Mucosal Pathology Research Articles

Colonoscopic findings in patients referred to Erbil public endoscopy units

Background and objective: Colonoscopy, which is the visual examination of the large bowel and distal part of the small bowel, is an important diagnostic and therapeutic procedure. This study aimed to find out diagnostic findings of endoscopies in Erbil endoscopy unit and relation to important personal data including age and gender. Methods: An observational study was carried out from July 2017 to October 2017. Colonoscopies were done for 125 patients who met the inclusion criteria. Results: The findings of 125 colonoscopies were classified into gross and pathological findings. Colitis was found in 17 patients (13.6%), of which 10 patients (58.4%) had inflammatory bowel disease with higher incidence in females (60%). Polyps were found in 20 patients (16%) with adenomatous type being the most common pathological type (12 patients, 60%). Grossly sessile types were found in 13 patients (60%).Malignant tumors were found in eight cases (6.4%) with male predominance (62.5%). Ulcers were found in six cases (4.8%), and diverticula in five cases (4%). Normal colonoscopy was found in 46 cases (36.8%), with majority of these cases (37 cases) aged 21-41 years. Hemorrhoids were found in 23 patients (18.4%). Conclusion: Polyps were the most common colonic mucosal pathology with male predominance and older ages, followed by colitis with a higher incidence in females. Malignancies had lesser frequencies, the majority being in male and old age people. Normal colonoscopies and hemorrhoids were the largest groups, and diverticula with ulcers were the least findings.

A Novel Mouse Model of Enteric Vibrio parahaemolyticus Infection Reveals that the Type III Secretion System 2 Effector VopC Plays a Key Role in Tissue Invasion and Gastroenteritis.

The Gram-negative marine bacterium Vibrio parahaemolyticus is a common cause of infectious gastroenteritis due to the ingestion of contaminated seafood. Most virulent V. parahaemolyticus strains encode two type III secretion systems (T3SS1 and T3SS2); however, the roles they and their translocated effectors play in causing intestinal disease remain unclear. While studies have identified T3SS1 effectors as responsible for killing epithelial cells in culture, the T3SS2 effectors caused massive epithelial cell disruption in a rabbit ileal loop model. Additional models are thus needed to clarify the pathogen-host interactions that drive V. parahaemolyticus-associated gastroenteritis. Germfree mice were infected with a pathogenic clinical isolate of V. parahaemolyticus, RIMD2210633 (RIMD). The pathogen was found to adhere to as well as invade the cecal mucosa, accompanied by severe inflammation and dramatic mucosal damage, including widespread sloughing of infected epithelial cells. Mice infected with a V. parahaemolyticus strain lacking the T3SS1 (POR2) also developed severe pathology, similar to that seen with RIMD. In contrast, the ΔT3SS2 strain (POR3) appeared unable to invade the intestinal mucosa or cause any mucosal pathology. Confirming a role for TS332 effectors, a strain expressing the T3SS2 but lacking VopC (POR2ΔvopC), a T3SS2 effector implicated in epithelial cell invasion in culture, was strongly attenuated in invading the intestinal mucosa and in causing gastroenteritis, although infection with this mutant resulted in more pathology than the ΔT3SS2 strain. We thus present an experimental system that enables further characterization of T3SS effectors as well as the corresponding host inflammatory response involved in the gastroenteritis caused by invasive V. parahaemolyticusIMPORTANCEVibrio parahaemolyticus causes severe gastroenteritis following consumption of contaminated seafood. Global warming has allowed this pathogen to spread worldwide, contributing to recent outbreaks. Clinical isolates are known to harbor an array of virulence factors, including T3SS1 and T3SS2; however, the precise role these systems play in intestinal disease remains unclear. There is an urgent need to improve our understanding of how V. parahaemolyticus infects hosts and causes disease. We present a novel mouse model for this facultative intracellular pathogen and observe that the T3SS2 is essential to pathogenicity. Moreover, we show that the T3SS2 effector VopC, previously shown to be a Rac and Cdc42 deamidase that facilitates bacterial uptake by nonphagocytic cells, also plays a key role in the ability of V. parahaemolyticus to invade the intestinal mucosa and cause gastroenteritis. This experimental model thus provides a valuable tool for future elucidation of virulence mechanisms used by this facultative intracellular pathogen during in vivo infection.

