Focal Necrosis Research Articles

Main factors determining the use of free MS-TRAM and DIEP flaps and comparing the results of breast reconstruction

This study aimed to compare the results of free MS-TRAM and DIEP-flap based on the volume of the transplant and the unique characteristics of blood flow in the tissues. The study included 83 patients, 42 in the MS-TRAM-flap reconstruction group and 41 in the DIEP-flap breast reconstruction group. In the MS-TRAM-flap group, 35 patients received delayed reconstruction, and 7 received one-stage breast reconstruction, including one case of bilateral transplantation. In the DIEP-flap group, 5 patients received one-stage reconstruction, and 36 received delayed reconstruction. Complications associated with the flap tissue were observed in 7 (16.67%) in the MS-TRAM-flap group and 8 (19.51%) cases in the DIEP-flap group. The total level of fat necrosis in MS-TRAM-flap was 7.14% (p=0.033), and in DIEP-flap, it was 9.75% (p=0.039) (2 patients had a substantial amount of fat necrosis, while 2 patients had a modest amount of focal fat necrosis). The number and diameter of perforators (including veins), as well as the transplant volume, are the primary determinants of whether to use a DIEP- or MS-TRAM-flap. DIEP-flap is preferred if there are 1-2 large artery perforators (≥1 mm) and tissue volume of 700-800 grams, while MS-TRAM-flap is used when the tissue volume is significant (>2/3 of standard TRAM-flap).

腹腔镜下诊疗大网膜局灶性扭转坏死伴急性化脓性阑尾炎：1例报道及文献回顾

腹腔镜下诊疗大网膜局灶性扭转坏死伴急性化脓性阑尾炎：1例报道及文献回顾

Protective Effects of Fuziline on Dobutamine-Induced Heart Damage in Mice.

Fuziline is one of the many antioxidants currently being tested to treat cardiac damage. In our study, histopathological and biochemical effects of fuziline were investigated in mice with dobutamine-induced heart damage in vitro. Thirty-two adult male BALB/c mice, average weight of 18-20 g, were randomly divided into four groups - Group 1 (sham, n=8), Group 2 (control, dobutamine, n=8), Group 3 (treatment 1, dobutamine + fuziline, n=8), and Group 4 (treatment 2, fuziline, n=8). Biochemical parameters and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were measured. Interleukin 1 beta (IL-1β), NLR family, pyrin domain containing protein 3 (NLRP3), 8-hydroxy-deoxyguanosine (8-OHDG), gasdermin D (GSDMD), and galectin 3 (GAL-3) levels were analyzed by enzyme-linked immunosorbent assay method, and histopathological examination of heart tissues was performed. When dobutamine + fuziline and fuziline groups were compared, troponin-I (P<0.05), NLRP3 (P<0.001), GSDMD (P<0.001), 8-OHDG (P<0.001), IL-1β (P<0.001), and GAL-3 (P<0.05) were found to be statistically significant. TOS level was the highest in the dobutamine group (P<0.001) and TAS level was the highest in the fuziline group (P<0.001). OSI level was statistically significant between the groups (P<0.001). In histopathological examination, focal necrosis areas were smaller in the dobutamine + fuziline group than in the dobutamine group, and cardiac myocytes were better preserved. Fuziline markedly reduced cardiac damage and pyroptosis in mice with dobutamine-induced heart damage by lowering the levels of GSDMD, 8-OHDG, IL-1β, and GAL-3. It also prevented necrosis of cardiac myocytes in histopathological evaluation.

Cardioprotective Effect of Pistacia vera L. (Green Pistachio) Hull Extract in Wistar Albino Rats with Doxorubicin-Induced Cardiac Damage.

Pistacia vera L. (green pistachio) has been shown to increase antioxidant capacity and protect against cardiovascular diseases and cancer. This study investigated the protective effect of the Pistacia vera L. hull in rats with experimental cardiac damage induced by doxorubicin. Sixty adult Wistar albino rats were randomly divided into 5 groups (n = 12). Sham, doxorubicin, doxorubicin + Pistacia vera L. extract 50 mg/kg, doxorubicin + Pistacia vera L. extract 100 mg/kg, and Pistacia vera L. extract 100 mg/kg. Biochemistry parameters, total antioxidant status, total oxidant status, oxidative stress index, 8-hydroxydeoxy guanosine, and caspase 3/7 values were measured in serum samples. Excised heart tissues were examined histopathologically. The groups were statistically significantly different in 8hydroxydeoxy guanosine, caspase 3/7, total antioxidant status, total oxidant status, oxidative stress index, and basal biochemical parameter values (P <.05, P <.001). In group II, 8-hydroxydeoxy guanosine, caspase 3/7, and total oxidant status values increased while the total antioxidant status value decreased (P <.001). In the treatment groups (group III and group IV), 8-hydroxydeoxy guano sine and caspase 3/7 values decreased compared to group II (P <.001). While total oxidant status and oxidative stress index values decreased in the treatment groups, total antioxidant status values increased (P <.001). The histopathological examination of the heart revealed fewer areas of focal necrosis in the treatment groups compared to group II. In this study, the cardioprotective effect of Pistacia vera L. hull extract was investigated in vivo. It was shown that Pistacia vera L. hull extract reduced apoptosis and deoxyribonucleic acid damage in the face of cardiac damage and had antioxidant activity. Future studies will increase our knowledge on this subject.

