Intense Infiltration Research Articles

A-289 Multiple Gastric Polyps as an Unusual Presentation of Syphilitic Gastritis

Abstract Background Syphilis is a sexually transmitted infection caused by Treponema pallidum and can clinically progress through four different stages. Syphilitic gastritis is one of the rare manifestations of the disease, harboring the potential to mimic several types of unrelated disorders such as malignant lymphomas, Langerhans cell histiocytosis, auto-immune gastritis and refractory Helicobacter pylori infection. The classics symptoms are weight loss, abdominal pain, and gastroparesis, nausea, vomiting and hematemesis. The most common endoscopic finding is gastric ulcers. The rising trends of syphilis in the last decade, detected in both developing and developed countries, calls for continued efforts for case detection on rare syphilis manifestations. Methods A 35-year-old male patient was submitted to gastric biopsy due to endoscopic findings of multiple polyps in the corpus and antrum of stomach. The material was processed and analyzed in a pathology laboratory in São Paulo, Brazil. Histological sections were stained with hematoxylin and eosin and immunohistochemical staining. Results The specimens exhibited intense inflammatory lympho-histiocytic infiltrate, rich in plasma cells, neutrophils and eosinophils affecting the gastric mucosa. Immunohistochemical staining revealed spiral-shaped bacteria consistent with T. pallidum affecting the gastric mucosa surface, adjacent to vessels, and permeating glands. Conclusions This case report has the goal of showing the occurrence of syphilitic gastritis, an uncommon extracutaneous manifestation of T. pallidum infection with the potential to mimic other etiologies. Due to the rarity of syphilitic gastritis and its non-specific symptoms, a combination of clinical, endoscopic, and histopathological findings is necessary to secure diagnosis of syphilitic gastritis. The advent of immunohistochemistry for T. pallidum has facilitated microscopic diagnosis, as special stains such as Warthin-Starry can still pose interpretation challenges.

Effect of slope angle on fractured rock masses under combined influence of variable rainfall infiltration and excavation unloading

Intense precipitation infiltration and intricate excavation processes are crucial factors that impact the stability and security of towering and steep rock slopes within mining sites. The primary aim of this research was to investigate the progression of cumulative failure within a cracked rock formation, considering the combined effects of precipitation and excavation activities. The study was conducted in the Huangniuqian eastern mining area of the Dexing Copper Mine in Jiangxi Province, China. An engineering geological investigation was conducted, a physical model experiment was performed, numerical calculations and theoretical analysis were conducted using the matrix discrete element method (MatDEM), and the deformation characteristics and the effect of the slope angle of a fractured rock mass under different scenarios were examined. The failure and instability mechanisms of the fractured rock mass under three slope angle models were analyzed. The experimental results indicate that as the slope angle increases, the combined effect of rainfall infiltration and excavation unloading is reduced. A novel approach to simulating unsaturated seepage in a rock mass, based on the van Genuchten model (VGM), has been developed. Compared to the vertical displacement observed in a similar physical experiment, the average relative errors associated with the slope angles of 45°, 50°, and 55° were 2.094%, 1.916%, and 2.328%, respectively. Accordingly, the combined effect of rainfall and excavation was determined using the proposed method. Moreover, the accuracy of the numerical simulation was validated. The findings contribute to the seepage field in a meaningful way, offering insight that can inform and enhance existing methods and theories for research on the underlying mechanism of ultra-high and steep rock slope instability, which can inform the development of more effective risk management strategies.

Pathological and oxidative stress responses of Mytilus galloprovincialis to Vibrio mediterranei infection: An in vivo challenge

