Thick Band Research Articles

Days, Dances, Deities

Days, Dances, Deities Jay Rogoff (bio) In The Day, Wendy Whelan's new hour-long collaboration with choreographer Lucinda Childs and onstage cellist Maya Beiser, which had its world premiere in August at the Jacob's Pillow Dance Festival in the Berkshires, Whelan starts out all in white, costumed by Karen Young. She perches on a stool at our right, facing left in profile, her right leg bent before her, her left trailing behind. For fans of the New York City Ballet, where Whelan danced for 30 years, a light might flash in the brain: Apollo assumes the identical pose in George Balanchine's earliest surviving ballet, a young god eagerly preparing to watch his three muses dance in competition for his favor. It's as though Whelan, who often danced in Apollo in the role of Terpsichore, the muse of dance and winner of the contest, and who became a contemporary muse to such choreographers as Christopher Wheeldon and Alexei Ratmansky, has evolved to a higher degree of divinity. Beiser now becomes the apparent muse to Whelan, playing two absorbing, related pieces by David Lang called the day and world to come. For the day, Lang provides a crowdsourced text, a kind of found poem collated from the internet, with every line beginning "I remember the day …," recorded in Beiser's voice, joined occasionally by Whelan's. Memory dominates the work's atmosphere—fittingly, since the music originated as a response to the September 11 terrorist attacks, which barely obtrude upon the dance except for its sense of the significance of everyday people and their lives. The impression of recursiveness wafting from Lang's score and Beiser's playing reinforces the feeling of dailiness—how waking every morning constitutes a kind of miracle, even if we merely, modestly rehash the identical activities of the day before. The work's enticing reticence rescues it from sentimentality or pedantry and fits the stoical distance of Whelan's dancing, mostly improvised upon Childs's larger movement scheme. As a ballerina at NYCB for 30 years, Whelan earned fame for her speed and angularity, but her dance in the day depends on slowness and even stillness, and, at 52, the elegant, muscular solidity that has replaced her wiriness. Whelan's performance also depends on props, which she, in a post-performance talkback, called "a pain in the butt." She holds a ball with fabric trailing from it when Beiser reads, "I remember the day I fell in love." She uses long, thin rods to measure the stage—the world—like a Blakean god. Most significantly, she stretches thick elastic bands into triangles and rectangles that suggest portals, and at times she steps through them, moving from our world into another, a home of dancers or gods who share her special talents and powers. Whelan sometimes sheds her white over-gown to let it trail from her shoulders like a superhero cape, becoming a creature from another realm; just as often she is one of us—or a god or alien being playing one of us, discovering ordinary existence through her divine point of view, an apt role for a former ballerina on a quest for new symbols and new ways to perpetuate her identity as a dancer. The [End Page 135] hypnotic motion, the slow and deliberate turns, the mesmerizing incantation of the poetic text, and the lush intensity of Beiser's playing make this the most fully realized work Whelan has performed since her departure from ballet. (She has returned to NYCB in an administrative capacity, as associate artistic director.) Lang's score for The Day's second section, world to come, sounds darker and more anguished, a memorial to those killed in the World Trade Center attack. (The title and the buildings have the same initials.) Childs's choreography at first counters the sometimes harrowing music with a surprisingly classical calm. Whelan, now in gray-black, embarks on a series of surprisingly balletic moves—passés, balances, spins on both toes—but with modernist inflections, like the flexed wrists on her downward-extending arms during a series of turns. (Balanchine would have approved.) Whelan almost seems to be saying, "I remember...

Revisiting the anatomy of rotator cuff relevant to rotator cuff injury

The rotator cuff is the prime stabilizer of the glenohumeral or shoulder joint. The last decade saw introduction of three components, namely, rotator cable, rotator crescent, and rotator interval of rotator cuff, which were being studied and published in dozen of literatures belonging to clinical specialties of orthopaedics and radiology. At times when these terms have helped the clinician to understand the biomechanics of the rotator cuff while improving the outcome of its repair, the knowledge of the same remains at large for the anatomists. The preoperative assessment of rotator cuff tear has helped surgeons to identify the structure and its functional deficits thereof. The rotator cable is a thick fibrous band that behaves like a suspension bridge. Tears of rotator cable result in partial loss of function or pseudoparalysis of shoulder joint. The rotator interval is a four-layered protective cover of ligaments and the capsule in the rotator cuff. The current knowledge of the rotator interval revealed that the minor underlying ligaments of the shoulder joint play a crucial role in maintaining the congruency of the rotator cuff. The rotator cuff injury is often misdiagnosed due to a lack of knowledge and identification of its recently reported components. This review intends to sensitize the anatomists to investigate further about rotator cuff anatomy and biomechanics of the shoulder joint.

