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The thyroid in Graves' disease undergoes a considerable divergence in size and position from the normal anatomy. However, knowledge of the pathological anatomy related to the change, which is required before planned surgical or local intervention, or diagnosis, is neglected. To investigate Graves' disease, we established a model of mice that successfully mimicked all the signs presented in the clinic. Under a long-term immunization (35 weeks), the animals displayed large heterogeneity in thyroid size, such as the cases of natural occurrence. These thyroids in the model were sized into various phases and registered. A blend of the registered thyroids and the thyroid and tracheal cartilage landmarks led to the production of site-dependent incidence graphs of thyroid in the front view and on the section for each phase. The merger of the incidence graphs of all the phases resulted in thyroid phase-dependent topography. The depicted graphs illustrate the fine localization of the thyroid in various sizes and their dynamic changes during enlargement, which may facilitate currently used fine-needle aspiration biopsy and ultrasonography-guided biopsy techniques. Familiarity with this knowledge might avoid misclassifying an abnormality as normal, or vice versa, and be helpful for imaging diagnosis and local surgery therapy in Graves' disease. [ABSTRACT FROM AUTHOR]

Aims Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes. Methods and results Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707). Conclusion Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD. [ABSTRACT FROM AUTHOR]

Background Pericoronary adipose tissue (PCAT) may influence plaque development through inflammatory mechanisms. We assessed PCAT density, as a measure of pericoronary inflammation, in relationship to coronary plaque among people with human immunodeficiency virus (HIV [PWH]) and to a matched control population. Methods In this baseline analysis of 727 participants of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Mechanistic Substudy, we related computed tomography–derived PCAT density to presence and extent (Leaman score) of coronary artery disease (CAD), noncalcified plaque, coronary artery calcium (CAC), and vulnerable plaque features using multivariable logistic regression analyses. We further compared the PCAT density between PWH and age, sex, body mass index, CAC score, and statin use–matched controls from the community-based Framingham Heart Study (N = 464), adjusting for relevant clinical covariates. Results Among 727 REPRIEVE participants (age 50.8 ± 5.8 years; 83.6% [608/727] male), PCAT density was higher in those with (vs without) coronary plaque, noncalcified plaque, CAC >0, vulnerable plaque, and high CAD burden (Leaman score >5) (P <.001 for each comparison). PCAT density related to prevalent coronary plaque (adjusted odds ratio [per 10 HU]: 1.44; 95% confidence interval, 1.22–1.70; P <.001), adjusted for clinical cardiovascular risk factors, body mass index, and systemic immune/inflammatory biomarkers. Similarly, PCAT density related to CAC >0, noncalcified plaque, vulnerable plaque, and Leaman score >5 (all P ≤.002). PCAT density was greater among REPRIEVE participants versus Framingham Heart Study (−88.2 ± 0.5 HU versus −90.6 ± 0.4 HU; P <.001). Conclusions Among PWH in REPRIEVE, a large primary cardiovascular disease prevention cohort, increased PCAT density independently associated with prevalence and severity of coronary plaque, linking increased coronary inflammation to CAD in PWH. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC). Methods: The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed. Results: In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P =.008) and 42%, 79%, 89% versus 32%, 58%, 74% (P =.024), respectively. Conclusions: For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first. This study investigated the impact of surgical margin and hepatic resection on prognosis for patients with hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

Aims The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. Methods and results From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64–68 years vs. 52–56 years, respectively, P < 0.001). The Leiden CCTA risk score was independently associated with MACE: score 6–20: HR 2.29 (1.69–3.10); score > 20: HR 6.71 (4.36–10.32) in women, and score 6–20: HR 1.64 (1.29–2.08); score > 20: HR 2.38 (1.73–3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P -interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6–20: HR 2.21 (1.57–3.11); score > 20: HR 6.11 (3.84–9.70) in women; score 6–20: HR 1.57 (1.19–2.09); score > 20: HR 2.25 (1.58–3.22) in men], with a significant interaction for the highest risk group (adjusted P -interaction = 0.004). Conclusion Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity. [ABSTRACT FROM AUTHOR]

