Sclerotic Changes Research Articles

New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Study objective: to determine the dynamics of type 9 metalloproteinase (MMP-9) and its tissue inhibitor-1 (TIMP-1) in the pathogenesis of early miscarriage in women with chronic diseases of the hepatobiliary system.Materials and methods. The study included 39 women with a history of early pregnancy miscarriage, who were diagnosed with chronic liver diseases as a result of clinical, instrumental and laboratory studies (17 persons with steatosis and 22 persons with non-alcoholic steatohepatitis). The control group consisted of 8 women without somatic pathology and 8 pregnant women at the first trimester of gestation. MMP-9 and TIMP-1 value in the blood serum was determined by the enzyme immunoassay.Results. MMP-9 and TIMP-1 growth in the blood serum of women with a history of miscarriage was established in the pre-gravidar period. The most significant increase in the parameters of the intercellular matrix was found in patients with non-alcoholic steatohepatitis. MMP-9 and TIMP-1 increased in in blood serum in the first trimester in women with liver diseases. MMP-9 increased against the background of a decrease in the TIMP-1 activity in patients with the threat of premature pregnancy termination. Miscarriage was diagnosed in patients with a minimum value of a tissue inhibitor. Conclusions. There is an imbalance between MMP-9 and TIMP-1 in the blood serum in women with early miscarriage and chronic diseases of the hepatobiliary system. MMP-9 and TIMP-1 level in patients with hepatic steatosis is lower than in patients with non-alcoholic steatohepatitis. MMP-9 increased during physiological pregnancy, and the TIMP-1 activity practically did not change, which indicates the role of MMP-9 in the initial stages of placentation. MMP-9 value in women with a burdened premorbid background with a physiological course of pregnancy and threatening early spontaneous miscarriage was significantly different. The highest activity of MMP-9 was in women with the threat of spontaneous miscarriage in the early stages. TIMP-1 in the first trimester in women with chronic liver disease increased in those with a favorable course of pregnancy and decreased in the threat of spontaneous miscarriage. Such changes in MMP-9 and TIMP-1 in patients with miscarriage indicate the accumulation of intercellular matrix and sclerotic changes in the vessels that provide blood to the uterus.

Influence of portal hypertension on the state of the hemomicrocirculatory level of rat skin: morphological study

The effect of portal hypertension on the condition of the hemomicrocirculatory tract of the skin male white nonlinear rats was studied. Hypertension was simulated by applying a ligature to the portal vein according to the conventional method. After 30, 60 and 90 days, skin biopsies were taken from the anterior abdominal wall for optical microscopy examination, which was subjected to routine histological processing. In animals of the control group, which underwent sham surgery, the skin remained unchanged. In rats of the experimental group after 30 days in the basal layer of the epidermis there were cells with signs of degenerative changes. The basement membrane of the epidermis had small areas with thinning and thickening, which in both cases were accompanied by the formation of small and massive leukocyte infiltrates. Its edema was noted, which extended to the papillary and reticular layer of the dermis. Elastic fibers were unchanged. Only 50% of the microvessels looked intact, 20% microvessels were narrowed, and 30% had signs of stagnant hyperemia due to dilatation. After 60 days the epidermis was thinned, in the basal layer the cells with picnotized and displaced to the periphery nucleus were detected. In all studied layers of epidermis, besides reticular layer, expansion of arterioles, venules and capillary loops was observed. After 90 days the epidermis was represented by 3-6 layers of cells, its general refinement was observed due to the reduction of the thickness of the spinous and granular layers with simultaneous thickening of the horny layer. In the papillary layer of the dermis, the number of thin-walled blood vessels was increased. The average diameter of the arterioles of the hypodermis decreased relative to the values on the 60th day. The mean diameter of the arterioles of the subdermal network on the border of the papillary and reticular layers and capillary loops under the basal membrane was reduced what can be a sign of sclerotic changes in the microvessels. The venules diameter remained increased. In arterioles and venules, stasis of the microvessels, edema of their walls, microaneurysm, and venous sacculation were detected. Thus, we believe that the changes in the microvessels of the skin, which are observed in portal hypertension, are the result of hemodynamic disturbances in the tissue, which is a complex chain of hemomicrocirculatory flow to the direct action of hypertension in the portal vein and is a secondary response to systemic vascular damage.

