Visceral Surface Research Articles

Ultrathin Bronchoscopy Without Virtual Navigation for Diagnosis of Peripheral Lung Lesions

BackgroundThe increasing incidence of encountering lung nodules necessitates an ongoing search for improved diagnostic procedures. Various bronchoscopic technologies have been introduced or are in development, but further studies are needed to define a method that fits best in clinical practice and health care systems.Research questionHow do basic bronchoscopic tools including a combination of thin (outer diameter 4.2 mm) and ultrathin bronchoscopes (outer diameter 3.0 mm), radial endobronchial ultrasound (rEBUS) and fluoroscopy perform in peripheral pulmonary lesion diagnosis?Study Design and MethodsThis is a retrospective review of the performance of peripheral bronchoscopy using thin and ultrathin bronchoscopy with rEBUS and 2D fluoroscopy without a navigational system for evaluating peripheral lung lesions in a single academic medical center from 11/2015 to 1/2021. We used a strict definition for diagnostic yield and assessed the impact of different variables on diagnostic yield, specifically after employment of the ultrathin bronchoscope. Logistic regression models were employed to assess the independent associations of the most impactful variables.ResultsA total of 322 patients were included in this study. The median of the long axis diameter was 2.2 cm and the median distance of the center of the lesion from the visceral pleural surface was 1.9 cm. Overall diagnostic yield was 81.3% after employment of the ultrathin bronchoscope, with more detection of concentric rEBUS views (93% vs. 78%, p < 0.001). Sensitivity for detecting malignancy also increased from 60.5% to 74.7% (p = 0.033) after incorporating the ultrathin scope into practice, while bronchus sign and peripheral location of the lesion were not found to affect diagnostic yield. Concentric rEBUS view, solid appearance, upper/middle lobe location and larger size of the nodules were found to be independent predictors of successful achievement of diagnosis at bronchoscopy.Interpretation: This study demonstrates a high diagnostic yield of biopsy of lung lesions achieved by utilization of thin and ultrathin bronchoscopes. Direct visualization of small peripheral airways with simultaneous rEBUS confirmation increased localization rate of small lesions in a conventional bronchoscopy setting without virtual navigational planning.

Gross Morphometry of Spleen in Postnatal Development Period of Indian Domestic Pig (Sus scrofa domesticus)

The present postnatal developmental study was conducted on 18 healthy pigs (Sus Scrofa domesticus) irrespective of sex. The size, shape, colour, weight, volume, length, width, and thickness were studied. Gross features revealed that the spleen in the pig was an elongated flat lymphoid organ located on the left side of the abdominal cavity along the greater curvature of the stomach in close relation to it and the colon. The colour of the spleen changed from reddish brown in the early stages to dark brown with the advancement of age. The pig's spleen presented two surfaces, two borders and two extremities, of which the parietal surface was convex and related to the left lateral wall of the abdomen. The visceral surface was divided by a longitudinal ridge into the anterior area related to the stomach and the posterior area to the colon. Hilus was located on the ridge. All gross parameters increased with the advancement of age in this study.

An Analysis of the Anomalous Fissure of the Ligamentum Teres Hepatis: A Morphological Perspective in the North Indian Population.

Background The liver, being the largest internal organ of the body shows a variety of gross morphological variations about lobes, fissures and processes which may be clinically significant. Among various anatomical variations, the most found is the variant fissure for ligamentum teres hepatis.The present study was done to classify, review, compare and discuss the literature for anomalies in fissures for ligamentum teres hepatis. Methods A total of 100 formalin-preserved human livers were obtained from the Department of Anatomy of King George's Medical University, Lucknow, and studied for one year. Result In our study, 15% of the liver showed morphological variations in fissures for ligamentum teres hepatis. These were classified into four types. In type I (2%), the fissure was converted into a tunnel by pons hepatis. In type II (3%), there was an incomplete fissure for ligamentum teres hepatis extending into the diaphragmatic surface.In type III (4%), there was an incomplete fissure for ligamentum teres hepatis present only on the visceral surface. In type IV (6%), the fissure was covered by a thin membrane. Conclusion In this study of the North Indian population, 15% ofliver have gross morphological variations. So thorough anatomical knowledge of the existence of variant or abnormal surface features on the liver isimperativeto understanding the underlying pathology for radiologists and surgeons so that a favorable outcome can be achieved.