Since the identification of Vibrio mediterranei as a causative agent in mass mortalities of pen shells across the Mediterranean, elucidating its pathogenicity, virulence, and interactions with other bivalves has gained importance. While the cellular and immune responses of bivalves to various Vibrio species have been extensively studied, the infectious characteristics of this Vibrio species, particularly in the context of pen shell outbreaks, remain unclear for other bivalves. Therefore, to evaluate its pathogenicity, we investigated the histological and oxidative effects on the Mediterranean mussel (Mytilus galloprovincialis), a key species in aquaculture. Two distinct infection setups were established: one involving the inoculation of seawater with the bacterial isolate and another involving direct injection of the bacteria into the mussels. After a 24-h exposure period, histological evaluations were conducted on the mantle, gill, and digestive gland tissues of the mussels. Additionally, measurements of superoxide dismutase (SOD), catalase (CAT), glutathione-S-transferase (GST), and lipid peroxidation levels were performed in the gill and digestive gland tissues. Oxidative responses were significantly elevated in both infection setups compared to the control group, with the directly injected samples exhibiting the highest oxidative responses (p < 0.05). Histological findings indicated that tissue-specific responses to host-pathogen interactions were consistent under both infection conditions. Notable observations included intense hemocytic infiltration in tissues, epithelial hyperplasia, and vacuolization in the gills, as well as focal necrotic areas in the digestive gland. The findings of this study indicate that V. mediterranei, a relatively novel pathogen, can provoke significant acute immune responses and tissue-level reactions in M. galloprovincialis, a species that is both widely distributed and vital to the food chain. These insights into the potential susceptibility of mussels underscore the need for further comprehensive research and inform the development of effective management strategies.

A challenging coexistence: community-acquired methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis

BackgroundCommunity-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) usually emerges after a viral infection and causes severe disease in immunocompetent individuals. Concurrent infection with tuberculosis (TB) is generally very rare in immunocompetent patients. Our case is the first report of the coexistence of CA-MRSA and TB in an immunocompetent patient.Case presentationA 24-year-old male patient of African origin, who has been living in Turkey for a year, was admitted to our hospital 3 months ago with fever, cough, and sputum complaints, which developed following symptoms of influenza infection. More intense bilateral infiltration and cavitary appearance were observed on the left in the chest radiography of the patient who did not respond to amoxicillin and gemifloxacin treatments. The patient’s sputum culture showed MRSA growth, and his sputum acid-resistant bacteria (ARB) was reported as three positive. Vancomycin, isoniazid, rifampicin, pyrazinamide, and ethambutol treatments were started. Subsequently, Mycobacterium Tuberculosis growth was also detected in the mycobacteria culture. Vancomycin treatment was completed in 14 days. There was no growth in the control sputum culture. When the patient, who gave clinical and laboratory response, was admitted with increased shortness of breath complaint two months after discharge, it was observed that minimal spontaneous pneumothorax developed in the left lung, and it was decided to follow up without intervention. In the second month of tuberculosis treatment, sputum ARB and mycobacteria culture became negative, and the patient was switched to dual antituberculosis treatment (isoniazid, rifampicin), and his treatment is still ongoing.ConclusionsMixed infections should be considered in case of non-response to treatment in patients with pneumonia. Mixed infections should also be followed closely as they may be more complicated.

Fixed oil from the Caatinga palm Syagrus coronata with effect on Complete Freund's Adjuvant (CFA)-induced arthritis.

Syagrus coronata, a native palm tree in the Caatinga domain, produces fixed oil (ScFO) used therapeutically and dietary by Northeast Brazilian communities. This study evaluated its anti-inflammatory potential of CFA-induced arthritis and its effect on behavioral parameters. In the acute model, ScFO at 25, 50, and 100mg/kg showed edematogenic effects similar to indomethacin at 4mg/kg (p > 0.05). In the arthritis model, 100mg/kg ScFO treatment was comparable to indomethacin (4mg/kg) (p > 0.05). TNF-α and IL-1β levels were significantly reduced in ScFO-treated groups at 25, 50, and 100mg/kg, and the indomethacin group (4mg/kg) versus the positive control (p > 0.05). Radiographs showed severe soft-tissue swelling and bone deformities in the control group, while the 100mg/kg ScFO group had few alterations, similar to the indomethacin group. Histopathological analysis revealed intense lymphocytic infiltration in the control group, mild diffuse lymphocytic infiltration in the indomethacin group, and mild lymphoplasmacytic infiltration with focal polymorphonuclear infiltrates in the 100mg/kg ScFO group. Behavioral analysis showed improved exploratory stimuli in ScFO and indomethacin-treated mice compared to the positive control (p > 0.05). ScFO demonstrated anti-inflammatory effects in both acute and chronic arthritis models, reducing edema and pro-inflammatory cytokines, and improved exploratory behavior due to its analgesic properties.

