Macroscopic Evaluation Research Articles

Microfracture Augmentation With Direct In Situ Radial Shockwave Stimulation With Appropriate Energy Has Comparable Repair Performance With Tissue Engineering in the Porcine Osteochondral Defect Model

Background: The first-line clinical strategy for small cartilage/osteochondral defects is microfracture (MF). However, its repair efficacy needs improvement. Hypothesis: Appropriate energy radial shockwave stimulation in MF holes would greatly improve repair efficacy in the porcine osteochondral defect model, and it may obtain comparable performance with common tissue engineering techniques. Study Design: Controlled laboratory study. Methods: Osteochondral defect models (8-mm diameter, 3-mm depth) were established in the weightbearing area of Bama pigs’ medial femoral condyles. In total, 25 minipigs were randomly divided into 5 groups: control (Con; without treatment), MF, MF augmentation (MF+; treated with appropriate energy radial shockwave stimulation in MF holes after MF), tissue engineering (TE; treated with compounds of microcarrier and bone marrow mesenchymal stem cells), and sham (as the positive control). After 3 months of intervention, osteochondral specimens were harvested for macroscopic, radiological, biomechanical, and histological evaluations. The statistical data were analyzed using 1-way analysis of variance. Results: Based on the macroscopic appearance, the smoothness and integration of the repaired tissue in the MF+ group were improved when compared with the Con and MF groups. The histological staining suggested more abundant cartilaginous matrix deposition in the MF+ group versus the Con and MF groups. The general scores of the macroscopic and histological appearances were comparable in the MF+ and the TE groups. The high signal areas of the osteochondral unit in the magnetic resonance images were significantly decreased in the MF+ group, with no difference with the TE group. The micro–computed tomography data demonstrated the safety of direct in situ radial shockwave performance. Biomechanical tests revealed that the repaired tissue’s Young modulus was highest in the MF+ group and not statistically different from that in the TE group. Conclusion: Direct in situ radial shockwave stimulation with appropriate energy significantly improves the short-term repair efficacy of MF. More encouragingly, the MF+ group in our study obtained repair performance comparable with the TE therapy. Clinical Relevance: This strategy is easy to perform and can readily be generalized with safety and higher cartilage repair efficacy. Moreover, it is expected to be accomplished under arthroscopy, indicating tremendous clinical transformative value.

Utilização de flap de omento para indução da cicatrização de enxertos cutâneos

ABSTRACT The objective of this study was to assess healing induction of free skin grafts following transposition of omental flap through a subcutaneous tunnel to the recipient bed. Macroscopic and microscopic evaluations were performed. Nineteen piglets were used. Two surgical wounds were created of each subject. The graft removed from the left side (LS) was placed on the right side (RS) without the omental flap in the graft-bed (control group-CG). On the LS, an omental flap was placed between the graft removed from the RS and the recipient bed (omentum group-OG). Macroscopic evaluations showed edema, which gradually decreased on both groups. Suture dehiscence was highest at day 10 compared to other days in both groups. The CG had a higher incidence of unvitalized tissue compared to OG, although no difference was found among days of postoperative evaluation. The presence of unvitalized tissue was seen on 32% on OG and 53% on CG. Microscopic evaluations revealed higher collagenization, reepithelization, keratinization and less swelling in the OG compared to CG. In conclusion, mesh skin grafts evolved satisfactorily in swine even in newly created bedding without granulation tissue, but with appropriate vascularization. The omentum flap provided better macroscopic and microscopic outcomes regarding graft integration.

Investigation of the hemostatic mechanism of Gardeniae fructus Praeparatus based on pharmacological evaluation and network pharmacology.