A nonparasitic cyst of the spleen in children — is surgery a must? Two clinical cases

BACKGROUND: Non-parasitic splenic cysts is a rare pathology in children, accounting for 0.5–2% of all splenic diseases. Typically, most cysts, as a rule, are asymptomatic However, as the cyst is enlarging, clinical symptoms — such as pain, discomfort in the left abdomen, and nausea — may appear. These symptoms are indicators for surgical intervention. Splenic cysts larger than 5 cm have a higher risk of complications such as rupture, bleeding, and infection; therefore, surgical treatment is recommended in these cases. Some authors consider the surgical intervention to be appropriate for cysts sized greater than 4 cm. However, small size of splenic neoplasms can complicate their visualization and surgery, thus increasing the risk of intraoperative complications and recurrences. Currently, in cases of borderline sizes of asymptomatic non-parasitic splenic cysts, it is recommended to assess the dynamics of size changes, so as to find the optimal curative tactics for the patient. CLINICAL CASE DESCRIPTION: Two clinical examples of non-parasitic splenic cysts in children are discussed in the article. In the first case, a splenic formation with diameter 40 mm was found in a 5-y.o. girl; the diagnosis was confirmed at ultrasound and computed tomography examinations. At the recommended dynamic follow -up , it was found out that the cyst decreased to 5 mm in diameter. In the second case, a 14-y.o. boy was hospitalized for an elective surgery, because a splenic formation was diagnosed at the regular dispensary check-up. Ultrasound and computed tomography examinations of the abdominal cavity revealed a cyst of 45 mm on the visceral surface of the upper segment of the spleen. Laparoscopy failed to visualize the splenic cyst. The follow-up monitoring with a repeated ultrasound examination of the abdominal cavity in 3-6 months was recommended. Imaging diagnostic techniques have confirmed that cyst location and size remained unchanged. CONCLUSION: The two described clinical cases demonstrate the importance of dynamic follow-up monitoring in case of borderline-sized non-parasitic splenic cysts in children, as it helps to avoid unnecessary surgical interventions.

Anatomical, Radiological, and Corrosion Casting of the Liver, Gallbladder, and Biliary Duct System of Local Breed Cattle (Bos ttaurus)

Local breed cattle's liver, reddish-brown, occupies the right hypochondriac region with 35.2 ± 3.24 cm long and 5.5 ± 0.5 kg weight. Connected by left and right triangular ligaments; and falciform ligaments with the diaphragm, and hepatorenal ligament with the right kidney. While the coronary ligament encompassing the caudal vena cava divides into dorsal and ventral branches, enclosing the nuda region. The round ligament connects the umbilical fissure to the umbilicus. The lesser omentum on the liver's visceral surface connects the stomach and duodenum through hepatogastric and hepatoduodenal ligaments, respectively. The liver has, parietal and visceral surfaces; right, left, ventral, and dorsal borders; and left, right, caudate, and quadrate liver lobes that are not clearly separated, except for the caudate. The gallbladder has a dark green color and pear-shaped morphology, measures 16 ± 1.5 cm, and is located in a shallow cystic fossa. Consisting of the neck, forms an inverted funnel shape, body, and fundus. The diameters were 2 ± 0.3, 6 ± 1.2, and 4 ± 1.3 cm, respectively. The biliary tract consists of extrahepatic and intrahepatic ducts. The extrahepatic ducts have a left duct of 3 ± 0.5 cm and a right duct of 2 ± 0.25 cm. Converging to form a common hepatic duct 8 ± 0.5 cm. The cystic duct is 3± 0. cm, joins with the common hepatic duct ventrally. The intrahepatic ducts consisted of primary, secondary, tertiary, interlobular, intralobular, and intercalated ducts. The left hepatic duct received 9 ± 1 of dorsal primary ducts and 8 ± 2 ventral primary ducts. The right hepatic duct receives 4 ± 1 dorsal ducts and 2 ± 1 ventral ducts.