Thromboxane A2 receptor antagonist (ONO-8809) attenuates renal disorders caused by salt overload in stroke-prone spontaneously hypertensive rats.

Epidemiological and clinical studies have demonstrated that excessive salt intake causes severe hypertension and exacerbates organ derangement, such as in chronic kidney disease (CKD). In this study, we focused on evaluating the histological and gene expression effects in the kidneys of stroke‐prone spontaneously hypertensive rats (SHRSP) with a high salt intake and the thromboxane A2/ prostaglandin H2 receptor (TPR) blocker ONO‐8809. Six‐week‐old SHRSPs were divided into three groups and were fed normal chow containing 0.4% NaCl, 2.0%NaCl or 2.0%NaCl + ONO‐8809 (0.6 mg/kg p.o. daily). Histological analyses with immunohistochemistry and a gene expression assay with a DNA kidney microarray were performed after 8 weeks. The following changes were observed in SHRSPs with the high salt intake. Glomerular sclerotic changes were remarkably observed in the juxtamedullary cortex areas. The ED1, monocyte chemoattractant protein‐1 (MCP‐1), nitrotyrosine and hypoxia inducible factor 1α (HIF‐1α) staining areas were increased in the glomeruli and interstitial portion of the kidneys. The genes Tbxa2r (that encodes TPR), Prcp and Car7 were significantly underexpressed in the kidneys. The plasma 8‐isoprostane level was significantly elevated and was attenuated with the ONO‐8809 treatment. Thromboxane A2 (TXA2) and oxidative stress exaggerated renal dysfunction in the salt‐loaded SHRSPs, and ONO‐8809 as a TPR blocker suppressed these changes. Therefore, ONO‐8809 is a candidate drug to prevent CKD in hypertensive patients when CKD is associated with a high salt intake.

Effect of alcohol on the morpho-functional state of the ovaries in HIV-infected women

Women are a special group of people who need close attention in terms of early detection of HIV. The aim of our work was to determine the effect of alcohol on the morpho-functional state of the ovaries in HIV-positive women. Sectional material from 100 women of reproductive age, who were divided into four groups according to the criteria of HIV infection and chronic alcoholism, was studied. As a result of the study, it was established that the negative impact of HIV infection can be enhanced due to alcohol abuse. A group of HIV-positive women suffering from alcoholism was defined as a special group of patients. These women needed additional attention, timely and effective medical care. Such facts were determined by the severity of pathological changes due to HIV infection, chronic alcoholism, and a combination of these factors. It was concluded that chronic alcoholism negatively affects the morpho-functional state of the ovaries of HIV-positive women. Under the influence of HIV infection, destructive, degenerative, sclerotic changes in the structure of the ovaries occur. Keywords: HIV, ovary, follicle, chronic alcoholism.

Morphological Changes of the Ureter in Patients with Ureterolithiasis Depending on the Duration of Clinical Manifestations

Urolithiasis (URL) is a common urological disease that often appears in the population, has a high recurrent rate and a significant impact on the social status of the population. Almost half of patients with URL disease are people with ureteric stones, 95% of which have secondary genesis. The main methods of treatment of such patients are extracorporeal shock-wave lithotripsy (ESWL) and ureterolithotripsy (URS). It is important in these cases to determine morphological changes (inflammation, edema, sclerosis, necrosis, etc.) that appear in the ureter in the placement of the stone and may reduce the effectiveness of minimally invasive treatment or/and removal of fragments during URS. The objective: studying morphological changes of the ureter wall in patients with ureterolithiasis in the zone of the calculus in dependence of the duration of clinical manifestations. Materials and methods. We have studied histological changes of the ureter wall in the location of the stone in patients with ureterolithiasis. We explored the ureter wall in patients depending on duration of typical manifestations of ureterolithiasis, which were 7-en days long, 30 days, and more than 2 months. Results. If the stone in the ureter is up to 7 days, it does not cause significant microscopic changes of the ureter wall. If the stone been in the ureter during 1 month, more significant morphological changes are determined with desquamation of the urothelium, edema and inflammatory changes in the submucosal membrane. In case of the duration of the calculi in the ureter is more than 2 months, we noted the exfoliation of the urothelium with the denudation of the basement membrane. In the submucosal layer there is an edema, diffuse disorganization of connective tissue fibers, fragments of growth of granulation tissue and dense connective tissue in the form of separate layers. Conclusion. With increasing duration of the disease in the wall of the ureter increases the manifestations of inflammatory, sclerotic and necrotic changes. Such changes have a direct impact on the quality of visualization of the calculus during endoscopic interventions, the rate of fragmentation and extraction (elimination) of fragments, as a consequence, increase the overall duration of the operation and the risk of intra- and postoperative complications.

