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Background Despite controversial evidence, intra-aortic balloon pump (IABP) is still the most used temporary mechanical support in cardiogenic shock (CS), as a bridge to recovery or to more advanced mechanical support and/or heart transplantation [1]. Indeed, the available evidence, which is mainly restricted to the context of acute coronary syndromes (ACS) and is limited by the variability of CS definitions, shows no benefit in terms of mortality [2]. Randomized controlled trials on IABP in the setting of non-ACS CS are still missing. As a result, European guidelines do not recommend the routine use of IABP, which may be considered in refractory CS [3]. Purpose The aim of our study was to analyse the use of IABP in the context of CS, providing insights into its indications, outcomes, and complications in relation to the aetiology (ACS vs non-ACS) of CS. Methods We retrospectively enrolled all consecutive adult patients receiving IABP for refractory CS at our tertiary referral Hospital between 2009 and 2018, and analysed data focusing on in-hospital outcomes, including death, recovery, heart transplantation, and escalation to more advanced mechanical support such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or left ventricular assist device (LVAD), and on IABP-related complications. Results 403 patients received IABP, 75.2% (n=303) for ACS CS and 24.8% (n=100) for non-ACS CS. With respect to ACS patients, non-ACS patients were younger (age 59±18.3 vs 73.1±12.6 years old, p0.05]. The incidence of IABP-related overall and major complications (including ischemic stroke, major bleeding, and peripheral or visceral ischemia) was not different with respect to the non-ACS vs ACS aetiology [major complications: 8.0% (n=8) vs 5.0% (n=15), p>0.05]. Conclusions In our experience, in the clinical setting of CS treated with IABP, non-ACS patients show a worse clinical profile and prognosis than ACS patients, and more often require escalation to more advanced mechanical support and/or heart transplantation, while the incidence of IABP-related complications appears similar independently of the aetiology. Funding Acknowledgement Type of funding sources: None.

In order to elucidate the ultrastructural dynamics of endometrium differentiation, uterine samples of fetuses aged 14 to 22 weeks of gestation (WG) were analyzed. Samples were processed for light (LM), transmission (TEM) and field-emission scanning electron microscopy (FE-SEM). Initial stratification of the uterine wall occurred at 14 WG: endometrial, myometrial, and perimetrial primordia were identified. At this age, the endometrial epithelium was simple columnar to pseudostratified and consisted of microvillous cells. Blood capillaries developed mainly in the stroma and between the myometrium and perimetrium primordia. At 18-20 WG the endometrial epithelium became clearly pseudostratified, with active ciliogenesis and a predominance of microvillous cells. Primordia of tubular glands were present at 20 WG. Microvillous cells still predominated in the endometrial epithelium at 21-22 WG and showed morphological features of apoptosis. The endometrial stroma at this stage was organizing into a thick lamina propria provided with subepithelial capillary plexuses. However, the stroma was formed by still undifferentiated mesenchymal cells during the whole period of study. Our data showed that the epithelial differentiation and distribution in the uterus occur in the human fetus in a similar way as in the adult. The above events are likely the expression of an early developmental patterning and related to future reproductive processes, such as the regulation of gamete passage and blastocyst implantation. Because the structure of the adult uterus is determined by the degree of paramesonephric duct fusion, septum absorption, and differentiation of the uterine primordial layers, our study may contribute toward clarifying to normal urogenital development.