ИНВАЗИВНОСТЬ BR. HYODYSENTERIAE И ДИНАМИКА ГИСТО-УЛЬТРАСТРУКТУРНЫХ ИЗМЕНЕНИЙ В СЛИЗИСТОЙ ОБОЛОЧКЕ ТОЛСТОГО КИШЕЧНИКА ПРИ ДИЗЕНТЕРИИ СВИНЕЙ

The paper discusses the urgent problems associated with the effect of β-hemolytic Br. hyodysenteriae on pathological processes in the large intestine. For establishing histological and ultrastructural changes in the large intestine, the study used the material from the slaughtered animals. The intestinal mucosa was examined according to generally accepted histological and ultrastructural methods. The tryptic soyabean casein blood agar was used for isolation of Br. hyodysenteriae under anaerobic conditions. Histological and ultrastructural examination of the intestinal mucosa in pigs with swine dysentery revealed catarrhal hemorrhagic inflammation with focal necrosis of the epithelium, edema of lamina propria. The earliest changes in colonocytes include destruction of microvilli, which is a morphological expression of membrane indigestion and malabsorption. The damaging effect of pathogens involves desquamated colonocytes, bare stroma, circulatory abnormalities, cell element proliferation. Mucoid and fibrinoid swelling of collagen fibres, fragmentation, coarsening of elastic and reticular fibres, proliferation of fibroblasts and histiocytes are observed in the connective tissue stroma of the intestine. The study established the effect of Br.hyodysenteriae on structural changes in the large intestine. The findings should be applied to the areas of a differential diagnosis and swine dysentery control measures.

An unexpected case of non-uremic calciphylaxis in a patient with multiple risk factors.

A 58-year-old woman with a history of morbid obesity, asthma, and prior warfarin use presented to the hospital with shortness of breath and a three-month history of painful, ulcerated ulcers with retiform purpura of her bilateral distal extremities. A punch biopsy specimen demonstrated focal necrosis and hyalinization of the adipose tissue with subtle arteriolar calcium deposition, findings consistent with calciphylaxis. We discuss the presentation of non-uremic calciphylaxis and review the risk factors, pathophysiology, and interdisciplinary management approach of this rare disease.

Ultrastructural reorganization of the constituent components of the rat periodontium under conditions of chronic opioid exposure

Opioid addiction has acquired the characteristics of an epidemic in recent years and is a serious problem in modern medicine. In users of narcotic substances, a significant prevalence of diseases of the oral cavity and periodontal tissues is noted in comparison with the general population. The aim of the work was to investigate the ultrastructural organization of the periodontal tissues of rats at the end of the fourteenth week of the experimental opioid effect. The animals were administered intramuscularly, daily, once, the opioid analgesic nalbuphine (pharmacotherapeutic group: analgesics, opioids, morphinan derivatives) in increasing doses for 14 weeks: 1-2 weeks – 0.212 mg/kg, 3-4 weeks – 0.225 mg/kg, 5-6 weeks – 0.252 mg/kg, 7-8 weeks – 0.260 mg/kg, 9-10 weeks – 0.283 mg/kg; 11-12 – 0.300 mg/kg, 13-14 weeks – 0.450 mg/kg. At the end of the fourteenth week of opioid exposure, ultrastructural changes in the epithelium of the mucous membrane of the gums, periodontium, and hemomicrovessels with the development of decompensation and pronounced dystrophic-destructive changes were established. With the long-term effect of an opioid analgesic, signs of karyorrhexis, segregation of nucleoli, spongiosis, apoptosis, violation of the integrity of intercellular contacts, as well as vacuole-like formations, which were a manifestation of focal necrosis of epitheliocytes, were revealed. The development of necrotic changes was caused by significant damage and destruction of organelles, as well as fragmentation or lysis of bundles of tonofilaments. The intercellular spaces were mostly expanded and uneven, which was caused by edematous phenomena. Fragmentation and destruction of periodontal collagen fibers, destructive changes in fibrocytes and fibroblasts were found in the periodontium. The translucency of the amorphous component of the intercellular substance of the connective tissue was determined. The ultrastructural reorganization of the cellular components of the periodontium was caused by vascular disorders of a systemic nature, which were manifested by the phenomena of dilatation, hemoptysis, sludge phenomenon, dystrophic changes in the endotheliocytes of hemocapillaries and venules, and the progression of sclerotic changes, which significantly disturbed the trophism of the periodontal tissues of rats.