Influence of melatonin supplementation on tissue response of endodontic sealers in Wistar rats.

This study evaluated the influence of melatonin supplementation on tissue's response of endodontic sealers in Wistar rats. Forty-eight rats received subcutaneous implants of four polyethylene tubes: one empty (control) and three filled with endodontic sealers (AH Plus, Endofill and Sealapex). Half of the animals were supplemented with melatonin (ME) and the remaining treated with water (WA) for 15days before the implantation until euthanasia, forming the groups: control-WA, AH Plus-WA, Endofill-WA, Sealapex-WA, Control-ME, AH Plus-ME, Endofill-ME and Sealapex-ME. After 5, 15 and 30days, (n = 8) tubes were removed and evaluated in H&E., immunohistochemistry, PSR, VK and POL. The results were statistically analyzed (p < 0.05). In animals treated with water, Endofill-WA evoked more intense inflammatory infiltrate compared to AH Plus-WA and Control-WA in a 30-day period (p < 0.05). In animals supplemented with melatonin, there was any difference among endodontic sealers' response in any period of analysis (p > 0.05). Comparing the individual response of each sealer, over a 30-day period, Endofill-ME and Sealapex-ME showed less inflammatory infiltrate compared to Endofill-WA and Sealapex-WA, respectively (p < 0.05). Immunostaining for IL-6 and TNF-α was less intense for all groups in animals supplemented with melatonin, in most periods, except for the Endofill sealer (p < 0.05). Furthermore, Endofill-ME at 5days and AH-Plus-ME at 30days showed a higher percentage of mature collagen fibers compared to the Endofill-WA and AH Plus-WA, respectively (p < 0.05). Positive structures for von Kossa staining and birefringent to polarized light were observed only for Sealapex-WA and Sealapex-ME in all periods. It can be concluded that melatonin influences the tissue response to endodontic sealers, modulating the inflammatory and reparative process.

Biopreparation of titanium dioxide nanoparticles mediated by Calendula officinalis flower extract for catalytic reduction of 4-nitrophenol and treatment of allergic conjunctivitis

This study investigates the an eco-friendly synthesis for the production of titanium dioxide nanoparticles (TiO2 NPs) by employing the water-soluble flower extract of Calendula officinalis as a natural reducing and stabilizing agent. The green produced TiO2 NPs/C. officinalis were characterized using different advanced analytical techniques, including FT-IR, FE-SEM, EDS-elemental mapping, XRD, ICP-OES and TEM. It represents the TiO2 NPs were found to be spherical in shape and well distributed without agglomeration. It also revealed the particle sizes were in the range of 30–50 nm. EDX represented the Ti atomic species along with C and O are seen to be well-dispersed in a homogeneous manner. The broad absorption band appeared at 3200–3450 cm−1 assigned to OH bond stretching belong to the adsorbed water over the titanium dioxide nanoparticles. Further, newly synthesized TiO2 NPs/C. officinalis are used as a nanocatalyst for the reduction of 4-nitrophenol (4-NP). A UV–Vis spectrophotometer is employed to track the effectiveness of the reduction process. Recyclability in 8 further degradation cycles is used to assess the sustainability of this catalyst, and the results show a steady and notable degradation activity. After a week of daily treatment, the allergic conjunctivitis clinical scores in Dunkin-Hartley guinea pigs were evaluated. The guinea pigs were sensitized with intraperitoneal ovalbumin and then subjected to topical conjunctival challenge. Different doses of TiO2 NPs/C. officinalis (20 and 100 µg/kg), prednisolone (30 mg/kg), chlorpheniramine (10 mg/kg), or PBS (10 mL/kg) were administered. The levels of serum Immunoglobulins were measured by ELISA. It was observed that the levels of ovalbumin-specific IgE notably decreased. Notably, the treatment with TiO2 NPs/C. officinalis at both doses led to a notably lower clinical score for allergic conjunctivitis. Furthermore, the TiO2 NPs/C. officinalis-treated guinea pigs conjunctival tissue showed mild mononuclear infiltration compared with the intense conjunctival tissue inflammatory infiltration observed in the PBS-treated group. These data suggest that TiO2 NPs/C. officinalis may have clinical efficacy in alleviating allergic conjunctivitis.