Many of the treatment strategies for sigmoid diverticulitis are actually focusing on nonoperative and minimally invasive approaches. The aim of this systematic review was to evaluate the actual role of damage control surgery (DCS) in the treatment of generalized peritonitis caused by perforated sigmoid diverticulitis. A literature search was performed in PubMed and Google Scholar for articles published from 1960 to July 2013. Comparative and noncomparative studies that included patients who underwent DCS for complicated diverticulitis were considered. Acute Physiology and Chronic Health Evaluation score, duration of open abdomen, intensive care unit length of stay, reoperation, bowel resection performed at first operation, fecal diversion, method, and timing of closure of abdominal wall were the main outcomes of interest. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm for the literature search and review, 10 studies were included in this systematic review. DCS was exclusively performed in diverticulitis patients with septic shock or requiring vasopressors intraoperatively. Two surgical different approaches were highlighted: limited resection of the diseased colonic segment with or without stoma or reconstruction in situ, and laparoscopic washing and drainage without colonic resection. Despite the heterogeneity of patient groups, clinical settings, and interventions included in this review, DCS appears to be a promising strategy for the treatment of Hinchey III and IV diverticulitis, complicated by septic shock. A tailored approach to each patient seems to be appropriate. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Perinatal asphyxia is attributed to hypoxia and/or ischemia around the time of birth and may lead to multiorgan dysfunction. Aim of this research article is to investigate whether different metabolomic profiles occurred according to oxygen concentration administered at resuscitation. In order to perform the experiment, forty newborn piglets were subjected to normocapnic hypoxia and reoxygenation and were randomly allocated in 4 groups resuscitated with different oxygen concentrations, 18%, 21%, 40%, and 100%, respectively. Urine metabolic profiles at baseline and at hypoxia were analysed by 1H-NMR spectroscopy and metabolites were also identified by multivariate statistical analysis. Metabolic pathways associations were also built up by ingenuity pathway analysis (IPA). Bioinformatics analysis of metabolites characterized the effect of metabolism in the 4 groups; it showed that the 21% of oxygen is the most "physiological" and appropriate concentration to be used for resuscitation. Our data indicate that resuscitation with 21% of oxygen seems to be optimal in terms of survival, rapidity of resuscitation, and metabolic profile in the present animal model. These findings need to be confirmed with metabolomics in human and, if so, the knowledge of the perinatal asphyxia condition may significantly improve. © 2014 V. Fanos et al.

The peritoneal fossae are usually related to rotation and adhesion of the abdominal viscera to the posterior abdominal wall during fetal development, and/or the presence of retroperitoneal vessels running just under the peritoneum and raising serosal folds. These fossae, therefore, are regarded as congenital and have been considered clinically and surgically as sites of internal abdominal hernias. The authors describe a peritoneal fossa interposed between the fourth portion of the duodenum and the abdominal aorta. Due to a scoliosis of the lumbar column, the abdominal aorta had shifted to the left of the duodenum, stretching two semilunar avascular peritoneal folds connecting the vessel with the ascending duodenum. These two folds bounded above and below an entrance into a fossa lined by the posterior parietal peritoneum and bordered by the fourth portion of the duodenum on the right and the aorta on the left. This recess extended as far as the anterior surface of the second and third lumbar vertebrae. On the basis of the anatomic findings, the authors suggest that acquired fossae, because of their size and topography, may play a part in the etiopathogenesis of internal abdominal hernias.

Supernumerary ossicles (or Wormian bones) of the cranial vault are formations associated with insufficient rate of suture closure, and regarded as "epigenetic" and "hypostotic" traits. These bones rest along sutures and/or fill fontanelles of the neonatal skull. In this autoptic report of a 66-year-old Caucasian woman, a peculiar supernumerary bone is described, unusual size and shape, filling completely the bregmatic fontanelle. The skull was CT-scanned through coronal sections at 80 kV and 60 mA, with a slice thickness of 1.0 mm and a resolution of 0.35 mm/pixel. Segmentation and 3D rendering were computed using MIMICS 7.0 (digital endocast). The bone was pentagonal and remarkably large, more on the exocranial surface than on the endocranial one, involving both tables and diploe of the vault. This feature might represent a wedge to completion of the vault architecture. Considering the functional and structural matrix of cranial morphogenesis, this case displays the possibility of discrete diversification of the ossification centres, as well as the relative stability of the structural skull matrix in response to discrete changes.

