Gland Atrophy Research Articles

Long-Term Oral Administration of LLHK, LHK, and HK Alters Gene Expression Profile and Restores Age-Dependent Atrophy and Dysfunction of Rat Salivary Glands.

Xerostomia, also known as dry mouth, is caused by a reduction in salivary secretion and by changes in the composition of saliva associated with the malfunction of salivary glands. Xerostomia decreases quality of life. In the present study, we investigated the effects of peptides derived from β-lactoglobulin C on age-dependent atrophy, gene expression profiles, and the dysfunction of salivary glands. Long-term oral administration of Leu57-Leu58-His59-Lys60 (LLHK), Leu58-His59-Lys60 (LHK) and His59-Lys60 (HK) peptides induced salivary secretion and prevented and/or reversed the age-dependent atrophy of salivary glands in older rats. The transcripts of 78 genes were upregulated and those of 81 genes were downregulated by more than 2.0-fold (p ≤ 0.05) after LHK treatment. LHK upregulated major salivary protein genes such as proline-rich proteins (Prpmp5, Prb3, Prp2, Prb1, Prp15), cystatins (Cst5, Cyss, Vegp2), amylases (Amy1a, Amy2a3), and lysozyme (Lyzl1), suggesting that LLHK, LHK, and HK restored normal salivary function. The AP-2 transcription factor gene (Tcfap2b) was also induced significantly by LHK treatment. These results suggest that LLHK, LHK, and HK-administration may prevent and/or reverse the age-dependent atrophy and functional decline of salivary glands by affecting gene expression.

Let-7 microRNA is a critical regulator in controlling the growth and function of silk gland in the silkworm

ABSTRACTThe silk gland is characterized by high protein synthesis. However, the molecular mechanisms controlling silk gland growth and silk protein synthesis remain undetermined. Here we demonstrated that CRISPR/Cas9-based knockdown of let-7 or the whole cluster promoted endoreduplication and enlargement of the silk gland, accompanied by changing silk yield, whereas transgenic overexpression of let-7 led to atrophy and degeneration of the silk gland. Mechanistically, let-7 controls cell growth in the silk gland through coordinating nutrient metabolism processes and energy signalling pathways. Transgenic overexpression of pyruvate carboxylase, a novel target of let-7, resulted in enlargement of the silk glands, which is consistent with the abnormal phenotype of the let-7 knockdown. Overall, our data reveal a previously unknown miRNA-mediated regulation of silk gland growth and physiology and shed light on involvement of let-7 as a critical stabilizer and booster in carbohydrate metabolism, which may have important implications for understanding of the molecular mechanism and physiological function of specialized organs in other species.

How to Manage a Patient With Gastric Intestinal Metaplasia: An International Perspective

How to Manage a Patient With Gastric Intestinal Metaplasia: An International Perspective

Upfront Docetaxel with LH-RH Antagonist for Metastatic Hormone Sensitive Prostate Cancer Considering Epithelial to Mesenchymal Transition