Histopathological findings and diagnosis of cutaneous leishmaniasis, confirmed by PCR, in an endemic region of Brazil.

Diagnosis of cutaneous leishmaniasis (CL) is difficult, and the correct use of histopathological criteria can be useful in clinical practice. The present study evaluates the association between histopathological findings and the results of polymerase chain reaction (PCR) in clinically suspected cases of CL. Skin samples were received in a laboratory from an endemic region of Brazil for over nine years. Associations were analyzed by means of the Chi square test with a 5% level of significance. Of the 222 examined samples, 190 (85.6%) tested positive by PCR. All 25 cases identified by microscopic examination also tested positive by PCR. Except for the more intense inflammatory infiltrate, all other evaluated histological variables (ulceration, epidermal hyperplasia, hyperkeratosis, presence of granuloma, neutrophils, histiocytes, lymphocytes, plasmocytes, and necrosis) were not significantly associated with PCR positivity. The intensity of the inflammatory infiltrate is a good indicator of the occurrence of CL. Histopathological aspects are useful to increase the predictive values of CL diagnoses, but PCR is still necessary to confirm or exclude the disease.

Increase Toll-like receptors 2 and 4 in apical periodontitis of rats with chronic liver disease.

The aim of this study was to evaluate the influence of liver fibrosis (LF) on the expression of Toll-like receptors (TLR) 2 and 4 in apical periodontitis (AP) in Wistar rats. Forty Wistar rats were allocated in the following groups (n = 10): C-control; AP-apical periodontitis; LF-liver fibrosis; AP + LF-rats with AP and LF. LF and AP were induced by established methodologies. Histological, bacteriological, and immunohistochemical analyses were performed according to pre-established scores. For comparisons between AP and AP + LF groups, the Mann-Whitney test was used (P < .05). The livers of the LF and AP + LF groups showed generalized portal inflammatory infiltrate and collagen fibers confirming the presence of LF. Histopathological analysis in the maxilla of the AP + LF group showed areas of necrosis comprising the entire dental pulp and periapical tissue surrounded by a more intense inflammatory infiltrate than observed in the AP group (P = 0.032). A significant number of specimens in the AP + LF group showed microorganisms beyond the apical foramen adhered to the extraradicular biofilm, demonstrating greater invasion compared to the AP group (P = .008). Immunohistochemical analysis showed a large number of cells immunoreactive for TLR2 and TLR4 in the AP + LF group, compared to the AP group (P < 0.05). Liver fibrosis favors the inflammation and contamination of microorganisms in apical periodontitis and triggers the expression of TLR2 and TLR4, modulating innate immunity response in periapical lesions.

Reduction in reproductive activity from degeneration of testicular follicles in Megapitaria squalida (Mollusca: Bivalvia) exposed to metal pollution in the Gulf of California

Over a reproductive cycle, the prevalence and intensity of degeneration of testicular follicles in Megapitaria squalida collected from the mining port of Santa Rosalia (a highly metal-polluted area), and San Lucas (a less polluted site), Gulf of California, Mexico, were evaluated. At San Lucas, most individuals had a typical testicular structure, and degeneration of testicular follicles was present in 9.5 % of spawning organisms. In contrast, at Santa Rosalia, 68 % of males, mainly in the ripe stage, had testicular degeneration (72 % severe intensity, mostly in medium and large-sized). Degeneration was characterized by intense hemocyte infiltration, identified as dense masses with numerous melanized cells in the follicle lumen. In both sites, males with testicular follicles degeneration had a lower condition index compared to males without degeneration. Degeneration of testicular follicles before spawning compromises and decreases the reproductive activity of M. squalida males at Santa Rosalia, which may ultimately affect the population sustainability.