As documented in the Chinese Pharmacopoeia, Gardeniae fructus Praeparatus (GFP) can cool the blood during hemostasis and treat various internal hemorrhagic diseases. However, the underlying mechanisms are not yet well understood. This work was designed to decipher the possible mechanism by which GFP prevents hemorrhage. The integration of pharmacodynamics-based and bioinformatics-based methods provided evidence to support the clinical effects of GFP in treating bleeding. Using ultra-performance liquid chromatography (UPLC) analysis, we quantified the main active ingredients for a preliminary quality assessment of GFP. The pharmacology study was conducted to confirm the essential antihemorrhagic effects of GFP. A rat model of ethanol-induced gastric hemorrhage was established and was followed by intervention with GFP in low, middle, and high doses (4.5, 9, 18 g/kg). Gastric tissues were harvested for macroscopic and histological evaluation of lesions. The contents of thromboxane B2 (TXB2) and 6-keto-prostaglandin-F1α (6-keto-PGF1α) in the serum were determined. Additionally, network pharmacology was proposed to illuminate the potential mechanisms. Following the collection of GFP compositions, the compound- and hemorrhage-related targets were retrieved from public databases. The protein-protein interaction (PPI), gene ontology, pathways analysis, and molecular docking were performed for targets of GFP in gastrointestinal bleeding. The study found ten main active ingredients that could be used for quality control of GFP. Importantly, the middle and high doses of GFP were found to promote the healing of gastric bleeding. The content of 6-keto-PGF1α was significantly degraded in the middle and high treated groups (P<0.05). The level of TXB2 was augmented by a middle (P<0.05) and high dose of GFP. Further, we constructed the network of candidate ingredients and hemorrhage-related targets. Pathway analysis predicted the mechanisms associated with interleukin 4 and interleukin 13 signaling and platelet activation. PPI analysis identified subnetworks with biological functions and also sifted hub targets that affected the antihemorrhagic progress. The candidate proteins had a good binding force with major components. GFP exhibits a promising effect in ameliorating bleeding, with the relevant molecular mechanisms possibly being related to the regulation of the immune system and platelet activation. Therefore, GFP can potentially exert a protective effect on gastrointestinal bleeding in clinic.

S1094 Diagnostic Accuracy of Endoscopic Ultrasound (EUS)-Guided Fine Needle Biopsy (FNB) by Macroscopic On-Site Evaluation (MOSE): A Systematic Review and Meta-Analysis

S1094 Diagnostic Accuracy of Endoscopic Ultrasound (EUS)-Guided Fine Needle Biopsy (FNB) by Macroscopic On-Site Evaluation (MOSE): A Systematic Review and Meta-Analysis

Midterm Performance of the Autologous Adventitial Overlay Method in Aortic Surgery

BackgroundWe developed an adventitial overlay method for reinforcing aortic anastomoses. This study evaluated the midterm morphologic and clinical outcomes of this method. MethodsWe harvested and prepared adventitia from a resected aneurysm or dissected aortic wall and performed aortic repair using the adventitial overlay method. At the midterm follow-up, we examined the differences between overlay, inversion, and felt sandwich methods by evaluating the morphologic features of the anastomosis on computed tomography scans. Moreover, we performed macroscopic evaluation of 1 patient who required a second operation. ResultsBetween May 2009 and April 2020, 160 consecutive patients (104 men, 56 women; mean age, 68.6 ± 11 years; range, 39-88 years) underwent thoracic aortic surgery. The overlay technique was successfully performed in 84 cases. The anastomosis sites of the overlay method maintained their morphologic appearance without any clinical complications. The inner diameter ratio of anastomosis/graft was measured by computed tomography, which revealed that the overlay method was not significantly different from inversion and was significantly larger than the felt sandwich method. There was no anastomotic stenosis in the proximal or distal overlay anastomosis. Only 1 patient required a second operation for an enlarged aneurysm of the distal false lumen. We observed that the proximal overlaid adventitia was smoothly attached to the native lumen and was macroscopically indistinguishable from the original intima. ConclusionsThis study showed the midterm stability of the overlay technique. The midterm outcome was clinically acceptable. No anastomotic stenosis or pseudoaneurysm formation in either the true aortic aneurysm or dissection cases was observed.