Type 2 sclerotic Modic change affect fusion result in patients undergoing PLIF with pedicle screw instrumentation: a retrospective study

BackgroundBony fusion rate was significantly lower in patients with type 3 Modic change than patients with normal endplates. It is not known whether there are relevant differences in fusion efficiency among patients with type 2 sclerotic Modic change or non-sclerotic Modic change, or no Modic change.MethodsA retrospective study contained 196 lumbar segments in 123 subjects undergoing posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation (PSI) to assess the effect of type 2 sclerotic Modic change on fusion efficiency. These endplates were allocated into groups A, B, and C, according to their Modic changes. Group A had endplates with type 2 Modic change and endplate sclerosis. Group B had type 2 Modic change without endplate sclerosis. Group C had neither Modic change nor endplate sclerosis. The presence of Modic change was determined by magnetic resonance imaging (MRI). Endplate sclerosis in type 2 Modic change was detected by computed tomography (CT) before the operation. We collected CT data 3 months to more than 24 months after operation in patients to assess bony fusion.ResultsIncidences of bony fusion were 58.8% in group A, 95.0% in group B, 94.3% in group C. The bony fusion rate was significantly lower in group A than in either group B or C. There was no significant difference between groups B and C. Thus, endplates with type 2 sclerotic Modic change had a lower fusion rate in patients undergoing PLIF with PSI.ConclusionType 2 sclerotic Modic change could be an important factor that affects solid bony fusion in patients undergoing PLIF with PSI. CT may help diagnose endplate sclerosis in patients with type 2 change and inform the choice of the best site for spinal fusion.

Osteocyte Dysfunction in Joint Homeostasis and Osteoarthritis.

Structural disturbances of the subchondral bone are a hallmark of osteoarthritis (OA), including sclerotic changes, cystic lesions, and osteophyte formation. Osteocytes act as mechanosensory units for the micro-cracks in response to mechanical loading. Once stimulated, osteocytes initiate the reparative process by recruiting bone-resorbing cells and bone-forming cells to maintain bone homeostasis. Osteocyte-expressed sclerostin is known as a negative regulator of bone formation through Wnt signaling and the RANKL pathway. In this review, we will summarize current understandings of osteocytes at the crossroad of allometry and mechanobiology to exploit the relationship between osteocyte morphology and function in the context of joint aging and osteoarthritis. We also aimed to summarize the osteocyte dysfunction and its link with structural and functional disturbances of the osteoarthritic subchondral bone at the molecular level. Compared with normal bones, the osteoarthritic subchondral bone is characterized by a higher bone volume fraction, a larger trabecular bone number in the load-bearing region, and an increase in thickness of pre-existing trabeculae. This may relate to the aberrant expressions of sclerostin, periostin, dentin matrix protein 1, matrix extracellular phosphoglycoprotein, insulin-like growth factor 1, and transforming growth factor-beta, among others. The number of osteocyte lacunae embedded in OA bone is also significantly higher, yet the volume of individual lacuna is relatively smaller, which could suggest abnormal metabolism in association with allometry. The remarkably lower percentage of sclerostin-positive osteocytes, together with clustering of Runx-2 positive pre-osteoblasts, may suggest altered regulation of osteoblast differentiation and osteoblast-osteocyte transformation affected by both signaling molecules and the extracellular matrix. Aberrant osteocyte morphology and function, along with anomalies in molecular signaling mechanisms, might explain in part, if not all, the pre-osteoblast clustering and the uncoupled bone remodeling in OA subchondral bone.