Objective: Upfront docetaxel use for hormone naïve advanced prostate cancer is reported that it successfully delayed the progression to hormone refractory stage, though the adequate methodology to obtain the maximum effect is unclear. We investigated these issues from our experiences of upfront docetaxel use with LH-RH antagonist for metastatic hormone sensitive prostate cancer, aiming at the prevention of epithelial-mesenchymal transition (EMT) for apoptosis tolerance. Patients and Methods: Of 31 stage IV new prostate cancer patients treated with upfront docetaxel and LH-RH antagonist (Degarelix), 25 patients who could be followed more than 12 months (mean 36.2 months) were analyzed. Docetaxel was used two to three courses basically 75 mg/m2 dose initializing two weeks after the induction of first Degarelix. Results: The clinical course was divided clearly to two groups according to prostate specific antigen (PSA) values. Of 25 patients, 12 patient’s PSA did not decrease below 0.1 ng/ml within 6 months (group A) and gradually rose afterwards. PSA in another 13 patients (group B) decreased below 0.1 within 6 months and kept below 0.1 during the follow up period. Although statistically not significant, the initial group A’s PSA was higher than group B’s (average 1308 and 353 ng/ml), however, number of metastasis, Gleason sum, and bone metastatic extent of disease showed no difference between them. Among group B patients, 7 cases had only upfront docetaxel and hormonal therapy, and some of these patients showed only atrophic gland and fibrotic tissue at second prostate biopsy (specimens after more than two years of therapy), suggesting complete response. Conclusion: Our study suggested that PSA value at 6 months may predict the outcome of whole therapy. Patients showing PSA less than 0.1 ng/ml at 6 months and requiring no therapy other than docetaxel and hormone may be induced to complete response. Upfront docetaxel with LH-RH antagonist may prevent EMT for obtaining apoptosis tolerance, in case the patient does not have the castration-resistant clone at the beginning of the therapy (group B).

Effect of Ethanolic Extracts from Taiwanofungus camphoratus and T. salmoneus (Agaricomycetes) Mycelia on Osteoporosis Recovery.

Osteoporosis is common in postmenopausal women and elderly people. In this study, the ovariectomized mice were used as an in vivo test to evaluate the effects of 70% ethanolic extracts of Taiwanofungus camphoratus and T. salmoneus (Polyporales, Agaricomycetes) on postmenopausal osteoporosis. Ovariectomized mice had significantly higher body weight and histopathological alterations of the liver were found to have diffused fatty infiltrated vesicles. The bone parameters of the femur were determined by microcomputed tomography. In addition, the relative weight of the uterus is significantly lower and atrophy of the uterine glands was found in histopathological alterations. The results of trabecular bone parameters showed that feeding high doses of T. camphoratus mycelia ethanolic extract to ovariectomized mice had the ability to delay bone loss. The bone density of trabecular bone and cortical bone were also significantly higher than those of ovariectomized mice, indicating that the ethanolic extract of T. camphoratus has the potential to delay the occurrence of osteoporosis.

Wound healing after applying a gelatin-based hydrogel sheet to resected rat submandibular gland.

The present study was done to develop a useful experimental model for analysis of the effects of physiologically active substances on atrophy and regeneration of salivary gland acinar cells. Resection wounds (diameter, 3 mm) were made in the submandibular glands of 8-week-old Wistar rats (n = 24) for histochemical examination on Days 3, 5, 7, 10, 14, and 21 after implantation of a gelatin-based hydrogel sheet. The results showed that the sheet had nearly disappeared by Day 10. Regions around the resection wounds were classified as normal, atrophic, or necrotic. In atrophic regions, acinar cells atrophied after resection, and few acinar cells were observed on Day 7. On Days 5-7, striated and granular ducts resembled duct-like structures. On Day 10, newly formed acinar cells were confirmed by increased periodic acid-Schiff staining, and a greater number of mature cells was present thereafter. In necrotic regions, acinar and ductal cells were destroyed, and scattered enucleated acinar cells and duct-like structures were present, on Day 3; newly formed acinar cells were observed on Day 10. Thus, the experimental model demonstrated atrophy and regeneration of the submandibular gland and enabled analysis of the effects of sustained release of physiologically active substances contained within an implanted sheet.

Screening of Congenital Hypothyroidism in North-East Romania. Benefits and Messages for Further Improvement.

