Angiogenesis and eosinophilia in the nasal mucosa of patients with different clinical phenotypes of chronic rhinosinusitis.

INTRODUCTION: Dense inflammatory cell infiltration and vascularization of the nasal mucosa are histological characteristics of chronic rhinosinusitis (CRS). We aimed to evaluate the association between eosinophilia and vascularization in the stroma of mucosal layer/nasal polyps (NP) and clinical parameters in patients with different phenotypes of CRS. METHODOLOGY: This cross-sectional study involved 33 patients who had CRS with NP without aspirin sensitivity (CRSwNP), 20 NP patients as a part of aspirin-exacerbated respiratory disease (AERD), and 10 patients who had CRS without NP (CRSsNP), selected for surgery. Control group consisted of 31 subjects without nasal/sinus inflammation, selected for surgery of pneumatized middle turbinate. All patients were clinically scored before surgery for nasal symptoms, quality of life (QoL) outcome and findings from computed tomography scans. NP/nasal mucosa samples of participants were immunohistochemically stained for eosinophil infiltration marker BMK13 and angiogenesis markers CD31 and CD34. RESULTS: AERD patients had the highest level of immunoexpression for BMK13. The strongest staining pattern of CD34 was found in AERD group and the highest expression level for CD31 in CRSwNP group. We found a positive correlation between BMK13, impaired QoL and radiologically evaluated disease extent in patients with CRSwNP. Excepting CRSsNP patients, no correlation was found between the marker of tissue eosinophilia and markers of vascular proliferation. CONCLUSIONS: Patients from AERD phenotype have the highest degree of stromal eosinophilic infiltration and endothelial proliferation in comparison to other CRS phenotypes. Eosininophil infiltration marker BMK13 correlates better with the clinical parameters of CRS in comparison to the vascular proliferation markers.

Timing Is Important-Management of Metabolic Syndrome According to the Circadian Rhythm.

Physiological processes occur in accordance with a rhythm regulated by the endogenous biological clock. This clock is programmed at the molecular level and synchronized with the daily light-dark cycle, as well as activities such as feeding, exercise, and social interactions. It consists of the core clock genes, Circadian Locomotor Output Cycles Protein Kaput (CLOCK) and Brain and Muscle Arnt-Like protein 1 (BMAL1), and their products, the period (PER) and cryptochrome (CRY) proteins, as well as an interlocked feedback loop which includes reverse-strand avian erythroblastic leukemia (ERBA) oncogene receptors (REV-ERBs) and retinoic acid-related orphan receptors (RORs). These genes are involved in the regulation of metabolic pathways and hormone release. Therefore, circadian rhythm disruption leads to development of metabolic syndrome (MetS). MetS refers to a cluster of risk factors (RFs), which are not only associated with the development of cardiovascular (CV) disease (CVD), but also with increased all-cause mortality. In this review, we consider the importance of the circadian rhythm in the regulation of metabolic processes, the significance of circadian misalignment in the pathogenesis of MetS, and the management of MetS in relation to the cellular molecular clock.

The pterygopalatine fossa: morphometric CT study with clinical implications.

PURPOSE: The pterygopalatine fossa is a deep viscerocranial space containing the maxillary artery and nerve, the pterygopalatine ganglion, and the nerve of the pterygoid canal (vidian nerve). The endoscopic approach to this area relies on adequate preoperative imaging, such as computed tomography (CT). The aim was to determine the morphometric characteristics of the pterygopalatine fossa and its communications, including several previously unpublished measurements. METHODS: 100 CT scans (56 male and 44 female patients) were analyzed. The axial, coronal, and sagittal slices, together with the three-dimensional reconstructions, were used in the study. RESULTS: The central diameter and the length of the foramen rotundum, the vertical diameter and the length of the pterygoid (vidian) canal, and the diameter of the sphenopalatine foramen were significantly larger in men. The central diameters of the foramen rotundum and the vidian canal were significantly smaller than their anterior and posterior transverse diameters. The vidian canal length of 12.1 mm indicates the presence of the type 3 VC with a sensitivity of 83% and a specificity of 85%. CONCLUSION: Several new descriptions of the pterygopalatine fossa are presented here (such as the angle between the sphenopalatine foramen and the vidian canal, a new aspect in the understanding of the FR, and the distance between the posterior wall of the maxillary sinus to the vidian canal and the foramen rotundum), which might prove useful in the comprehension of the anatomy of the pterygopalatine fossa.

Duplication of the middle cerebral artery in a neonate: case report.

The middle cerebral artery, a terminal branch of the internal carotid artery, participates greatly in the blood supply of the cerebral cortex and basal nuclei. The aim of this paper is to present a case of middle cerebral artery duplication in a 3-day-old neonate. A brief literature overview in this paper serves to summarize the research on the middle cerebral artery duplication. Also, possible etiology of this anatomical variation will be discussed, together with the embryology of the middle cerebral artery. The arteries of the circle of Willis are affected by numerous neurovascular diseases and the knowledge of these anatomical variations is important in the diagnostic and therapeutic interventions in this field.