The relationship of bioelectric activity and structural changes in the hippocampus at pharmacoresistant temporal lobe epilepsy

Background. Epilepsy is one of the most common neurological diseases globally. The unified concept about the role of hippocampus in the development of pharmacoresistant temporal lobe epilepsy is currently missing. Patients with pharmacoresistant temporal lobe epilepsy is often carried out by invasive electrocorticography to identify an epileptic focus. Registration of bioelectric activity of the hippocampus and comparison of data from the MRI pattern of the patient will determine the neurophysiological correlates of structural changes in hippocampus.Objective. The aim of the work was to determine the neurophysiological correlates of structural changes in the hippocampus in patients with focally caused temporal lobe epilepsy.Design and methods. The study was based on the analysis of the results of extraoperative invasive monitoring of the bioelectrical activity of the cortex and hippocampal complex, performed in 19 patients with focally caused drug-resistant epilepsy. The quantitative analysis included 34 tracks of hippocampal activity.Results. A distinctive feature of the bioelectrical activity of the hippocampal complex with its structural damage is the stable dominance of delta activity, which makes up 40–45 % of the total spectrum power. When the hippocampal complex is included in the epileptic system, high-index epileptiform activity is recorded. In the absence of structural damage to the hippocampal complex, the pattern is predominantly formed by the activity of theta and alpha frequency ranges. However, in the group of patients with the absence of a neuroimaging picture of sclerotic changes in the hippocampus, in 63 % of cases, a neurophysiological pattern of “prolapse” was recorded on the electrocorticogram. The spontaneous activity of the hippocampus had a low coherent relationship with the parameters of activity in the cortex of the ipsilateral and contralateral temporal lobes.Conclusions. The electrophysiological correlate of MR-positive structural changes in the hippocampal complex in drug-resistant epilepsy is the pattern of “loss of bioelectric activity”. Spontaneous hippocampal activity is generated independently of activity in the cortex of the ipsilateral and contralateral temporal lobes.

ПЕРСПЕКТИВЫ ИСПОЛЬЗОВАНИЯ РАДИОНУКЛИДНЫХ МЕТОДОВ ИССЛЕДОВАНИЯ ДЛЯ ДИАГНОСТИКИ И ОЦЕНКИ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ПОСЛЕДСТВИЙ ПЕРЕНЕСЕННОЙ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Purpose: to determine the role of nuclear medicine methods in the diagnosis and quality control of treatment and rehabilitation of patients with complications after coronavirus diseasr (COVID-19)
 The article provides a brief analysis of the incidence of COVID-19 and highlights the role of diagnosis, treatment and rehabilitation of patients suffering from the consequences of coronavirus diseasr after the end of the pandemic. The most common clinical manifestation of coronavirus diseasr is bilateral interstitial pneumonia, one of the complications of which is the development of acute respiratory distress syndrome, its pathogenesis is highlighted. It is also noted that the leading link in the development of the disease is a systemic lesion of the endothelial vascular wall, which is the cause of thrombosis and its complications, primarily pulmonary embolism, ischemic brain infarctions and cardiovascular catastrophes. 
 Specific methods of radionuclide diagnostics are described for individual organs and systems: respiratory, cardiovascular, brain, and others. The need to diagnose and control the quality of treatment and rehabilitation of patients with post-inflammatory changes in the parenchyma of internal organs and a decrease in their functional ability due to sclerotic changes, patients with changes in the state due to the transition of inflammation to the chronic stage, as well as with an overactive immune response to inflammatory changes.
 Conclusion: at the stage of diagnosis and treatment of the consequences of a previous coronavirus diseasr and subsequent rehabilitation, molecular imaging methods are essential in a complex of studies.

Comparative characteristics of bone marrow cell composition, stroma, and trabecular bone in allogenic hematopoietic stem cell transplantation in patients with primary myelofibrosis

