Muscularis Propria Research Articles

Physiology of lower gastrointestinal tract.

The lower gastrointestinal (GI) tract, formed from the midgut and hindgut, encompasses the colon, rectum and anal canal. The aim of this review is to provide an overview of the anatomy and physiology of the lower GI tract. Literature review on anatomy and physiology of the lower GI tract, including normal motility and phases of defecation. It derives its blood supply from the superior and inferior mesenteric arteries while it is innervated by the extrinsic autonomic (the thoracolumbar and sacral nerves) and the intrinsic enteric nervous system. The colon has four layers: mucosa, submucosa, muscularis externa and serosa. The anal canal ends in the internal and external anal sphincters (EASs) involved in continence and defecation. The lower GI tract is predominantly involved in digestion, absorption, defecation and protection. Defecation is a complex process that requires inter-neural (enteric and autonomic nervous systems), neurohormonal and neuromuscular coordination. It has four phases which include basal, pre-expulsive, expulsive and end phase. High-propagating contractions in the colon propel stool to the rectum leading to rectal distention and the recruitment of the recto-anal inhibitory reflex. Once able, the EAS, under full conscious control, is then relaxed allowing stool to be evacuated. Other defecation reflexes include the gastrocolic, gastroileal and coloanal reflexes. Recent advances provide novel techniques to investigate motility patterns including high-resolution manometry protocols with automated assessments, magnetic resonance imaging techniques for defecography, wireless motility capsules and fecobionics.

Review on Exploration of Phytomolecules in the Treatment of Peptic Ulcer

Peptic ulcers are defined as the presence of destructions on the mucosa of the gastrointestinal system, which might extend to the muscular layer. Their origin is complex and arises when there is a disruption in the equilibrium between the elements that cause harm and those that protect the mucosa. Peptic ulcers are a significant international health issue, impacting millions of individuals and exhibitingelevated recurrence rates. The enormous range of structural diversity and unique biological activity exhibited by natural products has significantly contributed to the creation and discovery of novel medications. An exhaustive analysis on the investigation of phytomolecules in the management of gastricabscess might offer important considerate of the existing data regarding the utilization of these compounds. This review may analyze and combine the results of several research to discover potential of phytomolecules, explain how they work, and evaluate their safety and effectiveness. This data can contribute to the advancement of efficacious and secure therapeutic alternatives for peptic ulcer. By advocating for the utilization of natural therapies and plant-based medications, the aim is to enhance the health results of individuals suffering from peptic ulcer.

Report on the application of endoscopic intermuscular dissection for diagnostic resection of early rectal cancer

Objective: This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins. Methods: On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management. Results: The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm²/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation. Conclusion: Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

Effects of oxidized fish oil diet supplemented with tea polyphenols on intestinal health and liver metabolism of spotted sea bass (Lateolabrax maculatus)

In this study, the effects of oxidized fish oil diet supplemented with tea polyphenols (TP) on the intestinal health and liver metabolism of spotted sea bass (Lateolabrax maculatus) were investigated. Five kinds of diets were designed. They were the negative control (NC) group without antioxidants and TP, the positive control (PC) group with antioxidants, three experimental groups were supplemented with 0.05 %, 0.10 %, and 0.15 % TP (TP1, TP2, and TP3). The fish with a mean body weight of 11.43±0.02 g was fed on five diets for 56 days. The results showed that TP1 improved lipase (LPS) activity. The intestinal superoxide dismutase (SOD) activity of TP1 was significantly higher than that of the NC group and was not different from that of the PC group. Histological observation of the intestine showed that the height of the intestinal villus was significantly increased and the width of the intestinal villus was significantly decreased in TP1, while the muscular thickness layer did not change significantly. Furthermore, inflammatory symptoms were present in the intestines of all groups, with improvements observed in TP1 and TP3. By intestinal microbial analysis, the results showed that the ACE and Chao1 indexes of TP1 were significantly higher than those of the NC and PC groups, and the Shannon and Simpson indexes were significantly lower than those of the NC and PC groups. Regarding the structure of the microbiome community, there were a lot more Fusobacteriota in TP2 and TP3 at the phylum level, and there were a lot more Cetobacterium at the genus level. The metabolomic analysis of TP1's liver showed that it controls the metabolism of amino acids, nucleotides, cofactors, vitamins, energy, and carbohydrates. The results showed that adding TP to the oxidized fish oil diet enhanced the intestinal health and liver metabolism of spotted sea bass.