Aims The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography angiography (CCTA). Methods and results From a multicenter study, we enrolled patients who underwent a clinically indicated baseline CCTA and experienced ACS during follow-up. Separate core laboratories performed blinded adjudication of ACS events and quantification of CCTA including compositional plaque volumes by Hounsfield units (HU): calcified plaque >350 HU, fibrous plaque 131–350 HU, fibrofatty plaque 31–130 HU and necrotic core <30 HU. In 234 patients (mean age 62 ± 12 years, 36% women), early and late ACS occurred in 129 and 105 patients after a mean of 395 ± 622 days, respectively. Patients with early ACS had a greater maximal diameter stenosis and maximal cross-sectional plaque burden as compared to patients with late ACS (P  < 0.05). Larger total, fibrous, fibrofatty, and necrotic core volumes were observed in the early ACS group (P  < 0.05). Findings for total, fibrous, fibrofatty, and necrotic core volumes were reproduced in an external validation cohort (P  < 0.05). Conclusions Volumetric differences in composition of coronary atherosclerosis exist between ACS patients according to their timing antecedent to the acute event. These data support that a large burden of non-calcified plaque on CCTA is strongly associated with near-term plaque instability and ACS risk. [ABSTRACT FROM AUTHOR]

Background: Ectatic infarct-related artery (IRA) has been shown to be associated with higher thrombus burden, no-reflow, stent thrombosis (ST) and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). The effect of ectatic non-IRA on ST without ectatic IRA is not known. We aimed to assess the effect of ectatic non-IRA presence on ST within 1 month after primary percutaneous intervention (pPCI) in patients with STEMI.Methods: A total of 1541 patients with a diagnosis of STEMI and underwent pPCI between 2015 and 2020 were retrospectively included in the study. Patients with and without 1 month ST were compared. Penalised logistic regression method was used to assess the association between ST and candidate predictors due to the risk of overfitting.Results: Median age of the study group was 56.5 (48.7 to 67.2) years. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, ectatic non-IRA presence and use of tirofiban were significantly higher in the ST group (18.2±9.9 vs 15.1±9.9, p=0.03; 25% vs 7.2%, p<0.001; 54.2% vs 30.5%, p<0.001; respectively). Significantly higher thrombus aspiration (14.3% vs 6.7%, p=0.03) and lower stent implantation (67.7% vs 84%, p<0.001) rates were observed in ectatic IRA group compared with ectatic non-IRA group. In multivariable analysis, ectatic non-IRA presence was independently associated with 1-month ST (OR 4.01, 95% CI 1.86 to 8.63, p=0.01).Conclusion: Ectatic non-IRA presence without ectatic IRA in patients with STEMI increases the risk of ST within the first month of pPCI. [ABSTRACT FROM AUTHOR]

Aims The role of atherosclerosis in the pathogenesis of aortic enlargement is uncertain. We aimed to evaluate the relationship between the diameters of the ascending, descending and abdominal aorta, and coronary artery calcification. Methods and results Individuals in the Copenhagen General Population Study underwent thoracic and abdominal computed tomography. Maximal aortic diameters were measured in each aortic segment and coronary artery calcium scores (CACS) were calculated. Participants were stratified into five predefined groups according to CACSs and compared to aortic dimensions. The relation between aortic diameter and CACS was adjusted for risk factors for aortic dilatation in a multivariable model. A total of 2678 eligible individuals were included. In all segments of the aorta, aortic diameter was associated to CACSs, with mean increases in aortic diameters ranging from 0.7 to 3.5 mm in individuals with calcified coronary arteries compared to non-calcified subjects (P -value < 0.001). After correction for risk factors, individuals with CACS above 400 had larger ascending, descending and abdominal aortic diameter than the non-calcified reference group (P -value < 0.01). Conclusion Enlarged thoracic and abdominal aortic vascular segments are associated with co-existing coronary artery calcification in the general population. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a significant global public health threat, causing 1.2 million deaths in 2019. In Brazil, the incidence of the disease in the same year was 46 new cases per 100,000 inhabitants. Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis, resulting from the spread of mycobacteria through hematogenous dissemination from a latent chronic pulmonary infection or by local spread. Objective: This study aims to present a case series of genitourinary tuberculosis in male patients from a tertiary university hospital. Method: The study conducted a descriptive analysis of a case series using data from the Unit of Pathological Anatomy Laboratory and the Center for Infectious Diseases between 1999 and 2020. Results: Four male patients, with a mean age of 32 years (ranging from 23 to 46), were evaluated. Key symptoms reported during medical consultations at the Urology outpatient service included scrotal nodules, increased testicular volume, and orchialgia, with an average symptom duration of six months. Physical examinations revealed a hard nodular mass in the epididymis or upper testicular pole, mostly on the right side (in half of the cases) or the left side (in the other half). Histological examination of biopsies indicated chronic granulomatous inflammation consistent with tuberculoid in all cases, with negative tumor markers. Notably, none of the patients reported contact with tuberculosis or leprosy patients, and only one patient had a positive PPD test (>24mm). Conclusion: Genitourinary tuberculosis is a treatable and preventable disease. Understanding its clinical aspects, forms of presentation, dissemination, diagnosis, and treatment is crucial. Drug therapy, including rifampicin, isoniazid, pyrazinamide, and ethambutol, was effective in resolving symptoms in all patients. Surgical intervention in the form of orchidectomy was required for some cases, resulting in positive outcomes. Financing: No conflict. [ABSTRACT FROM AUTHOR]