Introduction. Primary myelofibrosis (PMF) is a clonal disease violating the cell composition, histological topography and stroma in bone marrow (BM). Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a curative therapy in PMF.Aim — description of change in the haematopoietic tissue cell composition and stroma, as well as in trabecular bone in allo-HSCT patients with fibrotic PMF.Materials and methods. We studies 24 trephine biopsy samples from nine PMF patients with allo-HSCT at the intervals: I — 1 month prior to, II — past 1–3 months and III — past 4–6 months from allo-HSCT. BM trephine biopsy slides were prepared in a standard histological assay with haematoxylin—eosin and additional staining with Gomori’s silver and Masson’s trichrome. Morphological change was evaluated in reticulin and collagen stroma, bone trabeculae, cellularity and topography of haematopoietic tissue.Results. The BM trephine biopsies of interval I were morphologically distinguished in three types by haematopoietic cellularity, stromal and trabecular sclerotic change. Post-transplant intervals II and III (3–6 months after allo-HSCT) did not reveal these types but showed an evident myelofibrosis and osteosclerosis reduction and signs of a restoring bone remodelling cycle. Myelopoietic lineages recovered in stages: the erythroid germ restored in three, granulocytic — in six months, and megakaryocytic cellularity did not fully recover in six months. Myelopoietic cellularity recovery outpaced blood recovery, which may be due to induced myelodysplasia or disruption of stromal niches.Conclusion. Allo-HSCT leads to the disappearance of PMF-pathognomonic BM morphology reflecting a histological remission. The reduction of myelofibrosis and osteosclerosis and normalisation of the trabecular bone remodelling cycle in post-transplant periods indicates an impact of cell microenvironment on PMF pathogenesis and warrants research into the composition and histological topography of cell microenvironment in PMF.

Hypocalcemia in Setting of Malignancy of Unknown Origin: A Case Report

Background: Hypercalcemia is a common finding well-recognized in up to 30% of cases of malignancy, associated with poor prognosis and advanced disease state. Hypocalcemia, while uncommon, can also be found in cases of malignancy facilitated by its own unique mechanism and etiologies. We present a case of severe hypocalcemia in the setting of malignancy of unknown origin. Clinical Case: 72-year-old female with a history of metastatic carcinoma of unknown origin, followed actively by Oncology, presented acutely with shortness of breath, chest pain, stiff hands and clenched fist. Patient had reported a 20 lbs weight loss over three months with a “knot” in the epigastric area affecting appetite and interfering with eating. Prior CT showed diffuse adenopathy with diffuse permeative bone destruction highly suspicious for malignancy. Follow up PET-CT showed mixed lytic lesion and sclerotic changes throughout the entire skeleton from the skull to mid thighs compatible with osseous metastatic. Initial tests show severe hypocalcemia with appropriately PTH elevation and normal vitamin D25 (calcium 5.5 mg/dL, albumin 3.9 g/dL, phosphorus (PO4) 2.3 mg/dL, magnesium (Mg) 1.5 mg/dL, PTH 243 pg/mL, vitamin D25 31.44 ng/mL). Further workup shows normal creatinine levels (0.88 mmol/L) and elevated alkaline phosphatase (1140 IU/L). Physical exam revealed bilaterally clenched fist and positive Chvostek sign. After two doses of 2 grams calcium gluconate, calcium had improved up to 7.2 mg/dL (corrected 7.76 mg/dL, albumin 3.3 g/dL) with plans to replete Mg and PO4. Patient was started on Calcium-Vitamin-D 500-200 mg-units (Oscal) two tabs trice daily. However, calcium continues to drop the next day with levels at 5.7 mg/dL (corrected 6.42 mg/dL, albumin 3.1 g/dL). A calcium infusion of 10 grams was then given over 16 hours. Calcitriol 0.25 mg twice daily was started. 24-hour urine study showed low calcium excretion (<0.8 mg/dL), normal Mg excretion (6.5 mg/dL) with an adequate creatinine collected (0.6 grams) showing no deficiencies in kidney resorption. Prior to discharge, patient’s calcium had stabilized (corrected 8.2 mg/dL, albumin 3.4 g/dL) and her associated symptoms had resolved. She was discharged on Oscal 2 tabs 4 times daily and Calcitriol 1 mcg twice daily. Conclusion: Given these biochemical results and imaging evidence of bone metastases, this case highlights the uncommon findings of hypocalcemia in the setting of malignancy. With the combination of low 24-hour urine calcium, elevated PTH, normal vitamin D25, low PO4, normal kidney function and increased alkaline phosphatase, these findings most likely indicate hypocalcemia secondary to osteoblastic bone metastasis, resulting from deposition of calcium in osteoblastic lesions.