Ultrasound semiotics of solitary rectal ulcer

AIM: to develop ultrasound semiotics of solitary rectal ulcer (SRU).PATIENTS AND METHODS: fifty-eight patients with a histologically verified SRU were included in the retrospective study. All patients underwent colonoscopy and transrectal ultrasound (TRUS). Changes in rectal wall detected by TRUS were compared with colonoscopy data.RESULTS: On TRUS SRU is represented by a significantly thickened rectal wall (median thickness of the rectal wall in the region of SRU is 9 (7–10) mm and 5 (4–6) mm outside, p < 0.001), most often with a predominance of muscular and submucosal layers (46/58, 79%). The structure and echogenicity of these layers are changed: the connective tissue layer is visualized in muscular layer (51/58, 88%), submucosal layer is hypoechogenic (47/58, 81%), boundaries between rectal wall layers are faded (50/58, 86%). Ulcers in SRU are characterized by presence of areas where the mucous layer cannot be traced (sensitivity 100%, specificity 95%), its extent is comparable to extent of ulcers detected on colonoscopy (p = 0.528). Polypoid SRU is characterized by local thickening of the mucosa (sensitivity 89%, specificity 95%). TRUS location of the SRU in height (p = 0.644) is comparable with colonoscopy data.CONCLUSION: the study determined general ultrasound signs of SRU and made it possible to differentiate macroscopic forms of SRU from each other with TRUS.

Transvaginal resection of a gastrointestinal stromal tumor of the rectum: a case report

BackgroundThe most common curative treatment for gastrointestinal stromal tumors (GISTs) is local excision. For rectal GISTs, however, local excision is difficult because of the anatomical features of the rectum. The optimal surgical approach is still under debate, and less invasive methods are desired. We herein report a case of transvaginal resection of a rectal GIST in a young woman.Case presentationA 21-year-old woman was diagnosed with a resectable GIST in the anterior rectal wall and underwent transvaginal tumor resection. The posterior vaginal wall was incised, revealing the tumor fully covered by the rectal mucosa. The rectal adventitia and muscular layer were incised, and the tumor was resected en bloc without rupture. The postoperative course was favorable, and the patient was discharged on postoperative day 12. No findings consistent with recurrence were present 6 months postoperatively.ConclusionTransvaginal tumor resection is a treatment option as a minimally invasive procedure for GISTs in the anterior rectal wall in female patients.

Ethanol exposure exacerbates 4-nitroquinoline-1-oxide induced esophageal carcinogenesis and induces invasive carcinoma with muscularis propria infiltration in a mouse model

Esophageal squamous cell carcinoma (ESCC) is one of the most fatal cancers worldwide. Most ESCC patients are diagnosed at an advanced stage; however, current research on in vivo animal models accurately reflecting their clinical presentation is lacking. Alcohol consumption is a major risk factor for ESCC and has been used in several disease models for disease induction. In this study, we used 4-nitroquinoline-1-oxide in combination with ethanol to induce an in vivo ESCC mouse model. Esophageal tissues were stained with hematoxylin and eosin for histopathological examination and lesion scoring. In cellular experiments, cell adhesion and migration invasion ability were observed using phalloidin staining, cell scratch and transwell assays, respectively, and the expression of epithelial-mesenchymal transition-related markers was detected using quantitative reverse transcription polymerase chain reaction and western blotting. The results showed that ethanol-exposed mice lost more weight and had an increased number of esophageal nodules. Histological examination revealed that the lesion scores of the ethanol-exposed esophageal samples were significantly higher than those of the unexposed esophageal samples. Furthermore, ethanol-exposed esophageal cancer samples had more severe lesions with infiltration of tumor cells into the muscularis propria. In vitro cellular experiments showed that ethanol exposure induced cytoskeletal microfilament formation, promoted cell migration invasion elevated the expression of N-cadherin and Snail, and decreased the expression of E-cadherin. In conclusion, ethanol exposure exacerbates ESCC, promotes tumor cell infiltration into the muscularis propria, and could be an effective agent for establishing innovative models of invasive carcinoma.

