The role of gastrointestinal endoscopy in Kaposi sarcoma / El papel de la endoscopia gastrointestinal en el sarcoma de Kaposi

We are writing to make endoscopists aware of the paramount of a prompt diagnosis of gastrointestinal Kaposi sarcoma (GI-KS). Patients with GI involvement have a two to five times higher risk of death and will benefit from chemotherapy to improve their survival. However, current evidence found that one out of three patients might have a false negative result even with HHV-8 since other entities such as gastrointestinal stromal tumors, angiosarcoma, and lymphoma shared macroscopic and histopathological characteristics. These cause a delay in treatment and significantly worsen the prognosis. We observed a trend for a positive diagnosis from ulcers and nodules. To our knowledge, this is the largest cohort of patients with GI-KS in the world. Our study suggests that in cases where a complete immunochemistry panel for KS is not available, HHV-8 remains as a bare minimum. However, other gastrointestinal lesions shared histopathological characteristics. Therefore, we suggest taking biopsies from nodular and ulcer-type lesions to increase the probability to establish a histopathological diagnosis.(AU)

Deep learning based tissue analysis predicts outcome in colorectal cancer.

Image-based machine learning and deep learning in particular has recently shown expert-level accuracy in medical image classification. In this study, we combine convolutional and recurrent architectures to train a deep network to predict colorectal cancer outcome based on images of tumour tissue samples. The novelty of our approach is that we directly predict patient outcome, without any intermediate tissue classification. We evaluate a set of digitized haematoxylin-eosin-stained tumour tissue microarray (TMA) samples from 420 colorectal cancer patients with clinicopathological and outcome data available. The results show that deep learning-based outcome prediction with only small tissue areas as input outperforms (hazard ratio 2.3; CI 95% 1.79-3.03; AUC 0.69) visual histological assessment performed by human experts on both TMA spot (HR 1.67; CI 95% 1.28-2.19; AUC 0.58) and whole-slide level (HR 1.65; CI 95% 1.30-2.15; AUC 0.57) in the stratification into low- and high-risk patients. Our results suggest that state-of-the-art deep learning techniques can extract more prognostic information from the tissue morphology of colorectal cancer than an experienced human observer.

Using cell nuclei features to detect colon cancer tissue in hematoxylin and eosin stained slides.

Currently, diagnosis of colon cancer is based on manual examination of histopathological images by a pathologist. This can be time consuming and interpretation of the images is subject to inter- and intra-observer variability. This may be improved by introducing a computer-aided diagnosis (CAD) system for automatic detection of cancer tissue within whole slide hematoxylin and eosin (H&E) stains. Cancer disrupts the normal control mechanisms of cell proliferation and differentiation, affecting the structure and appearance of the cells. Therefore, extracting features from segmented cell nuclei structures may provide useful information to detect cancer tissue. A framework for automatic classification of regions of interest (ROI) containing either benign or cancerous colon tissue extracted from whole slide H&E stained images using cell nuclei features was proposed. A total of 1,596 ROI's were extracted from 87 whole slide H&E stains (44 benign and 43 cancer). A cell nuclei segmentation algorithm consisting of color deconvolution, k-means clustering, local adaptive thresholding, and cell separation was performed within the ROI's to extract cell nuclei features. From the segmented cell nuclei structures a total of 750 texture and intensity-based features were extracted for classification of the ROI's. The nine most discriminative cell nuclei features were used in a random forest classifier to determine if the ROI's contained benign or cancer tissue. The ROI classification obtained an area under the curve (AUC) of 0.96, sensitivity of 0.88, specificity of 0.92, and accuracy of 0.91 using an optimized threshold. The developed framework showed promising results in using cell nuclei features to classify ROIs into containing benign or cancer tissue in H&E stained tissue samples. © 2017 International Society for Advancement of Cytometry.

Local Administration of Thiamine Ameliorates Ongoing Pain in a Rat Model of Second-Degree Burn.