Clinical mimics and diagnostic challenges in tick-borne borreliosis: a systematic review

Background. Ixodes tick-borne borreliosis (TBB) is a clinically multifaceted disease posing a serious threat in most territories of the Russian Federation. New TBB outbreaks emerge and spread to the country’s south.Objectives. The review highlights the TBB clinical diversity to physicians in order to improve the diagnosis quality and opportune aid. It focuses on the early and late clinical presentation of localised and disseminated polysystemic TBB.Methods. Sources were mined in the MEDLINE, PubMed and national electronic databases (Сyberleninka, eLibrary, etc.) with keywords “tick-borne borreliosis” [клещевой боррелиоз], “Lyme disease” [болезнь Лайма], “Lyme arthritis” [Лайм-артриты], neuroborreliosis [нейроборрелиоз] for the period of 2014–2020. Selected impactive publications within 2007–2013 were also included. Research was considered eligible if borreliosis was diagnosed using specific techniques like immune-enzyme assays, immunoblotting or PCR.Results. TBB is a common and cross-disciplinary situation. The disease may progress occult or manifest in a variety of forms, from annular erythema to cardiac, peripheral and central nervous system involvement or arthritis. The polysystemic nature of lesions, often long-term of the tick bite, forces multiple specialist visits ending with misdiagnoses, late aetiotropic therapy and transition into a chronic phase through ignorance of the patient’s epidemiological record. Some patients may have the acute phase followed by irreversible neurological damage associated with memory loss, cognitive decline, arthrosis and sclerotic skin change reducing the quality of life.Conclusion. TBB can be mimicked by therapeutic, neurological, skin and ophthalmic illnesses, which warrants the physician’s attention to the epidemiological record and knowledge of specific diagnostic techniques. Further research is necessary into the pathogenesis and clinical presentation of chronic TBB and its residual manifestations.

THE IMPACT OF SMOKING ON THE MORPHOFUNCTIONAL STATE OF PERIODONTAL TISSUES OF YOUNG ORGANISM

Background. The interrelation of disorders in periodontal tissues with metabolic changes caused, in particular, by a violation of microcirculation, observed namely in smoking but the fact that the effect of smoking on the condition of periodontal tissues at a young age has been studied less than other risk factors deserves special attention. The aim of our study was to experimentally assess the effect of smoking on the morphofunctional state of periodontal tissues in young animals. Materials and methods. Simulation of smoking has been performed with ten-week-old WAG rats using the Boyarchuck chamber. Morphometric studies were performed in the gingival zone which was chosen for morphological interpretation of volumes of specific vascular density in microcirculatory bed, specific density of connective tissue in lamina propria and specific area of tissue with ischemia. The obtained digital data were processed by the methods of variation statistics. Results. Simulation of smoking for four weeks in experimental animals leads to pathological changes in the morphofunctional state of the periodontium with reducing vascular density from 19.44±1.97% to 11.03±1.38 %, increasing area of connective tissue from 18.33±2.71% to 26.49±1.24%, spreading area of tissue with ischemia from 1.14±0.70% to 6.35±1.67%. Conclusions. Morphofunctional changes in the periodontium with damage to the structure of the epithelial membrane and changes in its permeability, microcirculatory disorders, sclerotic changes are a manifestation of the initial inflammatory and dystrophic processes that can lead to persistent chronic pathology.

Microscopic changes of the pancreas vessels in the dynamics after experimental thermal injury