Bronchoscopic intervention therapy for pulmonary mucormycosis with main bronchial occlusion: a case report

Pulmonary mucormycosis is one of the most common types of mucormycosis. Tracheobronchial pulmonary mucormycosis primarily affects the tracheobronchial tree, causing lesions that can invade the airway mucosa and muscular layer, damaging the cartilage. It is characterised by acute onset, rapid progression, and high mortality rate, making clinical treatment challenging. This article reports the diagnosis and treatment of a patient with pulmonary mucormycosis complicated by left main bronchus occlusion. In addition to systemic treatment, which consisted mainly of an intravenous injection of amphotericin B combined with an oral suspension of posaconazole, the patient underwent multiple bronchoscopic interventions, including local infusion of amphotericin B under endoscopy, balloon dilation and silicone stent placement. After four months of comprehensive treatment, the therapeutic effect was satisfactory. This report demonstrates that bronchoscopic intervention therapy plays an important role in the comprehensive treatment of pulmonary mucormycosis, especially in preventing death from the progression to obstructive pneumonia.

Immunohistochemistry study of PHOX2B expression in Hirschsprung's disease allied disorders

ObjectiveThis study aimed to investigate the significance of PHOX2B expression in Hirschsprung's disease allied disorders (HAD). MethodsEight specimens of HAD were surgically resected and collected at Beijing Children's Hospital Affiliated to Capital Medical University Heilongjiang Hospital in recent years. Additionally, three specimens from patients with immature ganglion development in the intestinal wall and six control specimens from normal colons were also collected. PHOX2B, S-100, and CR antibodies were used for immunohistochemical staining to observe their expression at the mucosal, submucosal, and intrinsic muscular layer ganglia. ResultsIn the control group,the nuclei of the submucosal and myenteric ganglion cells showed strong or weak PHOX2B staining pattern,the mature ganglion cells showed weak PHOX2B staining,and the immature ganglion cells showed strong staining;S-100 only stained nerve fibers but not ganglion cells; CR stained nerve fibers in the mucosal layer and submucosal layer and also stained ganglion cells. These three antibodies showed different expression patterns in poorly developed enteric ganglia and immature enteric ganglion cells. ConclusionPHOX2B is only expressed in the nucleus of ganglion cells, has discriminatory significance in identifying mature and immature ganglion cells, and is an essential marker for diagnosing HAD.

Vertebral Artery Pseudoaneurysm After Extreme Lateral Transcondylar Transodontoid Approach for Clival Chordoma: 2-Dimensional Operative Video

Chordomas can be treated surgically, with radiotherapy, and more recently, chemotherapy. 1,2 A 22-year-old female patient presented with recurrence of a clival chordoma, after subtotal resection at an outside institution 3 months prior. MRI showed a predominantly midline lesion at the craniocervical junction with significant lateral extension eccentric to the left. A 3-staged operation was planned. A redo-endoscopic endonasal transclival transodontoid approach 3-5 was used to resect the midline component, followed by an extreme lateral transcondylar transodontoid approach with transposition of the ipsilateral vertebral artery followed by drilling of the ipsilateral occipital condyle and C1 lateral mass to resect the lateral component, followed by occiput to C3 fusion given the induced craniocervical instability. Careful subperiosteal dissection with preservation of the periosteal sheath overlying the vertebral artery was performed. There was no overt evidence of vertebral artery injury intraoperatively or on immediate postoperative imaging. However, 3 weeks later, the patient presented with blood from the oral/nasal cavity. Computed tomography angiography showed an unexpected left vertebral artery pseudoaneurysm. Pseudoaneurysms can develop after microtears in the muscularis layer. 6-8 Management is based on size, location, and vertebral artery dominance. 9,10 This pseudoaneurysm was coiled. Postcoiling, the patient had left hypoglossal palsy. We demonstrate the step-by-step technique of an extreme lateral transcondylar transodontoid approach for a clival chordoma and the unfortunate complication of a vertebral artery pseudoaneurysm with discussion of its etiology and management options for this potentially devastating complication. The patient consented to the procedure/publication. Institutional Review Board approval not obtained as the patient was deidentified, and no additional risk is posed by the publication of this video.