Superficial palmar branch of the radial artery: A study of occurrence and diameter.

The superficial palmar branch (SPB) of the radial artery (RA) is an important blood vessel in plastic surgery procedures of the hand. It is used as the axial artery in a free flap used for finger reconstruction. The occurrence of this arterial branch is variable, as well as its diameter and course. The aim of this study was to determine the occurrence and measure the external diameter of the SPB, as well as the external circumference of the RA. All results were analyzed with the intent to determine a possible correlation between RA and SPB size, as well as between SPB occurrence and the cadavers' sex and height. The study was conducted on both upper extremities of 60 cadavers (31 male and 29 female), of 35-55 years of age (average age was 46.5 years). A radial artery sample was taken at the level of the wrist, together with its superficial palmar branch. The samples were preserved in 4% formaldehyde for four weeks. After the fixation, the external circumference of the radial artery and the external diameter of the superficial palmar branch were measured with a Vernier caliper and an operating microscope. Bilateral SPB absence was the most common variant of SPB occurrence in our material. There was no linear correlation between the size of the RA and the SPB, nor was there any relationship between SPB occurrence and the cadavers' age and height. Also, the correlation between the cadavers' height and the size of both blood vessels was not linear. We conclude that the SPB diameter and occurrence are independent of the other factors described in this study.

Comparison of cytological categories atypical (C3) and suspected (C4) with histopathological diagnoses of breast lesions.

PURPOSE: Fine needle aspiration cytology (FNAC) is a diagnostic method characterized by high sensitivity, specificity and predictive value. In order to obtain uniformed results of FNAC breast changes, the following categories are introduced: C1 (non-representative), C2 (benign), C3 (atypical), C4 (suspected) and C5 (malignant). The purpose of this study was to establish which pathological processes are most frequently diagnosed as C3 and C4 categories, which carry a malignant tumor risk. METHODS: The frequency of all cytological categories was determined in a retrospective analysis which included 1605 patients, all of whom had undergone FNAC of breast lesions, over a period of 5 years (2012-2016). Furthermore, histopathological diagnoses of 212 patients with cytological categories C3 (77) or C4 (135) were compared. RESULTS: In the sample of 1605 patients, 212 belonged to C3 or C4 cytological category ( frequency for C3 4.8%, for C4 8.4%). Also, in the group of patients with cytological categories C3 and C4 there were 208 women. The patients with C3 were younger than C4 patients. There was a statistically significant difference between the number of benign and malignant diagnoses in patients diagnosed with C3 or C4 cytological category (p<0.001). In C3 category, in 57.1% of the cases a benign condition was histopathologically diagnosed, while in C4 category, in 90.4% of the cases malignant tumor was histopathologically diagnosed. CONCLUSIONS: After histopathological analysis, C3 category in FNAC breast lesions is most commonly diagnosed as a fibrocystic breast disease or fibroadenoma, while C4 category is diagnosed as well-differentiated malignant tumor.

Clinical significance of understanding lateral and medial circumflex femoral artery origin variability.

The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.

Morphometric analysis of the fascicular organisation of the optic nerve.

BACKGROUND/AIM: The optic nerve is anatomically observed in four segments: intrabulbar, orbital, canalicular, and cranial. According to the literature, the surface of the transversal cut of the nerve is different through it. The aim of this study was to evaluate the fascicular organisation of the optic nerve, throughout its three segments fromthe eye. METHODS: Five pairs of optic nerves, obtained from the autopsies were examined. Using Heidenhain's (azan) staining, the cuts were prepared for microscopy. Morphometric analysis was performed using the stereological methods for morphometric cytology--the Weible's testing system M42. The following measures were established: the surface of the transverse cut of the nerve, the entire surface of fasciculi, the entire surface of connective tissue and blood vessels, the number of fasciculi, the surface of a single fasciculus. RESULTS: The surface of the transverse cut of the nerve was found to grow from the orbital to the cranial segment, as well as the entire surface of fasciculi. While their number is significantly lower in the cranial segment, the number of fasciculi varied slightly between the orbital and the canalicular segment. The surface of a single fasciculus grows from the bulb to the chiasma. There is probable a cause to believe that this may be due to fusion of the "small" fasciculi in the orbitocranial direction. CONCLUSION: There are significant differences among the examined parameters of the different parts of the optic nerve.

The bilateral anatomical variation of the sural nerve and a review of relevant literature.

The sural nerve is a sensory nerve, usually formed in the distal part of the leg by the union of the lateral sural cutaneous nerve or the communicating fibular branch with the medial sural cutaneous nerve. The aim of this paper is to present a case of a variant formation of the sural nerve and a review of the literature related to this case. During the dissection of an adult male cadaver, the medial sural cutaneous nerve and communicating fibular branch, after respectively deriving from the tibial and common fibular nerve, were noticed to continue their course without any formation of a unique nerve trunk on the posterior side of both lower limbs. A transverse communicating branch, connecting these two nerves, was present in both legs. As the sural nerve is of significant diagnostic and therapeutic importance, detailed knowledge of the sural nerve's anatomy and its contributing nerves is also of great importance.