A pilot study on the pulmonary anthracosis in stray dogs of Kathmandu Valley, Nepal: A potential public health threat for future.

Kathmandu is a densely populated metropolitan city in Nepal. In recent years, however, the metropolis has been ranked as one of the most polluted cities worldwide. Both humans and animals are susceptible to various respiratory diseases due to chronic exposure to polluted air. Due to the relative similarities in the anatomical structure and physiological functions of the respiratory system between humans and dogs, polluted environments may lead to respiratory illness in similar ways in both species living in the valley. On the basis of information on the air quality in the valley, this study was conceived to assess pulmonary illness in street dogs to discern the health hazards caused by polluted air. A total of 76 dogs with clinical signs of tachypnea, dyspnea, sneezing, coughing, mucopurulent discharge, moderate hyperthermia, and anorexia admitted from July 2020 to November 2020 in Animal Nepal for treatment were included in this study. Among them, 24 animals responded to treatment, and 52 dogs died during their stay in the hospital. The 52 dead animals were necropsied, and the lesions that resembled pulmonary anthracosis were further studied grossly and histologically in a blinded fashion by trained veterinary pathologists. Significant morphological alterations were observed in the lungs and associated lymph nodes of 25 animals, indicating pulmonary anthracosis. Gross morphological changes included multiple black foci with hemorrhage, congestion, nodular, and emphysema on the parietal and visceral surfaces of the lungs. The alveolar septa and visceral pleura exhibited deposition of black particles. Congestion, emphysema, and inflammatory exudates were also detected in the lung tissues and lymph nodes. The clinical, gross, and microscopic findings accurately resembled those of pulmonary anthracosis. This life-threatening condition in stray canines may be caused by a critical level of air pollution from different sources and carbon emissions from vehicles. To protect animals and humans living in the Kathmandu Valley, concerned government and non-government agencies should work toward reducing air pollution levels as soon as possible.

Challenges in diagnosing pediatric pericarditis and the etiology in remote areas during the COVID-19 pandemic: a socio-clinical dilemma

Inflammation of the visceral and parietal surfaces of the pericardium is defined as pericarditis. It can evolve to excessive production of pericardial effusion if the speed of fluid accumulation is faster than the absorption. Acute pericarditis is rare in children but it can lead to circulatory collapse and death. It accounts for &lt;0.2% of the emergency visits of children without prior heart diseases in tertiary pediatric emergency settings. The etiology of acute pericarditis varies depending on geography, and the most common etiology in children are bacterial infection, viral pericarditis, inflammatory or connective tissue diseases, malignancies, metabolic diseases, and post-cardiac surgery. Idiopathic pericarditis is presumed to have viral or post-viral etiology. It accounts for 37-68% of admissions in children with pericardial effusions or acute pericarditis.

An interlobar ligament connecting the right and left lobes of the liver &amp;ndash; A cadaveric case report

Several ligaments and peritoneal folds attach the liver to other organs and to the abdominal wall. These are the falciform ligament, ligamentum teres hepatis or round ligament, right triangular ligament, left triangular ligament, lessor omentum, and ligamentum venosum. We report a unique ligament connecting the right and left lobes of the liver, on its visceral surface near its inferior border. This ligament is seen forming a tunnel through which the ligamentum teres is seen to travel.The knowledge can be used by the radiologists and clinicians in image interpretation and subsequent clinical diagnosis and by anatomists and embryologists for academic interests. Further, this ligament and the tunnel formed by it maybe a potential site for strangulation of abdominal content.