The objective of this study was to develop rat model of second-degree burn pain and test analgesic efficacy of local thiamine administration. Automatic temperature-controlled hot plate was set at 85 ± 0.1°C with a filter paper on the top. Rats were thrust on hot plate landing on plantar surface for 4 to 7 and 10 seconds, respectively. Burnt skin was observed. Hematoxylin and eosin staining and Masson staining were used to monitor burn degree. Gait analysis detected change of locomotion. Allodynia and hyperalgesia in the burnt area were evaluated with von Frey test and Hargreaves Test, and ongoing pain was detected with conditional place preference test. Markers for the activity of microglia (Iba1), astrocytes (GFAP), and neurons (c-fos) were detected with immunofluorescence. Finally, thiamine was injected into blisters to observe its effect on burn pain. Blisters on burnt skin, space between dermal and epidermal layers in hematoxylin and eosin staining and burn injury limiting in dermal layer in Masson stain all indicated that burn injury lasting for 7 seconds matched second-degree burn. Behavioral tests revealed allodynia, ongoing pain, and increased expression of c-fos, GFAP, and Iba1, as well as the absence of hyperalgesia in Burn7s. Burn injury reduced distance of second and fourth digits. MK801 could relieve allodynia in Burn7s. Local administration of 1, 2, and 4 mg of thiamine had no effect on the allodynia, but 2 and 4 mg of thiamine also could induce conditional place preference (CPP) in Burn7s. A rat model of second-degree burn pain was developed and local administration of thiamine provided relief from pain.

Volume and composition of reflux after intravitreal injection.

PURPOSE: To quantify the amount of drug loss from cadaveric human eyes, which are injected via the pars plana with a known volume of dye at variable intraocular pressures. METHODS: Eight cadaver eyes were divided into 2 intraocular pressure groups: normal (15 mmHg; 4 eyes) or high (30 mmHg; 4 eyes). Each eye was injected with 50 µL of hematoxylin dye, and the subsequent reflux was immediately collected on a Schirmer's test strip. The test strip was scanned and digitally analyzed to determine the area of saturation and total color intensity present. Using a previously established equation, total volume of reflux and the amount of dye within that reflux were calculated. RESULTS: The average total volume of refluxed fluid was 1.68 µL (median, 0.62 µL), with a range of 0 µL to 8.05 µL. The average volume of refluxed dye was 0.37 µL (median, 0.08 µL), with a range of 0 µL to 2.15 µL. On average, only 0.74% of the original 50 µL of injected dye was lost (median, 0.15%), with a range from 0% to 4.30%. CONCLUSION: Although the presence of subconjunctival bleb formation after intravitreal injection may be a concern to the clinician, data from the present study shows that only a very small amount of the injected therapeutic agent is lost in the reflux.

A novel method for the measurement of reflux from intravitreal injections: data from 20 porcine eyes.

BACKGROUND: Reflux following intravitreal injection is a common phenomenon, but it is unknown how much, if any, medication is lost as a result. Reflux is known to be a combination of vitreous and the injected agent, but the relative composition is unknown. This article describes a novel method for the measurement of the volume and composition of reflux and presents data from porcine eyes. METHODS: Twenty porcine eyes were injected with 0.05 ml of dye at intraocular pressures (IOPs) of 15, 20, 25 and 30 mmHg (five eyes per subgroup). Reflux was captured on filter paper and the area of saturation and color intensity of the dye were digitally analyzed. Total refluxed volume and proportion of dye versus vitreous fluid were calculated from linear regression lines created from known standards. RESULTS: Average (median) total volume of reflux from all eyes was 1.19 µl (0.93 µl), volume of injected dye refluxed was 0.47 µl (0.11 µl) and composition of reflux was 20.8% dye (15.5%). Less than 1% of the injected dye was lost to reflux. There were no differences between IOP groups in the total volume refluxed, the total amount of dye refluxed, the average composition of the reflux or the amount of injected dye refluxed (df = 3 for all comparisons; p = 0.58, p = 0.51, p = 0.55, p = 0.51, respectively). CONCLUSIONS: This novel method allows for measurement of quantity and composition of reflux following intravitreal injection in vitro. While reflux occurs frequently, it is predominantly composed of vitreous, not the injected agent. In fact, <1% of the original injection was lost to reflux.

