Focal Hemorrhage Research Articles

Shaken baby syndrome resulting in death: a case series.

The aim of this study was to raise the awareness of all healthcare personnel, primarily Emergency Department physicians, forensic physicians, and paediatricians about cases of shaken baby syndrome (SBS), which can be difficult to diagnose, require a high level of suspicion in diagnosis and there is a high likelihood of missed diagnosis. A retrospective examination was made of 3400 forensic cases applied with autopsy between 2012 and 2018 to the Forensic Medicine Institution of Malatya Group Directorate. Of the total cases, 113 were aged < 2 years and head trauma was determined in 35. Eight cases were determined as SBS. Of the 8 cases that resulted in death, 75% were male and the mean age was 8.3 months. The trauma had been perpetrated by the father in 50% of cases. There was a history of seizure in 67.5% of the infants and 75% were taken to the Emergency Department with cardiopulmonary arrest. Subdural hematoma and subarachnoid hemorrhage were determined in 37.5% of the cases, subdural hematoma, subarachnoid hemorrhage and intracranial hemorrhage in 50%, and epidural hemorrhage and subarachnoid hemorrhage in 12.5%. In the microscopic examination of the medulla spinalis, focal subdural fresh bleeding was seen in 50% of cases. Bleeding around the optic nerves was determined in 37.5% of cases bilaterally and in 37.5% unilaterally. Retinal hemorrhage was determined in all the cases, which was bilateral in 75%. The actual worldwide incidence of SBS is not known, and in Turkey, it is thought to be much higher than has been determined. The most important reason for this is thought to be that the diagnosis of child abuse is difficult and physicians do not have a sufficient level of knowledge.

Calm the raging hormone - a new therapeutic strategy involving progesterone-signaling for hemorrhagic CCMs

Cerebral cavernous malformations (CCMs), one of the most common vascular malformations, are characterized by abnormally dilated intracranial microvascular capillaries resulting in increased susceptibility to hemorrhagic stroke. As an autosomal dominant disorder with incomplete penetrance, the majority of CCMs gene mutation carriers are largely asymptomatic but when symptoms occur, the disease has typically reached the stage of focal hemorrhage with irreversible brain damage, while the molecular "trigger" initiating the occurrence of CCM pathology remain elusive. Currently, the invasive neurosurgery removal of CCM lesions is the only option for the treatment, despite the recurrence of the worse symptoms frequently occurring after surgery. Therefore, there is a grave need for identification of molecular targets for therapeutic treatment and biomarkers as risk predictors for hemorrhagic stroke prevention. Based on reported various perturbed angiogenic signaling cascades mediated by the CCM signaling complex (CSC), there have been many proposed candidate drugs, targeting potentially angiogenic-relevant signaling pathways dysregulated by loss of function of one of the CCM proteins, which might not be enough to correct the pathological phenotype, hemorrhagic CCMs. In this review, we describe a new paradigm for the mechanism of hemorrhagic CCM lesions, and propose a new concept for the assurance of the CSC-stability to prevent the devastating outcome of hemorrhagic CCMs.

Hypersensitivity in Chicken (Gallus gallus domesticus) due to the Association of Lidocaine and Bupivacaine in Neural-Guided Femoral and Sciatic Nerve Block