Objectives The S1 dorsal foramen is the route for 30% of lumbar transforaminal epidural injections; it is therefore important to identify structures impeding S1 foraminal access. The study objective was to characterize the imaging findings, prevalence, and anatomic origin of synovial cysts presenting within the S1 neural foramen. Methods A case series (N = 14) established imaging characteristics of S1 synovial cysts. Imaging studies of 400 patients undergoing epidural injections were reviewed for lesions compromising S1 foraminal access. Cadaveric dissections defined the relationship of the inferior recess of the L5-S1 facet to the S1 dorsal foramen. Results Elderly patients (mean age = 76) exhibited S1 synovial cysts. Synovial cysts were typically 1–2 cm in diameter, hyperintense on sagittal T2 weighted magnetic resonance images (MRIs), fluid-density on computed tomography, and dorsal to the S1 spinal nerve. Sixty percent of cysts exhibited complex MRI signal characteristics (thick wall, internal structure). Tarlov cysts, in contrast, were larger, lobular, and exhibited pure fluid intensity. Lesions impeded access to the S1 dorsal foramina in 5% of reviewed imaging studies (16 Tarlov cysts, three synovial cysts, one conjoint S1-S2 nerve root). The multifidus muscle was interposed between the L5-S1 facet inferior recess and the S1 dorsal foramen on dissection specimens; severe atrophy of the ipsilateral multifidus was noted on imaging in 17/18 synovial cysts. Conclusions The S1 neural foramina should be inspected on sagittal MRI, when available, for confounding lesions before performing S1 epidural injections. Tarlov cysts are more common than synovial cysts; the latter are seen in elderly patients with severe multifidus atrophy. [ABSTRACT FROM AUTHOR]

Aims The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. Methods and results From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P  = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r  = 0.9888 vs. 0.9499; P  < 0.0001). The Bland–Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P  < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P  < 0.001). Conclusions CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume. [ABSTRACT FROM AUTHOR]

The ossifying fibroma is a benign fibro-osseous tumor rarely affecting the skull base. The incidence of ossifying fibroma itself is uncommon. It is considered to be an aggressive and fast-growing bone lesion. Early detection and complete surgical removal are essential to deal with its aggressive nature and recurrence. We report a case of a 20-year-old man admitted for the management of ossifying fibroma of the orbital roof extending inside the orbit mimicking meningioma and revealed by a progressive proptosis and headache. The patient underwent surgery for the subtotal removal of the tumor with its frontal infiltration with a good outcome. All meningiomas like tumors are not meningiomas and other tumors such as ossifying fibroma might be mistaken for meningioma and even get confirmation from the pathological anatomy study. Need be for these tumors to be looked at more closely for better therapeutic decision-making. [ABSTRACT FROM AUTHOR]

Aims Identification of invasive and radionuclide imaging markers of coronary plaque vulnerability by a single, widely available non-invasive technique may provide the opportunity to identify vulnerable plaques and vulnerable patients in broad populations. Our aim was to assess whether radiomic analysis outperforms conventional assessment of coronary computed tomography angiography (CTA) images to identify invasive and radionuclide imaging markers of plaque vulnerability. Methods and results We prospectively included patients who underwent coronary CTA, sodium-fluoride positron emission tomography (NaF18-PET), intravascular ultrasound (IVUS), and optical coherence tomography (OCT). We assessed seven conventional plaque features and calculated 935 radiomic parameters from CTA images. In total, 44 plaques of 25 patients were analysed. The best radiomic parameters significantly outperformed the best conventional CT parameters to identify attenuated plaque by IVUS [fractal box counting dimension of high attenuation voxels vs. non-calcified plaque volume, area under the curve (AUC): 0.72, confidence interval (CI): 0.65–0.78 vs. 0.59, CI: 0.57–0.62; P  < 0.001], thin-cap fibroatheroma by OCT (fractal box counting dimension of high attenuation voxels vs. presence of low attenuation voxels, AUC: 0.80, CI: 0.72–0.88 vs. 0.66, CI: 0.58–0.73; P  < 0.001), and NaF18-positivity (surface of high attenuation voxels vs. presence of two high-risk features, AUC: 0.87, CI: 0.82–0.91 vs. 0.65, CI: 0.64–0.66; P  < 0.001). Conclusion Coronary CTA radiomics identified invasive and radionuclide imaging markers of plaque vulnerability with good to excellent diagnostic accuracy, significantly outperforming conventional quantitative and qualitative high-risk plaque features. Coronary CTA radiomics may provide a more accurate tool to identify vulnerable plaques compared with conventional methods. Further larger population studies are warranted. [ABSTRACT FROM AUTHOR]