A case report of MiNEN: concomitant primary small-cell neuroendocrine carcinoma and high-grade papillary urothelial carcinoma of the urinary badder. Composite or Collision Tumor?

Bladder cancer is the tenth most diagnosed cancer worldwide, and urothelial carcinoma is the most common histologic type. On the contrary, small primary cell neuroendocrine carcinoma of the bladder is sporadic and accounts for less than 1% of all bladder tumors. These malignancies can be observed in mixed neuroendocrine/non-neuroendocrine neoplasms (MiNENs), which have been studied more in the gastrointestinal tract and lungs but scarcely in this organ due to their low incidence. There are concerns about the pathogenic connection between these two tumors, and the limited evidence accounts for the lack of consensus regarding prognosis and treatment for these patients; therefore, they may need a multimodal approach. Here, we describe the case of a 63-year-old woman who presented with gross hematuria, weight loss, and hypogastric discomfort for the past five months. An intravesical mass was found, and transurethral resection was performed. The Histopathology revealed a high-grade papillary urothelial carcinoma with an invasive component through muscularis propria of the bladder, so she was taken to radical cystectomy with extended pelvic lymphadenectomy. The final pathology report revealed an accompanying primary small cell neuroendocrine carcinoma intermingled with the urothelial one. She received postoperative adjuvant chemotherapy and finally died six months after surgery.

Addressing the Gap: Racial Disparities and Public Health Strategies in the Epidemiology of Gastrointestinal Stromal Tumors.

Background Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal neoplasms of the gastrointestinal tract, arising from the interstitial cells of Cajal. These tumors bridge the nervous system and muscular layers of the gastrointestinal tract, playing a crucial role in the digestive process. The incidence of GISTs demonstrates notable variations across different racial and ethnic groups, underscoring the need for in-depth analysis to understand the interplay of genetic, environmental, and socioeconomic factors behind these disparities. Linear regression analysis is a pivotal statistical tool in such epidemiological studies, offering insights into the temporal dynamics of disease incidence and the impact of public health interventions. Methodology This investigation employed a detailed dataset from 2009 to 2020, documenting GIST incidences across Asian, African American, Hispanic, and White populations. A meticulous preprocessing routine prepared the dataset for analysis, which involved data cleaning, normalization of racial terminologies, and aggregation by year and race. Linear regression models and Pearson correlation coefficients were applied to analyze trends and correlations in GIST incidences across the different racial groups, emphasizing an understanding of temporal patterns and racial disparities in disease incidence. Results The study analyzed GIST cases among four racial groups, revealing a male predominance (53.19%) and an even distribution of cases across racial categories: Whites (27.66%), Hispanics (25.53%), African Americans (24.47%), and Asians (22.34%). Hypertension was the most common comorbidity (32.98%), followed by heart failure (28.72%). The linear regression analysis for Asians showed a decreasing trend in GIST incidences with a slope of -0.576, an R-squared value of 0.717, and a non-significant p-value of 0.153. A significant increasing trend was observed for Whites, with a slope of 0.581, an R-squared value of 0.971, and a p-value of 0.002. African Americans exhibited a moderate positive slope of 0.277 with an R-squared value of 0.470 and a p-value of 0.201, indicating a non-significant increase. Hispanics showed negligible change over time with a slope of -0.095, an R-squared value of 0.009, and a p-value of 0.879, suggesting no significant trend. Conclusions This study examines GIST incidences across racial groups, revealing significant disparities. Whites show an increasing trend (p = 0.002), while Asians display a decreasing trend (p = 0.153), with stable rates in African Americans and Hispanics. Such disparities suggest a complex interplay of genetics, environment, and socioeconomic factors, highlighting the need for targeted research and interventions that address these differences and the systemic inequalities influencing GIST outcomes.