If not diagnosed at birth, congenital hypothyroidism (CH) can cause deleterious, irreversible neurodevelopmental sequels. The importance of thyroid newborn screening (NBS) is therefore well established. To evaluate the efficacy of NBS for CH in North-East Romania. Retrospective, descriptive study involving 271662 newborns screened between 2010 and 2019 for CH and phenylketonuria in maternities from six Romanian North-Eastern counties by measuring neonatal TSH (neoTSH) in the whole blood extracted from the heel between days 3 and 5 after birth. Values found higher than a cut-off level of 10 mIU/L were followed by serum evaluation of TSH and fT4 for the confirmation of CH. Thyroid ultrasound was further performed at children found with CH. NeoTSH was found elevated in 417 newborns, but CH was subsequently confirmed in only 57 cases (1/4766 newborns). Mean age at the time when diagnosis was communicated was of 37.2 ± 15 days (between 9 and 157 days). Mean age when therapy was started was of 44.2 ± 17.9 days (between 13 and 160 days) with a mean delay of one week from diagnosis (between 0 and 62 days). Thyroid ultrasound revealed athyreosis in only 3 cases, atrophic thyroid gland in other 10 cases, whereas the thyroid was described as present in the remnant 44 cases. The number of first year follow-up visits greatly varied from 0 to 5, with an average of 2. NBS allowed rapid diagnosis of CH in North East Romania. The communication of diagnosis to families and therapy onset were however often delayed. Diagnosis and therapy onset before the age of two weeks, as well as a tighter follow-up should be assured by the healthcare system. Etiological diagnosis should be more accurate, for a better prognosis of disease severity, as well as the possibility of genetic advice in selected cases.

Pathologic findings in prostate gland at autopsy with topographic distribution of these diseases within the prostatic zones: Eleven-month prospective study in Oauthc, Ile-Ife, Nigeria

Introduction: Different zones of prostate harbor different prostatic pathology. The peripheral zone shows majorly prostatic adenocarcinoma, which is among the common causes of cancer death in men in sub-Saharan Africa. Aim: The study aimed to determine the spectrum of prostate pathologies in routine autopsies of adult male 30 years and above whose death was unrelated to prostate diseases. Methods: A total of eighty cases of prostate glands were harvested over an 11-month period. These glands were fixed for 48 h, grossed, and processed. The hematoxylin- and eosin-stained slides were examined using multiheaded microscope. Results: The age range of patients was 30–85 years with a mean age of 41.84 ± 12.63 years standard deviation. The most common cause of death in these patients was trauma secondary to road traffic accident followed by cardiovascular diseases. The most common lesions in each prostatic zone as observed in this study were chronic prostatitis 26.3% in the central zone; nodular hyperplasia 16.3% in the transitional zone; prostatic atrophy (13.8%) and adenocarcinoma (8.3%) in the posterior peripheral zone (one of the cases (1.3%) showed multiple carcinomatous foci); and chronic prostatitis 15.0% in the anterior fibromuscular zone. Four patients' ages 30, 31, 32, and 48 years had Schistosoma haematobium infections observed in the seminal vesicles, whereas patient aged 48 years had in addition adenocarcinoma of prostate gland and prostatic atrophy (PA). A case (1.3%) of prostatic calculi and simple cyst of the prostate was seen in ages 56 and 85 years, respectively. Conclusion: Different zones of the prostate are associated with different disease entities, and S. haematobium show an association with adenocarcinoma of prostate in one individual

Imaging in Chronic Pancreatitis

AbstractChronic pancreatitis (CP) is a chronic progressive process which can cause irreversible damage to both the exocrine and endocrine systems of pancreas. There are various imaging modalities available to evaluate CP of which ultrasonography ( USG), computed tomography (CT), and magnetic resonance imaging (MRI) are most commonly used. USG is used as a screening modality which can show various changes of CP and its complications. However, the information obtained from USG can be limited because of the patient’s body habitus. CT is the workhorse modality which can provide comprehensive information and it is the best modality to detect calcification. MRI, on the other hand, is excellent in demonstrating the pancreatic parenchyma and the ductal system. Alcohol-related pancreatitis is the commonest cause which can show gland atrophy, ductal dilatation, and calcifications. Other less common causes include hereditary and genetic mutation–related pancreatitis. There are other special types of pancreatitis such as autoimmune pancreatitis and groove pancreatitis that have characteristic features on imaging.