The publications on morbid anatomy by Matthew Baillie and Samuel Thomas Soemmerring put pathological preparations and images center stage. A comparison between their works highlights major shifts from exceptional to more representative cases and significant differences in the art of representation. Initially Baillie provided careful descriptions of internal postmortem lesions (1793). Then Soemmerring's prompt German translation added a wealth of references to the literature and specifically to pathological images available in print (1794). Soon after a second unillustrated edition incorporating some of Soemmerring's comments (1797), Baillie issued ten installments with dozens of pathological plates (1799-1803). His plates differed from those referred to by Soemmerring for their broader scope, representing common and rare conditions alike, and specific attention to the fine changes of texture of the affected parts. Their works document the crucial status of pathological preparations and images at the time and highlight the achievement of Baillie's work at an artistic as well as at an intellectual level. [ABSTRACT FROM AUTHOR]

Abstract: Trim27 (Zinc finger protein RFP) is a potential regulator of hematopoietic stem cells (HSC), yet its role in hematopoiesis remains elusive. Here, we investigated the roles of Trim27 in hematopoiesis by enforcing its expression in mouse and human hematopoietic stem and progenitor cells (HSPC). Ectopic expression of Trim27 in mouse fetal liver (FL) HSPC confers repopulating advantage with myeloid dominance. However, the number of HSC from Trim27 group was comparable with empty vector control group, indicating that overexpression of Trim27 unlikely expanded HSC. Transcriptome analysis of Trim27‐overexpressing myeloid progenitor cells (MP) indicated that Trim27 up‐regulated essential regulators of myelopoiesis, including Spi1 and Cebpg, up‐regulated myeloid proliferation‐related signaling genes Nras, Runx1, and Cbfb, up‐regulated JAK/STAT signaling inhibitors Socs2, Socs3, and Cish, and up‐regulated myeloid maturation‐related genes Adam8 and Dek. Moreover, the myeloproliferative advantage caused by overexpressing Trim27/TRIM27 is conserved between mouse and human hematopoiesis. To our knowledge, this is the first study showing that Trim27 confers competitive hematopoiesis by promoting myeloid bias differentiation of HSPC, but not by expanding HSC. [ABSTRACT FROM AUTHOR]

Feto-fetal transfusion syndrome (FFTS) severely affects monochorionic (MC) multiple pregnancies and affects 1 in 1600 pregnancies overall. The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS. We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS. Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses, including arterio-arterial anastomosis and arterio-venous anastomosis. These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow. When encountering such challenging conditions, medical practitioners should discreetly compare the fetuses’ characteristics with features of placental blood vessels and consult morphological and pathological findings. Furthermore, they should perform ultrasound examinations, particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS, especially in MC multiple pregnancies with abdominal symptoms. [ABSTRACT FROM PUBLISHER]

In the article, the authors present a case of a 47-year-old male who returned for a second caudal epidural steroid injection (CESI) using a Quinke spinal needle who developed bilateral leg weakness with gait impairments after to discuss the potential risks of CESI. He also suffered bladder incontinence and headache. Also cited is a study on the termination level of the dural sac and anatomical features of the lumdosacral region during CESI.

In a previous study, the oral administration of an Aloe vera whole leaf extract induced dose-related mucosal and goblet cell hyperplasia in the rat colon after 13 weeks and colon cancer after 2 years. The primary goal of this study was to determine whether or not the administration of aloin, a component of the Aloe vera plant leaf, would replicate the pathophysiological effects that were observed in rats in the previous study with an Aloe vera whole leaf extract. Groups of 10 male F344/N rats were administered aloin at 0, 6.95, 13.9, 27.8, 55.7, 111, 223 and 446 mg/kg drinking water for 13 weeks. At the end of study, rat feces were collected and the composition of fecal bacteria was investigated by next generation sequencing of the PCRamplified V3/V4 region of the 16S rRNA gene. At necropsy, blood was collected by cardiac puncture and organs and sections of the large intestine were collected for histopathology. Aloin induced dose-related increased incidences and severities of mucosal and goblet cell hyperplasia that extended from the cecum to the rectum, with increased incidences and severities detected at aloin doses⩾55.7 mg/kg drinking water. Analysis of the 16S rRNA metagenomics sequencing data revealed marked shifts in the structure of the gut microbiota in aloin-treated rats at each taxonomic rank. This study highlights the similarities in effects observed for aloin and the Aloe vera whole leaf extract and points to a potential mechanism of action to explain the observed pathological changes via modulation of the gut microbiota composition. [ABSTRACT FROM AUTHOR]