Double esophageal duplication cysts: A rare case report in Nicaragua

Esophageal duplication cyst is a rare congenital anomaly arising from the posterior primitive foregut, typically located in the thoracic esophagus. Herein, we reported the case of a female newborn who was prenatally diagnosed with congenital diaphragmatic hernia. A subsequent computed tomography scan revealed an intact diaphragm and a large septated cyst measuring 132×59×41 mm with a volume of 120 mL, situated extrapleurally near the right paravertebral area. Surgical intervention involved a right thoracotomy under general anesthesia to remove the larger cyst, which was connected to the esophagus via an obliterated fistula. There was no communication between this cyst and the trachea. Histological examination of the removed cyst revealed four layers of tissue, consistent with esophageal tissue: mucosa, submucosa, muscularis propria, and either serosa or adventitia. A six-month follow-up ultrasound confirmed no residual disease or recurrence. This case marks only the fourth such instance reported globally.

Peripheral blood immune cell parameters in patients with high-grade squamous intraepithelial lesion (HSIL) and cervical cancer and their clinical value: a retrospective study

Objective The objective of this study was to delineate the profile of peripheral blood lymphocytic indices in patients afflicted with high-grade squamous intraepithelial lesions (HSIL) and cervical neoplasms, and to elucidate the correlation of these hematologic markers with the clinicopathological spectra in individuals diagnosed with cervical carcinoma. Methods We adopted a retrospective case-control modality for this investigation. An aggregate of 39 HSIL patients and 42 cervical carcinoma patients, who were treated in our facility from July 2020 to September 2023, were meticulously selected. Each case of cervical malignancy was confirmed through rigorous histopathological scrutiny. Concomitantly, 31 healthy female individuals, who underwent prophylactic health evaluations during the corresponding timeframe, were enlisted as the baseline control group. We systematically gathered and analyzed clinical demographics, as well as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), from peripheral blood samples. Pearson’s correlation coefficient was deployed to dissect the interrelation between peripheral NLR and PLR concentrations and the clinicopathological features in the cervical cancer group. Results Inter-group comparative analysis unveiled statistically substantial variances in the PLR and NLR values among the tripartite clusters (F = 36.941, 14.998, P < 0.001, respectively). Although discrepancy in NLR (P = 0.061) and PLR (P = 0.759) measures between the groups of cervical carcinoma and HSIL was not statistically appreciable, these indices were markedly elevated in the cervical carcinoma faction as juxtaposed with the normative control group (t = 5.094, 5.927; P < 0.001 for both parameters). A discernible gradation in peripheral blood PLR and NLR concentrations was noted when stratified by clinical stage and the profundity of myometrial invasion in cervical cancer subjects (P < 0.001). The correlation matrix demonstrated a positive liaison between peripheral blood PLR and the clinical gradation, as well as the invasiveness of the neoplastic cells into the muscularis propria (P < 0.05); a similar trend was observed with the NLR values (P < 0.05). Conclusion Augmented NLR and PLR levels in peripheral blood specimens are indicative of HSIL and cervical malignancy. These hematological parameters exhibit a pronounced interconnection with clinical staging and muscular wall penetration depth, serving as potential discriminative biomarkers for the diagnosis and prognosis of cervical cancer.

The Outcome of Snare-Assisted Traction Endoscopic Full-Thickness Resection for the Gastric Fundus Submucosal Tumors Originating from the Muscularis Propria

The Outcome of Snare-Assisted Traction Endoscopic Full-Thickness Resection for the Gastric Fundus Submucosal Tumors Originating from the Muscularis Propria

The Impact of Second Opinion Expert Pathology Review in Patient Management at the Time of Transurethral Resection of the Bladder

Background and objectivePathological features in non–muscle-invasive bladder cancer specimens are pivotal in determining correct patients’ therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer. MethodsThe study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines. Key findings and limitationsAmong 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found. Conclusions and clinical implicationsThe second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management. Patient summaryWe investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.