Intra-Operative Dermoscopy in Assessment of Melanonychia and as a Guide for Biopsy.

Background and Aims:Melanonychia can be a manifestation of benign or malignant pathology and often poses a diagnostic challenge on clinical examination. Even with distinguishing dermoscopic features (nail plate), it can be quite difficult to determine the nature of pigmentation as complete assessment of nail bed and matrix is still not possible. Intraoperative dermoscopy (IOD) can serve as a useful tool to appreciate the bed and matrix changes. The aim here is to study the intraoperative dermoscopic features in patients with melanonychia and correlate with histopathology.Methods:20 consecutive patients with melanonychia were recruited. Inclusion criteria was melanonychia of sudden onset, progressive nature, irregular width/color/symmetry on dermoscopy, positive Hutchinson sign, solitary nail involvement or associated nail dystrophy. Preoperative dermoscopy was performed and recorded. Patients were planned for nail matrix biopsy, during which IOD was performed over nail matrix and bed after removal of the nail plate. Images were recorded and analyzed and correlated with the histopathology.Results:Out of 20 patients, 12 were females and 8 males. On IOD-histopathological correlation, 2 patients were found to have melanoma of the nail unit, 5had nail lichen planus, 9 had benign melanocytic nevi, and 4 had fungal melanonychia. IOD revealed fine, parallel and regular lines of pigmentation localized to proximal nail bed and matrix in all patients with benign melanonychia, while dark thick bands with irregular borders, dots, globules, streaks and structureless areas in the two patients with melanoma. Fungal melanonychia revealed an unremarkable nail bed and matrix on IOD.Conclusion:Intraoperative dermoscopycan help in determining the nature of melanonychia and obviate the need to perform biopsy in certain cases. It can also aid in delineating the most suitable site for biopsy, along with grossly assessing the extent of involvement in case of malignancy.

Nodular and sclerosing gastritis caused by Cylicospirura felineus in a puma (Puma concolor).

An adult male puma (Puma concolor), hit by a car in an urban area, died three days later despite the therapeutic support provided. At necropsy, multiple firm nodules were identified in the gastric mucosa. The nodules were coated by an intact mucosa with a central opening from which reddish and cylindrical nematodes protruded into the lumen. Twenty-seven nematodes were retrieved for morphological and morphometric evaluations. During histopathological examination of the gastric tissue, the adult nematodes appear in longitudinal and transverse sections, surrounded by thick bands of collagen, interspersed with mixed inflammatory infiltrates. The nematodes had an eosinophilic cuticle with caudal serrated projections (bulbar type), coelomyarian musculature, pseudocoelom, and females with uterus containing numerous larvated eggs, characteristics consistent with the Cylicospirura genus. Morphologically, female nematodes had six large tricuspid teeth in the oral cavity and the vulva had an opening anterior to the esophagus-intestinal junction. Male nematodes had five pairs of small papillae near the tip of the tail. These findings were consistent with Cylicospirura felineus. This parasite should be included in the differential diagnosis of nodular gastric wall lesions in wild felids.

