Isthmus Region Research Articles

Cesarean Scar Hysterotomy: Assessment by Three-dimensional Transvaginal Ultrasound Scan

ABSTRACT Objective The combined study of two-dimensional (2D) and three-dimensional (3D) sonographic records may be useful to diagnose wound dehiscence from hysterotomy and forecast the well-being of future gestations. In that respect, irregular cicatrization patterns can be identified from the early puerperium over the whole postparturition recovery period, and may encourage the need for further cesarean in new pregnancies to come. Subjects and Methods A random sample of 42 female patients were subjected to transvaginal sonographic exploration at three sampling times, namely 4 days, 4 months, and 1 year following hysterotomy. All of these women recovered successfully from their cesarean and were discharged from hospital 5 days after parturition. The 2D and 3D surveys were subsequently undertaken at each of the three study times. Four days after surgery, the 2D ultrasound scan aimed at evaluating the early evolution of the uterine scar. On the contrary, 3D echographies were implemented frame-to-frame, in a transverse direction, from the right to left sides of the uterus. Results The 3D sonographic records from those dehiscent wounds displayed at this time a wide, irregular hypoechogenic area crossed over by linear structures representing the suture material (Vycril). Such a record was called a “shark bite” pattern. The latter puerperal dehiscence pattern persisted in the isthmic region for 4 months and 1 year after delivery. It consistently featured a notch between the scar borders that run perpendicular to the complete extent of the internal myometrium layer and bordered the anterior uterine wall. By considering the length of the hysterotomy-derived notch over the whole study period, two types of scars could be differentiated through 2D sonographic surveys, scar notches >2/3 (n=9) or ≤1/3 (n=4) of the total scar lengt. Six of the 13 wound-dehiscent women monitored in this study became pregnant within 2 years after their former cesarean. All were subjected to a second hysterotomy, before which an in situ examination of the previous uterine scar could be made. Early puerperal ultrasound scan focusing on hypoechogenic areas across the borders of hysterotomy-derived scars under suturing pressure must be undertaken by means of 2D transvaginal ultrasound scan, with the bonus that such exploration can be extended through several months to a 1 year period after surgery. The extent of dehiscent myometrium areas and the depth of the notch remaining between the serose and the cervical channel of the stigma can be used as reliable indicators for defective cicatrization processes and should be used as background information aiding in future gestations. The 3D transvaginal ultrasound scan provides the practitioner with thorough records of myometrial failure and enhances the morphological study of iatrogenic pathologies originating from cesarean surgery. The state and extent of healed vs failing cicatrization areas can be easily assessed by means of 3D transvaginal ultrasound scan. How to cite this article Troyano JM, Clavijo MT, Martinez-Wallin I, Molina-Betancor A, Alvarez-de-la-Rosa M, Padilla AI, Bajo-Arenas J. Cesarean Scar Hysterotomy: Assessment by Three-dimensional Transvaginal Ultrasound Scan. Donald School J Ultrasound Obstet Gynecol 2017;11(1):82-87.

Pea3 determines the isthmus region at the downstream of Fgf8-Ras-ERK signaling pathway.

It has been shown that strong Fgf8 signal activates Ras-ERK signaling pathway to determine metencephalon, which consists of rhombomere 1 (r1), where the cerebellum differentiates, and isthmus (r0). The present study was undertaken to check if Ets type transcription factor Pea3 functions downstream of Ras-ERK signaling to determine metencephalon. Pea3 misexpression resulted in repression of Otx2 expression in the mesencephalon, induction of Gbx2 and Fgf8 expression in the mesencephalon, and differentiation of the trochlear neurons in the posterior mesencephalon. Fate change of the tectum to the cerebellum did not occur. Repression of Pea3 function by misexpressing the chimeric molecule of Engrailed repressor domain EH1 and Pea3 (eh1-Pea3) resulted in induction of Otx2 expression in the metencephalon, repression of Gbx2 and Fgf8 expression in the metencephalon, and differentiation of the oculomotor neurons in the isthmus. It was concluded that Pea3 plays a pivotal role in determination of the isthmus (r0) property downstream of Fgf8-Ras-ERK signaling.