COMPARATIVE CHARACTERISTICS OF ANTIULCER ACTIVITY OF PLACENTAL CRYOEXTRACT UNDER DIFFERENT MODES OF APPLICATION IN THE EXPERIMENT

Peptic ulcer disease is one of the most common diseases of the gastrointestinal tract worldwide. Among the causes of disability in the adult population, diseases of the digestive tract occupy the 5th place, and about 20.0–30.0% of them is peptic ulcer disease, which leads to permanent disability in more than 50.0% of patients. According to scientific reports, the prevalence of this pathology is due to its polyetiology, which leads to clinical heterogeneity and recurrent course. The aim of this study is to conduct a comparative assessment of the antiulcer effect of placental cryoextract in prophylactic, therapeutic and therapeutic-prophylactic regimens in models of ethanol-prednisolone gastric lesions. The study was performed on 84 nonlinear laboratory male rats weighing 200–220 g. To simulate damage to the gastric mucosa, rats were administered a single ethanol-prednisolone mixture: prednisolone (20 mg/kg) dissolved in 80.0% ethyl alcohol (0.6 ml / 100 g of animal body weight). The rats were killed in 24 h after the administration of ethanol-prednisolone mixture. The drug "Cryocell-cryoextract of the placenta" was used in three modes: for prophylactic purpose – once a day for 5 days before the ethanol-prednisolone administration; for therapeutic purpose – once in 60 min after the administration of ethanol-prednisolone mixture; for the therapeutic and prophylactic purposes – once in 3 days before the administration of ethanol-prednisolone mixture and 60 min following the administration of ethanol-prednisolone mixture. The effect of the studied drug on the condition of the gastric mucosa was assessed macroscopically by L. V. Yakovleva scale. Macroscopic evaluation of the gastric mucosa showed that after 24 h following the administration of the ethanol-prednisolone mixture, the severity of damage averaged 3.7±0.37 points out of the five maximal points, and the ulcer index was 3.9 SU, respectively. The prophylactic five-day administration of esomeprazole resulted in an antiulcer activity in 45.9% of cases that was 1.8 times lower than that of the cryoextract rats. Erosive-ulcerative lesions of the gastric mucosa under the therapeutic-and-prophylactic modes of placental cryoextract were observed in only 28.6% of rats that corresponded to the value of the ulcer index equalled 0.3 units, and antiulcer activity was 92.3%. Under this regimen, the antiulcer activity of the cryoextract was practically comparable to the efficacy of esomeprazole (97.4%). Conclusion. The administration of cryoextracted placenta for the therapeutic purpose (once after ethanol-prednisolone mixture) is accompanied by the lowest antiulcer activity that was 22.2% and in 4.1 times lower than the effectiveness of esomeprazole. Therapeutic and prophylactic application of cryoextracted placenta led to a statistically significant (p&lt;0.05) attenuation of the damaging effects of ethanol-predniolone mixture, and antiulcer activity was 92.3%, respectively.

Feasibility and safety of a novel 3D-printed biodegradable biliary stent in an in vivo porcine model: a preliminary study