Next-generation sequencing proves clonal relationship between two distinguished lung and liver carcinomas by standard histopathology approach

Introduction: Two tumors having different histopathologies at anatomically distinct sites giving the picture of dual primary malignancies. Here we presented a case of two possible primary tumors and one secondary mass. Case Report: A 74-year-old female, active smoker, without personal or family cancer history presented with early satiety and weakness for two months. Systems review was positive for a “raw” feeling in stomach, alleviated with antacids. Vital signs were stable with a negative abdominal exam. Lab showed leukocytosis 24.8 K/uL (3.5–10.8 K/uL) with left shift, microcytic anemia with hemoglobin 6.1 g/dL (12.0–16.0 g/dL), and reactive thrombocytosis 477 K/uL (130–400 K/uL). Contrast-enhanced computed tomography (CT) showed right upper lobe necrotizing cavitating lesion with reactive mediastinal and right hilar lymphadenopathy, two irregular hypodense lesions in pancreatic head and tail without ductal dilation with two irregular hypodense liver lesions. Immunohistochemistry of lung and pancreatic lesions were biopsied through endoscopic ultrasound (EUS), consistent with poorly differentiated squamous cell carcinoma (SCC) with extensive necrosis, which indicates pancreatic masses are likely metastases from the lung. Liver lesion biopsy exhibited high-grade neuroendocrine tumor (NET) with focal necrosis. Next gene sequencing was pursued. Given poor functional status, palliative immunotherapy was offered; however, the patient succumbed to respiratory failure. Conclusion: Given the morphology and immunoprofile, differential diagnosis includes dual primary cancers with one metastasis, or primary SCC with metastasis with neuroendocrine differentiation. Despite having different histopathology and immunophenotype, both lung and liver tumors harbor the same molecular profile even at the variants of unknown significance that show identical mutations. As a result, they are directly related. TP53, RB1, MYCL1, and MEK1 mutations are more prevalent in SCC than NET. Tumor mutation burden values may vary as the tumor clonal structure varies between primary and metastatic sites, with higher rates of monoclonal structure recorded in metastases due to clonal selection, leading to a reduction in overall genetic diversity (“bottlenecking”). This raises the suspicion that the liver tumor is a SCC with neuroendocrine differentiation. The paucity of the specimen and rapid clinical course limited further investigation. Germline testing would have been useful to determine whether these findings are somatic or germline.

Preoperative Cholangiostomy for Pancreatic Head Cancer

The question of the need for routine preoperative drainage of the biliary tree in peripapillary tumor obstruction is still debatable. We conducted a retrospective randomized single–center study, the first control point of which was to study the safety of percutaneous drainage, the second was the effect of preoperative drainage on the number of postoperative complications in pancreatoduodenectomy (PD). The results of 85 Whipple’s PD for a tumor of the head of the pancreas were analyzed. Preoperative biliary drainage (PBD) was performed in 75 (88.2 %) cases and was represented by percutaneous transhepatic cholangiostomy. 10 (11.8 %) patients did not undergo PBD. In the preoperative period, the level of plasma bilirubin and the severity of mechanical jaundice were assessed according to E.I. Galperin, 2014. The frequency of postoperative complications was assessed, both after performing PBD and after PD, the severity was graded according to the Clavien–Dindo scale. The technical success of cholangiostomy was achieved in 100 % of cases, the clinical efficacy of PBD is represented by a significant decrease in serum bilirubin levels and a decrease in the severity of jaundice. Complications of transcutaneous interventions on the biliary tree corresponded to III A of the Clavien– Dindo scale and did not affect the preoperative status. Complications of PD among patients without PBD corresponded to classes IIIA and V of the Clavien–Dindo scale: failure of pancreatojejunostomy (30 %, 3 out of 10) with the formation of pancreatic fistula, complete or partial failure of hepaticojejunostomy (30 %, 3 out of 10). Infectious complications in the form of abdominal abscesses and suppuration of a postoperative wound were found in 20 % (2 out of 10). In patients after PBD, PD complications corresponded to classes IIIA and IIIB of the Clavien–Dindo scale: partial failure of pancreatojejunostomy and pancreatic accumulations of the abdominal cavity (18.7 %), acute pancreatitis (12 %) and focal pancreatic necrosis (12 %), partial failure of hepaticojejunostomy (6.7 %). Abscesses of the abdominal cavity and retroperitoneal space, infection of the wound were noted in 14.7 %. After PD, the mortality rate was 6 (7.1 %) cases, of which 3 (30 %, 3 out of 10) patients without PBD and 3 (4 %) patients with cholangiostomy. Using contingency tables with the calculation of Fisher’s exact test and Pearson’s contingency coefficient, it was found that PBD does not affect the frequency of complications from pancreatojejunostomy and the development of infectious complications; the absence of cholangiostomy significantly leads to an increase in the frequency of hepaticojejunostomy failure.

