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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, September 14, 2021

Protective action of ultrasound-guided intraparenchymal transplantation of BMSCs in adriamycin nephropathy rats through the RIPK3/MLKL and NLRP3 pathways

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Via histochem

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Acta Histochem. 2021 Sep 10;123(7):151773. doi: 10.1016/j.acthis.2021.151773. Online ahead of print.

ABSTRACT

BACKGROUND: Bone marrow stromal cells (BMSCs) are an effective new strategy for the treatment of kidney diseases. At present, noninvasive and efficient transplantation approaches to homing BMSCs to the renal parenchyma is still a serious challenge. The aim of this study was to investigate the feasibility and potential mechanism of ultrasound-guided intraparenchymal t ransplantation of BMSCs for the treatment of adriamycin nephropathy (AN) in rats.

MATERIALS AND METHODS: A rat AN model was induced by 2 injections of doxorubicin. The rats were randomly divided into 4 groups (n = 10 animals in each group) : normal group (N group, no treatment), control medium group (CM group, transplant medium 1.0 mL), adriamycin nephropathy group (ADR group, phosphate buffered saline 1.0 mL), or BMSCs group (BMSCs fluid 1.0 mL). Intraparenchymal injection was completed under ultrasound guidance. After 4 weeks of treatment, blood samples were collected for serum biochemical measurements and ELISAs. The kidneys were removed for histopathological examination, electron microscopy, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), and western blot analysis.

RESULTS: No deaths occurred in any group after BMSCs transplantation through the renal parenchyma under ultrasound guidance. Compared with the N and CM groups, in the ADR group, bloo d serum creatinine (SCr), blood urea nitrogen (BUN) and urine albumin (ALb) were higher, glomerular and tubular dilatation was observed, the number of apoptotic cells was higher, and the protein levels of receptor-interacting protein kinase 3 (RIPK3)/mixed lineage kinase domain-like protein (MLKL) and nucleotide leukin-rich polypeptide 3 (NLRP3), key components of pathways in rat kidney, were significantly higher. Compared with those in the ADR group, the levels of SCr, BUN, ALb and serum proinflammatory cytokines in the BMSCs group were lower, the pathological structure of the kidney was improved, the number of apoptotic cells was lower, and the levels of RIPK3/MLKL and NLRP3 were significantly lower.

CONCLUSION: Ultrasound-guided intraparenchymal transplantation of BMSCs regulated the RIPK3/MLKL and NLRP3 pathways in a minimally invasive and safe manner, thereby inhibiting renal necrosis and inflammation and playing a protective role in rat AN.

PMID:34517258 | DOI:10.1016/j.acthis.2021.151773

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Cancerous and non-neoplastic stem cells in the stomach similarly express CD44 and CD133

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Via histochem

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Acta Histochem. 2021 Sep 10;123(7):151787. doi: 10.1016/j.acthis.2021.151787. Online ahead of print.

ABSTRACT

CD44 and CD133 have been considered as cancer stem cell (CSC) markers. Stem cell markers are rarely described in healthy stomach tissues. However, the clinicopathological and prognostic value of CD44 and CD133 in gastric cancer remains controversial. This study investigated the expression of CD44 and CD133 in gastric cancer and non-neoplastic gastric mucosa. We used samples of primary gastric adenocarcinomas (n = 69), metastatic lymph nodes (n = 30), intestinal metaplasia (n = 17), and histologically normal gastric tissues of surgical margins (n = 54). The expression of CD44 and CD133 were studied in samples by immunohistochemistry. Fisher's exact test and a logistic regression model were used in this study. CD44 expression was observed in 12% of samples with intestinal metaplasia, 20% with lymph node metastases, 22% with normal mucosa, to 30% of samples with primary tumors. Most of these positive tumors showed immunostaining in less than 4% of cancerous cells, mainly in the diffuse type. CD133 expression was observed in 7% (intestinal metaplasia) to 46% (normal mucosa). In the positive cases of cancer (24%), in most of them, less than 3% of cells were marked. CD44 and CD133 expression in the histologically normal gastric mucosa was restricted to the deeper regions of the gastric crypts at the level where stem cells and progenitor cells are usu ally found. CD44 and CD133 expression occurs in few gastric cancer cells, mainly in diffuse carcinomas, and are expressed in histologically normal gastric mucosae. None of the markers are specific for cancer and are also present in intestinal metaplasia and the normal mucosa.

PMID:34517259 | DOI:10.1016/j.acthis.2021.151787

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Differential diagnoses of solitary and multiple pigmented lesions of the oral mucosa: Evaluation of 905 specimens submitted to histopathological examination

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Abstract

Background

The aim was to analyze the frequency, clinical and demographic features of solitary and multiple/diffuse oral pigmented lesions submitted to histopathological examination, and to summarize the features that guide the clinical differential diagnosis.

Methods

Clinical and demographic data were retrieved from biopsy records and descriptive statistics were performed.