IDIOPATHIC LARYNOTRACHEAL STENOSIS AND LOW ALPHA-ONE ANTITRYPSIN LEVELS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Idiopathic laryngotracheal stenosis (ILS) is an inflammatory condition resulting in the narrowing of the airway. (1) To date, in the literature, there has been no clear association between ILS and low alpha-one antitrypsin (A1AT) levels. We report a case in which a patient had both abnormalities and we postulate mechanisms through which low A1AT levels could cause airway stenosis. CASE PRESENTATION: A 57-year-old lady with a past medical history of Parkinson's disease was sent for a second opinion for shortness of breath and wheezing. She had been erroneously diagnosed with A1AT deficiency and was started on augmentation therapy. Physical examination demonstrated a hoarse voice and diffuse expiratory wheeze, but no stridor, emanating from the upper airway. Her A1AT level was 79 mg/dl (normal 80-220 mg/dl) and her A1AT phenotype was PI*MZ. Pulmonary function testing showed the following: FVC: 87%, FEV1: 82%, FEV1/FVC: 93% and DLCO: 91%. The flow-volume loop suggested a fixed airway obstruction. Chest and neck tomography showed a scant amount of secretions involving the superior aspect of the trachea inferior to the vocal cord. She underwent bronchoscopy, which revealed tracheal narrowing to 5mm in diameter approximately 3 cm below the vocal cords. There was a thick fibrous band on the left side and a few smaller webs tethering the trachea. There was also a tracheal diverticulum present on the left side of the thick fibrous band. The rest of the tracheobronchial tree was normal. Initially, endobronchial scissors and a YAG laser were used to cut the webs and the trachea partially unfolded. The trachea was then dilated from 10 to 15 mm in diameter. Complete tracheal patency was achieved. DISCUSSION: ILS is rare and is most commonly seen in post-menopausal women. Proposed mechanisms are related to estrogen, disruption of blood supply, gastroesophageal reflux, and unremitting cough. (2) Secondary causes of laryngotracheal stenosis include prolonged endotracheal intubation and autoimmune diseases such as granulomatosis with polyangiitis and sarcoidosis. (1) There is no clear evidence showing an association between low A1AT levels and ILS. A1AT is a potent inhibitor of proteases and is crucial in conserving the integrity of connective tissue. In patients with low A1AT levels, these proteolytic enzymes can lead to fibrosis and scarring. Though most commonly associated with emphysema, low levels of A1AT have also been associated with arterial fibromuscular dysplasia with evidence of altered extracellular matrix and connective tissue abnormalities. (3) Although causation is impossible to establish in this case, we speculate that low A1AT levels may have led to connective tissue dysregulation and stenotic lesions of the trachea. CONCLUSIONS: This case is the first report of ILS occurring in the setting of low levels of A1AT. We speculate that there may be a pathobiologic link between the two entities. Reference #1: Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J. Causes and consequences of adult laryngotracheal stenosis.Laryngoscope.2015 May;125(5):1137-43. https://doi.org/10.1002/lary.24956. Epub 2014 Oct 7. Reference #2: Damrose EJ. On the development of idiopathic subglottic stenosis. Med Hypotheses. 2008;71(1):122-5. https://doi.org/10.1016/j.mehy.2007.12.017. Epub 2008 Mar 4. Reference #3: Schievink WI, Björnsson J, Parisi JE, Prakash UB. Arterial fibromuscular dysplasia associated with severe alpha 1-antitrypsin deficiency. Mayo Clin Proc. 1994 Nov;69(11):1040-3. DISCLOSURES: No relevant relationships by Hamzah Alfahel, source=Web Response No relevant relationships by Anthony Cucci, source=Web Response No relevant relationships by Ahmad JABRI, source=Web Response No relevant relationships by Sanjiv Tewari, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response

Comparison of Staphylococcus aureus surface protein extraction methods and immunogenicity

Staphylococcus aureus is the major contagious bovine mastitis pathogen and has no effective vaccine. Strain variation and limited knowledge of common immunogenic antigen/s are among major constraints for developing effective vaccines. S. aureus cell surface proteins that are exposed to the host immune system constitute good vaccine candidates. The objective of this study was to compare two novel S. aureus surface protein extraction methods with biotinylation method and evaluate immune-reactivity of extracted proteins. Surface proteins were extracted from nine genetically distinct S. aureus strains from cases of bovine mastitis. After extraction, bacterial cell integrity was examined by Gram staining and electron microscopy to determine if extraction methods caused damage to cells that may release non-surface proteins. The extracted proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and evaluated for immune-reactivity using western blot. Results showed that all three extraction methods provided multiple protein bands on SDS-PAGE. Western blot result showed several immunoreactive surface proteins, in which some proteins strongly (well-resolved, thick, dark, and intense band) reacted across the nine strains tested. The three methods are valid for the extraction of surface proteins and hexadecane, and cholic acid methods are more feasible than biotinylation since both are easier, cheaper, and have minor effects on the bacterial cell. Strongly immune-reactive surface proteins may serve as potential candidates for a vaccine to control S. aureus mastitis in dairy cows.

