Granulomas without foreign body giant cells in perianal fistula tissue suggest Crohn's disease.

OBJECTIVES: Histopathological characteristics of granulomas in perianal fistula of patients with Crohn's disease (CD) remain unexplored. We aimed to assess the histopathological features of granulomas in perianal fistula in CD. METHODS: A retrospective analysis was conducted by reviewing the medical and pathological records of 4430 cases who underwent perianal fistulectomy at our hospital between June 2015 and June 2023. The patients were divided into the CD group, tuberculosis (TB), and non-CD group, respectively, based on their final diangosis. The detection rate of granulomas and differential histopathological features were investigated. RESULTS: Among the 4430 patients, granulomas were identified in 41 cases, including 25 had CD, 2 had pulmonary TB, and 14 only exhibiting perianal lesions with no other comorbidities. Additionally, there were altogether 93 CD cases, resulting in a detection rate of granuloma of 26.9%, which was considerably higher than that in the non-CD group (26.9% vs 0.3%, p < 0.001). The majority (85.7%) of the perianal fistula tissues in the non-CD group contained foreign body giant cells, while this was observed in only 1 (4.0%) out of the 25 cases with CD. We proposed that granulomas in the perianal fistula in the non-CD group were mostly foreign body granulomas. Moreover, granulomas in the non-CD group were larger than that of the CD group (1135 µm vs 519 µm, p < 0.001). CONCLUSION: Most CD cases have less granulomas (≤3) and no foreign body giant cells. Ribbon-like granulomas can be seen only in CD cases.

The arteriolar injury in hypertension.

In 1937, Drs. Moritz and Oldt described arteriolar injuries in the kidneys (and other viscera) in hypertension, across the age range, in both sexes, and, in different races. This hypothesis proposes that injuries to vasomotor nerves cause the arteriolar injury in the kidney in hypertension, (as well as that in the uterus in preeclampsia). Different patterns of perivascular hyalinisation in different viscera are clues to the varying causes and consequences of arteriolar injury. In the uterus there is a symmetrical, perivascular "halo of hyalinisation" that marks the lines of extension of regenerating, injured nerves to the placental bed, whereas in the kidney there is a disordered and asymmetrical "halo of hyalinisation" where persistent, and recurrent, increases in intravascular pressures interrupt development of regenerating nerves. Consequences of injuries to vasomotor nerves include releasing a "soup" of cytokines that cause regeneration of "new" nerves expressing primitive, pain and stretch receptors including TRPV-1 and P2X3 purinergic "stretch" receptors that may be significant in the afferent mechanism in preeclampsia. There is also concurrent, "background" hyperplasia of denervated tunica media and intima leading to narrowing of the arterioles and a further drive to hypertension through renal ischaemia (Goldblatt, 1942). These observations require support from animal studies and other investigations to establish causation. This hypothesis may provide a number of potential mechanisms that reinforce, or accelerate, the physiological processes that contribute to hypertension.

[Protective effects of Curcumin analogue L6H4 on kidney from type 2 diabetic rats].

OBJECTIVE: To investigate the protective effect of curcumin analogue L6H4 on the kidney from the type 2 diabetic rats. METHODS: Twenty-four SPF male SD rats were randomly divided into 3 groups(n=8):normal control group(NC),diabetes mellitus group(DM) and DM+L6H4-treatment group(DT). After rats were fed with high-fat diet for 4 weeks, both the DM and DT groups were injected with streptozotocin intraperitoneally to induce type 2 diabetes mellitus models. The rats in DT group were given L6H4 by gavage at the dose of 0.2 mg/kg·d for 8 weeks. After the treatment, the 24 h urinary protein, fasting blood glucose (FBG), triglyceride (TG), serum creatinine(Scr),blood urea nitrogen (BUN) and uric acid (UA) were detected biochemically. The pathological changes of the kidneys were observed under light and transmission electron microscopes. The expressions of TGF-ß1, FN and Col IV were detected by immunohistochemistry. RESULTS: The levels of the 24 h urinary protein, FBG, TG, Scr and BUN were elevated significantly in diabetic group(P<0.01). The glomerular volume of DM group rats became irregularly enlarged, diffused mesangial matrix accumulated, with basal membrane proliferous hypertrophy and fusion phenomenon of foot process, the expressions of TGF-ß1,FN and Col-IV were elevated significantly (P<0.05). After treated with L6H4, the levels of the 24 h urinary protein, FBG, TG, Scr and BUN were decreased in DT group compared to DM group (P<0.01), the morphological changes of kidney were ameliorated. The expression levels of TGF-ß1, FN and Col-IV were downregulated (P<0.05). CONCLUSIONS: L6H4 exerts the protective effect on kidneys of type 2 diabetic rats by reducing expression of TGF-ß1, inhibiting secretion of Col-IV and FN, relieving the deposition of the extracellular matrix.