Comparative Anatomical and Histological study of gall bladder in Mallard (Anas platyrhynchos) and Broiler fowl (Gallus gallus )

The current study was investigated anatomical and histological description of gall bladder of two specious which different in nutrition and life habitat Mallard (Anas platyrhnchos) aquatic life bird, and broiler fowl (Gallus gallus) wild life bird ,used ten bird of each specious ,anatomical result founded the gall bladder is located at the visceral surface right lobe of liver at right side of abdominal cavity, and composed of three parts head, neck and body, gall bladder in both specious appeared with dark green color. Gall bladder of mallard has balloon shape more elongated organ while in Gallus gallus is pear shape, the mean weight of gall bladder in mallard (1.91±0.56 g) , length (3.07±0.505 cm) and width (3.07±0.5 cm ) while broiler fowl weight of gall bladder (8.24±2.88 g), length (3.31±0.8 cm)and width (3.56±1.32 cm ) .Histologically; Gall bladder in mallard has three main layers: tunica mucosa, tunica muscularis and tunica adventitia ,tunica mucosa which lined by simple columnar epithelium non-ciliated with goblet cells and the lamina propria-submucosa composed of loos connective tissue , tunica muscularis was a thick layer of muscles (smooth muscles) and adventitia made of loos connective tissue , while gall bladder of Gallus gallus domesticus has three layer; tunica mucosa, lamina propria -submucosa, tunica muscularis and adventitia , tunica mucosa which lined by simple columnar epithelia non- ciliated without goblet cells , with present lamina propria -submucosa fused with lamina propria ,and thin layer of tunica muscularis and adventitia made of loos connective tissue .

A Macroscopic and Microscopic Study of Liver in Female Iraqi Green Freshwater Turtle (Chelonia mydas) Linnaeus,1758 during the Active Period

The study aims to provide anatomical and histological information about the liver in female Iraqi green freshwater turtles. Ten female green freshwater turtles (Chelonia mydas) were collected from Shatt Al-Hilla and used in this study. They were anesthetized by chloroform in closed chambers. The anatomical information was recorded and the histological sections of the liver were stained by using hematoxylin and Eosin stains. The result showed that the liver of a female green freshwater turtle (Chelonia mydas) is a large elongated organ. The mean weight of turtles is 735±0.04 gm, and the mean weight of the liver is 28±0.02 gm. The ratio between the weight of the liver to the weight of the body was 3.809 %. The liver of (Chelonia mydas) is formed from three lobes right, left and middle (central) lobes. The right lobe is the large one with an average weight of 13 ±0.022 gm. It looks like a square and has two surfaces ventral and dorsal (visceral) surface. The left lobe is smaller than the right with an average weight of 9±0.05gm, and its shape is rectangular. The middle lobe is rounded and small. Its mean weight is 7±0.01gm. Histologically, the liver is covered by mesothelium under its connective tissue layer as a hepatic capsule which divided the liver into lobules in the shape of hexagons with portal spaces, from the central to the walls of the hepatocyte.

Adaptation peculiarities of the liver structure in some representatives of the order Lagoriform

The work is devoted to the study of the adaptive features of the histological structure of the liver of some representatives of the hare order. The material for the study was organocomplexes from clinically healthy productive rabbits, decorative rabbits and white hare. Research work was carried out at the Department of Anatomy and Physiology of the Federal State Budgetary Educational Institution of Higher Education of the State Agrarian University of the Northern Trans-Urals. Conducted morphometric studies and selected material for morphological and histological studies. The liver of the studied species of the order Lagomorphs has a convex parietal and slightly concave visceral surface. The right and left lobes of the liver are divided into lateral and medial parts. In a productive rabbit and a decorative rabbit, the lateral right lobe is shorter than the lateral left lobe, and in the white hare, both of these are short. The square share of all is an elongated quadrangular shape. Caudate and mastoid processes are small. The gallbladder lies between the right lateral and right medial lobes and does not extend beyond the ventral edge of the liver. Histological studies were carried out according to generally accepted methods. In all species of the order of lagomorphs, formed triads were observed located on the border between the lobules. Hepatocytes form hepatic laminae. Trabeculae and loose fibrous connective tissue are not expressed. Analyzing the obtained histological data, we can say that the adaptive features will include: in rabbits bred under industrial conditions - an increased area of hepatocytes (376.29±22.95 µm2) and nuclei (52.44±4.51 µm2), a decrease in NCR 0.16±0.007; in ornamental rabbits - a decrease in the area of hepatocytes (38.32±1.77 µm2) and nuclei (7.06±0.59 µm2), but the average value of the Nuclear-Cytoplasmic Ratio is 0.42±0.01; in the hare - the average values of the area of hepatocytes (260.79±15.88 µm2) and nuclei (41.58±1.32 µm2), NCR 0.4±0.01. These features indicate significant differences in the nutrition and maintenance of these animals, as well as various adaptation processes.