VALIDATION OF MICRORNA EXPRESSION PROFILE IN ORAL LICHENOID DISEASE THROUGH CYTOLOGIC SAMPLES

Objective To validate oral exfoliative cytology in the analysis of the microRNA expression profile in oral lichenoid disease (OLD). Study Design The expression of 13 microRNAs was analyzed in 26 cases, 16 diagnosed as OLD and 10 controls with no oral mucosal pathology. Cytologic samples from the oral mucosa obtained using an Orcellex toothbrush were analyzed using reverse transcription-quantitative polymerase chain reaction and TaqMan microRNA assays. Results The aberrant expression was validated for 2 microRNAs (miR-146 a-5 P and miR-7-1-3 P) of those previously recognized in the biopsy study. Conclusion This is the first time that oral exfoliative cytology is validated in a microRNA study in OLD. The microRNAs validated in this study are associated with both inflammatory and carcinogenic phenomena that are involved in the etiopathogenesis of this potentially malignant oral disorder. To validate oral exfoliative cytology in the analysis of the microRNA expression profile in oral lichenoid disease (OLD). The expression of 13 microRNAs was analyzed in 26 cases, 16 diagnosed as OLD and 10 controls with no oral mucosal pathology. Cytologic samples from the oral mucosa obtained using an Orcellex toothbrush were analyzed using reverse transcription-quantitative polymerase chain reaction and TaqMan microRNA assays. The aberrant expression was validated for 2 microRNAs (miR-146 a-5 P and miR-7-1-3 P) of those previously recognized in the biopsy study. This is the first time that oral exfoliative cytology is validated in a microRNA study in OLD. The microRNAs validated in this study are associated with both inflammatory and carcinogenic phenomena that are involved in the etiopathogenesis of this potentially malignant oral disorder.

Frequency of Polyps and Adenocarcinoma in Colon Interposition After Esophagectomy in Adulthood - A Systematic Review.

Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek München. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.

NF-\u03baB2 signalling in enteroids modulates enterocyte responses to secreted factors from bone marrow-derived dendritic cells

Alternative pathway NF-κB signalling regulates susceptibility towards developing inflammatory bowel disease (IBD), colitis-associated cancer and sepsis-associated intestinal epithelial cell apoptosis and shedding. However, the cell populations responsible for the perturbed alternative pathway NF-κB signalling in intestinal mucosal pathology remain unclear. In order to investigate the contribution of the epithelial compartment, we have tested whether NF-κB2 regulated transcription in intestinal epithelial cells controls the intestinal epithelial response to cytokines that are known to disrupt intestinal barrier permeability. Enteroids were generated from the proximal, middle and distal regions of small intestine (SI) from C57BL/6J wild-type mice and displayed region-specific morphology that was maintained during sub-culture. Enteroids treated with 100 ng/mL TNF were compared with corresponding regions of SI from C57BL/6J mice treated systemically with 0.33 mg/kg TNF for 1.5 h. TNF-induced apoptosis in all regions of the intestine in vitro and in vivo but resulted in Paneth cell degranulation only in proximal tissue-derived SI and enteroids. TNF also resulted in increased enteroid sphericity (quantified as circularity from two-dimensional bright field images). This response was dose and time-dependent and correlated with active caspase-3 immunopositivity. Proximal tissue-derived enteroids generated from Nfκb2−/− mice showed a significantly blunted circularity response following the addition of TNF, IFNγ, lipopolysaccharide (LPS) activated C57BL/6J-derived bone marrow-derived dendritic cells (BMDC) and secreted factors from LPS-activated BMDCs. However, Nfκb1−/− mouse-derived enteroids showed no significant changes in response to these stimuli. In conclusion, the selection of SI region is important when designing enteroid studies as region-specific identity and response to stimuli such as TNF are maintained in culture. Intestinal epithelial cells are at least partially responsible for regulating their own fate by modulating NF-κB2 signalling in response to stimuli known to be involved in multiple intestinal and systemic diseases. Future studies are warranted to investigate the therapeutic potential of intestinal epithelial NF-κB2 inhibition.

