURE OF THE LEFT ATRIA-VENTRICULAR VALVULAR APPARATUS IN HUMAN AT THE MATURE AGE IN NORM

This article presents the morphological characteristics of the mitral valve of a normal heart of an adult at a mature age.The purpose of our investigation is to find out the peculiarities of the morphology of the structural components of the mitral valve apparatus of the heart of a person of mature age in the norm.Material and methods. The study was performed on 32 preparations of mitral valves of adult human hearts. A complex of morphological research methods was used: methods of light and electron microscopy, histochemical method.Results. With the use of a complex of morphological research methods, a study of the structural components of the mitral valve apparatus of a normal mature person was carried out and their histoarchitectonics was established at the micro- and sub-microscopic levels.Conclusions. The leaflets of the mitral valve are connective tissue plates covered with a single-layer flat epithelium - endothelium. The leaflets are formed by fibrous connective tissue of different density, as a result of which three layers are identified: spongy, fibrous and ventricular. Typical chordae tendineae in the form of connective tissue threads extend from the papillary muscles to the leaflets of the mitral valve and attach to their ventricular surface. The skeleton of chordae tendinea is formed by dense fibrous connective tissue. Striated cardiac muscle tissue is found in some chordae tendinea in the areas on the side of the papillary muscles. The papillary muscles are formed by the working fibers of cardiomyocytes, which form a kind of network due to branches and anastomoses. The working fibers of cardiomyocytes are accompanied by layers of loose fibrous connective tissue, which includes a large number of blood vessels.

Morphologic Features in Congenital Pulmonary Airway Malformations and Pulmonary Sequestrations Correlate With Mutation Status: A Mechanistic Approach to Classification.

Congenital pulmonary airway malformations (CPAMs) have a range of morphologies with varying cyst sizes and histologic features (types 1 to 3). Evidence suggested they arise secondary to bronchial atresia, however, we recently showed that cases with type 1 and 3 morphology are driven by mosaic KRAS mutations. We hypothesized that 2 distinct mechanisms account for most CPAMs: one subset is secondary to KRAS mosaicism and another is due to bronchial atresia. Cases with type 2 histology, similar to sequestrations, would be related to obstruction and therefore negative for KRAS mutations regardless of cyst size. We sequenced KRAS exon 2 in type 2 CPAMs, cystic intralobar and extralobar sequestrations, and intrapulmonary bronchogenic cysts. All were negative. Most sequestrations had a large airway in the subpleural parenchyma adjacent to the systemic vessel, anatomically confirming bronchial obstruction. We compared morphology to type 1 and 3 CPAMs. On average, type 1 CPAMs had significantly larger cysts, but there remained substantial size overlap between KRAS mutant and wild-type lesions. Features of mucostasis were frequent in sequestrations and type 2 CPAMs, while their cysts were generally simple and round with flat epithelium. Features of cyst architectural and epithelial complexity were more common in type 1 and 3 CPAMs, which rarely showed mucostasis. Similarity in histologic features among cases that are negative for KRAS mutation support the hypothesis that, like sequestrations, the malformation of type 2 CPAMs is related to obstruction during development. A mechanistic approach to classification may improve existing subjective morphologic methods.

Thrombophilia in a patient with short bowel syndrome

This article presents a clinical case of thrombophilia in a patient with short bowel syndrome. Thrombophilia is characterized by a disorder of the blood clotting system, in which the risk of thrombosis increases. Thrombophilia, local vascular insufficiency, intestinal obstruction with fistula formation requiring intestinal resection play a significant role in the pathogenesis of short bowel syndrome. The patient was admitted with the diagnosis “thrombophilia, resection of the small intestine (residual small intestine 17 cm), ileostoma”. Condition after multiple surgical interventions on the abdominal cavity. Surgeries performed: atypical gastric resection, resection of the greater omentum, jejunostomy, resection of the cardial and antral parts of the stomach, derivation of duodenostomy, esophagostomy, derivation of loop jejunostomy, Braun enteroanastomosis, perforation of the colon, suturing, derivation of colostomy, cholecystectomy, GI reconstruction, Roux esophagoenteroanastomosis, resection of the sigmoid colon, small intestine, bearing intestinal fistulas, removal of double-barrel ileostomy, abdominal cavity drainage, relaparotomy, closure of ileal perforation, retrograde intubation of the small intestine, determination of indications for intestinal transplantation. The following tests were performed: CT-enterography, colonoscopy with subsequent morphological examination, abdominal ultrasound, enterogastroscopy, clinical and biochemical blood tests, PCR, coagulogram, urinalysis, percussion and auscultation of the chest. Morphological examination showed fragments of the wall of the colon – with erosion, fragments of fatty tissue – with immature granulation tissue, fragment of stroma covered with multilayer flat keratinized epithelium with the focus of epithelized slit-like ulcer. Clexane was administered as part of the treatment complex, nutritional support additionally included Micrazyme capsules 25000 units, teduglutide, remabipid. Rebamipid and Teduglutide allowed to stabilize the patient's condition and improve the condition of the perioperative area tissues. In case of ineffectiveness of the therapy used the indications for liver transplantation are determined.

Confocal and Electron Microscopic Structure of the Cornea from Three Species of Penguin

Corneal confocal microscopy has not previously been performed in penguins, despite recognition of its unusually flat shape. To identify features that the penguin shares with other birds and or mammals and those specific to penguins, we undertook confocal microscopic examination of two little (Eudyptula minor), four gentoo (Pygoscelis papua) and five king (Aptenodytes patagonicus) penguin corneas. Transmission electron microscopy was performed on one gentoo and one king penguin, for finer details. Features shared with other higher vertebrates included a five-layered cornea and a similar limbus. Typically avian were a lower density of stromal cells, a more regular arrangement of collagen bands and an absent basal nerve plexus. Features unique to penguins included a flattened superficial epithelium (king penguin), stromal myofibroblasts (all) and an irregular endothelium (little penguin). Other features uniquely identified by confocal microscopy in birds include epithelial and stromal nerves, guttata and stromal imprints on Descemet's membrane. Transmission electron microscopy identified a lack of wing cells (king penguin), greater posterior collagen lamellae thickness (gentoo penguin) and significantly less interlacing of collagen lamellae in the central cornea (king and gentoo). Most of these unique features are yet to be explained, but some could be adaptations to diving.