Primo-vessels as new flow paths for intratesticular injected dye in rats.

After intratesticular injection of a chromium hematoxylin and fluorescent nanoparticle solution, we found a novel flow path in the abdominal cavity consisting of primo-vessels and primo-nodes. This flow path formed a network that crossed over the surfaces of abdominal organs, and generally linked to the greater omentum and adjacent visceral peritoneum. Some of these structures terminated at organs such as the small intestine and the urinary bladder; occasionally, the network entered the parenchyma of organs. The semitransparent primo-vessels and nodes were wholly or partially stained dark-blue by chromium hematoxylin. Injected nanoparticles were also observed in primo-vessels and nodes as well as the parenchyma of organs which were the site of primo-vessel termination. Transmission electron microscopy showed that the primo-vessels consist of many sinuses (4-6 mum), surrounded by collagen fibers, specific granules, cellular remnants, immune cells, extracellular matrices, and hematopoietic cells. These histological features are completely different from blood and lymph vessels indicating that primo-vessels are novel structures that allow the flow of dye.

The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction.

OBJECTIVE: The sentinel node concept is of great value in the treatment of various malignancies. In this study we investigated whether the application of the sentinel node procedure is feasible in esophageal adenocarcinoma and whether it can tailor surgical treatment of the individual patient. METHODS: In 40 patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction, blue dye was injected around the tumor intraoperatively. Sentinel nodes (blue-stained) and nonsentinel nodes were identified and dissected during transhiatal esophagectomy. In sentinel nodes negative for tumor cells on routine hematoxylin-eosin examination, multilevel sectioning and immunohistochemical staining were performed to search for micrometastases. RESULTS: The sentinel node procedure was technically successful in 39 of 40 patients (98%). The median number of sentinel nodes identified was 4. Sentinel nodes were present in more than 1 nodal station in 8 patients (21%). In 6 patients in whom the sentinel node was negative for metastasis, nonsentinel nodes were positive for tumor cells (false-negative rate 6/39 = 15%). Micrometastases and isolated tumor cells were detected in 7 of 19 patients (37%) with sentinel nodes, but this finding did not affect the false-negative rate. CONCLUSION: Detection of sentinel nodes is technically feasible during esophagectomy for cancer. However, given the relatively high false-negative rate of 15% and the high frequency of sentinel nodes in more than 1 nodal station, the clinical relevance of the sentinel node concept (through application of the blue dye technique) in the current treatment of patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction seems limited.

Dietary hematein ameliorates fatty streak lesions in the rabbit by the possible mechanism of reducing VCAM-1 and MCP-1 expression.

Hematein is a compound isolated from Caesalpinia sappan that has been used in oriental medicine as both an analgesic and an anti-inflammatory agent. In this study, we examined the anti-atherogenic potential of hematein using cholesterol-fed New Zealand White (NZW) rabbits. NZW rabbits were divided into a hematein-supplemented (0.05% in diet) group (n=6), a probucol-supplemented (0.25% in diet) group (n=6), and a control group (n=6). After 8 weeks of treatments, the extent of the atherosclerotic lesions was significantly reduced in the hematein-supplemented group and the probucol-supplemented group without changing plasma lipoprotein levels. Hematein and probucol prevented the up-regulation of the vascular cell adhesion molecule-1 (VCAM-1) expression on the descending aorta induced by cholesterol diet. In culture, hematein also significantly inhibited the secretion of soluble VCAM-1 and of monocyte chemotactic protein-1 (MCP-1) respectively induced by tumor necrotic factor alpha (TNF-alpha) and mildly oxidized low density lipoprotein in human umbilical vein endothelial cell (HUVEC) culture. Also, hematein inhibited monocyte adhesion to endothelial cell and the activation of NF-kappaB in HUVECs stimulated with TNF-alpha. The results of the present study suggest that the anti-atherogenic effect of hematein is not related to control of the plasma lipid profile but probably related to the inhibition of VCAM-1 and MCP-1 expression resulting in an amelioration of lesion development in the rabbit.