Two Cases of Allergic Fungal Sinusitis with Differing Postoperative Course

Allergic fungal sinusitis (AFS) often develops in unilateral paranasal sinuses, which must be differentiated from tumors. When AFS develops on both sides, however, it must be differentiated from eosinophilic chronic sinusitis with evident eosinophilic infiltration at nasal/paranasal sinus mucosa; both conditions are highly recurrent and commonly considered intractable paranasal sinusitis. Surgical correction is the primary treatment method for AFS, as it is essential to connect the paranasal sinus communication to ensure exhaustive resection of the pathologic mucosa and for nasal steroids to reach each paranasal sinus. We recently encountered two AFS cases with differing postoperative courses. Case 1 showed evident exacerbation in the computed tomography findings, which suggests progression to eosinophilic sinusitis. Case 2 showed a benign prognosis without recurrence. Close long-term follow-up should be mandatory after surgery for the treatment of AFS.

Analysis of oral pathology in an Australian paediatric population: A retrospective study

PurposeThere are very few published epidemiological studies that investigate oral pathology in the paediatric population in an Australian cohort. MethodsThe purpose of this study was to analyze data from histopathological specimens received over a period of 23 years at the Institute for Clinical Pathology and Medical Research (ICPMR), and to report on the frequency of oral pathology in the Australian pediatric population. Results obtained from ICPMR, were imported into an electronic database and data such as age, gender and histopathological diagnosis were used to determine the frequency of commonly occurring pathology in children. ResultsA total of 935 oral pathology specimens collected from paediatric patients aged 16 and under were included in the analysis. The most common pathology was salivary gland pathology (21.1%), followed by mucosal pathology (15.8%) and miscellaneous pathology (14.9%). The most frequently encountered lesion was the mucocele (19.1%), followed by periapical granuloma (5.9%), dentigerous cyst (5.1%) and the giant cell fibroma (5%). ConclusionIn the paediatric population, oral pathology shows an increasing tendency with age, with the majority of pathology being benign in nature comprising mainly of mucoceles and dental pathology particularly, periapical granuloma's and dentigerous cysts.

Analysis of oral and maxillofacial pathology lesions over an 18-year period diagnosed at Kuwait University.

The aim of the present study was to determine the range, frequency, prevalence, and distribution of oral lesions submitted for histopathological diagnosis at the oral pathology laboratory at Kuwait University. A retrospective analysis was conducted of all cases submitted to the oral pathology laboratory over an 18-year period. Age, sex, histopathological diagnosis, and location of the lesions were recorded. Lesions were classified into 10 diagnostic categories. Of the 697 biopsies examined, the average age of the patients ranged from 1 to 93years with a mean age of 37.83±16.62 (mean±SD). The most common diagnostic category was mucosal pathologies (N=205, 29.4%), followed by odontogenic cysts (N=158, 22.7%) and reactive lesions (N=97, 13.9%). The three most common histopathological diagnoses were hyperkeratosis (N=70), dentigerous cyst (N=48), and mucocele (N=44). Twenty-five malignant neoplasms were diagnosed, the majority of them in males. A significant association was observed between age and the group of lesions of the oral cavity (P≤0.001). The present study provides the first set of data from Kuwait that covers a wide range of oral lesions. Mucosal pathologies were the most frequently diagnosed lesions and the majority of diagnoses were benign.

Gastroscopy assisted laser Doppler flowmetry and visible light spectroscopy in patients with chronic mesenteric ischemia