改良的Ho-Vert法切片对21例经典型毛发扁平苔藓临床病理诊断价值的观察

Objective To compare diagnostic performance of traditional vertical section technique, horizontal section technique and modified Ho-Vert technique for classical lichen planopilaris. Methods Clinical data were collected from patients with classical lichen planopilaris in Department of Dermatology, The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 1st 2015 to January 1st 2019. With the help of dermoscopy, 2 scalp specimens were obtained from each patient and sliced horizontally and vertically respectively by using modified Ho-Vert technique. The horizontal and vertical sections were read separately or simultaneously, and histopathological changes were observed. Results Totally, 21 patients with classical lichen planopilaris were enrolled into this study, including 15 males and 6 females. Their age was 50.0 ± 13.6 years, and the average course of disease was 18 months. The patients mainly presented with multifocal or confluent patchy hair loss, and scalp atrophy, perifollicular hyperkeratosis, loss of follicular ostia, fibrous white dots and orbit sign were observed. On the horizontal sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles and follicular micro-scars could be observed in all patients, and the dermo-epidermal interface could be seen in 7 patients. On the vertical sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles only could be observed in 9 patients, follicular micro-scars could be seen in 4, and the dermo-epidermal interface could be observed in all patients. Moreover, the detection rates of interfollicular interface dermatitis, follicular keratotic plugs, lymphocytic infiltration around sebaceous glands, atrophy or disappearance of sebaceous glands and inflammatory infiltration around hair follicle bulbs were significantly different between the horizontal and vertical sections. In combination with clinical manifestations, 7 patients could be exactly diagnosed with lichen planopilaris according to findings from horizontal sections, and 9 could be diagnosed exactly according to findings from vertical sections, while 21 could be diagnosed exactly according to histopathological findings from both horizontal and vertical sections. Conclusion With the help of dermoscopy, modified Ho-Vert technique can improve the efficacy of pathological diagnosis of classical lichen planopilaris, by multidimensionally showing histopathological changes. Key words: Lichen planus; Alopecia; Hair follicle; Dermoscopy; Modified Ho-Vert technique; Hair pathology

A Deep Learning Approach for Meibomian Gland Atrophy Evaluation in Meibography Images.

PurposeTo develop a deep learning approach to digitally segmenting meibomian gland atrophy area and computing percent atrophy in meibography images.MethodsA total of 706 meibography images with corresponding meiboscores were collected and annotated for each one with eyelid and atrophy regions. The dataset was then divided into the development and evaluation sets. The development set was used to train and tune the deep learning model, while the evaluation set was used to evaluate the performance of the model.ResultsFour hundred ninety-seven meibography images were used for training and tuning the deep learning model while the remaining 209 images were used for evaluations. The algorithm achieves 95.6% meiboscore grading accuracy on average, largely outperforming the lead clinical investigator (LCI) by 16.0% and the clinical team by 40.6%. Our algorithm also achieves 97.6% and 95.4% accuracy for eyelid and atrophy segmentations, respectively, as well as 95.5% and 66.7% mean intersection over union accuracies (mean IU), respectively. The average root-mean-square deviation (RMSD) of the percent atrophy prediction is 6.7%.ConclusionsThe proposed deep learning approach can automatically segment the total eyelid and meibomian gland atrophy regions, as well as compute percent atrophy with high accuracy and consistency. This provides quantitative information of the gland atrophy severity based on meibography images.Translational RelevanceBased on deep neural networks, the study presents an accurate and consistent gland atrophy evaluation method for meibography images, and may contribute to improved understanding of meibomian gland dysfunction.

Improved method for inducing chronic atrophic gastritis in mice.