Background: Osteosyntheses, orthopedic surgeries that cause highly painful stimulation, are increasingly common in veterinary medicine. Epidural anesthesia is used to provide intraoperative and postoperative analgesia in mammals undergoing pelvic limb surgery. In birds, the synsacrum, the bone originating from the fusion of the lumbar and sacral vertebrae, makes this route inapplicable, thus peripheral nerve block is an easier option in this species. This report describes a case of local hypersensitivity following the association of lidocaine and bupivacaine in anesthetic blocks of the femoral and sciatic nerves in chickens (Gallus gallus domesticus).Case: A study was conducted in chickens evaluating the effectiveness of anesthetic sciatic and femoral nerve blocks, guided by a neural stimulator. Thirty-two 42-day-old male chickens of the species Gallus gallus domesticus, double breasted, weighing 1.86 ± 0.5 kg, were randomly divided into four groups: control (CG), lidocaine (LG), bupivacaine (BC) and the association of lidocaine and bupivacaine (LBG). The doses used were 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5% bupivacaine, without vasoconstrictor. For CG, 0.9% NaCl solution was used, respecting the total volume of 1 mL/kg. Only one bird from the LBG showed side effects, presenting sensory and motor loss for 24 h after the administration of these drugs, before euthanasia was performed using anesthetic induction with isoflurane through a face mask, followed by the intravenous administration of propofol and then potassium chloride. The chicken was submitted to a necropsy and macroscopically, soft, irregular, brownish lesions with a grayish focus were observed, indicating areas of necrosis in the muscles adjacent to the femoral and sciatic nerves. Histopathological examination showed mild, active inflammatory migration with perivascular organization, highlighting the presence of lymphocytes, plasmocytes, segmented heterophiles, and areas of hemorrhagic foci. The pairs of nerves evaluated showed edematous areas, but no inflammatory infiltrate, a histopathological finding that is considered to be nonspecific.Discussion: In the case of the chicken with side effects, histopathological examination showed vasculitis and hemorrhagic areas, which were correlated with ischemia and focal tissue necrosis, together with edematous lesions in the nerves evaluated, and extremities that showed an inflammatory response. These changes are related to acute hypersensitivity lesions, the drug response and drug hypersensitivity. Local anesthetics have been widely used in birds, but there are reports of reactions, including neurotoxicity and local myotoxicity, and bupivacaine is the drug that shows the highest cytotoxicity. However, long-term, repeated applications of bupivacaine on the sciatic nerve do not induce degenerative neural lesions in rats, rabbits, and dogs. The reactions described here are proportional to the concentration of the anesthetic injected, and in the case reported, the recommended dose for birds of 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5% bupivacaine, without vasoconstrictor, was adhered to. These findings suggest a reaction specific to the bird described; however, further studies regarding the local adverse effects of these anesthetics in birds should be conducted to make the practice of peripheral nerve block safer by testing different concentrations, associations and doses of the variety of drugs available.Keywords: birds, local block, drug hypersensitivity.

Simian Varicella Virus: Molecular Virology and Mechanisms of Pathogenesis.

Simian varicella virus (SVV) was first isolated in 1966 from African green monkeys (Cercopithecus aethiops) imported from Nairobi, Kenya, to the Liverpool School of Tropical Medicine in the United Kingdom (UK) (Clarkson et al., Arch Gesamte Virusforsch 22:219-234, 1967). SVV infection caused severe disease that resulted in a 56% case fatality rate (CFR) in the imported animals within 48h of the appearance of a varicella-like rash (Clarkson et al., Arch Gesamte Virusforsch 22:219-234, 1967; Hemme et al., Am J Trop Med Hyg 94:1095-1099, 2016). The deceased animals presented with fever, widespread vesicular rash, and multiple hemorrhagic foci throughout the lungs, liver, and spleen (Clarkson et al., Arch Gesamte Virusforsch 22:219-234, 1967). This outbreak was quickly followed by a second outbreak in 47 patas monkeys (Erythrocebus patas) imported from Chad and Nigeria by Glaxo Laboratories (London, England, UK), which quickly spread within the facility (McCarthy et al., Lancet 2:856-857, 1968).

Susceptibility-Weighted MRI in the Evaluation of Gynecologic Diseases

Introduction: Owing to the advanced development of MRI science, it causes obvious great changes of many diseases that affect the female genital system and affect their fertility. Hemorrhagic gynecological diseases especially endometriosis affect young females and cause cyclic pain, in addition to infertility. So early detection is essential for proper treatment. Susceptibility-weighted (SWI) as one of the most recent newly created MRI sequences is highly sensitive to detect products of hemorrhage within different gynecologic disorders with 94.7% sensitivity being more meticulous than conventional MRI sequences as T1 and T2. Aim of the Work: A comparison between T1 and T2 as conventional MRI sequences with susceptibility-weighted images (SWI) in many gynecologic disorders by the detection of the presence of internal products of hemorrhage at any stage. Subjects and Methods: 48 consecutive patients from Benha University clinics (age range, 17 - 60 years; mean age, 35.67 years). The patients included in the study were presenting with pelvic pain, irregular menses, Dyspareunia, and swelling. All with suspicious diagnosis of ovarian and extra-ovarian lesions. 38 patients out of the 48 patients were known to contain hemorrhagic disorder; all the patients underwent MRI routine pelvis protocol adding SWI sequence. Results: There was a greatly significant difference between SWI and conventional MRI sequences T1and T2 with sensitivity 94.7%, 57.9% and 33.3% respectively. Conclusion: SWI is a promising tool in the evaluation of hemorrhagic foci within different gynecological disorders. The great ability of detecting hemosiderin foci increases the value of SWI over conventional MRI or US.