Mucosal pathology due to chronic mesenteric ischemia (CMI) is rarely seen during upper endoscopy. Combining Laser Doppler Flowmetry (LDF) and Visible Light Spectroscopy (VLS) may aid in detection of CMI at an early stage.We aimed to investigate the utility of LDF and VLS in detecting microcirculatory changes in patients with CMI during upper endoscopy.In a single center, prospective study, 104 patients were evaluated for mesenteric ischemia during a 24 months period. Patients with a consensus diagnosis of CMI (n = 40) were examined with LDF and VLS. Thirty-two were successfully treated and had a definitive diagnosis of CMI. Results were compared with controls (n = 38) with normal intestinal circulation evaluated with duplex ultrasonography (DUS). Treatment response was evaluated clinically and with DUS at 1 month and with VLS and LDF at 3 months.A significant reduction in mucosal capillary hemoglobin oxygen saturation (SO2) was found in CMI patients compared to controls before treatment: mean ± SD: 67 ± 9%, 81 ± 4%, respectively (p < .001). A significant reduction was also seen for the relative hemoglobin (rHb) amount, flow and velocity (p < .001). The sensitivity of SO2 measured by VLS for diagnosing CMI was 94% and the specificity 72% (cut-off 78%), calculated with ROC curve analysis. A combination of SO2 and rHb increased the test sensitivity and specificity to 97% and 79%, respectively. Conclusion: CMI patients have significantly reduced microcirculation in the stomach and duodenum compared to controls. The results suggest that VLS should be included when performing an upper endoscopy in patients with suspected CMI.

Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy.

In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting. This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression. 500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program. Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.

The Associations Between the Gastric Mucosal Pathology and the Eradication Rate of H.Pylori :A Multicenter Study

The Associations Between the Gastric Mucosal Pathology and the Eradication Rate of H.Pylori :A Multicenter Study

The Effact of Helicobacter Hylori Eradication on the Development of Gastric Mucosa Pathology

The Effact of Helicobacter Hylori Eradication on the Development of Gastric Mucosa Pathology

Non-variceal gastrointestinal bleed in children: surgical experience with emphasis on management challenges.

This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed. Patients aged ≤ 18years treated surgically for NVGIB were analysed. Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed. The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.

Histological evidence supports low anesthetic bladder capacity as a marker of a bladder-centric disease subtype in interstitial cystitis/bladder pain syndrome.

Low anesthetic bladder capacity has been shown to be a biomarker for bladder-centric interstitial cystitis/bladder pain syndrome (IC/BPS). The goal of this study was to determine if histopathological evidence from bladder biopsies supports anesthetic bladder capacity (BC) as a marker to distinguish a bladder-centric IC/BPS subtype. From a review of our large IC/BPS cohort of patients undergoing hydrodistention, we identified a total of 41 patients with low BC (≤ 400ml); an additional 41 consecutive patients with BC > 400ml were selected as the comparator group. The original bladder mucosal biopsy pathology slides were re-reviewed by a single pathologist (blinded to patient information) using a standardized grading scale developed for this study. Histologically, the low BC subjects exhibited higher levels of acute inflammation (p = 0.0299), chronic inflammation (p = 0.0139), and erosion on microscopy (p = 0.0155); however, there was no significant difference in mast cell count between groups (p = 0.4431). There was no significant gender difference between the groups; female patients were the majority in both groups (low BC: 94.12%, non-low BC: 100%; p = 0.1246). Individuals in the low BC group were older (p < 0.0001), had a higher incidence of Hunner's lesions on cystoscopy (p < 0.0001), and had significantly higher scores, i.e., more bother symptoms, on two IC/BPS questionnaires (ICPI, p = 0.0154; ICSI, p = 0.0005). IC/BPS patients with low anesthetic bladder capacity have histological evidence of significantly more acute and chronic inflammation compared with patients with a non-low bladder capacity. These data provide additional evidence to support low bladder capacity as a marker of a distinct bladder-centric IC/BPS phenotype.

Evaluation of the Freelite MX™ kappa free and lambda free assays on the binding site Optilite® turbidimetric analyzer using CSF samples