Morphological and Molecular Characterization of Anisakid Nematode Larvae (Nematoda: Anisakidae) in the Black Cusk eel Genypterus maculatus from the Southeastern Pacific Ocean off Peru

The back cusk eel, Genypterus maculatus (Tschudi, 1846), (Ophiidiformes: Ophiididae) is one of the benthic-demersal fish usually consumed in northern Peru. Here, we identified the third stage (L3) Anisakidae sampled from 29 specimens of G. maculatus captured off the south American Pacific coast, Lambayeque Region, Peru. A total of 20 anisakid nematode larvae were collected on the visceral surface and divided morphologically into three types (Type I–III). These larvae were identified by mtDNA Cox2 sequences analysis, which indicated that corresponded to Anisakis pegreffii Campana-Rouget and Biocca, 1955, Skrjabinisakis physeteris (Baylis, 1923) and S. brevispiculata (Dollfus, 1966) Safonova, Voronova, and Vainutis, 2021, respectively. This is the first record of S. brevispiculata in Peru. The results obtained in this study provide knowledge on the diversity and distribution of Anisakis Dujardin, 1845 and Skrjabinisakis Mozgovoi, 1951, species in the south American Pacific waters and their relevance for public health. In addition, we suggest that combined use of molecular and morphological approaches is needed to characterize L3 anisakid larvae.

Mechanical Parameters Influencing Recurrence in Ventral Midline Incisional Hernia Open Repair

Abstract Background Ventral midline incisional hernia (VMIH) is common and recurrence rates remain of concern after gold-standard open repairs. Personalized optimization and risk stratification are traditionally performed through preoperative considerations regarding patients’ general and medical status and occulting mechanical factors. Aims The aim of this retrospective observational cohort study is to identify mechanical parameters potentially influencing VMIH recurrence (VMIHR) after repair. Methods Data were derived from an institutional quality database. Patients who underwent VMIH open repair with retromuscular or preperitoneal non-absorbable mesh reinforcement, confirmed by an available preoperative CT scan for biomechanical measurements, between June 2012 – June 2020 in a single centre, were included. Exclusion criteria were non-open repairs, non-midline hernias, absence of preoperative scan, absence of mesh reinforcement, intraperitoneal/bridging mesh positions, biologic/biosynthetic mesh and use of component separation techniques. The main outcome was VMIHR, a symptomatic clinically confirmed recurrence re-operated in the same institution within 36 months maximum following primary open repair. Patients with/without recurrence were compared using standard analytic tools. Results Fourty-eight patients met the inclusion criteria of which 11 (23%) developed VMIHR. The following parameters were statistically significantly associated with VMIHR: smaller visceral fat surface (mean of 244.9 cm2 in the recurrence group vs 286.3 cm2 in non-recurrence group, p = 0.0295), smaller mesh length (17.2 cm vs 23 cm, p = 0.001), smaller total mesh surface (315.2 cm2 vs 550.1 cm2, p = 0.0095), coated meshes (p = 0.033), absorbable suture for mesh anchoring (p = 0.043) and a greater largest defect width/mesh width ratio (0.42 vs 0.29, p = 0.0146). Conclusions When focusing on mechanical parameters, non-modifiable and patient-related parameters seem to play a limited role. However, using uncoated meshes of larger dimensions (greater than/equal to 3.5x defect size) than suggested previously (defect size + 5cm) resulted in fewer recurrences. This may help to orientate further larger prospective trials.

(087) Why Should Pelvic Floor Physical Therapy be Included in Treatment of Vestibulodynia?