Design and fabrication of crotch absorbers with beryllium diffuser for Cornell high energy synchrotron source upgrade

With the CHESS-U upgrade in 2018, the south arc region of Cornell Electron Storage Ring (CESR) has been replaced with new magnets and vacuum chambers, and CESR will operate with higher beam energy and beam current at lower beam emittance. A new crotch absorber has been designed for the upgrade, based on previous CHESS crotch absorbers. The main body of the crotch absorber is a water-cooled hollow cylinder made of oxygen-free high-conductivity copper, and it has a 5-mm thick beryllium band brazed on the outside in the middle section to reduce the power density it absorbs on the surface. In this paper, we describe the mechanical design, present finite element thermal and structural analysis results with a focus on the region with high temperature and high thermal stress, and discuss the fatigue lifetime of the absorber. For typical operation with 6 GeV beam energy and a 200 mA beam current, the highest temperature on the crotch is approximately 300 °C based on the thermal analysis. Correspondingly, the fatigue lifetime is conservatively estimated to be around 4 × 104 cycles. We also show some details in the fabrication of the crotch assembly, especially about the vacuum furnace brazing joint between the beryllium band and the copper main body, including X-ray fluorescence inspection of the brazing joint. In addition, in order to have a relevant comparison in an effort to estimate the fatigue lifetime, we carry out finite element analyses (FEA) for the low cycle fatigue experiment with beryllium tiles using electron-beam heating of Watson et al. [Fusion Eng. Des. 37, 553 (1997)] in 1990s and provide new understanding for some of their experimental observations. These analyses assure the effectiveness of the design.

3087 Combined Endoscopic and Surgical Management of Small Bowel Polyposis in a Patient With Peutz-Jeghers Syndrome

INTRODUCTION: A 55-year-old male with history of Peutz-Jeghers syndrome was referred for a colonoscopy for management of a large ileal polyp. Surgical history was notable for two laparatomies for small bowel obstructions in the setting of intussusception as well as multiple enterotomies for removal of polyps. CASE DESCRIPTION/METHODS: Colonoscopy confirmed a polypoid mass in the distal ileum that was partially obstructing. Endoscopic submucosal dissection of the polyp stalk was performed but revealed two feeding arteries as well as a thick muscular band, concerning for muscularis propria, that precluded further safe dissection. Hemoclips were placed on the feeding arteries in an attempt to cause necrosis of the lesion. After discharge the patient developed hematochezia. Repeat colonoscopy did not show any ongoing bleeding but the mass appeared to be necrotic. Repeat colonoscopy was planned in the operating room to evaluate the mass. If the necrosis was not complete, dissection of the stalk would be re-attempted with plans to convert to surgical resection if needed. On endoscopy, the mass appeared to have revitalized. Another attempt at submucosal dissection of the polyp stalk was performed. However as the area had already been dissected through, the submucosal plane was not easily identified in the stalk and did not feel that it was safe to continue the submucosal dissection. Subsequently, the patient was converted to surgical resection of the ileal polyp, which also revealed multiple polyps more proximally throughout the small bowel. The bowel resection included the initial large polyp and another large polyp at a prior ileal anastomosis that could not be removed without a resection. Multiple other polyps were removed via enterotomies. To clear the remaining small bowel of residual polyps, we performed a clean sweep. A pediatric colonoscope was introduced orally and the scope was able to be advanced distally to the ileal anastomosis by plicating the bowel over the scope. Multiple further polypectomies were then performed using standard endoscopic mucosal resection technique. On 3 month follow up MR enterography, there were no convincing polyps identified in the entire small bowel. DISCUSSION: This case demonstrates the importance of a multi-disciplinary approach to the management of this patient's polyposis. The combination of endoscopic and surgical approach allowed for effective management of both the large ileal polyp as well as his overall polyp burden. Watch the video: http://bit.ly/2JWHRA2

Next-Generation Sequencing in the Diagnosis of Rare Pediatric Sinonasal Tumors

The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the CTNNB1 gene consistent with desmoid fibromatosis. An 11-month-old male infant presented with a right nasal mass that extended through the cribriform plate into the anterior cranial fossa and involved the right ethmoid sinus and adjacent right orbit. Histology revealed an infiltrative atypical fibrous proliferation with focal calcifications that was negative for CTNNB1 and GNAS mutations. A novel RET E511K variant was identified in the tumor and later was also found in the germline and hence rendered of unknown significance. Both cases highlight the utility of next-generation sequencing in the evaluation of pediatric sinonasal spindle cell tumors that may have overlapping pathologic features. Reporting of rare or novel variants in tumor-only sequencing should be cautiously evaluated in children and pairing with germline sequencing may be needed to avoid the pitfall of assigning uncommon variants.