CD(Crohn's Disease)is a chronic idiopathic inflammatory disorders of the GI tract. It is increasing worldwide and has become a global health problem. The key pathological mechanism for CD occurrence has not been identified, and present treatments are mostly anti-symptom therapy, which has limited efficacy. In this study, we investigate whether lncRNAs are involved in the pathogenesis of CD and how they may regulate the target genes in CD process.CD patients were diagnosed in Zhongda Hospital of Southeast University between May 2017 and May 2018. Pathological and normal intestinal mucosa were collected and total RNA was extracted the expression of lncRNA and mRNA was profiled and analyzed by using lncRNA and mRNA gene chips. The lncRNAs and mRNAs with significant alternations (≥10 times and P < 0.05) were identified and verified. The co-expressed mRNAs with the differentially expressed lncRNAs were revealed by CNC analysis. The potential regulatory factors were determined by the Ce (cis/tans) mechanism analysis with the use of miRbase, Targetscan, and NCBI database. Finally, the lncRNA-miRNA/TF-mRNA expression network was predicted.Eight lncRNAs were found to be differentially expressed between the pathological mucosa and the normal mucosas in the ileal end. CNC analysis of the differentially expressed lncRNAs revealed fifty co-expressed mRNAs with positive or negative regulation. Base on the mRNAs KEGG pathway analysis, most of them appeared to be involved in cell signaling pathways. Six lncRNAs in the cytoplasm participated in the Ce mechanism, and the rest two lncRNAs in the nucleus participated in the cis/trans regulation mechanism. Finally, ternary relationship of lncRNAs-miRNAs and TFs-mRNAs was obtained by CNC,KEGG enrichment analysis and Ce (trans/cis) analysis.The differential expression of lncRNAs in CD mucosa indicated that lncRNAs were involved in immune reaction. These lncRNAs might contribute to the regulation of intestinal mucosa function through the genetic network of lncRNAs -miRNAs/TFs-mRNAs.

Oral mucosal changes associated with primary diseases in other body systems.

Systemic diseases may manifest in the oral cavity. This chapter reviews the oral mucosal pathology in blood diseases, gastrohepatic diseases, kidney diseases, immunologic and connective tissue diseases, endocrine diseases, pulmonary diseases, nutritional deficiencies, dermatologic diseases, as well as cancer-associated oral mucosal conditions. The oral mucosa is one of the most commonly affected tissues and may present with unique clinical appearances. Oral mucosal involvement may be the first presentation of the systemic disease or reflect activity or progression of the primary condition. Therefore, it is of importance to be familiar with oral mucosal manifestations of these systemic diseases.

Diagnosing celiac disease: A critical overview.

The diagnosis of celiac disease (CD) no longer rests on a malabsorptive state or severe mucosal lesions. For the present, diagnosis will always require the gold-standard of a biopsy, interpreted through its progressive phases (Marsh classification). Marsh classification articulated the immunopathological spectrum of gluten-induced mucosal changes in association with the recognition of innate (Marsh I infiltration) and T cell-based adaptive (Marsh II, and the surface re-organisation typifying Marsh III lesions) responses. Through the Marsh classification the diagnostic goalposts were considerably widened thus, over its time-course, permitting countless patients to begin a gluten-free diet but who, on previous criteria, would have been denied such vital treatment. The revisions of this classification failed to provide additional insight in the interpretation of mucosal pathology. Morever, the subclassification of Marsh 3 imposed an enormous amount of extra work on pathologists with no aid in diagnosis, treatment, or prognosis. Therefore, it should now be apparent that if gastroenterologists ignore these sub-classifications in clinical decision-making, then on that basis alone, there is no need whatsoever for pathologists to persist in reporting them. Since new treatments are under critical assessment, we might have to consider use of some other higher level histological techniques sensitive enough to detect the changes sought. A promising alternative would be to hear more voices from imaginative histopathologists or morphologists together with some more insightful approaches, involving molecular-based techniques and stem cell research may be to evaluate mucosal pathology in CD.

Expression alteration of long non-coding RNAs and their target genes in the intestinal mucosa of patients with Crohn’s disease