Abstract Introduction Vestibulodynia, vulvar pain localized to the vestibule without an identifiable cause, has a multifactorial etiology including neurologic, hormonal, inflammatory, psychologic, and musculoskeletal factors. Key pathophysiologic drivers likely vary from patient to patient. Published studies demonstrate that compared to controls, patients with provoked vestibulodynia are more likely to have pelvic floor hypertonicity and decreased pelvic floor strength, as measured by dynamometric speculum and ultrasound. Further, observational studies describe improvement of vestibulodynia symptoms with pelvic floor physical therapy, suggesting a causal relationship between pelvic floor hypertonicity and vestibulodynia. Objective To describe the pathophysiologic mechanism by which pelvic floor dysfunction and myofascial trigger point development could cause vestibuoldynia, with a focus on pelvic floor anatomy. Methods Literature about vestibulodynia, pelvic floor dysfunction, and pelvic floor anatomy was reviewed and synthesized in conjunction with expert clinical experience of pelvic floor physical therapists and gynecologists. Results The pelvic floor consists of the levator ani muscles (iliococcygeus, pubococcygeus, and puborectalis) and ischiococcygeus, which form a basket to support the pelvic organs. The puborectalis inserts in the posterior vestibule, and hypertonicity can cause allodynia in this region. The levator ani are innervated by the levator ani nerve, which originates from S3-S5 and traverses the visceral surface of the muscles. Some cadaveric studies suggest dual innervation of the levator ani by the pudendal nerve, which originates from S2-S4 and courses over the inferior surface of the muscles. Pelvic floor hypertonicity, increased resting tone of the pelvic floor muscles, can result from many factors including stress, bladder and rectum voiding habits, and painful pelvic processes (i.e. interstitial cystitis, endometriosis). Increased muscle tone can promote sensitization of muscle afferent fibers and neuropathic upregulation. This may be perceived as vestibulodynia because the vestibule contains visceral and somatic sensory nerve fibers, whose signals are integrated at the same spinal levels as those from the levator ani. This anatomy allows for somatovisceral convergence of afferent signals, and thus perception of vestibular pain. Hypertonicity of the pelvic floor muscles decreases circulation creating localized hypoxia that can promote development of myofascial trigger points (tender nodules) in the pelvic floor. These trigger points can cause allodynia, perceived in the vestibule. In some cases, vestibulodynia may develop first and promote pelvic floor hypertonicity. Conclusions As pelvic floor hypertonicity can contribute to the pathogenesis of vestibulodynia, it is imperative for clinicians to include pelvic floor tone evaluation in their assessment of vestibulodynia. If pelvic floor hypertonicity is present, it should be treated concurrently with vestibular pain through a combination of pelvic floor physical therapy, trigger point injections, and botulinum toxin injections as pelvic floor hypertonicity and vestibulodynia may each perpetuate the other. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson &amp; Johnson.

Antioxidant Defense Expressed as Glutathione Status and Keap1-Nrf2 System Action in Relation to Anthropometric Parameters and Body Composition in Young Women with Polycystic Ovary Syndrome.

Metabolic disorders present in women with polycystic ovary syndrome (PCOS) and the associated risk of obesity may result in increased oxidative stress and reproductive failure. Therefore, we evaluated the concentrations of reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione peroxidase (GPx), and reductase (GR), as well as nuclear factor erythroid 2-related factor 2 (Nrf2) and Kelch-like ECH-associating protein1 (Keap1) in the serum of 56 women with PCOS divided according to the visceral to subcutaneous fat surface ratio (VAT/SAT) and waist-to-hip ratio (WHR) values. Antioxidant parameter levels were measured by competitive inhibition enzyme immunoassay technique. As the VAT/SAT ratio and WHR increased, we observed significantly higher concentrations of GSSG and Keap1 protein and a lower value of the GSSG/GSH ratio (R-index), which is considered an index of cellular redox (p < 0.05). Negative correlations were found between the R-index and body weight, BMI, WHR, subcutaneous and visceral fat surface and the VAT/SAT ratio, and total body fat; positive links were found with fat free mass and total body water. Opposite associations were noted between GSSG level and the aforementioned body composition parameters. Oxidative stress characterized by a depleted reduced-to-oxidized glutathione index is associated with anthropometric and body composition parameters in women with PCOS. In particular, abdominal obesity expressed by the VAT/SAT ratio and/or WHR seems to have a negative impact on glutathione status, which may lead to a disruption of many biological cell processes. The observed negative association of Keap1 with R-index suggests that the elevated oxidative changes dependent on the VAT/SAT ratio may lead to Nrf2 activation to promote antioxidant enzyme expression. Although the GSH/GSSG index as well as the VAT/SAT ratio appear to be good indicators of oxidative status, studies on a larger group of patients should continue to confirm these links among women with PCOS.