To assess the feasibility and safety of a novel 3D-printed biodegradable biliary stent using polycaprolactone (PCL) in an in vivo porcine model. In this animal study using domestic pigs, biodegradable radiopaque biliary stents made of polycaprolactone (PCL) and barium sulfate were produced using 3D printing and surgically inserted into the common bile duct (CBD) of pigs (stent group, n = 12). Another five pigs were allocated to the control group that only underwent resection and anastomosis of the CBD without stent insertion. To check the position and status of the stents and stent-related complications, follow-up computed tomography (CT) was performed every month. The pigs were sacrificed 1 or 3 months after surgery, and their excised CBD specimens were examined at both the macroscopic and microscopic levels. Three pigs (one in the stent group and two in the control group) died within one day after surgery and were excluded from further analysis; the remaining 11 in the stent group and 3 in the control group survived the scheduled follow-up period (1 month, 5 and 1; and 3 months, 6 and 2 in stent and control groups, respectively). In all pigs, no clinical symptoms or radiologic evidence of biliary complications was observed. In the stent group (n = 11), stent migration (n = 1 at 3 months; n = 2 at 1 month) and stent fracture (n = 3 at 2 months) were detected on CT scans. Macroscopic evaluation of the stent indicated no significant change at 1 month (n = 3) or fragmentation with discoloration at 3 months (n = 5). On microscopic examination of CBD specimens, the tissue inflammation score was significantly higher in the stent group than in the control group (mean ± standard deviation (SD), 5.63 ± 2.07 vs. 2.00 ± 1.73; P = 0.039) and thickness of fibrosis of the CBD wall was significantly higher than that of the control group (0.46 ± 0.12 mm vs. 0.21 ± 0.05 mm; P = 0.012). Despite mild bile duct inflammation and fibrosis, 3D-printed biodegradable biliary stents showed good feasibility and safety in porcine bile ducts, suggesting their potential for use in the prevention of postoperative biliary strictures.

Sudden unexpected death in a 17-year-old boy due to unacknowledged adamantinoma-like Ewing sarcoma

A 17-year-old male with no previous medical history was admitted 2 days before his death to a local hospital after mild dyspnea. Electrocardiography, chest radiography, and blood analysis revealed no abnormalities. Blood oxygen saturation was 99%, and SARS-CoV-2 nasopharyngeal swabs tested negative; thus, he was discharged without prescriptions. After 2 days, the subject died suddenly during a pool party. Forensic autopsy was performed analyzing all anatomical districts. Cardiac causes were fully excluded after deep macroscopic and microscopic evaluation; lung and brain analyses showed no macroscopic pathology. Finally, a large subglottic solid mass was detected. The whitish neoplasm showed an aggressive invasion pattern to the thyroid and adjacent deep soft tissues and occluded the trachea. High-power microscopy showed sheets of small, uniform cells with scant cytoplasm; round nuclei; and small, punctate nucleoli, with immunohistochemical expression of CK8-18, AE1/AE3, and CD99. Using FISH analysis, the break-apart molecular probes (EWSR1 (22q12) Break – XL, Leica Biosystem, Nussloch, Germany) showed distinct broken red and green fluorochromes, diagnostic of Ewing sarcoma. The neoplasm was characterized as adamantinoma-like Ewing sarcoma, and the mechanism of death was identified as airway obstruction. The rarity of the case resides in the circumstances of death, which pointed to the possibility of sudden unexpected death due to heart disease, but an oncological cause and the underlying mechanism were finally diagnosed. The best method to perform autopsies is still complete, extensive, and systematic macroscopic sampling of organs and districts followed by histopathological analysis, in addition to immunohistochemical and molecular investigations in those cases in which they are necessary. In fact, when neoplasms are detected, the application of advanced techniques such as immunohistochemistry and molecular diagnostics is fundamental to accurately certify death.

Osteology applied to image diagnosis of the forelimb of the black-striped capuchin (Sapajus libidinosus Spix, 1823).

Macroscopic bone analysis and evaluation through imaging methods are essential in the recognition of natural and altered structures. Therefore, this study aimed at describing the osteology the thoracic limb of Sapajus libidinosus in bone pieces, identifying them in radiographic and tomographic images. For this, four cadavers were used in the macroscopic analysis and five animals for the imaging exams, of which four were euthanized and added to the macroscopic stage. For imaging exams, the animals were kept anesthetized. All bones were documented, structures described, and compared with literature data from human and nonhuman primates. There was no statistical difference between males and females regarding the length of the forelimb bones. Most of the bone structures of the scapula were well identified in the imaging methods, being more restricted in the ventrodorsal projection. The clavicle presented very limited visualization. The humerus, as well as the radius and ulna, were not well portrayed in their proximal and distal epiphyses by radiography. However, they were well identified on tomography. All structures described in the macroscopic image of the carpal and metacarpal bones could be identified through radiography and tomography, and the radiographic examination of this region is an excellent method for identifying fractures. The glenoid notch of the scapula was not visualized by any imaging method. S. libidinosus presented anatomical characteristics more similar to those of neotropical primates and man, being a great indicator of an experimental model for studies in these species.