The problem of burns is relevant in the world and in Ukraine. Thermal injury is not limited to local tissue changes, but causes significant morphofunctional disorders in the organs and systems of the affected organism, the result of this factor is a violation of blood supply to organs, including the pancreas. The aim of this work was to establish the histological condition of the vessels of the pancreas after experimental thermal injury. The experiments were performed on 40 adult white rats. Burns were applied under thiopental-sodium anesthesia with copper plates at a temperature of 96-97℃ on the epilated surface of the skin of the back of animals for 15 seconds (the lesion area was 18-20 % of the body surface). Decapitation of animals was performed on 1, 7, 14 and 21 days of the experiment. Pieces of the pancreas were taken for histological examination and processed according to generally accepted methods. Histological sections 5-6 μm thick were stained with hematoxylin-eosin, impregnated with silver by the Gordon-Sweets method, as well as staining by the tricolor method of MSB (ORB). Histological specimens were examined and documented using an SEO SCAN light microscope and a Vision CCD Camera. In the early stages of the experiment revealed a violation of the blood supply to the body. The lumens of most arteries were found to be dilated, and the wall thickness increased due to hypertrophy of the smooth muscle cells of the media. Leukocyte infiltration was determined in the perivascular spaces. The lumens of the small and middle veins were dilated and filled with blood, with parietal thrombi in some of them. Capillaries are characterized by a moderate expansion of their lumens, stasis. There was swelling of the paravasal spaces. Significant destructive-degenerative, inflammatory and sclerotic changes were observed in the later stages of the experiment. The walls of the vessels were moderately swollen. Smooth myocytes of the arterial media were hypertrophied, the cytoplasm was vacuolated, and contained pyknotically altered nuclei. Adventitia of vessels, especially veins, was swollen and fibrous. Occasionally there were violations of the wall of the components of the microcirculatory tract, which was accompanied by hemorrhage. There are single thrombosed vessels, spasmed arterioles, hemocapillaries with dilated lumens. The greatest changes, especially on the 21st day, were the adventitial membrane with the growth of collagen and reticular fibers. The blood supply to the vessels was moderate. Vessels of small diameter and hemomicrocirculatory tract were also significantly altered, their wall is deformed, thin, homogeneous. The lumens are dilated, with the formation of blood clots. Thus, in the early stages of the experiment there are adaptive-compensatory processes and initial destructive changes in the walls of the vessels of the organ, manifested by stasis, thrombosis, edema, deformation, infiltration of the wall and perivascular space. In the late period, significant destructive-degenerative changes in the structure of the walls of the vessels of the pancreas, accompanied by hemorrhage, inflammation, sclerosis of the wall and edema of the adventitia. These changes lead to a deterioration of blood supply and, consequently, a decrease in the functional activity of the body.

Ремоделирование мочевого пузыря и его сосудистого русла у лиц пожилого и старческого возраста в условиях инфравезикальной обструкции, обусловленной гиперплазией предстательной железы

Introduction. It is known that prolonged bladder obstruction caused by prostatic hypertrophy leads to serious structural changes in the bladder wall. However the detailed morphogenesis of this process, the features of the compensatory-adaptive reactions of the its vascular bed and the role of existing background diseases in this process, as well as age-related changes are still unclear. Aim of our study was to discover the features of the structural rearrangement of the bladder and its vasculature in elderly and senile people with BPH. Materials and methods. Autopsy material from 25 men 60-80 years old who had no urological pathology and from 25 men of the same age who had BPH without signs of urinary bladder decompensation was studied. There were 10 men aged 20-30 who died as a result of injuries in control group. Results. Histological and immunohistochemical studies revealed a pronounced structural reorganization of the bladder wall and its vasculature in patients with BPH. This process is superimposed on the already existing involutive changes in the detrusor such as its atrophy, sclerosis of the intermuscular stroma and neurodegenerative changes. The compensatory hypertrophy of detrusor and changes in its vasculature to regulate the local hemodynamics develop in men with ifravesical obstruction. Such changes in the arterial bed include bundles of intimate muscles, muscular-elastic sphincters and polypoid pillows formations. They provide a normal blood supply of the intact parts of the detrusor at the cost of deterioration the blood supply of its areas with atrophic and sclerotic changes. Regulatory changes such as muscle "couplings", muscle rollers and valves were also revealed in the veins. The contraction of this musculature imparts an impulse to the movement of venous blood to the heart and relaxation promotes its deposition. The valves are able to prevent the development of blood regurgitation. Conclusions. Рrostatic hyperplasia and infravesical obstruction cause the functional load on the detrusor increases, which leads to its local hypertrophy. This process occurs against the background of age-related changes. There is also a structural reorganization of the vascular bed of the bladder, the role of which is to redistribute blood flow in favor of detrusor sites that are subjected to greater functional load.

Erdheim-Chester Disease in a Patient after Double Lung Transplantation for Pulmonary Langerhans Cell Histiocytosis