Histopathological evaluation of lesions induced by dimethyl hydrazine in male rats

This study evaluated dimethylhydrazines' carcinogenic and toxic effect (DMH) in male rats; 30 albino rats were divided into three groups, randomly ten rates for each one. Group 1 control group was lifted for water only, group 2 was treated with DMH at a dose of 10 mg /kg bw in 0.9% sodium chloride subcutaneously once weekly for eight weeks, and group 3 was treated with DMH at a dose of 20 mg /kg bw in 0.9% NaCl subcutaneously once weekly for eight weeks. Liver grossly congested with pinpoint hemorrhage in a dose of 10 mg/kg of bw and enlarged in a dose of 20 mg/kg bw. Congestion of blood vessels in the heart with hypertrophy of myocardium in a dose of 20 mg/kg bw. Kidney grossly appears normal in both doses. Lesions of the liver treated with DMH in the dose 10 mg/kg BW show discontinuation of hepatocytes, infiltrations of inflammatory cells, and vacuolar degeneration of hepatocytes with apoptotic bodies. Section of the liver treated with DMH in the dose 20 mg/kg BW shows acute hemorrhage and focal necrosis of hepatocytes with edema. Heart treated with DMH in a dose of 10 mg/kg BW shows discontinuation of myocardial muscle fibers and infiltrations of inflammatory cells. In contrast, lesions in the dose 20 mg/kg bw show foci of inflammatory cells with cardiomyopathies of myocardium and congestion of blood vessels. Kidney treated with DMH in a dose of 10 mg/kg BW shows degeneration of epithelial cells lining renal tubule, infiltrations of inflammatory cells, hyaline cast with atrophy of glomerular tuft, increased space of Bauman's, and cloudy swelling. The kidney section treated with DMH in a dose of 20 mg/kg bw shows hemorrhages between renal tubules, congestion of blood vessels, infiltrations of inflammatory cells, a renal cyst, and degeneration of glomeruli.

Regulation of NETosis and Inflammation by Cyclophilin D in Myeloperoxidase-Positive Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is pathologically characterized by focal fibrinoid necrosis, in which ANCA-mediated neutrophil extracellular trap (NET) formation and subsequent endothelial cell necrosis occur. Cyclophilin D (CypD) plays an important role in mediation of cell necrosis and inflammation via the opening of mitochondrial permeability transition pores. This study was undertaken to examine the role of CypD in AAV pathogenesis. We assessed the role and mechanism of CypD in ANCA-stimulated neutrophils in vitro by immunostaining and electron microscopy observation. We performed a comprehensive RNA-sequencing analysis on ANCA-treated murine neutrophils. To investigate the role of CypD in vivo, we assessed disease features in CypD-knockout mice and wild-type mice using 2 different murine AAV models: anti-myeloperoxidase IgG transfer-induced AAV and spontaneous AAV. In vitro experiments showed that pharmacologic and genetic inhibition of CypD suppressed ANCA-induced NET formation via the suppression of reactive oxygen species and cytochrome c release from the mitochondria. RNA-sequencing analyses in ANCA-treated murine neutrophils revealed the involvement of inflammatory responses, with CypD deficiency reducing ANCA-induced alterations in gene expression. Furthermore, analyses of upstream regulators revealed the relevance of intracellular calcium (CypD activator) and cyclosporin (CypD inhibitor) in ANCA stimulation, indicating that the CypD-dependent opening of mitochondrial permeability transition pores is associated with ANCA-induced neutrophil activation and NETosis. In both AAV mouse models, the genetic deletion of CypD ameliorated crescentic glomerulonephritis via the inhibition of CypD-dependent neutrophil and endothelial necrosis. CypD targeting is a novel and specific therapeutic strategy for AAV via the resolution of necrotizing vasculitis.