A cross-sectional analysis of the association between testosterone and biopsy-proven non-alcoholic fatty liver disease in men with obesity.

To study the association between testosterone and non-alcoholic fatty liver disease (NAFLD) since prior studies have reported inconsistent results. A retrospective analysis was performed including obese men who underwent a liver biopsy and a metabolic and hepatological work-up. Free testosterone (CFT) was calculated by the Vermeulen equation. The association between total testosterone (total T) and CFT on the one hand and NAFLD and fibrosis on the other hand was investigated and corrected for biasing factors such as metabolic parameters. In total, 134 men (mean age 45 ± 12 years, median BMI 39.6 (25.0-64.9) kg/m²) were included. The level of total T and CFT did not significantly differ between NAFL and NASH and the stages of steatosis and ballooning. CFT was significantly lower in a higher stage of fibrosis (p = 0.013), not seen for total T and not persisting after controlling for the influence of BMI, HDL cholesterol and HOMA-IR. A higher stage of lobular inflammation was associated with a lower level of total T (p = 0.033), not seen for CFT and not persisting after controlling for the influence of visceral adipose tissue surface and HOMA-IR. This is the second largest study investigating the association between testosterone and biopsy-proven NAFLD. No significant association between testosterone levels and NAFLD, and the different histological subgroups or fibrosis was seen. The lower level of CFT in a higher stage of fibrosis and the association between total T and lobular inflammation was driven by poor metabolic parameters.

The TPA score (total psoas muscle area) is the best marker for preoperative measurement of pre-sarcopenia in pancreatic surgery.

Pre-sarcopenia, defined by the loss of muscle mass, is significantly associated with an increased risk of postoperative complications in digestive surgery, particularly pancreatic resection. The five predominant markers of sarcopenia are: psoas muscle area (TPA), intramuscular adipose tissue content (IMAC), Average Hounsfield Unit Calculation (HUAC), Skeletal Muscle Mass Index (MMI), and the ratio between visceral adipose tissue area and muscle surface area (VFA/TAMA). No standard reference marker has been determined. This retrospective cohort included patients who underwent pancreatic resection at the University Hospital of Angers between January 2008 and June 2017. The goal was to determine the marker that was most significantly associated with morbidity and mortality in pancreatic surgery. The secondary objective was to determine the characteristics of pre-sarcopenic patients. The TPA score is the most sensitive marker for identifying patients at highest risk for immediate complications (P=0.008), proving far more sensitive than MMI (P=0.02), HUAC (P=0.34), IMAC (P=1), or VFA/TAMA (P=0.42). Postoperative mortality was 3.3% (n=5), morbidity was 63.8% (n=97). Pre-sarcopenic patients, as identified by the TPA index had significantly more immediate complications (71.2% versus 49.5%, P=0.008), in particular, more gastroparesis (P=0.02) and pancreatic fistula (P=0.03). In patients requiring pancreatic surgery, the prevalence of pre-sarcopenia is high and seems to be associated with a greater risk of immediate postoperative complications. The TPA score seems to be the most sensitive marker for detecting pre-sarcopenia. Evaluation of TPA preoperatively would make it possible to identify priority patients a priori who might benefit from pre-habilitation programs.