Stereological and Histopathological Effects of Trigonella foenum-graecum Seeds on Rabbits Ovary

This study aimed to investigate the impacts of the Trigonella foenum-graecum (T. foenum-graecum) seeds on the female gonad. A total of twenty local rabbits were used in this study; were divided into four groups (5 each): first group (G1) was considered as the control group. The second group (G2), third group (G3) and fourth group (G4) were fed daily1.5%, 3%, and 4.5% of T. foenum-graecum seeds respectively for 60 days (twice daily). At the end of the experiment, the animals were euthanized by diethyl ether (C2H52O). Then the abdomen was incised, and the samples of ovaries were collected and fixed by 10% neutral buffered formalin. The histological assessment was done with a paraffin embedding technique and the histological sections were stained with Hematoxylin and Eosin stain. The result showed that the numbers of primary and secondary follicles were significantly (P&lt;0.05) decreased in G3and G4 compared with the control (G1) and G2. The numbers of Graafian follicles were significantly P&lt;0.05 decreased G4 compared with other groups. The diameters of the primary, secondary, and Graafian follicles were significantly smaller than the other groups. The thickness of the granulosa cell layer in G3and G4 were significantly thinner than the other groups. The histological figures declared that the ovary of G2 was similar to that in G1. The histological sections of G3 and G4 were revealed marked cortical and medullary vascular congestion and focal hemorrhage; there were also marked follicular degeneration and cystic necrosis. The study concluded that the low concentration of T. foenum-graecum (fenugreek) seeds do not have any positive effect in terms of ovarian stimulation.

PATHOMORPHOLOGICAL CHANGES IN DOGS IN CASE OF CORONAVIRUS INFECTION

In recent years, there is a tendency to increase the incidence of the disease in dogs with signs of diarrhea, not only in Ukraine but also in Europe. The article presents the results of a study on histological changes in organs and tissues of dogs with coronavirus infection. A histological study of pathological material sampled from 6 dogs of various breeds and gender, aged from 2 to 6 months, died from diarrheal syndrome was carried out. The presence of the coronavirus was confirmed in fecal samples by a polymerase chain reaction. The most expressed injuries and typical changes in all dead dogs we recorded in the small intestine, namely in the jejunum and ileum, regional lymph nodes, and also the spleen. Morphological manifestations of coronavirus infection in dogs at the macroscopic level are the following signs: the presence of exudative inflammation in the small intestine in form of serofibrinous jejunoileitis, hyperplasia and serohemorrhagic lymphadenitis of the mesenteric lymph nodes, multiple foci of hemorrhage in the parenchyma of the spleen and serous membrane of the small intestine, passive venous hyperemia of the liver and kidneys, dilatation of the right ventricle of the heart, pulmonary edema, cachexia and dehydration of the body. At the microscopic level, we registered the following: serofibrinous jejunoileitis, hyperplasia of the lymphoid nodules of the spleen and lymph nodes, hemorrhagic infarctions in the spleen, hyperplasia of individual and aggregated lymphoid nodules in the small intestinal mucosa, degenerative processes in the parenchyma of the liver and kidneys.&nbsp

Pericytes Within A Pulmonary Neurovascular Unit in Coronavirus Disease 2019 Elicited Pathological Changes.