BACKGROUNDChronic atrophic gastritis (CAG) is a common disease of the digestive system with pathological characteristics of a decreasing number, or disappearance, of inherent glands of the gastric mucosa. CAG has been defined as a precancerous condition of gastric cancer. Intestinal metaplasia or intraepithelial neoplasia accompanying atrophied glands of the stomach is regarded as one of the most important precancerous lesions of gastric cancer. As a common malignant tumour, gastric cancer remains without a satisfactory therapy and its pathogenesis remains unclear, seriously threatening human life. Therefore, some scholars have proposed to prevent the incidence of gastric cancer by avoiding precancerous lesions. If CAG can be reversed, the incidence of gastric cancer can be substantially reduced. To reverse and prevent CAG and study its pathogenesis and therapy, it is necessary to develop an ideal, safe, stable, animal model.AIMTo study a rapid, stable, and safe method of establishing a mouse model of human CAG.METHODSSix-week-old Kunming mice were divided into a phosphate buffered solution control group, a Helicobacter pylori (H. pylori) group, an N-methyl-N'-nitroguanidine (MNNG) group, an ammonia water group, and a group combining H. pylori, MNNG, and ammonia water (hereinafter referred to as the combined group). The mice were administrated with drinking water containing ammonia or infected with H. pylori through gavage. At the 30th, 60th, 90th, and 120th day after the last H. pylori infection, mice were selected randomly to collect their gastric mucosa for hematoxylin eosin staining, terminal nick-end labelling staining detection, and immunohistochemical staining for Bax and Bcl-2. In addition, H. pylori was isolated, cultured, and identified, and its extent of colonisation calculated. Blood was collected to detect inflammatory factors interleukin (IL)-1β, IL-8, and tumor necrosis factor (TNF)-α and immune function markers CD4 and CD8 to confirm successful establishment of the CAG model.RESULTSThe combined group showed slight CAG at the 90th day and moderate CAG at the 120th day, while other groups did not show CAG at that time.CONCLUSIONThe combination of H. pylori, MNNG, and ammonia is an effective method of developing a mouse model of human CAG.

The tear film cytokine profile is altered in congenital Aniridia

AbstractIncreased levels of inflammatory cytokines in the tear fluid have been found in patients with dry eye disease (DED). Dry eye disease is highly prevalent in congenital aniridia and correlates with severity of aniridia associated keratopathy (AAK). As inflammation can damage the corneal epithelium, DED may initiate and worsen AAK. Additionally, inflammation also characterizes AAK and might exacerbate DED, creating a vicious circle. We carried out an extensive analysis of inflammatory cytokines in the tear fluid of aniridia patients and control subjects. The results were correlated with several clinical parameters, including tests for DED and meibomian gland dysfunction (MGD). The concentration of a number of pro‐inflammatory cytokines was significantly elevated in tear fluid from aniridia patients. Increasing level of these cytokines was related to parameters for MGD, including atrophy of meibomian glands, and shorter break‐up time of the tear film. Increased inflammation of the ocular surface may be a factor in the development of MGD in aniridia patients and explain the high prevalence of MGD and DED in these patients.

Anti-inflammatory and vasculogenic conditioning of peripheral blood mononuclear cells reinforces their therapeutic potential for radiation-injured salivary glands