The Clinicopathological Significance of Tumor Cell Subtyping in Appendiceal Neuroendocrine Tumors: A Series of 135 Tumors

Appendiceal neuroendocrine tumors (NETs) are common and often are identified as incidental lesions at the time of appendectomy. The guidelines for management are based on tumor size, degree of invasion, and the Ki67 proliferation index. Most small bowel NETs are composed of serotonin-producing EC-cells, but there are multiple other neuroendocrine cell types. In the rectum, there are L-cell tumors that express peptide YY (PYY), glucagon-like peptides (GLPs), and pancreatic polypeptide (PP); they are thought to have a better prognosis than serotonin-producing tumors. We investigated whether the appendix has distinct neuroendocrine tumor types based on cell type and whether that distinction has clinical significance. We collected 135 appendiceal NETs from the pathology archives of UHN Toronto and UHCMC (Cleveland). We analyzed the expression of biomarkers including CDX2, SATB2, PSAP, serotonin, glucagon (that detects GLPs), PYY, and pancreatic polypeptide (PP) and correlated the results with clinicopathologic parameters. Immunohistochemistry identified three types of appendiceal NETs. There were 75 (56%) classified as EC-cell tumors and 37 (27%) classified as L-cell tumors; the remaining 23 (17%) expressed serotonin and one of the L-cell biomarkers and were classified as mixed. EC-cell tumors were significantly larger with more extensive invasion involving the muscularis propria, subserosa, and mesoappendix compared with L-cell tumors. Mixed tumors were intermediate in all of these parameters. Both EC-cell and mixed tumors had lymphatic and/or vascular invasion while L-cell tumors had none. Unlike EC-cell NETs, L-cell tumors were not associated with lymph node metastasis. Tumor type correlated with pT stage and the only patient with distant metastatic disease in this series had an EC-cell tumor. Our study confirms that appendiceal NETs are not a homogeneous tumor population. There are at least three types of appendiceal NET, including EC-cell, L-cell, and mixed tumors. This information is important for surveillance of patients, as monitoring urinary 5HIAA levels is only appropriate for patients with serotonin-producing tumors, whereas measurement of GLPs and/or PP is more appropriate for patients with L-cell tumors. Our data also show that tumor type is of significance with EC-cell tumors exhibiting the most aggressive behavior.

Histomorphological Development Study of Cecum in Local Awassi Sheep Fetuses (Ovis Aris): Prenatal Periods

This study was conducted at Al-Qasim Green University/College of Veterinary Medicine, Anatomy and Histology Branch. The experiment was designed to study the cecum of Awassi sheep fetuses: prenatal periods. Samples (30 male and female samples) were collected from healthy females uterine and divided according to age groups into four groups by crown rump length formula (CRL) for the prenatal stage. In the first age group (50-55), the cecum was in the process of development, as it was not distinguished visually. In the second age group (70-75 days), it was a small protrusion located between the ileum and the beginning of the ascending colon. With advancing age, the third group, which includes two ages in the third trimester of pregnancy, we found that the cecum was completely formed in (100-105) days and at (130-140) days of gestation. Also, upon histological study, we found that the wall of the cecum consists of four layers, as in the rest of the parts of the digestive system, and is lined with an epithelial layer surrounded by a layer of connective tissue. It is supportive of the epithelial tissue. We also found tunica submucosa constantly devolving with age, as it is mesenchymal cells in the first stage of intrauterine life and begin to transform into connective tissue with the presence of fibers and collagen (tunica submucosa) as a result of these cells transforming into spindle cells to form the inner muscle layer, as well as tunica muscularis externa. The latter is surrounded by loose connective tissue that contains a few collagen and elastic fibers surrounded by mesothelial cells (tunica serosa) that contain blood vessels to support development in the inner layers.