The research progress of anti-inflammatory and anti-fibrosis treatment of chronic pancreatitis.

Chronic pancreatitis (CP) is a chronic progressive inflammatory disease of the pancreas, caused by multiple factors and accompanied by irreversible impairment of pancreatic internal and external secretory functions. Pathologically, atrophy of the pancreatic acini, tissue fibrosis or calcification, focal edema, inflammation, and necrosis are observed. Clinical manifestations include recurrent or persistent abdominal pain, diarrhea, emaciation, and diabetes. In addition, CP is prone to develop into pancreatic cancer(PC) due to persistent inflammation and fibrosis. The disease course is prolonged and the clinical prognosis is poor. Currently, clinical treatment of CP is still based on symptomatic treatment and there is a lack of effective etiological treatment. Encouragingly, experiments have shown that a variety of active substances have great potential in the etiological treatment of chronic pancreatitis. In this paper, we will review the pathogenesis of CP, as well as the research progress on anti-inflammatory and anti-fibrotic therapies, which will provide new ideas for the development of subsequent clinical studies and formulation of effective treatment programs, and help prevent CP from developing into pancreatic cancer and reduce the prevalence of PC as much as possible.

Clinical and morphological features of arterial duct in premature newborns

The open arterial duct has a pathological significance in premature newborns. Closure of the ductus arteriosus is a complex process that includes functional and anatomical closure.Purpose. To identify the features of arterial duct remodeling in premature newborns.Material and methods. We conducted a retrospective clinical and morphological analysis of 35 deceased premature newborns. During their lifetime, all children were examined using clinical and laboratory-instrumental methods. In all cases, autopsies of deceased children were performed with a complex of morphological studies of the arterial duct.Results. It has been established that the open arterial duct in premature newborns plays an important role in increasing respiratory failure. It also necessitates the appointment and conduct of invasive respiratory therapy. The functioning of the arterial duct is facilitated by low partial pressure and blood oxygen saturation levels. Morphofunctional features of arterial duct remodeling were revealed. A positive correlation was established between the indicators of the gas composition of the child’s blood and the thickness of the duct wall.Conclusion. Risk factors for an open arterial duct in premature newborns are the age of the mother over 35 years, threatened miscarriage, prenatal discharge of amniotic fluid, gestational diabetes mellitus, fetoplacental insufficiency, and severe asphyxia at birth. Morphological changes in the form of thickening of the endothelial layer and the formation of intimal pillows, fragmentation and focal necrosis of the internal elastic membrane with the accumulation of mucoid matter, proliferation and migration of smooth muscle cells into the subendothelial space reflect the processes of remodeling of the arterial duct.

Treatment effects of phosphorylated Chrysanthemum indicum polysaccharides on duck viral hepatitis by protecting mitochondrial function from oxidative damage

To define the underlying mechanism of the beneficial role of Chrysanthemum indicum polysaccharides (CIPS) and phosphorylated Chrysanthemum indicum polysaccharides (pCIPS) in duck viral hepatitis (DVH), we evaluated the protective effects of the CIPS and pCIPS against DVH in terms of antioxidation and mitochondrial function. Fluorescence probes and several assay kits were used to determine the oxidative stress and mitochondrial dysfunction in vitro and vivo. Additionally, transmission electron microscopy was applied to observe the changes of mitochondrial ultrastructure in the liver tissue. Our results indicate that the CIPS and pCIPS significantly enhanced the survival of duck hepatitis A virus type 1 (DHAV-1) infected ducklings. Moreover, the CIPS and pCIPS suppressed oxidative stress and preserved mitochondrial function, such as enhanced antioxidant enzyme activity, increased ATP production, and stabilized mitochondrial membrane potential (MMP). Meanwhile, the results of hematoxylin-eosin (HE) staining and serum biochemical examination demonstrated that treatment with the CIPS and pCIPS could decrease focal necrosis and infiltration of inflammatory cells, which in turn reducing liver injury. Furthermore, the CIPS and pCIPS were able to preserve liver mitochondrial membrane integrity in DHAV-1 challenged ducklings. Notably, the pCIPS was significantly outperformed the CIPS on all measures of liver and mitochondrial function. These results suggested that mitochondrial homeostasis plays an important role in alleviating oxidative damage in the livers, and the hepatocyte protective effects of the CIPS were enhanced after phosphorylation modification.