BackgroundThere are currently no effective treatments available for patients with irreversible loss of salivary gland (SG) function caused by radiation therapy for head and neck cancer. In this study, we have developed an effective culture method to enhance the anti-inflammatory and vasculogenic phenotypes of peripheral blood mononuclear cells (PBMNCs) and investigated whether such effectively conditioned PBMNCs (E-MNCs) could regenerate radiation-injured SGs and ameliorate salivary secretory function in mice.MethodsMouse PBMNCs were expanded in primary serum-free culture with five vasculogenic proteins for 5 days, and then the resulting cells (E-MNCs) were analyzed for their characteristics. Subsequently, 5 × 104 E-MNCs (labeled with EGFP in some experiments) were injected intra-glandularly into a mouse model of radiation-injured atrophic submandibular glands. After 2–3 weeks, the submandibular glands were harvested, and then the injected E-MNCs were tracked. Four, 8, and 12 weeks after irradiation (IR), salivary outputs were measured to evaluate the recovery of secretory function, and the gland tissues were harvested for histological and gene expression analyses to clarify the effects of cell transplantation.ResultsThe resulting E-MNCs contained an enriched population of definitive CD11b/CD206-positive (M2 macrophage-like) cells and showed anti-inflammatory and vasculogenic characteristics. Salivary secretory function in E-MNC-transplanted mice gradually recovered after 4 weeks post-irradiation (post-IR) and reached 3.8-fold higher than that of non-transplanted mice at 12 weeks. EGFP-expressing E-MNCs were detected in a portion of the vascular endothelium and perivascular gland tissues at 2 weeks post-IR, but mainly in some microvessels at 3 weeks. Between 4 and 12 weeks post-IR, mRNA expression and histological analyses revealed that E-MNC transplantation reduced the expression of inflammatory genes and increased the level of tissue-regenerative activities such as stem cell markers, cell proliferation, and blood vessel formation. At 12 weeks post-IR, the areas of acinar and ductal cells regenerated, and the glands had less fibrosis.ConclusionsThis effective conditioning of PBMNCs is a simple, rapid, and efficient method that provides a non-invasive source of therapeutic cells for regenerating radiation-injured atrophic SGs.

Errors in radiation diagnosis of pituitary adenomas

Craniography, computer-aided tomography (CAT), and magnetic imaging (MI) are carried out in 236 patients with suspected pituitary adenoma. Causes of hypo- and hyperdiagnosis are analyzed. Algorithm of using radiodiagnostic methods is developed. Pituitary adenomas are recognized by assessing the size of the pituitary and sella turcica, detailed study of pituitary structure and status of the sella turcica walls and the adjacent tissues. Radiodiagnosis in combination with clinical laboratory findings permit the differentiation of pituitary adenomas from other pathological processes in this gland (hyperplasia, atrophy, inflammation, and dystrophy) and from changes in the neighboring tissues (calcification of different origin, increase of intracranial pressure, etc.). For minimizing the diagnostic errors, craniography is to precede CAT or MI. CAT or MI should be carried out in the “amplification ” mode, and in difficult diagnostic cases should be repeated over time. For an experienced specialist, MI by its informative value is the method of choice for the diagnosis of pituitary diseases (adenomas, cysts, etc.).

Serum Thyroid Hormone Balance in Levothyroxine Monotherapy-Treated Patients with Atrophic Thyroid After Radioiodine Treatment for Graves' Disease

Background: Some studies reported that among athyreotic patients on levothyroxine (LT4) after total thyroidectomy, patients with normal serum thyrotropin (TSH) levels had mildly low serum free triiodothyronine (fT3) levels, whereas patients with mildly suppressed serum TSH levels had normal serum fT3 levels. The reduction of the thyroid volume (TV) after radioiodine treatment for Graves' disease is well known; however, a few studies evaluated thyroidal function including serum triiodothyronine (T3) levels of hypothyroid patients on LT4 after radioiodine treatment in detail.Methods: We retrospectively studied 446 patients treated with LT4 for radioiodine-induced hypothyroidism and who had undergone ultrasonography. We compared serum fT4 and fT3 levels in hypothyroid patients on LT4 who presented an atrophic thyroid change after radioiodine treatment, with those in the euthyroid matched control group with intact thyroids. We also stratified patients with normal TSH levels according to TV and evaluated serum thyroid hormone levels.Results: In 356 of 446 (80%) patients, TV was lower than the lower limit of the 95% reference range of controls. Excluding 43 patients with high serum TSH levels, we assessed thyroid function test results in 313 patients with atrophic thyroid glands. Of these cases, eight patients with strongly suppressed TSH levels had serum fT3 levels that were significantly higher than those in controls (p < 0.001). Overall, 27 patients with mildly suppressed TSH levels had serum fT3 levels equivalent to those in controls (p = 0.386), whereas 278 patients with normal TSH levels had serum fT3 levels that were significantly lower than those in controls (p < 0.001). We also assessed fT3 levels relative to TV in 326 patients with normal TSH levels. Of these cases, in 267 patients with TV less than 5 mL and in 46 patients with TV between 5 and 10 mL, serum fT3 levels were significantly lower than those in controls (p < 0.001). In 13 patients with TV more than 10 mL, serum fT3 levels were equivalent to those in controls (p = 0.844).Conclusions: Serum thyroid hormone balance in most patients on LT4 after radioiodine treatment for Graves' disease was similar to that in athyreotic patients on LT4. Mild TSH suppression with LT4 is needed to achieve normal fT3 levels in such patients.