Peritoneal fossae derive from normal or anomalous coalescence of the peritoneum during fetal development, or from the course of retroperitoneal vessels. Clinically, internal abdominal hernias may be housed inside these fossae. In this report from an autopsy, a singular peritoneal fossa was delimited superiorly by an arcuate serous fold, raised up by the inferior mesenteric vein, and infero-posteriorly by two (right and left) avascular folds, extending from the abdominal aorta to the jejunum. The right fold reached the duodeno-jejunal flexure, which was located on the right side of the aorta. The left fold subdivided into two, anterior and posterior, secondary folds. The anterior fold reached the superior edge of the first jejunal loop, and the posterior fold turned medially to connect with the inferior edge of the proximal limb of the same loop. This fossa consisted of three recesses: superior, Located behind the subserous vascular arch, antero-inferior and postero-inferior, separated by interposition of the left posterior secondary fold, between the jejunum and aorta. The complex arrangement of this fossa suggests that it might have originated from a coalescence arising beyond the duodeno-jejunal flexure and including the first jejunal loop, and from the subserous course of the inferior mesenteric vein. Because of displacement to the right of the flexure, processes of coalescence in a location normally occupied by the ascending duodenum might have occurred in a similar pattern for the jejunum, involving the mesoduodenum and the proximal part of the mesentery. Labyrinthine fossae like this might cause strangulation of internal abdominal hernias and hinder intraoperative maneuvers.

After dissection of the abdominal cavity of a 59-year-old male, a long artery, extending from the hepatic artery to the transverse colon, and comprised proximally within the neck of the pancreas and distally within the transverse mesocolon, has been detected. This "pancreato-colic" artery (P-C A) was 13 cm in length and 4 mm in diameter at the origin. Its mesocolic part (2.5 mm in diameter) contributed to the formation of the marginal arcade. No middle colic artery from the superior mesenteric was observed. Thus, the transverse colon was supplied by the distal part of the P-C A. Considering both the P-C A caliber and topography, attention should be paid during pancreatic resections and in the interposition of the transverse colon for esophageal replacement in order to avoid serious bleeding and necrosis. Embryologically, the proximal part of the P-C A might be regarded as an intrapancreatic variant of the tract of the longitudinal anastomosis between the ventral segmental arteries, persisting in the adult as dorsal pancreatic artery. Different from its usual retropancreatic location, this part might be entrapped inside the gland by the developing primitive pancreatic anlages. The distal, mesocolic, part of the P-C A might be regarded as a replacing middle colic artery into the dorsal mesentery during midgut rotation.

In order to understand the 3-D distribution of collagen in relation to vascularization, chorionic villi of human placentae, belonging to normal pregnancies at term, were studied by scanning electron microscopy (SEM) after alkali maceration techniques, and by transmission electron microscopy (TEM). The villous tree appeared made of an uninterrupted structure of collagen fibres. The collagen fibres connected the chorionic villi axis with their basal plates and organised differently according to the various levels of villous branching. The collagen of stem villi showed copious fibres. The external fibres (facing the villous surface) were arranged mainly longitudinally. The central core of the villi (inner fibres) were arranged concentrically around the wall of the fetal vessels. Both external and internal fibres formed stratified lamellae or small parallel bundles. The inner core of stem villi showed small holes housing capillary spaces. Mature intermediate and terminal villi showed a scarce amount of collagen arranged in thin concentric layer within the villous core, surrounding numerous dilated capillary and sinusoid spaces.These observations demonstrated that the extracellular matrix of human chorionic villi is highly compartmentalised and shows a variable structural 3-D distribution depending on the branching level of the villous tree, such a distribution ensures the most favourable microenvironment for feto-maternal exchanges and it is likely able to provide a modulated support to the developing chorionic fetal vessels and trophoblastic layer as well.