Imaging of the spine is increasingly available, whether as dedicated spine examinations or as studies that include the spine in the images obtained (e.g. CT abdomen). This pictorial review discusses imaging of the spine with CT and MRI and how prior review of this imaging can be helpful with potentially difficult spinal procedures. Pathologies illustrated include osteoarthritis, scoliosis, inflammatory spondyloarthropathies and post-operative spines. [ABSTRACT FROM AUTHOR]

Objectives. We identify the contrast volumes needed to reach specific landmarks during S1 transforaminal epidural injections (S1-TFEIs). Design. Prospective, nonrandomized, observational human study. Setting. Academic/private pain management practice. Subjects. Forty-two patients undergoing S1-TFEIs were investigated. Thirty-seven patients were included in this study. Interventions. S1-TFEIs were performed using contrast-enhanced fluoroscopic visualization. Main Outcome Measurements. After confirming appropriate spinal needle position, up to 5 mL of nonionic contrast was slowly injected. Under biplanar fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: the ipsilateral S1 pedicle, the superior aspect of the L5-S1 disc space, and across the midline of the spinous process. Results. After injecting 2 mL of contrast, 100% of S1-TFEIs spread to the medial aspect of the ipsilateral superior pedicle of S1. After injecting 3.0 mL of contrast, 92% of S1-TFEIs spread to the superior aspect of the L5-S1 intervertebral disc. After injecting 4 mL of contrast, 27% of S1-TFEIs spread beyond the midline of the spinous process, but by only a few millimeters. Conclusions. This study demonstrates injectate volumes needed to reach specific anatomic landmarks in S1-TFEIs. A volume of 3.0 mL of contrast reaches the superior aspect of the L5-S1 intervertebral disc 92% of the time. [ABSTRACT FROM AUTHOR]

We compared the performance of the basophil count of 3 hematology instruments with a flow cytometric method (FCM) in which CD123 and CD193 were used as basophil markers. By analyzing 112 patient samples, we found the ADVIA 120 (Siemens Healthcare Diagnostics, Deerfield, IL) and CELL-DYN Sapphire (Abbott Diagnostics, Santa Clara, CA) to underestimate the number of basophils by approximately 50% and the Sysmex XE-2100 (Sysmex, Kobe, Japan) and ADVIA to overestimate the basophil count in some samples with pathologic leukocytes. All 3 instruments had large (25%-50%) analytic within-run coefficients of variation. Compared with the FCM, we found a relatively good correlation for the CELL-DYN basophil count (r = 0.81), an intermediate correlation for the Sysmex (r = 0.64), and a poor correlation for the ADVIA (r = 0.24). When excluding the 52 samples flagged for the presence of pathologic leukocytes, these correlations were found to be 0.84, 0.90, and 0.57, respectively. The basophil count of the 3 instruments is, at least presently, of unsatisfactory quality. [ABSTRACT FROM AUTHOR]

The type specimen of Stratiotosuchus maxhechti (DGM 1477-R), a baurusuchid mesoeucrocodylian from the Bauru Basin (Upper Cretaceous of Brazil) displays some abnormalities that are here described. The holotype was examined macroscopically and compared with other skeletal elements of S. maxhechti and Baurusuchus salgadoensis (UFRJ DG 288-R). After this analysis, the elements with signs of alterations were subjected to a computed tomography (CT) scan exam which gave more information about them. The medial and proximal thirds of the right metacarpal V show an extensive bone growth, which modified the normal form of this element. The left metatarsals I and II exhibit an abnormal bone callus covering part of the medial third of the distal end. Based on their morphology these features are regarded as the result of two injuries of distinct natures. In the right metacarpal V, the presence of a large bone callus and a fracture, with two possible causes: post-traumatic infection or tumour. In the metatarsal I and II a case of stress fracture with a marked bone callus. Additionally, insect boring marks in the left ulna and right and left tibia of the same specimen were observed, which could be confused with pathologies. These bone changes may provide additional clues about the palaeoenvironment, such as habitat conditions, in which the specimen studied here lived. © 2011 The Linnean Society of London, Zoological Journal of the Linnean Society, 2011, 163, S140-S151. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including prognostic implications of ‘vasa vasorum' (VV) in plaque volume (PV) progression, virtual histology(VH), and atherosclerosis progression.