A pericyte-centered theory suggesting that embolisms occurring within the microvasculature of a neurovascular unit that can result in either parenchymal hemorrhage or intravascular congestion is presented here. Dysfunctional microvascular pericytes are characterized by their location in the neurovascular unit, either on the arteriole or venule side. Pathophysiological and pathological changes caused by coronavirus disease 2019 (COVID-19) include pulmonary hypertension, edema, focal hemorrhage, microvascular congestion, and thrombosis. In this paper, the application of the pericytes-centered hypothesis to COVID-19 has been presented by proposing the concept of a pulmonary neurovascular unit (pNVU). The application of this concept implies that human lungs contain approximately 300 million pNVUs. This concept of existing local regulation of microvascular blood flow is supported by the observation of pathophysiology in pulmonary embolism and in acute high-altitude illness. The autonomic control seen in these three disease states matches blood flow with oxygen supply in each pNVU to maintain physiological blood oxygen saturation level. This paper illustrates how the malfunction of microvascular pericytes may cause focal hemorrhage, edema or microvascular congestion and thrombosis. A bypass existing in each pNVU would autonomically deviate blood flow from a COVID-19-affected pNVU to other healthy pNVUs. This action would prevent systemically applied medicines from reaching the therapeutic threshold in COVID-19-affected pNVUs. While testing this hypothesis with experimental evidence is urgently needed, supporting therapy aimed at improving microcirculation or rebuilding the physiological function of microvascular pericytes is recommended as a potentially effective treatment of COVID 19.

Diagnostics of the cause of aneurism rupture in case of basal subarachnoid hemorrhage: a rare case report

Background: Basal subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms usually has non-traumatic etiology. However, head injury shortly before death can start legal case, even if aneurysm was found. In such cases, forensic pathologists have to decide on the cause of the rupture and the role of the injury.&#x0D; Case presentation: The article presents a rare case from forensic practice: 43 years old male dies after a head blunt trauma. The death was caused by basal SAH, which was caused by a microaneurysm rapture of the left posterior cerebral artery. The autopsy revealed external damages on the face and focal hemorrhages in soft tissues of the head and back. A detailed analysis of the morphological findings, clinical picture and circumstances was performed. The results showed that it was non-traumatic basal SAH. The cause of aneurism rupture was intracranial hypertension increased by vomiting and unusual body position shortly before the death.&#x0D; Conclusion: Available published articles were studied on the causes of ruptures of pathological cerebral arteries and forensic interpretation in controversial cases. Results suggest that current recommendations should be revised. The hypothesis of the most significant sign indicating unnatural death (localization of the damage in the projection of the brain base) could not be confirmed.

Progression of adenomyosis magnetic resonance imaging features under ulipristal acetate for symptomatic fibroids

Research questionWhat is the evolution of adenomyosis on magnetic resonance imaging (MRI) after a 3-month treatment course of daily 5 mg doses of ulipristal acetate (UPA) for symptomatic fibroids? DesignA monocentric prospective pilot study on patients who underwent a 3-month treatment course of UPA for symptomatic fibroids between January 2014 and December 2017. Patients underwent pelvic MRI shortly before (pre-MRI) and after treatment (post-MRI). The diagnosis of adenomyosis on MRI was defined by the observation of intramyometrial cysts and/or haemorrhagic foci within these cystic cavities and/or a thickening of the junctional zone >12 mm. The progression of adenomyosis was defined by the presence of at least one of the aforementioned criteria of adenomyosis on the pre-MRI and by at least one of the following on the post-MRI: (i) increased thickness of the junctional zone ≥20% and/or (ii) increased number of intramyometrial cysts. The appearance of adenomyosis was defined by the absence of the aforementioned criteria of adenomyosis on the pre-MRI and the presence of at least one of these criteria on the post-MRI. ResultsSeventy-two patients were included. The MRI features of adenomyosis progressed for 12 of 15 patients (80.0%) for whom adenomyosis was identified on the pre-MRI. An appearance of adenomyosis was identified after treatment for 15 of 57 patients (26.3%) for whom adenomyosis was not identified on the pre-MRI. ConclusionsA 3-month treatment course of daily 5 mg doses of UPA could provoke a short-term progression or an emergence of typical adenomyosis intramyometrial cysts on MRI examinations.