Rare Presentation of Crescentic Glomerulonephritis in a 4-Week-Old Infant

Abstract Introduction/Objective Rapidly progressive glomerulonephritis is characterized by sudden decline in renal function and glomerular crescents. Crescentic glomerulonephritis develops along three pathways: glomerular basement membrane antibody in situ deposition , circulating immune complex glomerular deposition, or pauci-immune (typically ANCA-associated). For the latter, histopathologic diagnosis is more frequently obtained in adults than in children. Therefore, tissue examination opportunities in infants and neonates is exceptionally rare. Methods/Case Report Here we report the autopsy findings from a 4-week-old infant who was part of dichorionic, diamniotic twin pregnancy and born prematurely at 34 weeks to a 30-year-old G6P4 mother. The infant initially presented with labored breathing and poor oral intake, but subsequently developed Enterobactor meningoencephalitis and sepsis, leading to extensive strokes andstatus epilepticus. An infectious source was not identified clinically, and evaluation for an underlying immunodeficiency was indeterminant. The mother had no known autoimmune diseases or antenatal infections. At autopsy, kidney histology showed focal fibrinoid necrosis and/or cellular and fibrocellular crescents (~5%), especially mid to deep cortex. Intracapillary hypercellularity was minimal to absent. Mesangial matrix was not expanded. The interstitium contained patchy inflammatory infiltrates (mononuclear &amp;gt; polymorphonuclear). Direct immunofluorescence (IF) on pronase-treated paraffin sections did not show glomerular deposition of IgG, IgA, or IgM. Electron microscopy (EM) did not show electron dense deposits despite autolysis. Results (if a Case Study enter NA) NA. Conclusion The absence of immune complex deposition by IF and dense deposits by EM favors the rare diagnosis of pauci-immune glomerulonephritis in this case of neonatal crescentic glomerulonephritis associated with Enterobactor meningoencephalitis and sepsis, with no associated maternal autoimmune disease or antenatal infections.

PMON99 A Rare Case of an Intrasellar Epidermoid Cyst And Panhypopituitarism

Abstract Introduction Epidermoid cysts are rare intracranially occurring mainly in subarachnoid spaces such as parasellar cisterns, middle fossa and cerebellopontine angle. Only few cases of infundibular/sellar epidermoid cysts have been described. We present the case of a large sellar epidermoid cyst resulting in panhypopituitarism. Case 49 year old male with history of obesity and hypertension presented to the emergency department with acute onset progressively worsening headaches. He denied vision changes, nausea, vomiting or dizziness. Examination showed stable vital signs and ophthalmologic exam did not reveal any visual deficits. Further, he did not have any signs of pituitary hormone excess including hypercortisolemia or acromegaly. Brain MRI with and without IV contrast revealed a peripherally enhancing multilobulated cystic pituitary mass measuring 19.5 mm×17 mm×20.5 mm deviating the infundibulum to the left causing compression of the caudal aspect of the optic chiasm. Initial endocrinology work-up revealed noon time cortisol of 10.7 mcg/dL (range 7-23), 7 pm ACTH of 34.6 pg/mL (range 7.2-63.3), TSH of 1.71 mIU/mL (range 0.35- 4.94), free T4 of 0.93 ng/dL (range 0.5-1.39), FSH of 4.45 mIU/mL (range 1.27-19.26), LH 5.51 mIU/mL (range 1.24-8.62), IGF-1 level of 199 ng/mL (range 68-225), prolactin &amp;lt;0.60 ng/mL (range 2.64-13.13), and testosterone level of 186 ng/dL (range 175-800). A presumed diagnosis of non- functioning pituitary macroadenoma with compression of chiasm was made and he underwent transsphenoidal hypophysectomy after evaluation by a multi-disciplinary team including neurosurgery, ENT and endocrinology. Post-operative course was uneventful, he was started on empiric steroids which were tapered slowly. Final pathology of surgical specimen demonstrated epidermoid cyst, focal necrosis, lymphocytes and macrophages infiltration consistent with reactive granulation tissue. On subsequent laboratory evaluation, he was found to have hypogonadotropic hypogonadism with an undetectable testosterone. FT4 was also low at 0.61 ng/dL (range 0.5-1.39). He is closely following with endocrinology for management of hypogonadotropic hypogonadism and hypothyroidism. Conclusion Intracranial epidermoid cysts are uncommon benign congenital lesions arising from trapped surface of ectodermal elements. Very rarely, they are found in the sellar region. Sellar epidermoid cysts tend to present late and often after significant growth and mass effects. Complete resection is challenging and recurrence is a feared complication. Our patient presented with acute symptoms from expansion of a large epidermoid sellar cyst mimicking a pituitary macroadenoma. It also resulted in hypopituitarism. Although, a rare entity, early recognition and prompt management of such lesions is key. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP289 A rare case of COVID-19 vaccine-associated pituitary apoplexy