2760 A Case of Collagenous Gastritis: A Rare Entity

INTRODUCTION: Collagenous gastritis (CG) is a rare histopathologic entity that involves marked subepithelial collagen deposition in the gastric mucosa. Endoscopic findings can be diverse such as mucosal erythema, nodularity and ulceration. The presentation is very diverse such as abdominal pain, weight loss, gastrointestinal bleeding and dyspepsia. Its treatment remains unclear. CASE DESCRIPTION/METHODS: 71-year-old with long history of dyspepsia was referred to our institution due to a 6-month history of epigastric discomfort, profound weight loss (50 lb) and early satiety. Symptoms were mildly improved with sucralfate and smaller and more frequent meals. Tissue transglutaminase antibody was negative. Endoscopy at other institution suggested collagenous gastritis but biopsies were not conclusive. Endoscopic ultrasound at our institution was done for further characterization of the stomach layers and revealed a tubular J-shape stomach deformity with diffuse atrophic mucosa in the gastric body. Localized submucosal wall thickening was visualized endosonographically in the entire body of the stomach which measure up to 5 mm in thickness in the gastric wall. Random gastric biopsies could not confirm CG diagnosis. Persistent symptoms led to further work up including MRI enterography and gastric emptying study, all negative. Eight months later, “well type” biopsies were taken from the gastric body and antrum. Pathology report revealed antral glands atrophy with pyloric hyperplasia, prominent smooth muscle hyperplasia in the lamina propia, along with gastric corpus and antrum with thickened subepithelial collagen layer on hematoxylin and eosin, confirmed on trichrome stain. These features were consistent with a diagnosis of collagenous gastritis. Although limited evidence on the treatment of this disease, patient was started on budesonide therapy (9 mg/day). Future endoscopic surveillance and clinical follow up is planned to assess symptomatic improvement. DISCUSSION: Collagenous gastritis is a rare entity as only 60 cases have been reported in the literature. We need more awareness of this disease for early recognition and reduction of unnecessary work up. Clinical presentation is very diverse and endoscopic findings can be very subtle. High clinical suspicion is necessary to allow proper biopsy techniques. The well technique permits deep tissue sampling by taking multiple samples from the same site and has been advocated for use in subepithelial lesions, avoiding the need for full thickness biopsy or surgery.

Diagnosis and treatment of congenital submandibular duct dilatation

To study the clinical features and treatments of congenital submandibular duct dilatation. Seven children with congenital submandibular duct dilatation from January 2008 to March 2018 were included in this study, whose average age was 5 months and 22 days. The clinical manifestations are unilateral swelling of the mouth floor. All seven children underwent sublingual gland resection, submandibular gland dilatation catheter resection, and catheter reroute under general anesthesia. Intraoperatively, the orifice of the submandibular gland was constricted and part of the catheter was dilated. All seven patients had good healing without swelling or cyst formation. Congenital submandibular duct dilatation occurs at a young age. Early diagnosis and treatment can help prevent further expansion of the catheter and avoid gland atrophy, feeding difficulty, and breathing obstruction. Simultaneous excision of the sublingual gland can avoid the formation of postoperative sublingual cyst.