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

Abstract 14228: Pericytes Within a Pulmonary Neurovascular Unit in Covid-19-elicited Pathologic Changes

A pericyte-centered hypothesis suggests that embolisms occurring within microvasculature of a neurovascular unit can result in either parenchymal hemorrhage or intravascular congestion. Dysfunctional microvascular pericytes are featured depending on their location in the neurovascular unit. I extend the hypothesis by proposing a concept of pulmonary neurovascular unit (pNVU). In simulating pathophysiology in pulmonary embolisms, acute high-altitude illness and COVID-19, an existing local regulation of microvascular blood flow is believable. This control balances blood flow with oxygen supply to maintain physiological blood oxygen saturation level. We have reported a working module for the neurovascular unit in the sexually dimorphic nucleus of the preoptic area. Pericytes, labeled with alpha-smooth muscle actin immunoreactivity, are significantly denser within the microvasculature of the neurovascular unit in males, signifying their biological functions or potential pathophysiological role in diseases. Noticeably, an illustration provides an explanation of how malfunction of microvascular pericytes causes pulmonary focal hemorrhage, edema or microvascular congestion and thrombi [Fig. 1]. A bypass existing in the pNVU would autonomically deviate blood flow from COVID-19-affected pNVU to other healthy pNVU. Consequentially, systematically applied medicines including chloroquine and/or hydroxychloroquine became valueless due to low concentration of the medicine in the COVID-19-affected regions. Alternatively, a preventive, early antiviral therapy may be efficacious because dysfunctional blood-air exchange precedents and malfunction of pulmonary microcirculation follows. While testing the hypothesis with experimental evidence is urgently needed, supporting therapy aimed at improvement of microcirculation or rebuilding of microvascular pericytes’ physiological function may be recommended during the COVID pandemic.

Malignant Perivascular Epithelioid Cell Tumor Mimicking Renal Cell Carcinoma: A Diagnostic Pitfall

Abstract We describe a case of metastatic malignant renal perivascular epithelioid cell tumor in a 56-year-old male. Computed tomography initially revealed bilateral heterogeneous enhancing kidney masses, the right one significantly larger than the left. The patient underwent a right radical nephrectomy. Upon gross examination, the mass was infiltrating into the surrounding fat and had a heterogeneous cut surface with multiple hemorrhagic foci. Histologically, majority of cells were highly atypical with abundant clear cytoplasm, pleomorphic nuclei, and enlarged prominent nucleoli. Extensive lymphovascular invasion was noted. Based on morphology, the diagnosis of renal cell carcinoma, Fuhrman grade 4, with extensive rhabdoid and focal sarcomatoid features was rendered. Follow-up computed tomography demonstrated a hypodense area within the right hepatic lobe, which upon resection showed identical morphology to the renal mass, except for focal areas of prominent epithelioid cells with abundant eosinophilic cytoplasm. Immunohistochemistry of both resection specimens (kidney and liver) demonstrated positive staining for Melan-A, HMB-45, and epithelial membrane antigen, focal positive staining for TFE3, and negative staining for PAX8 and cytokeratin. The initial diagnosis of renal cell carcinoma was amended to malignant epithelioid angiomyolipoma with hepatic metastasis. The diagnosis of angiomyolipoma/perivascular epithelioid cell tumor is particularly problematic owing to the large number of potential mimics. Immunohistochemistry for myomelanocytic differentiation should be considered in the context of kidney lesions with epithelioid and spindled cell morphology.