Abstract Background The occurrences of pituitary apoplexy following COVID-19 vaccination had only been reported twice. We present the case of a 24-year-old female who developed pituitary apoplexy following the second dose of an AstraZeneca COVID-19 vaccine. Clinical Case A 24-year-old female presented with sudden onset of severe frontal headache, a day after receiving her second AstraZeneca vaccine dose. She denied other symptoms including blurring of vision, eye pain and diplopia. On admission, her blood pressure was 120/80 mmHg, with no evidence of postural hypotension. She was overweight with a BMI of 29kg/m2. Confrontational visual field assessment was normal with no evidence of bitemporal hemianopia. An MRI of the pituitary showed a heterogenous enhancement of the pituitary gland, extending to the suprasellar region, measuring approximately 1.1cm×1.6×1.9cm (AP×W x CC) with features suggestive of pituitary apoplexy with mass effect to the optic chiasm and cavernous portion of the left ICA. Pituitary hormonal tests results showed normal anterior pituitary hormone levels, with the exception of insulin-like growth factor-1 (IGF-1) at a level of 417 ng/ml. Overnight dexamethasone test was performed and showed suppressed cortisol level of 48.4 nmol/L. Growth hormone suppression test resulted in suppressed GH level of &amp;lt;0.1ng/ml in the presence of hyperglycemia. Pituitary hypophysitis was considered because of the more likely age group and the typical presentation of severe headache. In the context that the headache had started shortly after the administration of the second dose of COVID-19 vaccine, this potentially could have been the trigger for the occurrence of pituitary apoplexy She was treated with high dose steroids and the headache improved. A follow up pituitary MRI showed a significant 50% reduction in the size of the pituitary mass. To date, this report would be the third linking COVID-19 vaccination and pituitary apoplexy. The first one occurred in a 44-year-old man, who presented with sudden onset of blurring of vision 3 days following the second dose of COVID-19 vaccine. His MRI showed a suprasellar mass with optic chiasm. His endoscopic transsphenoidal resection of the pituitary tumor showed focal hemorrhage and necrosis of pituitary adenoma cells. The second case occurred in 37 years old lady 5 days following the dose of Astra Zeneca vaccine. MRI finding showed consistent with pituitary apoplexy . Conclusion This report highlights a rare complication of the COVID-19 vaccine that could cause pituitary apoplexy. Possible explanation could be due to vascular dysfunction secondary to the overwhelming immunological response. Reference Jaggi, S. and S. Jabbour, Abstract #1001394: A Rare Endocrine Complication of the COVID-19 Vaccine. Endocrine Practice, 2021. 27(6): p. S116-S117 Piñar-Gutiérrez, A., P. Remón-Ruiz, and A. Soto-Moreno, CASE REPORT: Pituitary apoplexy after COVID-19 vaccination. Medicina clinica, 2021. Presentation: No date and time listed

Numerical Study on a Focus-Control Method Using Breast Model With Intentionally Assigned High-Absorbing Layer Near Skin for High-Intensity Focused Ultrasound Treatment.

To prevent undesirable skin burns that occur in high-intensity focused ultrasound (HIFU) treatment, we numerically study focus-control methods, such as phase compensation (PC) and amplitude adaptation (AA). We intentionally assign a high-absorbing layer (HAL) near the part of the skin, where heat generation and tissue ablation are observed, because of high energy loss in the interface between water and breast skin. Results show that PC improves the effectiveness of focusing by enhancing the focal peak and reducing the focal deviation; however, PC does not suppress skin burn. AA and PC eliminate skin burns only if appropriate amplitude weights are applied. A preliminary discussion on three algorithms for obtaining amplitude weights is conducted as follows; First, we switched off transducer channels using distance-to-HAL. This algorithm eliminates skin burns while causing other undesirable burns by preserving 100% input energy. Second, we use cross-correlated amplitude weights. It eliminates skin burn after properly limiting large-amplitude weights while producing focal necrosis in a smaller and slower manner. Third, we introduced root-mean-square (rms) level of back-propagated wave (BPW) into cross-correlated amplitude weights. This new algorithm produces focal ablation in 20 s without causing any skin burn. Although longer irradiation time brings back skin burn, the result is satisfying since short irradiation time is needed in HIFU treatment to avoid exceeding the physical endurance of human patients. Moreover, this work indicates that focus-control associated with an acoustic peak is insufficient. The effects of the high attenuation area are significant and should be captured.