Thoracoscopic enucleation of an esophageal glomus tumor in the prone position: a case report and literature review

BackgroundGlomus tumors (GT) generally occur in the skin. However, esophageal GT, an extremely rare condition, has no established standardized treatment guidelines. Herein, we report the case of an esophageal GT successfully removed by thoracoscopic enucleation in the prone position using intra-esophageal balloon compression.Case presentationA 45-year-old man underwent an annual endoscopic examination and was found to have a submucosal tumor in the lower esophagus. Endoscopic ultrasound (EUS) revealed a hyperechoic mass originating from the muscular layer. Contrast-enhanced computed tomography identified a 2 cm mass lesion with high contrast enhancement in the right side of the lower esophagus. Pathologic findings of EUS-guided fine needle aspiration biopsy (EUS–FNA) revealed round to spindle shaped atypical cells without mitotic activity. Immunohistochemically, the tumor was positive for alpha-smooth muscle actin, but negative for CD34, desmin, keratin 18, S-100 protein, melan A, c-kit, and STAT6. He was diagnosed with an esophageal GT and a thoracoscopic approach to tumor resection was planned. Under general anesthesia, a Sengstaken–Blakemore (SB) tube was inserted into the esophagus. The patient was placed in the prone position and a right thoracoscopic approach was achieved. The esophagus around the tumor was mobilized and the SB tube balloon inflated to compress the tumor toward the thoracic cavity. The muscle layer was divided and the tumor was successfully enucleated without mucosal penetration. Oral intake was initiated on postoperative day (POD) 3 and the patient discharged on POD 9. No surgical complications or tumor metastasis were observed during the 1-year postoperative follow-up.ConclusionsAs malignancy criteria for esophageal GT are not yet established, the least invasive procedure for complete resection should be selected on a case-by-case basis. Thoracoscopic enucleation in the prone position using intra-esophageal balloon compression is useful to treat esophageal GT on the right side of the esophagus.

Outcomes of Vaginal Repair and Vaginal Repair Combined With GnRHa Administration in the Treatment of Cesarean Section Scar Defects: A Randomized Clinical Trial

Study ObjectiveTo prospectively investigate whether the application of vaginal repair (VR) of cesarean section scar defect (CSD) combined with a gonadotropin-releasing hormone agonist (GnRHa) achieve better clinical outcomes than VR alone. DesignA randomized clinical trial. SettingUniversity hospital. PatientsA total of 124 women with CSD were undergoing expectant management from December 2016 to September 2021. 61 were randomised to VR+ GnRHa and 63 to VR alone. InterventionVaginal repair combined with GnRHa and vaginal repair alone. Measures and Main ResultsThe primary outcome was the duration of menstruation and thickness of the remaining muscular layer (TRM) at 6 months after surgery. Secondary outcomes included the length, width and depth of the CSD; operation time; estimated blood loss; hospitalization time; and operative complications. Women were treated with either VR (n = 63) or VR + GnRHa (n = 61). Menstruation and TRM in patients pre. vs. post comparisons either with VR or VR + GnRHa are significant improved (P < .05). Significant differences in menstruation duration and TRM occurred in patients treated with VR + GnRHa compared with those treated with VR (P < .05). Moreover, the rate of CSD after surgery in the VR group was significantly higher than that in the VR + GnRHa group (P = .033), and CSD patients in the VR + GnRHa group achieved better therapeutic effects than those in the VR group (P = .017). Patients who received VR + GnRHa had a shorter menstruation duration and a greater increment of TRM postoperatively than did patients treated with VR alone (P = .021; P = .002, respectively). ConclusionVR + GnRHa therapy has a greater potential to improve scar healing and reduce the number of menstruation days than VR alone for symptomatic women with CSD. PrécisVaginal Repair Combined with GnRHa Creates Better Therapeutic Effects of CSD. Trial registrationDate of registration: October 13, 2016, Date of initial participant enrollment: December 20, 2016, Clinical trial identification number: NCT02932761, URL of the registration site: ClinicalTrials.gov, Figshare DOI: 10.6084/m9.figshare.24117114 Link to the clinical trial registrationhttps://clinicaltrials.gov/study/NCT02932761