Results

Nine hundred and five (0.51%) oral pigmented lesions were retrieved among 177 356 specimens, being 95.9% solitary and 4.1% multiple/diffuse lesions. Regardless the overlapping clinical presentation, age, site, association with amalgam restoration, and a nodular appearance may help in the clinical differential diagnosis of solitary oral pigmentations. Patient's habits, site, and systemic signs and symptoms are helpful in the clinical differential diagnosis of multiple/diffuse lesions.

Conclusions

Oral pigmented lesions are a rare diagnosis in oral pathology and solitary lesions are more commonly submitted to biopsy. Some key features help in the differential diagnosis, though biopsy can be warranted in doubtful cases.

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Intracavernous internal carotid artery-originating ophthalmic artery entering the orbit via the optic canal

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Surg Radiol Anat. 2021 Sep 13. doi: 10.1007/s00276-021-02835-1. Online ahead of print.

NO ABSTRACT

PMID:34515832 | DOI:10.1007/s00276-021-02835-1

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The influence of age on the anatomical variability of sciatic nerve divisions in the thigh: an ultrasound study

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Surg Radiol Anat. 2021 Sep 13. doi: 10.1007/s00276-021-02824-4. Online ahead of print.

ABSTRACT

PURPOSE: The Sciatic Nerve Division (SND) into the Common Peroneal Nerve and Tibial Nerve presents a great anatomical variability in its location in the thigh, but the influence of age on it has not been fully addressed.

METHODS: Anatomical distances from greater trochanter to SND and from SND to popliteal crease were obtained by ultrasound examination in 60 children (age 1- 12 years) and 60 adult patients (age 13-80 years) who were scheduled for programmed surgery. A sciatic nerve/thigh coefficient [Greater Trochanter-SND/(Greater Trochanter-popliteal crease)*100] and its coefficient of variation (standard deviation/mean*100) were calculated. Greater Trochanter-SND and SND-Popliteal crease were also correlated with patients´ age, weight and height.

RESULTS: There were statistically significant differences between children and adult in Greater Trochanter-SND (20.5 ± 5,5 vs 33.9 ± 2.7; p < 0.0001) and in SND-Popliteal (4.9 ± 2.1 vs 6.7 ± 1.6; p < 0.0001) distances measured in cm. There were also statistically significant differences between children and adults in Sciatic nerve/thigh coefficient (80% vs 83%; p < 0.0001) and its index of variation (8.1% vs 4.8%; p < 0.0001). In children, both Greater Trochanter-SND and SND-Popliteal distances were strongly correlated with age (r2 = 0.868 and r2 = 0.261, respectively; p < 0.0001), weight (r2 = 0.778 and r2 = 0.278, respectively; p < 0.0001) and height (r2 = 0.898 and r2 = 0.225, respectively; p < 0.0001). However, in older patients, only Greater Trochanter-SND distance was statistically correlated with height (r2 = 0.372; p = 0.0001) and not with age or weight; SND-Popliteal distance did not show statistically relevant correlation, either.

CONCLUSION: Children presented even more anatomical variability than adults in sciatic nerve division due to the growth of both the proximal and distal nervous structures of the thigh before 12 years of age.

PMID:34515831 | DOI:10.1007/s00276-021 -02824-4

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Post-dural puncture pseudomeningocele ('arachnoid bleb'): An underrecognized etiology of spontaneous intracranial hypotension symptomatology

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Clin Imaging. 2021 Sep 7;80:377-381. doi: 10.1016/j.clinimag.2021.08.023. Online ahead of print.

ABSTRACT

Spontaneous intracranial hypotension (SIH) is an important secondary cause of a persistent headache syndrome, classically presenting as sudden onset debilitating positional headaches related to reduced intracranial cerebrospinal fluid (CSF) volume. Current understanding of SIH pathogenesis recognizes three underlying etiologies: dural tear, meningeal diverticulum, and CSF-venous fistula, with a fourth broad category of indeterminate/unknown etiologies. Post-dural puncture headache (PDPH) is a well-known and common complication of dural puncture, typically remitting spontaneously within two weeks of onset or with autologous epidural blood patch, though with some patients developing complex and difficult to manage chronic PDPH. Herein, we present a case of chronic PDPH resulting in SIH symptomatology secondary to a post-dural puncture pseud omeningocele, or "arachnoid bleb," successfully treated with curative surgical intervention. Increasing awareness of additional potential etiologies of SIH symptomatology will allow for improved detection for targeted definitive therapy, ultimately improving patient outcomes including quality of life in this debilitating and difficult to manage secondary headache syndrome.

PMID:34517304 | DOI:10.1016/j.clinimag.2021.08.023

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Applications of Endoscopic Endonasal Surgery in Early Childhood: A Case Series

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Pediatr Neurosurg. 2021 Sep 10:1-10. doi: 10.1159/000518681. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic endonasal surgery (EES) has been slower to gain popularity in early childhood due to anatomical challenges. We sought to describe the safety and efficacy of EES in early childhood.