The article focuses on the origination and development of primary biliary cirrhosis (PBC). It discusses the pathogenesis of PBC, a chronic cholestatic liver disease affecting the biliary epithelial cells lining small intrahepatic bile ducts. It discusses the pathological factors in PBC from an immune system perspective, from a target cell perspective and environmental and genetic factors.

Background: Impaired artery elasticity has been found in various pathological conditions related to endothelial dysfunction. Recently, CD31+/CD42− microparticles (MPs) emerged as a marker of endothelial injury. Whether CD31+/CD42− MPs, generated under physiological conditions, are correlated with artery properties has not been reported. Methods: We evaluated brachia–ankle pulse-wave velocity (baPWV) (n = 76) and C1 large-artery and C2 small-artery elasticity indices (n = 56), using noninvasive devices for pulse-wave analysis in a group of healthy persons. The number of circulating CD31+/CD427− MPs (n = 76) was measured by flow cytometric analysis. Results: Circulating CD31+/CD42− MPs were positively correlated with values of baPWV (r = 0.371, P = .008) and with C1 large-artery and C2 small-artery elasticity indices (r = −0.294, P = .037; and r = −0.310, P = .027, respectively). Multivariate analysis identified CD31+/CD42− MPs as potent contributors to the development of impaired systemic artery elasticity. Conclusions: The level of circulating CD31+/CD42− MPs, an important biomarker of dysfunctional endothelium and vascular injury, is closely associated with impaired systemic artery elasticity in healthy subjects. The present study suggests that CD31+/CD42− MPs may be a novel surrogate marker for the clinical evaluation of vascular damage. [Copyright &y& Elsevier]

Background Matrilysin (MMP-7), a member of the matrix metalloproteinase (MMP) family of proteins, is expressed in various types of malignant tumours. There have been no previous studies of the correlation between matrilysin expression and melanoma. Objectives Protein expression of matrilysin was evaluated in human cutaneous melanomas, metastatic melanomas, acquired common melanocytic naevi and Spitz naevi, and the data were corrected with the clinicopathological factors. Methods We retrospectively investigated 18 primary melanomas, 15 metastatic melanomas, 10 common melanocytic naevi and five Spitz naevi samples at our clinic using immunohistochemistry (IHC). Both promatrilysin and active matrilysin were found in the melanoma tissue extracts by Western immunoblotting. In situ hybridization demonstrated that melanoma cells selectively express matrilysin mRNA. Results Of the melanoma samples, 29 of 33 (87·9%) were positive for matrilysin, including 14 of 18 (77·8%) primary cutaneous melanomas and 15 of 15 (100%) metastatic melanomas. In contrast, matrilysin was not expressed in common naevi or Spitz naevi. The matrilysin IHC staining score in primary melanomas was associated with the presence of metastases, tumour thickness and TNM staging ( P = 0·001, 0·025 and 0·021, respectively). The 5-year overall survival was 26·3% for matrilysin-positive cases and 100% for matrilysin-negative cases among melanoma specimen. Conclusions We found matrilysin expression in primary melanomas and in metastatic melanomas. We further demonstrated that the matrilysin IHC staining score was associated with invasive depth of primary melanoma lesions and metastases. Our observations indicate that matrilysin may be associated with melanoma progression, and may enhance melanoma tumour cell invasion. Therefore, matrilysin may be potentially valuable as a prognostic indicator to predict the clinical behaviour of melanoma. [ABSTRACT FROM AUTHOR]

The article focuses on the validation of the processes involved in the quantification of cocaine, benzoylecgonine, and cocaethylene in the pericardial fluid. The method requires the collection of pericardial fluid samples from an autopsy welfare work made for cocaine-related deaths. The dry extracts were then derivatized and were analyzed through gas chromatography. Moreover, it states that the procedure has been accomplished in several forensic cases related to cocaine intoxication.

Background. Surveillance for Creutzfeldt-Jakob disease (CJD) in the United States has become a focus of public health attention due to concerns about disease acquired through exposure to transmissible spongiform encephalopathy in other species. A definitive diagnosis requires neuropathologic examination, yet concerns about the invasiveness of procedures and infection control may be barriers to brain biopsy or autopsy in patients with suspected CJD. Methods. We reviewed medical records of 50 of the 97 patients identified through the Massachusetts Department of Public Health CJD surveillance system for 1991-2001 and of an additional 21 patients in whom CJD was suspected but later ruled out. Results. Of the 50 patients, brain biopsy was performed on 14 (28%), brain biopsy or autopsy was performed on 27 (54%), and brain biopsy and autopsy were performed on 4 (8%). Brain biopsy or autopsy was declined for an additional 7 patients (14%) by family or health care proxy. The proportion of patients on whom brain biopsy was performed was inversely correlated with age, with only 9 (21%) of the 43 patients >60 years old having brain tissue diagnosis. Brain biopsy was performed on patients in whom CJD was suspected but ruled out somewhat less often than it was for patients with confirmed CJD (4 [19%] of 21 patients vs. 7 [23%] of 30 patients, respectively; P = .71). Conclusion. The majority of patients with CJD-related death whose medical records were available had a brain biopsy or autopsy performed or requested (34 [68%] of 50 patients). [ABSTRACT FROM AUTHOR]