Sonographic Findings in Adult Congenital Madelung Deformity: A Case Study

This case study describes six sonographic findings, with correlative imaging, in an adult patient with congenital Madelung deformity. Two are typical of congenital Madelung deformity: a thick volar hyperechoic band extending from the ulnar side of the distal radius toward the lunate-triquetrum area, the so-called Vickers ligament, adjacent to the radiotriquetral ligament, and a cortical defect on the ulnar and volar side of the distal radius. Other findings may be also observed, such as a narrowed distance between the Lister tubercle and the distal radioulnar joint, a dorsal subluxation of the ulnar head, an extensor tendons entrapment and pronator quadratus modifications. Although the diagnosis of congenital Madelung deformity is based usually on clinical examination, this rare malformation may remain undiscovered until adulthood. When sonography is used as the first imaging technique, the sonographic findings of congenital Madelung deformity can facilitate diagnosis and the appropriate radiographs.

Evidence of pollen features and peroxidase isozymes in their morphological complexity of ten local cultivars of sweet potato from Indonesia

Abstract. Suranto, Wahyuni D, Edy Purwanto E. 2019. Evidence of pollen features and peroxidase isozymes in their morphological complexity of ten local cultivars of sweet potato from Indonesia. Biodiversitas 20: 2511-2518. Sweet potato (Ipomoea batatas Lam) has been recorded to have many cultivars and variations in the morphological characters not only for the leaves but also for the tubers. Sweet potatoes had economically significant role, especially as an additional food due to its high content of carbohydrate and other nutrient values. In order to test whether the morphological variation in this species was also expressed at the micro character; such as pollen morphology and enzyme activity, ten sweet potato cultivars were used in this study. The morphological characters such as shape and structure of the pollen features were examined using Scanning Electron Microscopy (SEM). Accordingly, Polyacrylamide Gel Electrophoresis (PAGE) was used to look-at the banding pattern of peroxidase isozymes. Morphological characters of leaves, flowers, and tuber were observed qualitatively both for the typical shape and colors. More detail of flower shapes was drown manually especially their petal edges. The results showed that there was variation among the ten sweet potato cultivars confirmed not only on their morphological characters but also the isozyme banding patterns of ten cultivars tested. At least, two cultivar Antin 3 and Papua Solossa had uniques characters especially the purple stem and yellow tuber and dark skin on the tuber, respectively. In addition, the structural analysis of pollen showed that Beta 1 cultivar has very large pollen; 116,50 μm (axis polar) and the contour surface of exine pollen was concave with the aperture shape and ornamentation were prolate spheroidal and echinate respectively. This unique character was also shown by its peroxidase isozyme bands. Eleven bands of leaf and 13 bands of stem samples were detected respectively. The typical Rf values of 0.31, 0.48 and 0.41 were detected for the leaf, while for stem samples were 0.14, 0.20 and 0.26. The Beta 1 cultivar showed very thick bands in between Rf values of 0.13 and 0.26. Meanwhile, the unique band pattern of Papua Salosa was the absence of band at 0.38.

Novel Investigation of the Deep Band of the Lateral Plantar Aponeurosis and Its Relationship With the Lateral Plantar Nerve.

We describe a thick fascial band arising from the medial aspect of the lateral plantar aponeurosis diving deep into the forefoot crossing over a branch of the lateral plantar nerve. Because a review of current literature resulted in limited and outdated sources, we sought to first determine the frequency of this fascial band and the location where it crosses the lateral plantar nerve and, second, discuss the clinical applications these anatomical findings could have. 50 pairs of cadaveric feet (n = 100) were dissected to investigate for presence of the fascial band and its interaction with the lateral plantar nerve. Images were taken of each foot with the fascial band. ImageJ was used to take 2 measurements assessing the relationship of the tuberosity of the base of the fifth metatarsal to where the nerve crossed deep to the fascial band. Overall, 38% of the feet possessed the fascial band. It was found unilaterally in 10 pairs and bilaterally in 14 pairs. On average, the point at which the lateral plantar nerve passed deep to the fascial band was 2.0 cm medial and 1.7 cm anterior to the tuberosity of the base of the fifth metatarsal. When present, the deep band of the lateral plantar aponeurosis (PA) was consistently found to be crossing the lateral plantar nerve. The discovery of the location where this most commonly occurs has not been previously reported and adds an interesting dimension that elevates an anatomical study to one that has clinical potential. The established target zone gives a precise location for where the relationship between the deep band of the lateral PA and the lateral plantar nerve exists when evaluating the foot. The target zone provides a potential springboard for future investigations concerning said relationship clinically.