Causality Analysis and Risk Assessment of Haze Disaster in Beijing

Due to the lack of training data and effective haze disaster prediction model, the research on causality analysis and the risk prediction of haze disaster is mainly qualitative. In order to solve this problem, a nonlinear dynamic prediction model of Beijing haze disaster was built in this study. Based on the macroscopic evaluation of multiple influencing factors of haze disaster in Beijing, a causality model and flow diagrams of the Beijing crude oil consumption system, Beijing coal consumption system, Beijing urban greening system and sulfur dioxide emission system in Hebei and Tianjin were established. The risk prediction of Beijing haze disaster was simulated at different conditions of air pollutant discharge level for the Beijing–Tianjin–Hebei region. Compared with the governance strategies of vehicle emission reduction, petrochemical production emission reduction, coal combustion emission reduction, greening and reducing dust and collaborative governance policy, the Beijing–Tianjin–Hebei cross-regional collaborative governance policy was more effective in controlling the haze disaster of Beijing. In the prediction, from 2011 to 2017, the air quality of Beijing changed from light pollution to good. By 2017, the PM2.5 of Beijing reduced to 75 µg/m3. From 2017 to 2035, the control effect of urban haze disaster for Beijing further strengthened. By 2035, the PM2.5 of Beijing reduced to 35 μg/m3. Finally, the PM2.5 of Beijing continued to reduce from 2035 to 2050. The speed of reduction for PM2.5 in Beijing slowed down. Meanwhile, the achievements of haze control in Beijing were consolidated. By 2050, the risk of haze disaster for Beijing was basically solved. The nonlinear dynamic prediction model in this study provides better promise toward the future control and prediction of global haze disaster under the condition of limited data.

Endoscopic Ultrasound-Guided Fine-Needle Biopsy versus Fine-Needle Aspiration in the Diagnosis of Focal Liver Lesions: Prospective Head-to-Head Comparison.

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA) from focal liver lesions are indicated in selected cases, but there has been no previous comparison of needle types of the same size. The aim of our study was to compare the histologic diagnostic accuracy and adequacy of cores obtained with EUS-FNB needles in contrast to those obtained with FNA needles in focal liver lesions. This prospective one-center study included patients with left lobe hepatic focal lesions with contraindications for percutaneous liver biopsy or need for EUS for concomitant lesions. Each patient had one pass of 22G EUS-FNB (Franseen) needle and one pass of 22G EUS-FNA in a crossover manner, without macroscopic on-site evaluation. Each sample was analyzed separately for histologic adequacy and diagnosis. The final diagnosis was based on histology results or on imaging follow-up in the case of negative biopsies. The EUS-FNB samples (n = 30) were found to be more adequate for histologic analysis, with more cellularity and longer tissue aggregates than the EUS-FNA samples (n = 30). The accuracy of EUS-FNB was 100%, whereas that of EUS-FNA was 86.7% (p = 0.039). No post-procedure complications were noted. The 22G EUS-FNB needle proved superior to 22G EUS-FNA in terms of tissue acquisition diagnostic accuracy and histologic adequacy in focal liver lesions.

Reassessment of a Decade of Experience on Testicular Torsion: Are We Making a Mistake?