Determines whether the analysis of a variety of postmortem biological specimens would aid in the toxicological interpretation of quetiapine in the cause and manner of death determinations. Examination of the postmortem quetiapine concentrations in medical examiner cases; Analysis of specimens; Estimation of quetiapine concentrations indicative of toxicity.

Presents the case of a 34-year-old white male who was found dead at home by his roommate. Drugs being administered at the time of his death; Details on the cause and manner of death; Observation of the fluid and tissue distribution of tramadol, amitriptyline, and their metabolites in an acutely fatal ingestion.

Presents a study investigating the postmortem distribution of sildenafil in biological fluids and tissues. Analysis of the quantitation of sildenafil in blood samples; Difference in the quantitative values of sildenafil in fixed tissues and at the autopsy; Stability and concentration level of the drug in biological specimens.

The article discusses the autopsy findings from 111 deaths in the 1999 Athens earthquake as a basis for auditing the emergency response. Background on the subject examined; Methods used in the study; Results of the study conducted.

Exogenous treatment with L-arginine has been shown to restore impaired nitric oxide synthase (NOS)-dependent dilatation of peripheral blood vessels during disease states. We have shown that nicotine impairs NOS-dependent arteriolar dilatation in the cerebral circulation. However, the role of L-arginine in impaired responses of cerebral arterioles during infusion of nicotine has not been examined. Thus the goal of the present study was to examine the role of L-arginine in nicotine-induced impairment of cerebral arteriolar reactivity. We measured the diameter of pial arterioles in response to NOS-dependent (5'-adenosine diphosphate [ADP] and acetylcholine) and NOS-independent (nitroglycerin) agonists before and after infusion of vehicle or nicotine (2 microg/kg/min intravenously for 30 min followed by a maintenance dose of 0.35 microg/kg/min) in the absence or presence of L-arginine (10(-3) M). We found that topical application of L-arginine to cerebral microvessels during infusion of nicotine could prevent impaired NOS-dependent vasodilatation. We suggest that exogenous L-arginine may have a beneficial role in preventing cerebral microvascular dysfunction during exposure to nicotine. [ABSTRACT FROM AUTHOR]

Thymic tissue obtained at autopsy from 123 victims of sudden death, ranging from neonates to individuals older than 80 years and predominantly male, was studied with histometric techniques, i.e. a combination of test point analysis and planimetry on unit optical fields. The pattern of 'natural' age-dependent involution of the thymic cortex was examined using computerized mathematical models. The range of variations of results was greatest in children and young adults, followed by the very old, then the middle age group. In a first approximation, regression for thymic cortical volume in individuals older than 15 years corresponded better lo a negative exponential than to a negative linear function of age. Best fits for the data suggest at least a two-component negative exponential function of age, with a steeper slope of the regression for individuals beyond the age of 30 years. Extrapolation on a log-normal plot of regression lines for thymic cortical involution points to near-zero values at an age range below the estimated maximum human life span, corresponding to the steepest slope of survival curves in Western Europe. [ABSTRACT FROM AUTHOR]

The microcytotoxicity assay has been used to study human maternal cell-mediated immunity against foetal lung cells derived from foetal autopsies and amnion cells from lull-term deliveries. Cytotoxicity against semi-allogeneic foetal lung cells but not against adult skin fibroblasts was detected in fourteen cases. No cytotoxicity was detected in six mothers tested during the first 15 weeks of gestation whereas 58% of mothers in the 15-17 weeks of gestation (twelve cases) and 88% with more advanced pregnancies (eight cases) were specifically cytotoxic. Cross-reactions against allogeneic foetal lung cells were mainly produced by effector cells from patients with 16-17-week-old pregnancies. No cytotoxicity was detected against semi-allogeneic amnion cells by effector cells from mothers after full-term deliveries. Cytotoxicity was blocked by autologous post-abortum sera in two out of seven cases. The effect of autologous post-abortum sera on non-cytotoxic effector cells was nonspecifically arming in four out often cases. [ABSTRACT FROM AUTHOR]