THE MORPHOLOGY OF THE INFLAMMATION OF THE GASTRIC AND DUODENUM MUCOSA WITH HELICOBACTER PYLORI CONTAMINATION

The aim of the study was to study the morphological features of the inflammatory processes of the mucous membrane of various parts of the stomach and duodenum in patients with chronic gastritis and duodenitis. 24 patients (18 men and 6 women) were observed with chronic gastritis and duodenitis associated with Helicobacter pylori. The average age of the patients was 47 years. 120 biopsy samples of the mucosa of different parts of the stomach and duodenum were studied using histological, histochemical, morphometric and microbiological methods. Histological and microbiological examination of biopsy specimens revealed chronic antral gastritis, chronic fundal gastritis and chronic diffuse pangastritis. Superficial chronic duodenitis was rare and was erosive only in 11.4%. Helicobacter pylori in biopsy of stomach samples were detected more often in associations of various forms. Chronic antral gastritis of the type B was characterized by a predominantly high activity of the pathological process, moderate atrophy of the pyloric glands and a high incidence of small bowel metaplasia. Violations of the microvasculature, hemorrhages in the interfoveolaris part, plethora of blood vessels, and sludge in the capillaries were revealed in the lamina propria of the mucosa of the antrum of the stomach; lymph nodes with pronounced germinal centers were observed in half the cases. In the interfoveolaris part of the lamina propria of the mucous membrane, a high density of inflammatory cell infiltrate was observed, in which plasmocytes, lymphocytes, fibroblasts, fibrocytes, eosinophilic and neutrophilic granulocytes, macrophages were detected. Chronic fundal gastritis of the type B was characterized mainly with moderate and minimal activity of the pathological process. Helicobacter pylori were detected on the surface of the entire epithelium. Focal small intestinal metaplasia and atrophy of the main glands were rarely detected. Atrophy of the main glands was predominantly and minimal and was often combined with hyperplasia of parietal cells. The density of the inflammatory cellular infiltrate remained high; plasmocytes, lymphocytes, fibroblasts, eosinophilic and neutrophilic granulocytes, macrophages were found in it (in decreasing order). The study of biopsy samples of the mucosa of different parts of the stomach and duodenum against the background of contamination with a pyloric helicobacter revealed the presence of chronic antral, fundal gastritis and chronic duodenitis of the II-III degree with the development of small bowel metaplasia and dysplasia.

Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis.

Evaluation of Helicobacter pylori infection status (non-infection, past infection, current infection) has become important. This study aimed to determine the usefulness of the Kyoto classification of gastritis for diagnosing H.pylori infection status by endoscopy. In this prospective study, 498 subjects were recruited. Seven well-experienced endoscopists blinded to the history of eradication therapy performed the examinations. Endoscopic findings were assessed according to the Kyoto classification of gastritis: diffuse redness, regular arrangement of collecting venules (RAC), fundic gland polyp (FGP), atrophy, xanthoma, hyperplastic polyp, map-like redness, intestinal metaplasia, nodularity, mucosal swelling, white and flat elevated lesion, sticky mucus, depressive erosion, raised erosion, red streak, and enlarged folds. We established prediction models according to a machine learning procedure and compared them with general assessment by endoscopists using the Kyoto classification of gastritis. Significantly higher diagnostic odds were obtained for RAC (32.2), FGP (7.7), and red streak (4.7) in subjects with non-infection, map-like redness (12.9) in subjects with past infection, and diffuse redness (26.8), mucosal swelling (13.3), sticky mucus (10.2) and enlarged fold (8.6) in subjects with current infection. The overall diagnostic accuracy rate was 82.9% with the Kyoto classification of gastritis. The diagnostic accuracy of the prediction model was 88.6% for the model without H.pylori eradication history and 93.4% for the model with eradication history. The Kyoto classification of gastritis is useful for diagnosing H.pylori infection status based on endoscopic findings. Our prediction model is helpful for novice endoscopists. (UMIN000016674).