Evaluación de la prueba rapida de ureasa en la infección por helicobacter pylori / Rapid test of ureasa in the helicobacter pylory infection

El propósito de este estudio es comparar una prueba rápida de ureasa (PRUtest) elaborada en el servicio de gastroenterología del Hospital Universitario de Maracaibo, con CLOtest. Usando como Gold Standard para el diagnóstico de infección por H.pylori, histología con Giemsa. Se incluyeron 60 pacientes a quienes se le practicó endoscopia digestiva superior con toma de 4 biopsias a nivel de curvatura mayor de antro, cerca del píloro. Dos biopsias antrales fueron destinadas para estudio histológico con Giemsa y Hematoxilina & Eosina, una para CLOtest y una para PRUtest. A través de histología se identifico 33 (55 por ciento) especímenes positivos para H.pylori y 27 (45 por ciento) fueron negativas. Con PRUtest se obtuvo una sensibilidad de 93,93 por ciento y especificidad de 92,59 por ciento sin diferencia estadísticamente significativa con el CLOtest. Se concluye que el PRUtest es un método seguro para el diagnóstico de infección por H.pylori

Observaçöes histopatológicas dos diferentes graus de inflamaçäo da mucosa oral diante de estímulos provocados por próteses totais mucossuportadas / Histopathological observations of different, degrees of inflammation on mouth mucosa produced by complete denture

A finalidade do nosso trabalho foi observar histologicamente alteraçöes que ocorreram na mucosa oral, resultantes do uso das próteses totais mucossuportadas. Para tanto, foram selecionados dez pacientes portadores de prótese total mucossuportada, nos quais a mucosa oral, que seria a regiäo de suporte, apresentasse, simultaneamente, áreas consideradas clinicamente sadias, com leves alteraçöes severas. Foram realizadas três biópsias em cada paciente, cada uma correspondendo às áreas previamente referidas, e esse material foi submetido à técnica de preparo histológico de rotina. Os cortes foram corados por hematoxilina e eosina. Baseados nos resultados histopatológicos, foi-nos lícito concluir que o fato de o paciente utilizar prótese total mucossuportada pode induzir a algum tipo de alteraçäo histofisiológica da mucosa oral. Por sua vez, a existência de fatores irritantes locais pode, do mesmo modo, levar a mucosa oral a profundas alteraçöes em nível tanto epitelial quanto conjuntivo

The applicability of hematoxylin-eosin staining plus fluorescence or confocal laser scanning microscopy to the study of elastic fibers in cartilages.

This study focuses on the use of hematoxylin-eosin staining plus fluorescence microscopy for the investigation of elastic fibers in some elastic cartilages. We have observed that elastic fibers are consistently imaged by the proposed procedure and the resolution attained is similar to that obtained with the classical Weigert's fuchsin-resorcin. The results also demonstrate that elastin autofluorescence gives little or no contribution to the final fluorescence and that the use of the confocal laser scanning microscope adds to the resolution, permits the use of thicker sections and reveals of minute structural at features. We conclude that this is a relevant tool in elastin research.

A controlled hematoxylin-eosin for actinic elastosis-lysis. Its versatility and use for vascular damage (actinic arteriopathy) in the skin and orbit.

To demonstrate elastic tissue and its reactions in the skin and other organs, the hematoxylin-eosin staining method had been modified in two ways: (a) the hematoxylin solution is used once only to obtain its full potential, and (b) aqueous eosin is given greater selectivity by controlling its pH with a buffer. This stain highlights the broad supporting role of elastic tissue, particularly in pressure-containing blood vessels. It also helps to define the hyperplasia, degeneration, and elastolysis that arise from its peculiar sensitivity to actinic radiation.