Introduction: Testicular torsion is a serious surgical emergency of children. Prompt recognition and exclusion of other acute scrotal causes are essential for avoiding testicular loss. The aim of this study was to evaluate 10 years of experience with testicular torsion, point out our pitfalls in diagnosis and management, determine our likelihood of performing orchiectomy for potentially reversible injury. Material and Method: Records of patients operated for testicular torsion in the last decade were reviewed retrospectively. Clinical findings, symptoms, type of surgery, accuracy of radiological evaluation, and the outcome were analyzed. Orchiectomy specimens were reevaluated and histologically graded to determine the existence of previously undetermined low-grade injury. Results: In total, 107 children were operated for testicular torsion. Presentation included pain 96 (89.7%), scrotal swelling 48 (44.8%). Doppler ultrasonography was performed in 96 patients with false-negative results in 26 (27%). Testicular salvage occurred in 65 (60.7%) patients of which 6 (9.2%) developed subsequent testicular atrophy. Forty-two (33.9%) patients were treated with orchiectomy and histologic reevaluation, and grading of the specimens revealed 4 (9.7%) low-grade injury which indicates a potential of reversible injury. Seventeen (13.7%) patients had normal testicular anatomy in surgery. Conclusion: Surgical exploration is mandated in case of clinical suspicion for testicular torsion even with a normal flow Doppler ultrasound. Macroscopic evaluation does not always correlate with microscopic findings, and a decision according to it may result in excision of potentially viable testis. Further studies are required to determine the actual risk of contralateral autoimmune damage and increase the rate testicular salvageability after testicular torsion.

Lung lobe torsion in association with a pulmonary papillary carcinoma in a dog.

Lung lobe torsion (LLT) is an uncommon condition in dogs reported to be most commonly idiopathic or secondary to trauma, pleural effusion, lung lobectomy or thoracic neoplasia. Carcinomas are the most common primary lung tumours in dogs, but only a few cases have been reported in association with LLT in veterinary medicine. This case describes an adult male neutered Labrador, which presented with lethargy, weight loss and pleural effusion. Computed tomography (CT), cytology of the lung, thoracocentesis and fluid analysis were performed. CT revealed pleural effusion and torsion of the left cranial lung lobe with no evidence of a pulmonary mass or metastatic disease. Thoracotomy and left cranial lung lobectomy were performed. Intraoperatively there was no macroscopic evidence of pulmonary neoplasia. Histopathology of the lobar tissue confirmed grade 2 pulmonary papillary carcinoma. It is possible that early detection and surgical management might help to prevent the morbidity and mortality associated with LLT. However, as in this case, the underlying cause for the LLT will ultimately determine the patient's prognosis. The final diagnosis of papillary carcinoma in this case, was only made via histopathological assessment of the pulmonary tissue as it was unclear on the advanced imaging and macroscopic intraoperative evaluation of the lungs. This case highlights the importance of considering pulmonary neoplasia as a differential for LLT even in the absence of a macroscopic mass, and therefore the value of performing histopathology on the excised lung tissue.

217.7: Neutrophil Extracellular Traps Removal Using Ex Vivo Lung Perfusion Restored Lung Function in Gastric Aspiration Damaged Porcine Lungs

Background: Lung transplantation (LTx) is an established therapeutic option for end-stage pulmonary disease. However, it remains hampered by donor lung scarcity. Treatments which could regenerate lungs rejected for transplant should be explored in order to combat waiting list mortality. Aspiration induced acute lung injury (ALI) is one of the contributes to the low utilization of donor lungs. Neutrophil extracellular traps (NETs) are implicated in the inflammation profile of ALI. Reduction of NETs could be used as a therapeutic option with the arrival of devices specific to their removal. NucleoCapture device selectively removes NETs from the blood by utilizing human histone H1.3 protein conjugated to polymer beads. This study investigated the impact of the NETs capture device during ex vivo lung perfusion (EVLP) on ALI damaged lungs. Methods: Healthy pigs (n=12) were stratified into two groups, treated (n=6) and not treated (n=6). All animals received 4ml/kg body weight gastric content distributed equally between the different lung segments using a bronchoscopy to induce acute lung injury. Mild to moderate ARDS was developed over 6 hours and confirmed via blood gas values, chest x-ray imaging and histological examination. Lungs were subsequently explanted en bloc and placed on EVLP for 4 hours. Treated lungs were placed in line with a NucleoCapture device connected to the EVLP circuit and the non-treated group underwent the same EVLP protocol without the device. Results: Aspiration induced ALI was induced in all subjects as confirmed by infiltration on chest x-ray, histopathological examination and by PaO2/FiO2 ratio. Following treatment with the NucleoCapture device during 4 hours of EVLP, the PaO2/FiO2 ratio was significantly increased compared to non-treated lungs and was found to surpass the threshold values suitable for transplantation. Furthermore, macroscopic evaluation of the treated lungs demonstrated improvement relative to both the initial injury as well as comparison with the non-treated cohort. Conclusions: Removal of NETs using the NucleoCapture device did restored lung function in aspiration damaged lungs. The amelioration of lung function by removing NETs shows potential clinical use of the device to increase the donor lung pool for lung transplantation.