METHODS: All patients younger than 7 years who underwent EES at a large Cranial Base Center from 2002 to 2019 were reviewed as a retrospective cohort study.

RESULTS: Thirty-six patients underwent EES before the age of 7 years. Four patients had two-stage EES. Two patients required combined transcranial and endonasal approaches. The mean age at the time of initial surgery was 4 years (range: 1-6). Twenty patients were male, and 16 were female. Of 21 tumors intended for resection, 11 patients had gross total resections, and 10 had near total (>95% tumor removed) resections. Nine patients (43%) had recurrences, of which 6 were craniophar yngiomas (p = 0.01). There was no difference in recurrence rates based on the degree of resection (p = 0.67). Three cerebrospinal fluid (CSF) leaks occurred following primary EES (8%). Following an increase in nasoseptal flap usage (31-52%) and CSF diversion (15-39%) in 2008, there was only one CSF leak out of 23 patients (4 vs. 15%; p = 0.54). Postoperatively, 1 patient developed a permanent new cranial neuropathy, and 1 patient developed a permanent visual field cut. Six patients developed permanent postoperative panhypopituitarism, of which all were craniopharyngiomas (p < 0.001). The mean follow-up was 64 months.

CONCLUSIONS: Early childhood EES is both safe and technically feasible for a variety of pathologies.

PMID:34518465 | DOI:10.1159/000518681

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Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

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Fetal Diagn Ther. 2021 Sep 8:1-8. doi: 10.1159/000518507. Online ahead of print.

ABSTRACT

INTRODUCTION: Prenatal closure of open spina bifida via open fetal surgery improves neurologic outcomes for infants in selected pregnancies. Fetoscopic techniques that are minimally invasive to the uterus aim to provide equivalent fetal benefits while minimizing maternal morbidities, but the optimal technique is undetermined. We describe the development, evolution, and feasibility of the laparotomy-assisted 2-port fetoscopic technique for prenatal closure of fetal spina bifida in a newly established program.

METHODS: We conducted a retrospective cohort study of women consented for laparotomy-assisted fetoscopic closure of isolated fetal spina bifida. Inclusion and exclusion criteria followed the Management of Myelomeningocele Study (MOMS). Team preparation involved observation at the originating center, protocol development, ancillary staff trainin g, and surgical rehearsal using patient-matched models through simulation prior to program implementation. The primary outcome was the ability to complete the repair fetoscopically. Secondary maternal and fetal outcomes to assess performance of the technique were collected prospectively.

RESULTS: Of 57 women screened, 19 (33%) consented for laparotomy-assisted 2-port fetoscopy between February 2017 and December 2019. Fetoscopic closure was completed in 84% (16/19) cases. Over time, the technique was modified from a single- to a multilayer closure. In utero hindbrain herniation improved in 86% (12/14) of undelivered patients at 6 weeks postoperatively. Spontaneous rupture of membranes occurred in 31% (5/16) of fetoscopic cases. For completed cases, median gestational age at birth was 37 (range 27-39.6) weeks and 50% (8/16) of women delivered at term. Vaginal birth was achieved in 56% (9/16) of patients. One newborn had a cerebrospinal fluid leak that required postnatal surgical repair.

CONCLUSION: Implementation of a laparotomy-assisted 2-port fetoscopic spina bifida closure program through rigorous preparation and multispecialty team training may accelerate the learning curve and demonstrates favorable obstetric and perinatal outcomes.

PMID:34518445 | DOI:10.1159/000518507

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Tracheoesophageal fistula and pharyngoesophageal stenosis repair by double skin paddle radial forearm flap

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Publication date: Available online 14 September 2021

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): V. Poissonnet, D. Culie, C. Rouanet, A. Bozec

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Comparing the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children

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Eur Arch Otorhinolaryngol. 2021 Sep 14. doi: 10.1007/s00405-021-07049-0. Online ahead of print.

ABSTRACT

INTRODUCTION: In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.

MATERIALS AND METHODS: In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too.

RESULTS: There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding.

CONCLUSION: According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.

PMID:34518906 | DOI:10.1007/s00405-021-07049-0

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A Case of Clinically Diagnosed ANCA Negative Granulomatosis With Polyangiitis

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Ear Nose Throat J. 2021 Sep 14:1455613211037086. doi: 10.1177/01455613211037086. Online ahead of print.

ABSTRACT

SIGNIFICANCE STATEMENT: Granulomatosis with polyangitis (GPA) is a systemic necrotizing vasculitis comprising of inflammation of small and medium-sized vessels.1 It typically presents with involvement of the upper and lower airways as well as the kidneys. If left untreated, end-organ damage may occur. Hematological investigations typically demonstrate th e presence of antinuclear cytoplasmic antibodies (ANCA).2 Here, we discuss an unusual presentation of ANCA negative GPA, presenting initially with nasal symptoms.

PMID:34519237 | DOI:10.1177/01455613211037086

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