Mesotelioma epitelial maligno em vacas senis Sindi do Brasil

ABSTRACT: Mesotheliomas in cattle are often described as isolated case reports, and investigations of multiple cases within the same bovine herd are lacking. A series of cases of malignant epithelial mesothelioma, tubulopapilary type, is described in five 15 to 21-year-old Red Sindhi cows from the same herd. Clinical signs included three to eight months of progressive emaciation, dehydration, subcutaneous edema of the lower extremities, and abdominal distension. Grossly, severe subcutaneous edema and hydroperitoneum were noted. Multiple organs’ parietal and visceral serosal surfaces had multifocal to coalescing yellow, firm, sessile nodules ranging from 0.1 to 29.0cm. Similar free nodules floated in the peritoneal fluid. Histologically, the masses comprised a layer of cubic to columnar neoplastic cells forming papillary or cystic proliferation supported by a dense fibrovascular stroma. Neoplastic cells had strong and diffuse cytoplasmic immunolabeling for pan-cytokeratin but were negative for cytokeratin 7 and vimentin. Ultrastructurally, neoplastic cells had delicate microvilli and tight and anchoring junctions. Within the cytoplasm, a moderate amount of loose aggregate of intermediary filament with small mitochondria was observed. Epidemiological investigation evidenced endogamy in this herd. Asbestos exposure was not detected. The diagnosis was based on clinical, gross, histological, and immunohistochemical findings and confirmed by transmission electron microscopy features. A definitive underlying etiology remains unknown.

Deep learning for diagnosis of malign pleural effusion on computed tomography images

BackgroundThe pleura is a serous membrane that surrounds the lungs. The visceral surface secretes fluid into the serous cavity and the parietal surface ensures a regular absorption of this fluid. If this balance is disturbed, fluid accumulation occurs in the pleural space called “Pleural Effusion”. Today, accurate diagnosis of pleural diseases is becoming more critical, as advances in treatment protocols have contributed positively to prognosis. Our aim is to perform computer-aided numerical analysis of Computed Tomography (CT) images from patients showing pleural effusion images on CT and to examine the prediction of malignant/benign distinction using deep learning by comparing with the cytology results. MethodsThe authors classified 408 CT images from 64 patients whose etiology of pleural effusion was investigated using the deep learning method. 378 of the images were used for the training of the system; 15 malignant and 15 benign CT images, which were not included in the training group, were used as the test. ResultsAmong the 30 test images evaluated in the system; 14 of 15 malignant patients and 13 of 15 benign patients were estimated with correct diagnosis (PPD: 93.3%, NPD: 86.67%, Sensitivity: 87.5%, Specificity: 92.86%). ConclusionAdvances in computer-aided diagnostic analysis of CT images and obtaining a pre-diagnosis of pleural fluid may reduce the need for interventional procedures by guiding physicians about which patients may have malignancies. Thus, it is cost and time-saving in patient management, allowing earlier diagnosis and treatment.

Tumour location predicts occult N1 nodal metastasis in clinical stage I non-small-cell lung cancer.

Pathological lymph node metastases are often observed in patients with clinical N0 lung cancer. Identifying preoperative predictors of occult hilar nodal metastasis (OHNM) is important in determining the surgical procedure in patients with clinical stage I non-small-cell lung cancer. This study aimed to determine the frequency and predictors of OHNM by tumour location in these patients. Between April 2007 and May 2019, data of patients who underwent lobectomy or segmentectomy for clinical stage I pure-solid non-small-cell lung cancer were retrospectively reviewed. The ratio of the distance from the pulmonary hilum to the proximal side of the tumour to the distance from the pulmonary hilum to the visceral pleural surface through the centre of the tumour, named 'distance ratio (DR)', was calculated. The relationship of the DR with clinicopathological findings and prognosis was discussed. A total of 357 patients were enrolled. OHNM frequency was 14.6%. Patients were divided into 2 groups based on whether the DR was ≤0.67 (central type) or >0.67 (peripheral type). The frequency of OHNM was significantly higher in the DR ≤0.67 group (21.5% vs 7.4%; P < 0.001). Multivariable analysis revealed that DR was the only independent preoperative predictor of OHNM (odds ratio, 3.63; 95% confidence interval, 1.83-7.18; P < 0.001). The frequency of OHNM was significantly lower in peripheral-type lung cancer; therefore, tumour location was the most important preoperative predictor of OHNM.