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

BackroundPurpose of this experimental study was to investigate the influence of cerclages on the primary stability of the MUTARS® system using distally fractured synthetic femora. Methods4 MUTARS® prostheses were implanted in synthetic femora respectively. Groups consisted of 4 intact bones, 4 fractured with cerclages and 4 fractured bones without cerclages. Spatial micromovements were measured with a high-precision rotational setup. FindingsThe order from the weakest to the strongest torque transmission of the intact bones was rm1-rm4-rm2-rm3 (p=0.011) and of the fractured bones with cerclages rm4-rm1-rm3-rm2 (p=0.013). The MUTARS® stems broke out of the fractured femoral shaft by removing cerclages (p<0.001) and by the influence of bone defect A (p<0.001). Overall micromovements of the intact bones were lower than those of the fractured bones without cerclages (p<0.001) and overall micromovements of the fractured bones with cerclages were lower than those of bones without cerclages (p<0.001). InterpretationDue to high press-fit at the proximal and distal isthmus region fissural fractures of the femur may occur. This should always be taken into account. It is advisable to secure them and provide a prophylaxis for these fissural fractures by means of cerclages.

A candidate gastric stem/progenitor cell marker revealed by genome-wide analysis.

Despite the important role of the gastric stem cell in tissue homeostasis and gastric carcinogenesis, its residence and identity remain poorly understood. In a recent paper in The Journal of Pathology, Vange et al suggest ASPM as a candidate stem/progenitor cell marker for oxyntic glands. Identification of ASPM was achieved by genome-wide gene expression analysis of the micro-dissected isthmus zone, where the majority of stem/progenitor cells are believed to reside. ASPM-positive cells, scattered in the proliferative isthmus region, do not express most differentiated cell markers and are largely quiescent. Together with ASPM, 11 other genes that are uniquely expressed in the isthmus zone constitute a regulatory network downstream of the core transcription factor E2F1. The authors further demonstrated that up-regulation of E2F1 and ASPM is associated with gastric cancers. This study provides novel candidates for future lineage-tracing experiments that will lead to the ultimate discovery of bona fide gastric stem cell markers. Additionally, the E2F1-ASPM axis may represent a new mechanism for gastric carcinogenesis.

EP10.12: Usefulness of elastography in assessment of the post‐Caesarean uterine wall scare in women with abnormal uterine bleeding

The purpose of this study was to establish the validity of transvaginal elastographic assessment of the post-Caesarean uterine wall scare in women with abnormal uterine bleeding. We performed ultrasound examinations in 265 premenopausal women with a history of at least one Caesarean section. The region of the uterine isthmus was visualised by transvaginal ultrasonography. A Caesarean scar defects (CSD) is defined on ultrasound as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. Finally the elastography option was activated. Elastographic evaluation of the uterine post-Caesarean scar was performed using an Accuvix V20 Prestige equipped with ElastoScan TM software. A four colour scale was used to estimate the myometrial tissue stiffness: purple (hard), blue (medium-hard), yellow (medium-soft) and red (soft). 55 women had a history of 2 to 10 days of postmenstrual spotting. In 39 patients the uterine Caesarean scar was evaluated as CSD. Twenty five cases with CSD was evaluated as soft (64.1%). In patients with normal appearance of uterine aesarean scar (226 cases) sixteen women had postmenstrual spotting and thirteen of them the uterine Caesarean scar was evaluated by elastography as soft (81.25%). Elastography may be useful in identifying patients with a history of Caesarean section who may suffer from postmenstrual spotting.

The Kra Isthmus Canal: A New Strategic Solution for China's Energy Consumption Scenario?

This paper is a conceptual study that examines the viability of the construction of the Kra Isthmus within the context of the five dimensions of megaproject success of Sovacool and Cooper (The governance of energy megaprojects: politics, hubris, and energy security, 2013)-social (governance), technological (systems), democratic (politics), externalities (economics, ecology), and risks assessments (accountability), and its possible impact on China's strategic energy supply chain. One of the objectives of this study is also to discuss the current impacts, perceived benefits, and risks of China's dependence on its multinational and transnational pipelines. China could see the construction of Kra Canal as an alternative option for its strategic sourcing activities especially crude oil and gas at much lower costs. The megaproject would become a passageway that connects the Indian Ocean, Andaman Sea, and the Gulf of Siam at the choke point of Isthmus region in Thailand. However, this megaproject could also trigger the internal conflicts of Thailand, and affect the ASEAN countries' political and economic relationships.