Quantitative studies of the effects of defibrination (with ancrod) have been undertaken in two forms of allergic glomerular damage, nephrotoxic serum nephritis and acute serum sickness in rabbits. No differences in intrarenal fixation of nephrotoxic antibody, complement activation or host antibody response were detected between defibrinated and untreated rabbits with nephrotoxic serum nephritis. Defibrination prevented intraglomerular fibrin deposition in this disease; but some glomerular damage as shown by a rise in blood urea and endothelial proliferation still occurred in defibrinated animals. No differences in immune elimination of BSA, circulating immune complex formation or intrarenal localization of immune complexes were noted in defibrinated animals with acute serum sickness. No intraglomerular fibrin deposition was detected in treated or untreated animals in this disease model. It is concluded that the protective effects of ancrod are directly related to defibrination, and not to any other modification of allergic events. [ABSTRACT FROM AUTHOR]

The article presents a study which characterizes the variabilities in nasal airway (NA) dimensions among adults. The procedure of the anatomical study conducted among non-smoking adults with no notable nasal airway disease of structural pathology is described. It highlights the significant relationships between subject height and dorsoventral head width for total NA volume and surface area. The unequal partitioning of airflow between the right and left NAs is noted.

Sweat glands from normal skin obtained at autopsy or as routine biopsies were examined using a panel of immunoperoxidase-linked antibodies. The results indicate that such a panel of antibodies defines all known functional regions of the eccrine sweat gland and provides a reliable distinction from all other skin elements. [ABSTRACT FROM AUTHOR]

The transmission of optical radiation in the wavelength range 300-600 nm through thirteen human toenails obtained at autopsy was examined. The total transmitted radiation at fifteen different wavelengths was measured using an irradiation monochromator in conjunction with an integrating sphere and photodiode. A correction was included for fluorescence radiation from the nails. The nails exhibited decreasing transmission of optical radiation in the wavelength region 600-300 nm. These findings may be helpful in the understanding of photo-onycholytic reactions and in the design of suitable regimens for the treatment of psoriatic nail changes. [ABSTRACT FROM AUTHOR]

Reports on the donation of Sir William James Erasmus Wilson to the University of Aberdeen in Aberdeen, Scotland to found and endow a Chair of Pathological Anatomy. Persuasion of William Pirrie for Wilson's donation; Disappointment of the first holder of the newly founded Chair of Pathology, David James Hamilton, over the only chair of pathology in Great Britain; Comparison of the personality of Wilson and Alexander Ogston.

We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage. [ABSTRACT FROM PUBLISHER]

A study of the finger nail of 87 consecutive autopsies was undertaken. The histological changes observed in finger clubbing, ridging, leuconychia, subungual haemorrhages and transverse white bands are described. No new association between systemic disease and finger nail changes was noted. [ABSTRACT FROM AUTHOR]

A macroscopic and microscopic study of 87 consecutive autopsies was undertaken. The normal histology is described, using as controls material from 3 healthy young subjects all of whom died suddenly after an accident. [ABSTRACT FROM AUTHOR]

A patient with toxic epidermal necrolysis is described. Bronchopneumonia due to Aspergillus fumigatus was found at autopsy. [ABSTRACT FROM AUTHOR]

A case of systemic lupus erythematosus is described which displayed the typical skin lesions of this disease and also multiple skin nodules and swellings, combined with ascites, polyserositis and general lymphadenopathy. Post- mortem examination revealed visceral lesions which conformed to those described by Libman and Sacks (1924), Baehr, Klemperer and Schifrin (1935), and Klemperer, Pollack and Baehr (1941). [ABSTRACT FROM AUTHOR]

The article offers information on microbial heat resistance and its effect when applied with acidic and alkalinic substances. According to a study conducted by Henry Charlton Bastian, Professor of Pathological Anatomy at the University College in London, England, that 100 degres centigrade is enough to subdue to most of the microbial germs and through his experimentation by boiling urine for about 100 degrees, his hypothesis was supported by his experiment that most of the microbial germs can no longer withstand the heat for about 100 degrees, thus their resiliency have limitation.

The article informs that the automobiles to human corneal epithelium were demonstrated by the immunofluorescent technique in the serum of a patient suffering from ulcus rodens corneae. Biopsy-tissue from the cornea of a patient with ulcus rodens corneae was obtained during lamellar keratoplasty. Normal human cornea was obtained from two subjects at autopsy as soon as possible, but no more than 8 hr, after death. The immunoglobulin class to which the antibodies belonged was determined by a three-stage technique involving subsequent incubation of corneal tissue with the serum under test, rabbit antisera directed against human IgG, IgM or IgA, and a fluorescent horse anntirabbit Ig reagent.