Totally endoscopic aortic valve replacement: technique and first experience

Abstract Background Cardiac surgery is still looking for new minimally invasive techniques with less trauma and better cosmetic results. In the field of aortic valve replacement, several types of less invasive procedures were introduced, allowing a reduction in blood loss, infections, ventilation times, morbidity and mortality. The most common technique for minimally invasive aortic valve replacement is the mini-sternotomy approach. In this report, the initial experience with a non-sternotomy approach for aortic valve replacement by means of a totally endoscopic surgical technique is presented. Methods The totally endoscopic aortic valve replacement was carried out in 201 patients (59,7% males, mean age: 71.6±11.7 years) from October 2017 until October 2019. Severe aortic valve stenosis was the surgical indication for all patients, who had a mean EuroSCORE II of 2.35±3.82. The surgery was carried out with the patient in supine position and a standard zero-degree optics was used. A 20 mm working port in the 2nd right intercostal space and two 5 mm trocars gained access to the aorta. After groin cannulation, cardiopulmonary bypass was initiated. Transthoracic aortic cross-clamping followed by antegrade administration of a single shot cold mixed-blood cardioplegia was assessed. The aortotomy was followed by the excision of the stenotic aortic valve and the aortic valve prosthesis was implanted in supra-annular position. After the closure of the aorta, an external pacemaker wire was placed. Results Mean cross-clamp and cardiopulmonary bypass times were 62±14 and 94±25 minutes, respectively. No conversion to a sternotomy was needed. The mean length of stay at the intensive care unit was 69.4±149.6 hours while patients spend 9.6±10 days at the hospital. Due to our new fast track protocol, the mean hospital stay in the last two months was 6.1 days (26 patients, 12.9%). The average postoperative blood loss (24h) was 251±298 mL and the patients were ventilated for 6.9±9 hours. In 10 patients (4.9%), re-exploration in an endoscopic way was needed. None of them had a surgical bleeding focus. No paravalvular leakages were detected at discharge. 69 patients (34.7%) developed atrial fibrillation after surgery. In addition, 10 patients (4.9%) underwent a pacemaker implantation postoperatively whereas 4 patients (1.9%) suffered from a CVA. Finally, the 30-day mortality was 2.0%. Conclusion These results concerning the feasibility and safety of totally endoscopic aortic valve replacement are promising. The aortic cross clamping times are acceptable, and the morbidity and mortality rates are low. Long term results are needed to confirm these initial findings. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

Abdominal Inflammatory Myofibroblastic Tumor: Minimal Inflammatory Infiltrate and Diffuse Immunoreactivity for Caldesmon are Potential Diagnostic Pitfalls

Abstract Introduction/Objective Inflammatory myofibroblastic tumor (IMT) is an uncommon spindle cell lesion that can involve various organs and occurs in multiple body sites. While older terminology (i.e. inflammatory pseudotumor) suggested otherwise, recent molecular studies point toward a neoplastic pathogenesis for IMTs. Herein, we report a case of an abdominal IMT and discuss the morphologic and immunohistochemical pitfalls pertaining to this entity. Methods A 75-year-old woman presented with complaints of generalized abdominal pain and distention. An abdominal CT scan showed multiple peritoneal masses, the largest of which measured 23 cm. Biopsy revealed compact fascicles of bland spindle cells exhibiting diffuse actin and caldesmon immunoreactivity, consistent with a spindle cell tumor with smooth muscle differentiation. Mitotic activity was low-to-unapparent. Surgical excision was performed. The cut surface of the tumor was tan-white with hemorrhagic foci. Histopathologic examination of the tumor showed elongated spindle cells set in a loose myxoid stroma rich in blood vessels and a mixed inflammatory infiltrate. Deeper sections of the tumor were more cellular, showing a similar morphology to that seen in the original biopsy, which was virtually devoid of inflammatory cells. Immunohistochemistry showed diffuse staining for desmin, caldesmon, smooth muscle actin, and ALK. FISH analysis showed ALK gene rearrangement in 52% of tumor cells, confirming the diagnosis of IMT. Results Studies in the literature show that IMTs express smooth muscle markers such as SMA (90%) and desmin (50%). However, immunoreactivity for caldesmon is rarely reported. ALK immunoreactivity is seen in about 35–60% of cases, and when gene rearrangement involving ALK is detected the diagnosis can be confirmed. Conclusion Historically, several terms have been used to describe IMTs, including inflammatory pseudotumor and inflammatory pseudosarcomatous fibromyxoid tumor. While the nomenclature consistently implies an inflammatory infiltrate, this tumor could have various morphological patterns with some areas showing very little to absent inflammation, as demonstrated in our case. Hence, making an accurate diagnosis could be challenging on a limited biopsy. Therefore, ALK testing should be included as part of the diagnostic workup of spindle cell neoplasms with smooth muscle differentiation.