Introduction Both, Langerhans cell histiocytosis (LCH) and Erdheim-Chester Disease (ECD) belong to the heterogeneous group of histiocytoses. Their association is exceptional and thought to be linked to the BRAF mutation. Both diseases express with different radiographic and histopathologic phenotypes. Radiological features of pulmonary LCH include cystic and fibrotic changes sparing the costophrenic angles. On histology, positive staining with CD1a and Langerin is characteristic. Lung transplantation is the only therapeutical option in end-stage LCH. Radiologic manifestations of ECD include sclerotic bone lesions, retroperitoneal fibrosis, and cardiovascular involvement with infiltration of tissues by foamy histiocytes negative for CD1a. Case Report With an end-stage pulmonary LCH, a 38 years old man received a double lung transplantation (DLuTX). The explanted lungs revealed on histology clusters of Langerhans cells histiocytes positive for CD1a. Nine years after DLuTX and continuous immunosuppression, a PET-CT presented sclerotic changes in the scapula and 3rd thoracic vertebra, soft-tissue infiltration of the right atrium and circumferentially surrounding aorta and right coronary artery (“coated” aspect) and edematous thickening of the renal capsule (”hairy kidney“). The imaging findings were thus compatible with ECD. Bone biopsy showed fibrosis of the bone marrow. Biopsy of the retroperitoneum revealed fibrosis, cells inconsistent with Langerhans cells, immune-histochemically lacking CD1a expression. The mediastinal changes slowly progressed over years, requiring biopsy, which also yielded fibrotic tissue. Additionally, the patient developed a massive jaundice and anorexia. The abdominal CT showed intra- and extrahepatic cholangiectasis with circumferential soft tissue sheathing of the common bile duct (CBD). An ERCP with biopsy of the CBD revealed cells positive for langerin and CD1a. Further cranial CT showed symmetric sclerotic bone lesions. Patient died 12 years after DLuTx due to cardiovascular complications. He had never developed any dysfunction of his lung allografts. Summary Distinctive histopathologic results of various tissues at different time points and the extensive radiologic features in the same patient indicate the concomitant occurrence of two distinct histiocytoses, LCH and ECD after DLuTX.

Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect.

The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma. This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected. A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors. PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.

A Case of 73-Year-Old Male with Chronic Invasive Fungal Sinusitis Mimicking Sino-Nasal Malignancy

Fungal sinusitis is a sinus infection caused by fungal species, most of which are aspergillus species. They can be classified mainly into two groups, invasive fungal sinusitis and non-invasive fungal sinusitis. Invasive fungal sinusitis is characterized by fungi not confined to the paranasal sinuses or the nasal cavity but invading the adjacent tissue and bone. Chronic invasive fungal sinusitis is one type of invasive fungal sinusitis and is a relatively rare disease. It can invade the adjacent sinus bone and tissue for months to years, resulting in bony sclerotic change, formation of mass and bony destruction, which can be mistaken for pseudotumor or malignant tumor. In this report, we report a case of a patient with chronic invasive fungal sinusitis, which was mimicking sino-nasal malignancy.

Bone remineralization of lytic lesions in multiple myeloma - The Arkansas experience.

Multiple myeloma (MM) patients frequently present with extensive osteolytic bone lesions. However, the impact of myeloma treatment on focal lytic lesion remineralization has not been extensively studied. In this study, the effect of anti-myeloma treatment on the extent of bone remineralization was examined and potential mediators identified. Newly diagnosed MM patients enrolled in the Total Therapy 4 and 5 (TT4; n = 231, TT5; n = 64) protocols were longitudinally evaluated for changes in radiological parameters for a median of 6.1 years. Bone remineralization was defined as a sclerotic CT change within the lytic lesion and quantified as a percentage of remineralization, using the initial lesion size as a reference. Such changes were correlated to clinical and biochemical parameters, and the gene expression profile of bone marrow biopsy. Overall, remineralization occurred in 72% of patients (213/295). Of those patients that experienced remineralization, 36% (107/295) achieved at least 25% of bone remineralization. Patients with high-risk disease defined by gene expression profile signature (GEP70 ≥ 0.66) experienced significant remineralization compared to low-risk MM. Female patients were also more likely to experience bone remineralization and in a shorter median time (2.0 vs. 3.3 y). Factors such as serum alkaline phosphatase along with high levels of RUNX2 and SOX4 gene expression correlated with increasing extent of bone remineralization. This analysis demonstrated significant remineralization of lytic lesions in MM patients treated on TT clinical trials. While the underlying mechanism remains elusive these findings support the hypothesis that patient baseline bone-related factors play a fundamental role in the skeletal repair of bone lesions in MM that provide new opportunities for improving patient outcomes.

Mastoid effusion on temporal bone MRI in patients with Bell\u2019s palsy and Ramsay Hunt syndrome

This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.