SYMMETRICAL PALATAL fiBROMATOSIS (SPF) – 5 NEW CASES AND A LOGICAL DIAGNOSTIC NAME FOR A RARE LESION WITH A DOZEN DIFFERENT NAMES

Objective To present 5 new cases of a lesion reported fewer than 20 times in the literature, under a dozen different names, and to recommend the most appropriate name. Methods 5 new SPF cases are clinically and microscopically characterized, with a literature review. Findings 5 cases (3F & 2M) presented in patients 20-39 years of age. All presented as bilateral, symmetrical, asymptomatic, sessile, moderately firm or soft (n = 2) masses of the lateral posterior hard palate; 2 were isolated to the tuberosities. All masses were normal in color, with smooth, nonulcerated surfaces and occasional broad surface nodularity. One case had bilateral secondary, anterior extensions. Underlying bone was radiographically normal, and adjacent teeth were asymptomatic. All masses seemed to originate from tissues over the palatal bone, only secondarily extending to gingivae and/or crestal tuberosity bone, i.e. this does not appear to be a gingival entity, as previously thought. Cases had been present 2-15 years, with no familial or environmental etiologies identified. Histopathologically, masses were comprised of dense, avascular fibrous connective tissue with scattered thick bands of collagen and occasional slight surface nodularity. Surface epithelium showed regions with long, pointed and/or thin rete processes, and subepithelial stroma contained scattered large, angular fibroblasts, sometimes with multiple nuclei, sometimes with a “smudged” appearance, consistent with those in giant cell fibroma; melanin granules were not present. Conservative surgical excision affected cure in all cases. Conclusion The present investigators propose SPF as the most accurate name for this chronic, presumably rare and certainly unique entity. It fits the definition of fibromatosis more than reactive fibrous hyperplasia, and the presence of giant fibroblasts in the stroma is a unique, possibly required, histopathologic feature. Conservative surgical excision is the recommended treatment, with no recurrences reported to date.

Suboccipital myodural bridges revisited: Application to cervicogenic headaches.

There seems to be no complete demonstration of the suboccipital fascial configuration. In 30 human fetuses near term, we found two types of candidate myodural bridge: (1) a thick connective tissue band running between the rectus capitis posterior major and minor muscles (rectus capitis posterior major [Rma], rectus capitis posterior minori [Rmi]; Type 1 bridge; 27 fetuses); and (2) a thin fascia extending from the upper margin of the Rmi (Type 2 bridge; 20 fetuses). Neither of these bridge candidates contained elastic fibers. The Type 1 bridge originated from: (1) fatty tissue located beneath the semispinalis capitis (four fetuses); (2) a fascia covering the multifidus (nine); (3) a fascia bordering between the Rma and Rmi or lining the Rma (13); (4) a fascia covering the inferior aspect of the Rmi (three); and (5) a common fascia covering the Rma and obliquus capitis inferior muscle (nine). Multiple origins usually coexisted in the 27 fetuses. In the minor Type 2 bridge, composite fibers were aligned in the same direction as striated muscle fibers. Thus, force transmission via the thin fascia seemed to be effective along a straight line. However, in the major Type 1 bridges, striated muscle fibers almost always did not insert into or originate from the covering fascia. Moreover, at and near the dural attachment, most composite fibers of Type 1 bridges were interrupted by subdural veins and dispersed around the veins. In newborns, force transmission via myodural bridges was likely to be limited or ineffective. The postnatal growth might determine a likely connection between the bridge and headache. Clin. Anat. 32:914-928, 2019. © 2019 Wiley Periodicals, Inc.

Intratumor Heterogeneity in Interstitial Fluid Pressure in Cervical and Pancreatic Carcinoma Xenografts

Preclinical studies have suggested that interstitial fluid pressure (IFP) is uniformly elevated in the central region of tumors, whereas clinical studies have revealed that IFP may vary among different measurement sites in the tumor center. IFP measurements are technically difficult, and it has been claimed that the intratumor heterogeneity in IFP reported for human tumors is due to technical problems. The main purpose of this study was to determine conclusively whether IFP may be heterogeneously elevated in the central tumor region, and if so, to reveal possible mechanisms and possible consequences. Tumors of two xenograft models were included in the study: HL-16 cervical carcinoma and Panc-1 pancreatic carcinoma. IFP was measured with Millar SPC 320 catheters in two positions in each tumor and related to tumor histology or the metastatic status of the host mouse. Some tumors of both models showed significant intratumor heterogeneity in IFP, and this heterogeneity was associated with a compartmentalized histological appearance (i.e., the tissue was divided into compartments separated by thick connective tissue bands) in HL-16 tumors and with a dense collagen-I-rich extracellular matrix in Panc-1 tumors, suggesting that these connective tissue structures prevented efficient interstitial convection. Furthermore, some tumors of both models developed lymph node metastases, and of the two IFP values measured in each tumor, only the higher value was significantly higher in metastatic than in non-metastatic tumors, suggesting that metastatic propensity was determined by the tumor region having the highest IFP.