Microstructure and properties of C/C and C/SiC composites brazed by reactive infiltration of Si[sbnd]Zr filler alloy

The joint between C/C composites and liquid silicon infiltrated-C/SiC composites was achieved using a Si10Zr (at. %) eutectic filler. The microstructure and mechanical properties of joints at different brazing temperature and holding time were characterized. The results showed that the melting filler infiltrated along the carbon fiber bundle gaps and formed SiC reaction layers at both interfaces. On the side of C/SiC composites, the residual silicon in the original base material dissolved into the molten Si10Zr alloy during the brazing procedure. The phenomenon resulted in intense infiltration of the liquid filler into C/SiC composites, which formed a unique C/SiC-Si-ZrSi2 multiphase-ceramic gradient structure. Excessive filler was squeezed out around the joint seam to form a fillet. The shear strength of the joint reached up to 37 MPa, with fracture occurrence in both substrates and the joint seam. Reliable bonding between C/C and C/SiC dissimilar composites was finally achieved.

Endomyocardial Fibrosis Secondary to Chronic Eosinophilic Leukemia: Case Report

Endomyocardial fibrosis (EMF) is characterized by fibrosis of the endomyocardium of one or both ventricles and atrioventricular valves. Progressive fibrosis leads to irreversible restrictive cardiomyopathy, progressing to heart failure (HF), thromboembolic phenomena, and arrhythmias. It is one of the main complications of chronic eosinophilic leukemia (CEL), resulting from intense eosinophilic infiltration into cardiac tissue. This case is of a 34-year-old male patient with past medical history of CEL, who developed EMF and severe heart failure, NYHA (New York Heart Association) IV, and underwent endocardectomy and mitral and tricuspid valvuloplasty. After the procedure, he improved to NYHA II, initiated cardiovascular rehabilitation, and returned to daily activities.

Health of Holochilus chacarius (Rodentia: Cricetidae) in rice agroecosystem in a neotropical wetland assessed by histopathology.

Small mammals have a short lifetime and are strictly associated with their environment. This work aimed to use histopathology to assess the health of Holochilus chacarius in a rice agroecosystem in the Pantanal of Mato Grosso do Sul. During necropsy, fragments of the lung, kidney, skin, liver, and reproductive system of 33 animals were collected and submitted to histological processing. Tissue damages were evaluated as mild, moderate, and severe and arranged in a matrix for further statistical analysis. Furthermore, we used generalized linear models to verify the influence of tissue changes on the body condition, obtained by a regression between body mass and length. In the lungs, we found an intense inflammatory infiltrate associated with anthracosis that had a negative influence on the body's condition. Also, we observed degenerative and inflammatory changes in the liver, kidneys, skin, and reproductive system that ranged from mild to moderate. The histopathological lesions observed in this study may be associated with environmental alterations of anthropic origin such as the exposure to soot from wildfires and heavy metals, evidenced by lesions in the lung, kidney, and liver. The present study provided a histopathological matrix as a new approach that allows to classify and quantify the tissue alterations. Tissue changes when associated with body condition demonstrated to be an effective tool to assess the health of small free-living mammals, showing that these animals can be used as bioindicators of environmental condition.

Disseminated histoplasmosis in an urban canine with access to the rural environment

Histoplasmosis is a systemic disease caused by the fungus Histoplasma capsulatum. The microorganism causes localized granulomatous disease, with the respiratory tract being most affected, and can spread through the lymphatic and blood stream. Severe infection in dogs is associated with immunosuppressive therapies. The reported case occurred in a canine, brought to care with a serious clinical condition, which did not respond to treatment and was euthanized. The necropsy examination showed white nodules, of firm consistency and distributed throughout the omentum, liver, splenic capsule, pancreas, stomach serosa, intestines, bladder, mesenteric and inguinal lymph nodes, diaphragm, parietal pleura, aorta and aortic lunate. Microscopically, all nodular lesions consisted of areas of necrosis, with intense histiolymphoplasmacytic infiltrate, epithelioid macrophages and Langhans-type giant cells with yeast-like structures, with morphology and arrangement consistent with Histoplasma spp., confirmed by special Periodic Acid-Schiff (PAS) stains and Grocott. Therefore, the present study aims to describe a case of multisystemic histoplasmosis in a canine, diagnosed through anatomopathology and histochemistry, and to alert to this potential infection in urban canines with access to rural areas and/or environments with the fungal agent.