Morphometric Study of the Mare Oviductal Mucosa at Different Reproductive Stages

The objectives of this work were to describe some morphometric characteristics and to establish quantitative parameters of different regions of the equine oviductal mucosa from the isthmus, ampullary-isthmic junction (AIJ), and ampulla. Twenty-one mixed-bred mares were used for this study. Mares were selected in the following reproductive phases: anestrus, estrus, and diestrus. The left oviducts were examined with light microscopy, and rights ones were studied through the intraoviductal molds. The isthmus showed the smallest luminal area, mucosal area, epithelial perimeter, and luminal diameter. On the molds surfaces, some grooves extended as longitudinal canals, reducing their depth as they approached to the AIJ. Several small height projections, some obliquely positioned towards utero-tubal junction, were observed in all reproductive phases. These formations may represent pockets or cul-de-sacs in the basal areas of the epithelial folds. The AIJ mucosa gradually changed from the smooth isthmic region toward highly folded ampulla. The number and complexity of epithelial folds showed moderate increase in the same way that many of the morphometric parameters. Multiple curves were observed on the molds of the AIJ, creating a zigzag path in the oviductal lumen. In the ampulla, the high branched epithelial folds occupied most of the lumen, leaving a small luminal area free. A linear relationship between epithelial perimeter and mucosal area was found. The presence of glandular-like structures was observed in all the reproductive stages studied. The equine endosalpinx reveals a highly complex tridimensional arrangement where each region shows very particular and specific designs.

Pitfalls in Echocardiography: Coarctation of the Aorta Presenting as Dilated Cardiomyopathy (DCM).

Purpose: The morphologic spectrum of aortic coarctation extends from discrete isthmic obstruction to tubular hypoplasia of the entire aortic arch. Neonates with coarctation frequently present with congestive heart failure and critically reduced perfusion of the descending aorta following ductal closure. During the recent years we observed several infants with coarctation who presented beyond the neonatal period with dilated cardiomyopathy (DCM). We reviewed our patients with coarctation to determine whether this presentation represents an exception or is relevant for the differential diagnosis of children with DCM. Materials and Methods: From 1/2001 to 12/2013 74 babies with isolated coarctation were diagnosed in our institution. 50 patients presented in the neonatal period and 24 patients beyond the first month. Results: 5/74 infants presented after the neonatal period with poorly contractile, dilated left ventricles. Echocardiographic detection of the coarctation was facilitated by application of the ductal view and by Doppler interrogation of the celiac artery revealing a significantly diminished systolic flow velocity. All patients underwent resection of the coarctation and end-to-end anastomosis ofthe aorta. Postoperative normalization of left ventricular function was observed within a median interval of 2 months. Conclusion: Coarctation of the aorta presenting as DCM accounted for 21 % of our infants with coarctation who presented beyond the neonatal period and 7 % of those in the first year of life. The stenosis was difficult to detect because of its distal location and normal configuration of the aortic arch. Isthmic coarctation should be included in the differential diagnosis of infants with DCM and requires careful examination of the isthmic region in these children.

Olfactomedin-related proteins 4 (OLFM4) expression is involved in early gastric carcinogenesis and of prognostic significance in advanced gastric cancer.

Olfactomedin 4 (OLFM4) has been demonstrated to be upregulated in various cancers and involved in many cellular processes such as cell adhesion, apoptosis, and cell proliferation. In gastric cancer, clinicopathological relevance of OLFM4 expression has been reported. However, there are few studies showing how expression of OLFM4 evolves during multistep gastric carcinogenesis. In this study, we investigated OLFM4 expression during gastric carcinogenesis using RNA in situ hybridization (ISH). We found that OLFM4 expression is absent in normal gastric mucosa, begins to appear at the isthmus region in gastric glands in chronic gastritis, and is remarkably increased in intestinal metaplasia (IM). Interestingly, gastric-type glands around IM frequently expressed OLFM4 before CDX2 was expressed, suggesting that OLFM4 might be involved in regulating CDX2 expression. However, overexpression of OLFM4 failed to induce CDX2 transcription. All gastric adenomas were strongly positive for OLFM4. OLFM4 expression was higher in intestinal type, well to moderately differentiated and early-stage adenocarcinomas, and decreased in poorly differentiated and advanced-stage gastric cancer (GC). Although OLFM4 expression had no prognostic value for GC overall (P = 0.441), it was associated with poor survival of GC in stage II, III, and IV (P = 0.018), suggesting that OLFM4 expression has prognostic significance for late-stage GC. Our findings suggest that OLFM4 is not only involved in early stages of gastric carcinogenesis but also a useful prognostic marker for advanced GC, which is encouraging for further studies exploring OLFM4 as a potential target for therapy of GC.