A case of spontaneous colonic perforation in collagenous colitis

BackgroundCollagenous colitis (CC) is a clinicopathologic syndrome characterized by chronic watery diarrhea and distinctive histopathologic features. Spontaneous perforation of CC is extremely rare, because CC is usually managed medically, and the need for surgical intervention is rare. We report a surgical case of spontaneous colonic perforation of CC with acute abdomen disease.Case presentationA 77-year-old man was admitted to our hospital for abdominal pain and watery diarrhea. Computed tomography (CT) showed a thickened bowel wall with edema involving free air around the splenic flexure of the colon. Therefore, we performed emergency surgery with a diagnosis of colonic perforation. Intraoperative findings revealed colonic necrosis at the splenic flexure, so we performed a left hemicolectomy. Histopathological examination revealed typical findings of CC, a thick subepithelial collagenous band and deep ulcers with perforation. The postoperative course was uneventful, and the patient was discharged on the 28th postoperative day. After changing the proton pump inhibitor (PPI) from lansoprazole (LPZ) to rabeprazole (RPZ), he has not complained of diarrhea symptoms.ConclusionsAlthough spontaneous perforation is a rare complication of CC, it is possible to be diagnosed by symptom of acute abdomen disease. This is the seventh case of spontaneous colonic perforation of CC worldwide.

SUN-506 An Interesting Case Of Low-Grade Parathyroid Carcinoma

Background: Parathyroid Carcinoma (PC) is a rare form of malignancy and accounts for < 1% of cases of primary Hyperparathyroidism (PHT). It is challenging to diagnose PC due to lack of specific clinical features and biochemical markers. Pathological diagnosis can be troublesome as well, causing a delay in the ideal surgical treatment. Clinical Case: A 39 year old male with history of HTN, recurrent kidney stones, asthma and drug abuse was involuntarily admitted to the hospital by his fiancé after a domestic fight. Initial labs were significant for Calcium 13.2 mg/dl (N 8.8-10.5 mg/dl), Phosphorus 2.8mg/dl (N 2.5-4.5 mg/dl), Magnesium 1.2 mg/dl (N 1.8-2.4 mg/dl), BUN 24 mg/dl (N 6-22mg/dl), Creatinine 2 mg/dl (N 0.8-1.4 mg/dl), CPK 2550 u/l (32-230 u/l). Due to the physical assault, CT Brain and cervical spine were obtained which showed multiple calcified discs and ligaments along with hyperdense vertebral bodies and salt and pepper appearance of the cranial bones. A 2.7 x 2.3 x 4.5 cm mass adjacent to the posterior aspect of the left thyroid lobe concerning for possible parathyroid adenoma or thyroid neoplasm was also reported. Patient was treated with IV fluids and further investigation revealed iPTH 194 pg/ml (N 15-65 pg/ml), ca 12.7 mg/dl, Vit D(OH)25 - 21 ng/ml. Thyroid US and NM Parathyroid imaging confirmed a large 6 x 2.5 x 2.3 cm left superior parathyroid.The patient underwent parathyroidectomy, intraoperatively PTH dropped from 233 to 64 pg/ml. Kidney function and calcium normalized after the surgery. The patient was screened for MEN due to hyperparathyroidism and resistant hypertension. Gastrin, calcitonin, catecholamines were all within the normal range. During the surgery, a very large gland was noted without any local invasion. Gross pathologic examination of the specimen showed a markedly enlarged, fragmented and hemorrhagic parathyroid (12.6 gm). Histologically, tumor demonstrated uniform oxyphil cells with focal cellular atypia and low mitotic rate, divided by thick fibrous bands. No definitive vascular invasion was seen, however, peripheral nerve entrapment was noted. Fragmentation of the specimen with limited representation of the tumor stroma interface precluded accurate evaluation of capsular invasion and made this a difficult case to diagnose. The specimen was sent to Johns Hopkins for further evaluation. An immunostain for parafibromin demonstrated abnormal loss of nuclear expression, a finding that is 95% specific for parathyroid carcinoma. Based on the combination of these atypical features, the loss of parafibromin staining, entrapment of peripheral nerve, and the markedly enlarged parathyroid, the lesion were best regarded as a low-grade parathyroid carcinoma. Conclusion: PC is often a difficult pre-operative diagnosis and the patients are subjected to recurrent surgeries. Our patient underwent left thyroid lobectomy after the pathological confirmation of PC.