BackgroudCD(Crohn's Disease)is a chronic idiopathic inflammatory disorders of the GI tract. It is increasing worldwide and has become a global health problem. The key pathological mechanism for CD occurrence has not been identified, and present treatments are mostly anti-symptom therapy, which has limited efficacy. In this study, we investigate whether lncRNAs are involved in the pathogenesis of CD and how they may regulate the target genes in CD process. MethodsCD patients were diagnosed in Zhongda Hospital of Southeast University between May 2017 and May 2018. Pathological and normal intestinal mucosa were collected and total RNA was extracted the expression of lncRNA and mRNA was profiled and analyzed by using lncRNA and mRNA gene chips. The lncRNAs and mRNAs with significant alternations (≥10 times and P < 0.05) were identified and verified. The co-expressed mRNAs with the differentially expressed lncRNAs were revealed by CNC analysis. The potential regulatory factors were determined by the Ce (cis/tans) mechanism analysis with the use of miRbase, Targetscan, and NCBI database. Finally, the lncRNA-miRNA/TF-mRNA expression network was predicted. ResultsEight lncRNAs were found to be differentially expressed between the pathological mucosa and the normal mucosas in the ileal end. CNC analysis of the differentially expressed lncRNAs revealed fifty co-expressed mRNAs with positive or negative regulation. Base on the mRNAs KEGG pathway analysis, most of them appeared to be involved in cell signaling pathways. Six lncRNAs in the cytoplasm participated in the Ce mechanism, and the rest two lncRNAs in the nucleus participated in the cis/trans regulation mechanism. Finally, ternary relationship of lncRNAs-miRNAs and TFs-mRNAs was obtained by CNC,KEGG enrichment analysis and Ce (trans/cis) analysis. ConclusionThe differential expression of lncRNAs in CD mucosa indicated that lncRNAs were involved in immune reaction. These lncRNAs might contribute to the regulation of intestinal mucosa function through the genetic network of lncRNAs -miRNAs/TFs-mRNAs.

Clinical photography: Attitudes among dental students in two dental institutions.

Clinical photography is an important tool in teaching, clinical practice and academia especially for mucosal pathologies. Our aim was to examine differences in attitude towards clinical photography for mucosal pathologies among students. Questionnaires about clinical photography were completed by students in dental teaching hospitals in Birmingham (UK) and in Israel (ISR). The questionnaires focussed on the perceived value of clinical photography for a number of purposes and also explored perceived barriers to clinical photography and technology in general. The two departments have different access to clinical photography; in the United Kingdom a separate dedicated photography unit takes all the photographs, whereas in ISR the clinicians take their own photographs. Pearson Chi-squared tests determined statistical significance between categorical variables (P<0.05). Among the 163 respondents, there were no significant differences in the value of photography between countries or genders. The participants felt that the aims of photography included: teaching (99.4%), monitoring premalignancy (97.6%) and clinician communication (95.8%). More than 90% thought photography should be used for dysplasia and erosive lichen planus cases. Respondents from ISR were more in favour of photographing pathologies including simple leukoplakia, reticular lichen planus, vesiculobullous or pigmented lesions (P<0.001 compared to the UK). Overall, the main reasons for not using photography were time constraints (25.5%) and access (21.8%). This study highlights a favourable attitude towards clinical photography for various teaching and clinical indications thereby demonstrating its importance. In order to maximise the benefits of clinical photography, access should be simplified.

A Retrospective Analysis of Esophageal Eosinophilia in Patients with Aspirin-exacerbated Respiratory Disease

Gastrointestinal symptoms are the most common side effect leading to discontinuation of aspirin therapy in patients with aspirin-exacerbated respiratory disease (AERD). Some patients with gastrointestinal symptoms on high-dose aspirin demonstrated biopsy-proven esophageal eosinophilia (EE). In a large cohort of patients with AERD we report on this novel clinical entity. Charts from 387 patients enrolled in the Brigham and Women’s Hospital AERD registry were reviewed for history of biopsy-proven EE. All subjects were diagnosed with AERD by a Partners Healthcare physician. Data was analyzed using student’s t-test and chi-square tests where appropriate. 13 (3.4%) patients had a history of biopsy-proven EE documented in the medical chart. 10 of 13 were desensitized to aspirin with 9 of them first developing EE 3 months to 6 years after aspirin initiation. AERD subjects with EE demonstrated greater rates of gastric irritation at follow-up visits (p<0.001) and of aspirin discontinuation due to gastric irritation (p=0.013, Pearson’s Chi-Squared test) than the non-EE group. Those with EE reported a faster rate of nasal polyp regrowth compared to the non-EE group (4.75±3.35 versus 14.9±20.8 months, p<.0001). Our study is the first to explore the relationship between aspirin therapy in AERD and the development of EE. We observed that EE develops in subjects with AERD both before and after initiation of daily aspirin therapy with more cases reported after starting aspirin. We found that the presence of EE is associated with faster regrowth of nasal polyps suggesting more severe sino-nasal mucosal pathology in this population.