Teleocortin: A Novel Member of the CRH Family in Teleost Fish

The CRH family of neuropeptides, including CRH and urocortins, plays pivotal roles in the regulation of physiological and behavioral stress responses in vertebrates. In this study, we identified a previously undescribed member of the CRH family of peptides in a teleost fish species (medaka; Oryzias latipes) and named this peptide teleocortin (Tcn). Medaka Tcn is a 41-amino acid polypeptide derived from the C terminus of a larger precursor protein that is encoded by a 2-exon gene, thus sharing common structural features with known CRH family peptides. tcn was found exclusively in teleost fish. Phylogenetic analysis suggested that tcn probably has an ancient origin but was lost from the tetrapod lineage shortly after the divergence of the teleost and tetrapod lineages. In the medaka brain, tcn was expressed in nuclei of the telencephalon, preoptic area, hypothalamus, tegmentum, and isthmic region. Because none of these nuclei have been implicated in the control of ACTH secretion from the pituitary, Tcn may exert its effects centrally in the brain rather than via stimulation of the pituitary-adrenal/interrenal axis. Most, if not all, tcn-expressing neurons also expressed crh, suggesting that Tcn and Crh share common physiological functions. Moreover, Tcn activated Crh receptors 1 and 2 with equivalent or slightly higher potency than Crh, further suggesting that these peptides share common functions. Taken together, these data identified Tcn as a novel, teleost-specific member of the CRH family of peptides that may act centrally with Crh to regulate physiological and behavioral stress responses.

Oviduct-Embryo Interactions in Cattle: Two-Way Traffic or a One-Way Street?

This study examined the effect of the presence of single or multiple embryos on the transcriptome of the bovine oviduct. In experiment 1, cyclic (nonbred, n = 6) and pregnant (artificially inseminated, n = 11) heifers were slaughtered on Day 3 after estrus, and the ampulla and isthmic regions of the oviduct ipsilateral to the corpus luteum were separately flushed. Oviductal epithelial cells from the isthmus region, in which all oocytes/embryos were located, were snap-frozen for microarray analysis. In experiment 2, heifers were divided into cyclic (nonbred, n = 6) or pregnant (multiple embryo transfer, n = 10) groups. In vitro-produced presumptive zygotes were transferred endoscopically to the ipsilateral oviduct on Day 1.5 postestrus (n = 50 zygotes/heifer). Heifers were slaughtered on Day 3, and oviductal isthmus epithelial cells were recovered for RNA sequencing. Microarray analysis in experiment 1 failed to detect any difference in the transcriptome of the oviductal isthmus induced by the presence of a single embryo. In experiment 2, following multiple embryo transfer, RNA sequencing revealed 278 differentially expressed genes, of which 123 were up-regulated and 155 were down-regulated in pregnant heifers. Most of the down-regulated genes were related to immune function. In conclusion, the presence of multiple embryos in the oviduct resulted in the detection of differentially expressed genes in the oviductal isthmus; failure to detect changes in the oviduct transcriptome in the presence of a single embryo may be due to the effect being local and undetectable under the conditions of this study.

Intracardiac myocardial elastography in canines and humans in vivo.