Rebaudioside A administration prevents experimental liver fibrosis: an in vivo and in vitro study of the mechanisms of action involved.

Rebaudioside A (Reb A) is a diterpenoid isolated from the leaves of Stevia rebaudiana (Bertoni) that has been shown to possess pharmacological activity, including anti-inflammatory and antioxidant properties. However, the ability of Reb A to prevent liver injury has not been evaluated. Therefore, we aimed to study the potential of Reb A (20mg/kg; two times daily intraperitoneally) to prevent liver injury induced by thioacetamide (TAA) administration (200mg/kg; three times per week intraperitoneally). In addition, cocultures were incubated with either lipopolysaccharide or ethanol. Antifibrotic, antioxidant and immunological responses were evaluated. Chronic TAA administration produced considerable liver damage and distorted the liver parenchyma with the presence of prominent thick bands of collagen. In addition, TAA upregulated the expression of α-smooth muscle actin, transforming growth factor-β1, metalloproteinases 9, 2 and 13, and nuclear factor kappaB and downregulated nuclear erythroid factor 2. Reb A administration prevented all of these changes. In cocultured cells, Reb A prevented the upregulation of genes implicated in fibrotic and inflammatory processes when cells were exposed to ethanol and lipopolysaccharide. Altogether, our results suggest that Reb A prevents liver damage by blocking oxidative processes via upregulation of nuclear erythroid factor 2, exerts immunomodulatory effects by downregulating the nuclear factor-κB system and acts as an antifibrotic agent by maintaining collagen content.

Studies of Reproductive Changes during Pregnancy in the Bitch

In the present study, seven mongrel bitches were used, their age ranged from 15 months to 3 years. Vaginal cytology was carried out during pregnancy period of these bitches by taking vaginal smears weekly to investigate vaginal cytological changes. Serial ultrasonography was performed daily on these bitches from the 15th day after the last breeding until birth day to determine the time of appearance of different gestational structures. The first observation of the extra-fetal and fetal structures was as follows: The yolk sac membrane was first detected as an echogenic U-shaped fetal membrane in a range of 24-25 days. A third echogenic fetal membrane, allantoic membrane, was first detected on Day 27. On Day 23, in the uterine wall surrounding the gestational sac, an apparently hyperechoic inner layer was differentiated to the zonary placenta which appeared as two thick bands one on either side of the fetus on Day 29. The embryo appearance was on Day 20.5. The early time of the position of the embryo either opposed to the uterine wall or dependent on chorionic cavity was nearly on Day 22 and on Day 24, respectively. The heartbeat, which is one of fetal vital signs, was detected as a bright echogenic flickering motion on Day 21. On Day 26 in mongrel bitches, the features of the embryo changed from an oblong to bipolar shape and form two loops of number 8, size and density the same. An anechoic area in the head of the embryo was detected on Day 29. The limb buds were firstly detected on Day 29. Fetal movement was firstly detected on Day 33. Meanwhile, the skeleton of the fetus was first detected as hyperechoic structure on Day 33.

The Synthetic ALMA Multiband Analysis of the Dust Properties of the TW Hya Protoplanetary Disk

Abstract Analyzing multiband observations of dust continuum emission is one of the useful tools to constrain dust properties that help us to understand the physical properties of the protoplanetary disks. We perform a synthetic ALMA multiband analysis to find the best ALMA band set for constraining the dust properties of the TW Hya disk. We find that the Band [10, 6, 3] set is the best set among the possible combinations of ALMA Bands [3, 4, 5, 6, 7, 8, 9, 10]. We also find two conditions for the good ALMA band sets providing narrow constraint ranges on dust properties: (1) Band 9 or 10 is included in the band set, and (2) there are enough frequency intervals between the bands. These are related to the conditions that give good constraints on dust properties: the combination of optically thick and thin bands is required, and large β (β is the power-law index of dust opacity, κ ν ∝ ν β ) and low dust temperature are preferable. To examine our synthetic analysis results, we apply the multiband analysis to ALMA archival data of the TW Hya disk at Bands 4, 6, 7, and 9. The Band [9, 6, 4] set provides the dust properties close to the model profile, while the Band [7, 6, 4] set gives the dust properties deviating from the model at all radii with too broad a constraint range to specify the accurate values of dust temperature, optical depth, and β. Since these features are expected by the synthetic multiband analysis, we confirm that the synthetic multiband analysis is consistent with the results derived from real data.