Intracranial Hemorrhage In Patients Receiving Direct Oral Anticoagulant Therapy: Clinical Assessment, Management And Related Laboratory Studies

Abstract Introduction/Objective Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Although relatively rare with DOAC therapy, intracranial hemorrhage may become a medical emergency and needs to be managed with caution to avoid adverse consequences. Methods During the review of 94 patients with DOAC therapy related bleeding complications at William Beaumont hospital – Troy, Michigan, 3 patients were identified with intracranial hemorrhage. Information on DOAC therapy, the cause related to intracranial hemorrhage, and clinical assessment and management of these patients were collected from electronic medical charts with concurrent laboratory studies. Results There were 1 male and 2 female patients, ages 63, 67 and 86. Two patients were taking rivaroxaban 20 mg daily and 1 patient apixaban 5 mg bid for atrial fibrillation and DVT. Patients were clinically stable with no prior significant bleeding events, except for minor skin rashes. All patients experienced a minor trauma to the head and showed signs of brain injury. They were brought to the emergency department immediately. DOAC therapy was discontinued during the emergency evaluation. CT studies revealed 1 patient with subdural hematoma and 2 patients with focal intraparenchymal hemorrhage without mass effects. Both clinical and laboratory assessment revealed stable medical conditions. Patients received conservative care without surgical intervention and repeat CT studies demonstrated resolution of hemorrhage. One patient discontinued DOAC therapy permanently and the others resumed DOAC therapy with antidotes available. Clinical follow up showed no additional bleeding events. Conclusion Intracranial hemorrhage can occur in patients received DOAC therapy, even in clinically stable patients, and most likely happens after head injury. In this small group of patients, both clinical and laboratory evaluations showed stable medical conditions, with no need for surgery intervention. However, the decision of continuing DOAC therapy should be made with caution and it is reasonable to have antidote available for these patients.

Long Non-coding RNA Expression Profile in Broiler Liver with Cadmium-Induced Oxidative Damage.

Cadmium pollution is serious heavy metal pollution in environmental pollution and impacts on livestock productivity. However, the effect and mechanisms of cadmium toxicity on the broiler remain unclear. This study aimed to explore the liver oxidative damage and reveal the related long non-coding RNA (lncRNA) expression patterns in the broiler liver with cadmium exposure. The broilers were fed with diets containing CdCl2 and detected the oxidative stress indexes in the liver tissues. Transcriptome sequencing of broiler liver was performed to identify cadmium exposure-related differentially expressed lncRNAs (DElncRNAs). The functions and pathways of DElncRNAs were analyzed by GO and KEGG. The sequencing results were verified by the quantitative real-time polymerase chain reaction. Cadmium exposure induced tissue structure disorder, focal hemorrhage, and irregular hepatocytes in the broiler liver, and significantly decreased GSH level and enzyme activities, and increased MDA expression in the liver. A total of 74 DElncRNAs were obtained in cadmium group compared with the control group, which were enriched in the GO terms, including intrinsic apoptotic signaling pathway in response to DNA damage by p53 class mediator, branched-chain amino acid biosynthetic process. The enriched KEGG pathways, including lysine biosynthesis, valine, leucine and isoleucine biosynthesis, and pantothenate and CoA biosynthesis, were related to oxidative stress. PCR analysis indicated that the changes in ENSGALG00000053559, ENSGALG00000053926, and ENSGALG00000054404 expression were consistent with sequencing. Our results provide novel lncRNAs involved in oxidative stress in the broiler liver with cadmium exposure.

Spontaneous Raman spectroscopy for intracranial tumors diagnostics ex vivo

Neurosurgery of intracranial tumors, especially of glial origin, is a non-trivial task due to their infiltrative growth. In recent years, optical methods of intraoperative navigation have been actively used in neurosurgery. However, one of the most widely used approaches based on the selective accumulation of fluorescent contrast medium (5-ALA-induced protoporphyrin IX) by the tumor cannot be applied to a significant number of tumors due to its low accumulation. On the contrary, Raman spectroscopy, which allows analyzing the molecular composition of tissues while preserving all the advantages of the method of fluorescence spectroscopy, does not require the use of an exogenous dye and may become a method of choice when composing a system for intraoperative navigation or optical biopsy. This work presents the first results of using the principal component method to classify Raman spectra of human glioblastoma with intermediate processing of spectra to minimize possible errors from the fluorescence of both endogenous fluorophores and photosensitizers used in fluorescence navigation. As a result, differences were found in the principal component space, corresponding to tissue samples with microcystic components, extensive areas of necrosis, and foci of fresh hemorrhages. It is shown that this approach can serve as the basis for constructing a system for automatic intraoperative tissue classification based on the analysis of Raman spectra.