Correlation between clinical outcomes and patients' satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects.

Aim To examine and quantify patients' satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique. Methods A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17 patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients' satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed. Results Pearson correlation coefficient between patients' satisfaction and clinical presentation was 0.534. Out of 510 (the highest summed score for patients' satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones. Conclusion Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.

Correlation between clinical outcomes and patients’ satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt;To examine and quantify patients&amp;amp;rsquo; satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/Hughes flap technique.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17&amp;lt;br /&amp;gt;patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO&amp;lt;br /&amp;gt;scale. Patients&amp;amp;rsquo; satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Pearson correlation coefficient between patients&amp;amp;rsquo; satisfaction and clinical presentation was 0.534. Out of 510 (the highest&amp;lt;br /&amp;gt;summed score for patients&amp;amp;rsquo; satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when&amp;lt;br /&amp;gt;poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.&amp;amp;nbsp;&amp;lt;/p&amp;gt;

SARS-CoV-2 Is Persistent in Placenta and Causes Macroscopic, Histopathological, and Ultrastructural Changes

SARS-CoV-2 is a virus that belongs to the Betacoronavirus genus of the Coronaviridae family. Other coronaviruses, such as SARS-CoV and MERS-CoV, were associated with complications in pregnant women. Therefore, this study aimed to report the clinical history of five pregnant women infected with SARS-CoV-2 (four symptomatic and one asymptomatic who gave birth to a stillborn child) during the COVID-19 pandemic. They gave birth between August 2020 to January 2021, a period in which there was still no vaccination for COVID-19 in Brazil. In addition, their placental alterations were later investigated, focusing on macroscopic, histopathological, and ultrastructural aspects compared to a prepandemic sample. Three of five placentas presented SARS-CoV-2 RNA detected by RT-PCRq at least two to twenty weeks after primary pregnancy infection symptoms, and SARS-CoV-2 spike protein was detected in all placentas by immunoperoxidase assay. The macroscopic evaluation of the placentas presented congested vascular trunks, massive deposition of fibrin, areas of infarctions, and calcifications. Histopathological analysis showed fibrin deposition, inflammatory infiltrate, necrosis, and blood vessel thrombosis. Ultrastructural aspects of the infected placentas showed a similar pattern of alterations between the samples, with predominant characteristics of apoptosis and detection of virus-like particles. These findings contribute to a better understanding of the consequences of SARS-CoV-2 infection in placental tissue, vertical transmission.

Preparing simvastatin nanoparticles by a combination of pH-sensitive and timed-release approaches for the potential treatment of ulcerative colitis.