Intracardiac echocardiography (ICE) is a useful imaging modality which is used during RF ablation procedures to identify anatomical structures. Utilizing ICE in conjunction with myocardial elastography (ME) can provide additional information on the mechanical properties of cardiac tissue and provide information on mechanical changes caused by ablation. The objective of this study was to demonstrate that ICE can be used at high frame rate using a diverging beam transmit sequence to image myocardial strain and differentiate myocardial tissue properties before, during, and after ablation for a clinical ablation procedure. In this feasibility study, three normal canines and eight patients with atrial fibrillation (AF) were studied in vivo. A 5.8-MHz ICE transducer was used to image the heart with a diverging beam transmit method achieving 1200 frames per second (fps). Cumulative axial displacement estimation was performed using 1-D cross-correlation with a window size of 2.7 mm and 95% overlap. Axial cumulative strains were estimated in the left atrium (LA) and right atrium (RA) using a least-squares estimator with a kernel of 2 mm on the axial displacements. In the canine case, radial thickening was detected in the lateral wall and in the interatrial septum during LA emptying. For AF patients, the mean absolute strain in the ablated region was lower (6.7 ± 3.1%) than before the ablation (17.4 ± 9.3%) in LA at the end of the LA emptying phase. In the cavotricuspid isthmus (CTI) region, mean absolute strain magnitude at the end of the RA emptying phase was found to be higher during ablation (43.0 ± 18.1%) compared with after ablation (33.7 ± 15.8%). Myocardial strains in the LA of an AF patient were approximately 2.6 times lower in the ablated region than before ablation. This initial feasibility indicates that ME can be used as a new imaging modality in conjunction with ICE in RF ablation guidance and lesion monitoring.

The oviduct: A key organ for the success of early reproductive events

Fertilization in a large number of animals occurs in a specific region of the female genital tract called the oviduct (uterine tube or Fallopian tube), which adjoins into the uterus and is located close to the ovary (Figures 1 and 2). The oviduct is a complex fibromuscular conduct with several layers comprising the mucosa, muscular layer, and a connective serosa. The size of these different layers depends on the anatomical region of the oviduct observed. In the ampulla, where the fertilization takes place, a highly folded mucosa was observed; however, the size and the number of the folds are reduced in the isthmus region and even more so at the uterine tubal junction (Figure 2c). The isthmus region is commonly associated with the storage of sperm before ovulation. Very important events for fertilization take place in the oviduct. For example, the oviductal environment is responsible of the final maturation of female and male gametes, fertilization, and early embryo development. It is important to take into consideration that early embryos spend several days in the oviduct before they reach the uterus, where implantation occurs. Consequently, the oviduct is a dynamic organ adapted to different situations that are mainly regulated by the varying hormone levels in the blood. The understanding of the oviductal secretions in which gametes and embryos are temporarily placed is continually

Endodontic management of fused maxillary central incisor with the help of endovac - A case report

Variations in canal morphology in fused teeth presents a clinical challenge when endodontic treatment is planned. Presence of pulpal remnants at the region of isthmus between the two root canals in fused teeth can compromise the success of endodontic treatment. To achieve a technically satisfactory treatment outcome, the clinician must have adequate knowledge of the internal canal anatomy and its variations to completely debride and obturate the root canal system. The aim of this case report is to present the endodontic management of left maxillary central incisor fused to a supernumerary tooth with the help of EndoVac. In the present case, we have used Endovac for establishing the presence of communication between the two root canals and for disinfecting the same.

Hypothyroidism affects differentially the cell size of epithelial cells among oviductal regions of rabbits.

Oviductal regions show particular histological characteristics and functions. Tubal pathologies and hypothyroidism are related to primary and secondary infertility. The impact of hypothyroidism on the histological characteristics of oviductal regions has been scarcely studied. Our aim was to analyse the histological characteristics of oviductal regions in control and hypothyroid rabbits. Hypothyroidism was induced by oral administration of methimazole (MMI) for 30 days. For both groups, serum concentrations of thyroid and gonadal hormones were determined. Sections of oviductal regions were stained with the Masson's trichrome technique to analyse both epithelial and smooth muscle layers. The percentage of proliferative epithelial cells (anti-Ki67) in diverse oviductal regions was also quantified. Data were compared with Student t-test, Mann-Whitney U-test, or Fischer's test. In comparison with the control group, the hypothyroid group showed: (i) a low concentration of T3 and T4, but a high level of TSH; (ii) similar values of serum estradiol, progesterone and testosterone; (iii) a large size of ciliated cells in the ampulla (AMP), isthmus (IST) and utero-tubal junction (UTJ); (iv) a large size of secretory cells in the IST region; (v) a low percentage of proliferative secretory cells in the fimbria-infundibulum (FIM-INF) region; and (vi) a similar thickness of the smooth muscle layer and the cross-sectional area in the AMP and IST regions. Modifications in the size of the oviductal epithelium in hypothyroid rabbits could be related to changes in the cell metabolism that may impact on the reproductive functions achieved by oviduct.