Abstract 5660: Gene expression signatures from FFPE to predict recurrent metastatic nasopharyngeal cancer

Abstract Nasopharyngeal cancer (NPC) is an EBV-driven epithelial cancer endemic to Southeast Asia, Southern China and the Middle East. Accurate profiling of the gene expression of NPC has been challenging because of its intense inflammatory infiltrate, as well as the 3 - 4mm size of biopsies limiting the amount of available material. Here we present a large cohort of 339 micro-dissected gene expression libraries from formalin-fixed paraffin-embedded (FFPE) biopsies from NPC patients treated at the National University Health System, Singapore, as well as healthy controls. NPC tumors from patients who subsequently developed recurrent or metastatic disease (Group A), and patients who did not develop recurrent or metastatic disease (Group B) were profiled. Tumor epithelial and microenvironment compartments were separately obtained using laser-capture microdissection, followed by library preparation performed for RNA-Seq using an in-house specialised technique. Gene signatures for NPC tumor epithelial and microenvironment content were used to validate the purity of gene expression libraries. Our preliminary analysis revealed that primary, pre-treatment tumors from patients who subsequently developed recurrence (Group A) showed downregulation of processes related to interferon gamma and interferon alpha response (p-adj &amp;lt;0.001 for both), while processes related to epithelial-mesenchymal transition (p-adj &amp;lt; 0.05) were enriched compared to patients who remained healthy (Group B). In contrast to primary tumors, recurrent tumors in Group A were enriched for cellular respiration including oxidative phosphorylation (p-adj &amp;lt; 0.0001). Our approach highlights the utility of whole transcriptome profiling from small quantities of archival FFPE material. The gene signatures identified from the primary tumors of high-risk patients are biologically relevant and have the potential to be used in precision medicine to guide additional targeted intervention. Citation Format: Joshua K. Tay, Wei Keat Teo, Joseph W. Foley, Luvita Suryani, Bing Cheng Wu, Chor Hiang Siow, Kwok Seng Loh. Gene expression signatures from FFPE to predict recurrent metastatic nasopharyngeal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5660.

Characterization of lamina propria remodeling in pediatric eosinophilic esophagitis using second harmonic generation microscopy

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition characterized by an intense infiltration of eosinophils into the esophageal epithelium. When not adequately controlled, eosinophilic inflammation can lead to changes in components of the extracellular matrix (ECM) of the lamina propria. Particularly, alterations to the collagen fiber matrix can lead to lamina propria fibrosis (LPF), which plays an important role in the fibrostenotic complications of EoE. Current approaches to assess LPF in EoE are prone to inter-observer inconsistencies and provide limited insight into the structural remodeling of the ECM. An objective approach to quantify LPF can eliminate inter-observer inconsistencies and provide novel insights into the fibrotic transformation of the lamina propria in EoE. Second harmonic generation (SHG) microscopy is a powerful modality for objectively quantifying disease associated alterations in ECM collagen structure that is finding increasing use for clinical research. We used SHG with morphometric analysis (SHG-MA) to characterize lamina propria collagen fibers and ECM porosity in esophageal biopsies collected from children with active EoE (n = 11), inactive EoE (n = 11), and non-EoE (n = 11). The collagen fiber width quantified by SHG-MA correlated positively with peak eosinophil count (r = 0.65, p < 0.005) and histopathologist scoring of LPF (r = 0.52, p < 0.005) in the esophageal biopsies. Patients with active EoE had a significant enlargement of ECM pores compared to inactive EoE and non-EoE (p < 0.005), with the mean pore area correlating positively with EoE activity (r = 0.76, p < 0.005) and LPF severity (r = 0.65, p < 0.005). These results indicate that SHG-MA can be utilized to objectively characterize and provide novel insights into lamina propria ECM structural remodeling in children with EoE, which could aid in monitoring disease progression.

Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Rainfall Infiltration through Stratified Colluvial Deposits: Analytical Approach vs. Numerical Modelling

This work investigates the rainfall infiltration process within homogeneous and stratified colluvial deposits caused by short (1–3 h) and intense (40–90 mm/h) rainfall, using both analytical and numerical infiltration modelling. The findings of the investigation demonstrate that the classic Green–Ampt model can be employed effectively to study homogeneous colluvial covers with permeability equal to or lower than kw = 10−5 m/s and that are subject to a 1 h rainfall with intensity I ≥ 45–50 mm/h. In these circumstances, a top-down saturation front forms within the colluvial deposit, leading to the saturation of a 70–100 cm-thick layer. This critical condition occurs every 5–10 years in the mountain area of the Friuli Venezia Giulia Region (NE Italy), which corresponds to a lower return period of critical hydrologic events when compared with other mountain basins in the Alps due to the higher initial degree of saturation characterising colluvial covers in this area (70–95%). When analysing stratified colluvial covers, the Dagan–Bresler approximate model, as well as the numerical modelling, emphasised the strong influence that abrupt variations in the permeability of the various soil layers have on the infiltration process at depth. In particular, the presence of a top organic soil horizon that is rich in macro-pores and is characterised by a higher permeability (k = 10−4 m/s) actually reduces the possibility of surficial ponding, which is the basic condition of the “piston” models. The highly permeable top soil allows for a rapid downward infiltration up to contact with the underlying colluvial material, which is less permeable (k = 10−5 m/s). Therefore, a perched water table forms starting from the organic soil–colluvium interface, originating pore–water overpressures within the colluvial deposit, with maximum values in the order of 5–10 kPa.

Ruptured Saccular Aneurysm Caused by Necrotizing Arteritis of the Polyarteritis Nodosa Type in Primary Angiitis of Central Nervous System.

Primary angiitis of central nervous system (PACNS) is a rare idiopathic vasculitis that typically involves small arteries. An 18-year-old woman was operated on for resection of a ruptured aneurysm in a cerebral artery. Multiple aneurysms of cerebral arteries had been detected by neuroimaging examinations since the age of 12, and she had been administered drugs following a diagnosis of PACNS since the age of 15. The resected aneurysm was a ruptured saccular aneurysm occurring in a medium-sized artery. Histologically, necrotizing arteritis of the polyarteritis nodosa (PAN) type was noted in the aneurysmal wall. It consisted of an admixture of acute and healing stages. In the acute stage, fibrinoid necrosis in the intima and media and intense inflammatory cell infiltrate in the entire wall were present. The inflammatory cells mainly consisted of lymphocytes, including plasma cells, neutrophils, and macrophages. In the healing stage, disappearance of fibrinoid necrosis, fibrosis in the intima and media, and scarce inflammatory cells were noted. The acute stage was mainly present near the ruptured site. From these findings, the aneurysm was considered to have been caused by necrotizing arteritis of the PAN type. Although saccular aneurysmal formation in a medium-sized artery is rare in PACNS, an understanding of aneurysms produced by necrotizing arteritis of the PAN type offers useful information for the diagnosis and treatment of PACNS.

Immune cell infiltrate in ductal carcinoma in situ and the risk of dying from breast cancer: case-control study.

Studies identifying risk factors for death from breast cancer after ductal carcinoma in situ (DCIS) are rare. In this retrospective nested case-control study, clinicopathological factors in women treated for DCIS and who died from breast cancer were compared with those of patients with DCIS who were free from metastatic disease. The study included patients registered with DCIS without invasive carcinoma in Sweden between 1992 and 2012. This cohort was linked to the National Cause of Death Registry. Of 6964 women with DCIS, 96 were registered with breast cancer as cause of death (cases). For each case, up to four controls (318; women with DCIS, alive and without metastatic breast cancer at the time of death of the corresponding case) were selected randomly by incidence density sampling. Whole slides of tumour tissue were evaluated for DCIS grade, comedo necrosis, and intensity of periductal lymphocytic infiltrate. Composition of the immune cell infiltrate, expression of oestrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and proliferation marker Ki-67 were scored on tissue microarrays. Clinical information was obtained from medical records. Information on date, site, and histological characteristics of local and distant recurrences was obtained from medical records for both cases and controls. Tumour tissue was analysed from 65 cases and 195 controls. Intense periductal lymphocytic infiltrate around DCIS was associated with an increased risk of later dying from breast cancer (OR 2.21. 95% c.i. 1.01 to 4.84). Tumours with more intense lymphocytic infiltrate had a lower T cell/B cell ratio. None of the other biomarkers correlated with increased risk of breast cancer death. The immune response to DCIS may influence the risk of dying from breast cancer.