In this study, an emulsion solvent evaporation method was used to produce Eudragit RL (ERL) nanoparticles (NPs) loaded with simvastatin (SIM) for the treatment of ulcerative colitis (UC). Accordingly, the effects of different formulation variables on the properties of NPs were evaluated using the Box-Behnken design. The optimized NPs were then coated by Eudragit FS30D (EFS30D). Drug release was studied in different physiological environments. Colitis was induced by 3% of acetic acid in rats, which received NPs of SIM (10mg/kg/day), mesalazine (150mg/kg/day), blank NPs and normal saline orally for 5days. Macroscopic histopathological evaluation and biochemical analysis, including myeloperoxidase (MPO) activity and malondialdehyde (MDA) level in the colon tissues, were carried out in this study. The optimized SIM-ERL NPs showed the particle size of 182.48 ± 4.57nm, the polydispersity index of 0.29 ± 0.12, the zeta potential of 26.45 ± 4.57mV, drug loading % of 34.64 ± 0.48, the encapsulation efficiency % of 98.68 ± 0.69, and the release efficiency % of 35.78 ± 1.37. Coating the optimized NPs with EFS30D caused an increase in particle size and a decrease in the zeta potential of NPs. The optimized SIM-EFS30D/RL NPs improved the macroscopic and histopathological scores. Also, MPO activity and MDA level were reduced significantly by NPs, as compared to the control group. Therefore, this drug delivery system can be an alternative to the previous treatments of UC.

Visual Feature Evaluation of Shenyang Greenway Landscape Based on Deep Learning

At present, the research on the visual characteristics of greenway landscape is mostly focused on the evaluation of beauty degree, landscape preference, and recreation preference and mainly on the overall macroscopic evaluation of a single greenway or typical spatial research in some areas, while less attention is paid to the overall characteristics of urban greenway landscape and the differences in visual characteristics of different types of greenway landscape. The emergence of new data and new technologies such as street view, Baidu map, and deep learning provides the possibility to study the visual characteristics of greenway landscapes in large scale and full sample. The study of greenway landscape based on large deep learning can effectively refine the overall pattern of visual characteristics of greenway landscape and reveal the differences of visual characteristics of different types of greenways and their key factors, so as to provide support for the planning and design of greenway landscape and landscape appearance enhancement.

Anti-inflammation properties of resveratrol in the detrusor smooth muscle of the diabetic rat.

In this paper, we aimed to prove that resveratrol can inhibit inflammation in the detrusor smooth muscle of diabetic rats, which may provide a new direction for diabetic cystopathy (DCP) treatment. We induced a Sprague-Dawley (SD) rat model of type 1 diabetes by intraperitoneal injections of streptozotocin (STZ). Then, we separated the SD rats into four groups: (1) an excipient-treated control group; (2) a resveratrol-treated control group; (3) an excipient-treated streptozotocin (STZ)-injected group; and (4) a resveratrol-treated STZ-injected group. We administered the resveratrol or excipient by intragastric administration. After 12weeks of diabetes induction, we measured the blood-sugar concentrations and bladder weights, and we took the bladder tissues of each group of rats for hematoxylin-eosin staining to observe the histological changes. We used real-time quantitative polymerase chain reaction (qPCR) and Western blotting to analyze the expression levels of tumor necrosis factor-alpha (TNF-α), nuclear factor kappa B (NF-κB), interleukin (IL)-6, and IL-1β. The bodyweights of the diabetic rats were appreciably reduced, while the bladder weights and blood-glucose concentrations were substantially increased. Oral resveratrol could not improve the changes in the bodyweights and blood-glucose concentrations, but it had a certain effect on the bladder weights. In a macroscopic evaluation, the bladder walls of the STZ-induced diabetes rats were thickened, and, from the H&E staining, we could see that the bladder tissues of the diabetic rats had inflammatory cell infiltration, edema, and the capillary congestion of the mucosa and lamina propria. After resveratrol treatment, the bladder-wall thickening was reduced, and the tissue damage and inflammation were significantly ameliorated. We could associate all these changes with markedly heightened expressions of TNF-α, IL-1β, IL-6, and NF-κB in the detrusor smooth muscle (DSM) tissues of the diabetic rats. Oral treatment with resveratrol alleviated the expressivity of the inflammatory cytokines in the DSM tissues. Resveratrol treatment ameliorated the histological changes in the bladder and inhibited the expressions of DSM-tissue inflammatory factors in diabetes rats. Resveratrol may provide a new direction of research for the treatment of diabetic cystopathy.