Monitoring Spatiotemporal Surface Soil Moisture Variations During Dry Seasons in Central America With Multisensor Cascade Data Fusion

Soil moisture is a critical element in the hydrological cycle, which is intimately tied to agriculture production, ecosystem integrity, and hydrological cycle. Point measurements of soil moisture samples are laborious, costly, and inefficient. Remote sensing technologies are capable of conducting soil moisture mapping at the regional scale. The advanced microwave scanning radiometer on earth observing system (AMSR-E) provides global surface soil moisture (SSM) products with the spatial resolution of 25 km which is not sufficient enough to meet the demand for various local-scale applications. This study refines AMSR-E SSM data with normalized multiband drought index (NMDI) derived from the moderate resolution imaging spectroradiometer (MODIS) data to provide fused SSM product with finer spatial resolution that can be up to 1 km. Practical implementation of this data fusion method was carried out in Central America Isthmus region to generate the SSM maps with the spatial resolution of 1 km during the dry seasons in 2010 and 2011 for various agricultural applications. The calibration and validation of the SSM maps based on the fused images of AMSR-E and MODIS yielded satisfactory agreement with in situ ground truth data pattern wise.

Comparative Evaluation of Canal Isthmus Debridement Efficacy of Modified EndoVac Technique with Different Irrigation Systems

IntroductionThe purpose of this study was to evaluate the canal isthmus debridement efficacy of a new modified EndoVac (Discus Dental, Culver City, CA) irrigation protocol in comparison with EndoVac, passive ultrasonic irrigation (PUI), and conventional needle irrigation in mesial roots of mandibular molars. MethodsThe mesial roots of 64 extracted mandibular molars mounted in resin using Kuttler's endodontic cube, sectioned at 2 and 4 mm from the working length, were randomly divided into 4 groups (n = 16): group 1: Max-I-Probe (Dentsply Tulsa Dental, York, PA), group 2: EndoVac (EVI), group 3: modified EndoVac, and group 4: PUI. The specimens were reassembled and instrumented. A standard irrigation protocol was used during cleaning and shaping and final irrigation with the 4 irrigation/agitation techniques. Images of the isthmus region were taken before and after cleaning and shaping and after final irrigation. The percentage reduction of debris in the isthmus region was calculated by using the software program Image J (v1.43; National Institutes of Health, Bethesda, MD). Intergroup analysis was performed using the Kruskal Wallis and Mann-Whitney U tests. Intragroup analysis was performed using Friedman and Wilcoxon signed rank tests. The level of significance was set at P < .05. ResultsIntragroup analysis revealed a statistically significant difference in the percentage reduction of debris after cleaning and shaping and after final irrigation protocol in all the groups (P < .001). The final irrigation protocol produced significantly cleaner canal isthmuses in all the groups (P < .001). On intergroup analysis, the modified EVI group performed significantly better than the other groups. The EVI and PUI groups performed better than the Max-I-Probe group. There was no statistical significance between the EVI and PUI groups. ConclusionsCanal isthmuses were significantly cleaner with the modified EndoVac irrigation technique when compared with the cleanliness seen with the other irrigation systems.

Usefulness of Sentinel Lymph Node Biopsy of Contralateral Neck Region in Papillary Thyroid Carcinoma.