CONSIDERAÇÕES IMUNOLÓGICAS SOBRE A PATOGENIA DA INFECÇÃO PELO SARS-COV-2

Nas últimas décadas, infecções por coronavírus representaram uma ameaça global à saúde pública. O novo coronavírus, SARS-CoV-2, que surgiu em Dezembro de 2019, levou poucos meses para provocar o surto da nova doença (COVID-19) declarada como pandemia pela Organização Mundial da Saúde (OMS). SARS-CoV-2 se dissemina, inicialmente, pelo trato respiratório com linfopenia e hipercitocinemia, características de desregulação imunitária. Enquanto muitos indivíduos infectados podem apresentar-se assintomáticos ou com sintomas respiratórios superiores, outros desenvolvem pneumonia intersticial que pode rapidamente seguir com insuficiência respiratória, podendo evoluir com falência de múltiplos órgãos. O propósito desta revisão consistiu em apresentar as interações moleculares do SARS-CoV-2 com células hospedeiras; assinalar os efeitos citopáticos; avaliar a extensão da desregulação imunológica; revelar os mecanismos imunológicos associados à patogênese pulmonar e extrapulmonar e verificar a influência de marcadores genéticos de suscetibilidade e de proteção para COVID-19. A produção de conhecimento desde o início da pandemia acerca da resposta imunitária ao SARS-CoV-2 aponta que, em indivíduos infectados, a proliferação viral e o dano tecidual ocorrem para além do tecido pulmonar. Dentre os achados sistêmicos foi demonstrado lesão do tecido linfático submucoso do trato gastrointestinal, hemorragias focais renais, edema e degeneração neuronal, degeneração de hepatócitos, manifestações cardiovasculares, hematológicas, cutâneas e obstétricas. No entanto, a possibilidade de infecções recorrentes sazonais por coronavírus de genótipos distintos estimularem memória imunitária parcial e favorecer o predomínio de casos brandos da doença, deve ser considerada.

Forensic-Medical Criteria for Evaluation of Poisoning by Alcohol Surrogates

Introduction: According to statistical data, fatal poisoning by alcohol and its surrogates account for morethan 55% of all poisonings. Fatal poisoning by alcohol surrogates equals for about 3-5%. The number ofpoisonings by organic solvents and technical fluids taken orally as alcohol surrogates has risen sharply.The widespread availability of these compounds and poor public awareness of their toxic properties lead topoisoning by these substances, and the frequency of such poisoning has a strong tendency to increase.Materials and Method: 20 archival forensic medical reports on the corpses of people who received chemicalintoxication due to poisoning by alcohol surrogates. The subject of the study was the effect of poisoningby alcohol surrogates on human systems and organs. Forensic medical examination of the corpses wascarried out according to the generally accepted method in the first 10-18 hours, but no later than 24 hoursafter death. Quantitative determination of alcohol surrogates in biological material was carried out by gaschromatographic and spectrophotometric method.Results: The most common signs of external examination of corpses in all cases studied during the studywere clearly defined bluish-violet cadaveric spots (in 100% of cases), pale pink conjunctiva (in 86% ofcases), and cyanosis puffiness of the skin of the face (in 74% of cases). Meanwhile, the most significant ofthe microscopic signs characteristic of most of the studied cases during forensic histological examinationwere: plethora of vessels in the lung tissue (in 100% of cases), edema of the pia mater and brain tissue (in86% of cases), edema and focal hemorrhages in the lung tissue (in 84% of cases).Conclusion: Respiratory, cardiovascular systems and pancreas are most vulnerable target organs for alcoholsurrogates and leads to early morbidities in people who consume chronically. The changes can be foundmacroscopically as well as microscopically in corpses during forensic medical examinations.