Non-clinical safety evaluation of salvianolic acid A: acute, 4-week intravenous toxicities and genotoxicity evaluations

BackgroundToxicological problem associated with herbal medicine is a significant public health problem. Hence, it is necessary to elaborate on the safety of herbal medicine. Salvianolic acid A (SAA) is a major active compound isolated from Danshen, a popular herbal drug and medicinal food plant in China. The aim of the present study was to explore the toxicological profile of SAA.MethodsThe acute toxicity studies were performed in mice and Beagle dogs with single administration with SAA. A 4-week subchronic toxicity was test in dogs. SAA was intravenously administered at doses of 20, 80 and 300 mg/kg. Clinical observation, laboratory testing and necropsy and histopathological examination were performed. The genotoxic potential of SAA was evaluated by 2 types of genotoxicity tests: a reverse mutation test in bacteria and bone marrow micronucleus test in mice.ResultsIn acute toxicities, the LD50 of SAA is 1161.2 mg/kg in mice. The minimum lethal dose (MLD) and maximal non-lethal dose (MNLD) of SAA were 682 mg/kg and 455 mg/kg in dogs, respectively. The approximate lethal dose range was 455–682 mg/kg. In the study of 4-week repeated-dose toxicity in dogs, focal necrosis in liver and renal tubular epithelial cell, the decrease in relative thymus weight, as well as abnormal changes in biochemical parameters, were observed in SAA 80 or 300 mg/kg group. The no observed adverse effect level (NOAEL) of SAA was 20 mg/kg. Thymus, liver and kidneys were the toxic targets. These toxic effects were transient and reversible. These results indicated that it should note examination of liver and kidney function during the administration of SAA in clinic. Furthermore, SAA had no mutagenic effect at any tested doses.ConclusionThese results provide new toxicological information of SAA for its clinical application and functional food consumption.

The Value of Myocardium and Kidney Histopathological and Immunohistochemical Findings in Accidental Hypothermia-Related Fatalities.

Background and Objectives: The post-mortem diagnosis of hypothermia is challenging in forensics. The aim of our study was to detect the kidney and heart histopathological changes that occurred in a group of hypothermia-related fatalities. Materials and Methods: The cohort included 107 cases identified in the database of our department between 2007 and 2021, which have been associated with extreme cold stress. Demographic and clinicopathological data were collected from the medico-legal reports. Archived tissue samples were evaluated to identify the histopathological features, in routine haematoxylin-eosin (H&E), Periodic acid-Schiff (PAS), and Masson's trichrome stainings, while cardiac sirtuin1 (SIRT1) and renal ubiquitin (Ub) immunostaining have been performed. Results: The majority of cases exposed to low temperatures were males (76%) from rural regions (68.2%) during the cold season. Paradoxical undressing was documented in 9.3% of cases. The common comorbidities included alcoholism (50.5%), neuropsychiatric diseases (10.3%), diabetes mellitus (3.7%), and lung tuberculosis (4.7%). The microscopic heart exam revealed areas of myocardial degeneration (100%), contraction bands (95.3%), fatty change (13.1%) and focal wavy contractile myocardial cells. Basal vacuolisation of renal tubular epithelial cells (Armanni-Ebstein lesions) (21.5%), focal tubular necrosis (7.5%), tubular renal cysts (7.5%), interstitial haemorrhages (5.6%), diabetic kidney disease (3.7%), background benign nephroangiosclerosis (42.1%), variable thickening of tubules and corpuscles basement membranes, capsular space amorphous material, and intratubular casts were identified in kidney tissue samples. Myocardial cells displayed SIRT1 weak expression, with a loss of immunopositivity correlated with areas with contraction bands, while a variable Ub expression was observed in renal corpuscles capsules, proximal, distal, and collecting renal tubules, Henle's loops, urothelium, and intratubular casts. Conclusions: In the context of the current concept that death associated with hypothermia is still a diagnosis of exclusion, our findings suggest that the microscopic exam provides relevant data that support the diagnosis of hypothermia-related fatalities in appropriate circumstances of death. A deeper insight into the histopathologic findings in hypothermic patients may lead to new therapeutic approaches in these cases.