Here, we present a 9-year-old male boy admitted at the Institute for Oncology and Radiology of Serbia due to enlarged lymph node in the left lateral neck region and palpable tumor in the upper pole of the left thyroid lobe. Clinically and sonographically, there were no metastases in the right jugulo-carotid chain, but the lymph nodes in the central pretracheal neck compartment and left jugulo-carotid chain were metastatic. Chest X ray, abdominal ultrasound, and laryngoscopy findings were normal. After injection of 2 mL of methylene blue dye in the normal right lobe, we accessed the right lateral neck region and the colored sentinel lymph node was removed, which was proven to be metastatic on frozen section analysis. Then, we explored entire thyroid gland and there were no nodules in the right lobe. The left lobe was explored and tumor was verified, which was in close contact to the infrahyoid muscles. We performed left loboisthmectomy by shaving off left lobe from trachea. Three foci of papillary carcinoma were found in the upper pole of left lobe 11 mm, just below 6 mm, and in isthmic region focus of 6 mm. We proceeded with the removal of the right lobe and central lymph nodes, including Delphian, which was metastatic, pretracheal, right paratracheal, and the lymph nodes behind the right recurrent laryngeal nerve down to the aortic arch. Upper mediastinal lymph nodes were removed. In the central neck region and upper mediastinal compartment, 15 lymph nodes were removed and 11 were metastatic. Right modified radical neck dissection from region two to four was performed. Twenty-one lymph nodes were examined, 5 were metastatic, including the sentinel lymph node. Left modified radical neck dissection, from level IIB to V, was performed on two incisions, which enabled reaching left level II and common carotid artery bifurcation. Left lateral lymph nodes were removed in one piece, berry picking must be avoided. Of 21 removed lymph nodes, 5 were metastatic in the left lateral region. A total of 57 lymph nodes were removed and 21 were metastatic. We showed the necessity and usefulness of sentinel lymph node biopsy of contralateral neck region by injecting vital dye in the normal right lobe. We confirmed the presence of metastases in a patient with clinically and sonographically negative lymph nodes. All authors declare no conflict of interest. Runtime of video: 10 mins.

Regulation of PSCA expression by m‐Numb in the stomach (904.2)

Prostate stem cell antigen (PSCA) is a GPI‐anchored cell surface protein expressed in the normal epithelium of several tissues including the isthmus region of the gastric mucosa. Recently, a genome‐wide association study revealed several SNPs in the PSCA‐gene to be associated with gastric cancer and duodenal ulcer risk. However, the underlying regulatory mechanisms of PSCA are still unclear.Methods: Msi1‐KO mice with lowered expression of m‐Numb in the stomach and wild‐type ICR mice were used for in vivo studies. In vitro studies were carried out with the mouse gastric epithelial cell line MGE507. Overexpression and suppression of m‐Numb in MGE507 cells was achieved by transfection with lentiviral particles carrying an m‐Numb expression vector and shRNA expression vector, respectively. Gene expression was analysed with qRT‐PCR, and western blotting was used to measure protein levels.Results: In Msi1‐KO mice, a significantly reduced expression‐ and protein level of PSCA was found when comparing the gastric mucosa to wild‐type ICR mice. Expectedly, the protein level of m‐Numb was also verified as lower in the KO‐line. Silencing m‐Numb expression in MGE507 cells resulted in a reduction in protein level of PSCA, and overexpression of m‐Numb led to an increased PSCA‐level.Conclusion: PSCA gene expression and protein level was regulated by m‐Numb in the mouse stomach and in mouse gastric epithelial cells.

Investigation of Mast Cell Distribution in the Ovine Oviduct During Oestral and Luteal Phases of the Oestrous Cycles

Mast cells are heterogeneous cell populations that play significant roles in many organs and systems and involve various physiological processes. We aimed to evaluate mast cells in the ovine oviduct mucosa by means of their staining and ultrastructural characteristics. The ovine oviduct samples of Akkaraman breed were collected from the slaughterhouse and they are categorized as luteal and oestral phases. They were fixed either with 10% formalin or IFAA and stained with Toluidine blue and Alcian blue and Safranin O (Ab/SO). Mast cells were located near blood vessels and basal membrane. Compared to 10% formalin fixed tissues, the number of mast cells were higher in IFAA fixed tissues (P=0.003). Importantly all mast cells Ab(+) and SO(-) so that they were categorized as mucosal type. The number of mast cells did not differ between luteal and oestral phases (P>0.05). However, there were significant differences among different regions of the oviduct with a less count in the isthmus regions (P=0.006). Transmission electron microscopy revealed that the oviduct mast cells contained two types of granules: an electron lucent, electron dense. Some electron lucent granules contained an eccentrically located crystal-like structure. The significance of less mast cell counts in the isthmus and the eccentrically located single crystal-like structure should be further investigated in future studies.