The lateral costal artery (LCA), a supernumerary branch of the internal thoracic artery (ITA), occurs in several ethnic groups on one side of the thorax or on both, in 15–30% of cases. It has been considered responsible for the “steal-syndrome” of the coronary blood after coronary artery bypass grafting and it used occasionally for myocardial revascularization. To clarify its functional significance, an interpretation based on our findings and human and comparative anatomy and embryology has been attempted. We report on a case where a right LCA of about 2 mm in caliber, rising from the ITA 2.5 cm below the subclavian, coursed as far as the 4th intercostal space for a distance of 13 cm after the anterior axillary line. Anastomosing with the intercostal arteries, it can act as a blood derivative circuit of the thoracic wall. Embryologically, this artery, like the normal parietal arteries of the trunk, might form a longitudinal channel connecting the intersegmental arteries. In mammals having a thoracic cage transversely restricted (quadrupeds), the ITA is more lateral than in primates having a circular thorax, and gives off a ventral branch toward the sternum. It might be hypothesized that the sternal branch occurring in quadrupeds, undergoing adaptation to the thoracic shape of primates, may become the main trunk of the ITA, whereas the LCA may be the remnant of the ITA of quadrupeds. Because the LCA ran partly along the “milk line” of humans, it might be regarded as a supernumerary mammary artery. Clin. Anat. 17: 218 –226, 2004. © 2004 Wiley-Liss, Inc.

A bilateral anomalous extended origin of the soleus muscle was observed in a 73-year-old female cadaver. It arose from the head, neck, and proximal two-thirds of the medial crest of the fibula and ran through the posterior intermuscular septum of the leg, from the lateral border of the fibula. The soleus muscle formed the vault of a muscular tunnel, overcoming the deep flexor muscles of the leg that was about 15 cm in length and directed inferiorly and laterally. The extended fibular origin delimited a blind recess lateral to the muscular tunnel and parallel to the posterior surface of the fibula. This recess measured 6.5 cm in length and extended 3.5 cm above the inferior opening of the muscular tunnel; the superior portion of the flexor hallucis longus was housed within it between the portions of the extended origin from the medial crest of the fibula and posterior intermuscular septum. The neurovascular bundle of the posterior leg coursed in the muscular tunnel. The tibial origin and calcaneal insertion of the soleus muscle were normal. Phylogenetic studies of the muscles of the lower limbs in mammals indicate that the fibular origin of soleus is more constant than the tibial origin and, in primates, the fibular origin is the only one observed in most monkeys. The case reported might be considered a conspicuous enlargement of the fibular origin observed in primates. This large fibular origin of the soleus muscle may prove to be a difficulty during surgery when accessing the proximal two-thirds of the fibula for ligation of the peroneal artery. Clin. Anat. 16:383–388, 2003. © 2003 Wiley-Liss, Inc.

The Authors report their experience with 25 patients operated for colorectal junction neoplasms from January 1998 to December 2002 in the Section of Oncological Surgery, at Perugia University. According to the international literature, the Authors maintain the absolute functional and anatomical individuality of this part of the large bowel, underlining the peculiarity of the sigmoidal junction neoplasms respect all the others colic sites regarding clinical manifestations, symptoms developing and biological behaviour. The characteristics seem also capable of changing the surgical choice as well as the prognosis of the disease.

An unusual case of bifurcation of the left superior pulmonary vein (LSPV) just before it enters the pericardium is described. The LSPV, which at the hilus of the lung originated from normal confluence of a superior and inferior root, bifurcated near the left atrium (LAt) of the heart into anterior (AB) and posterior (PB) branches that, separately invaginating the parietal pericardium, formed two individual serous sheaths. The PB coursed almost horizontally and opened, as usual, into the supero-dorsal wall of the LAt. The AB turned downward, reached the superior margin of the left auricle (LAu) and emptied into it. Thus, the AB was interposed between the pulmonary trunk and the LAt, obstructing on the left side the communication between the transverse sinus of the pericardium and the pericardial cavity. The auricular opening of the AB was avalvular, but, unlike those of the normal pulmonary veins (PVs) which are surrounded by a large smooth inner surface, was, except for a narrow smooth-walled zone, close to the pectinate muscles. Moreover, an inferior muscular ridge at the inferior margin of its orifice of entrance into the LAu, separated it from the cavity of the LAt. It is well known that in development the PVs arise from convergence of capillaries belonging to the mediastinal part of the primitive splanchnic plexus and drain this into the systemic (cardinal and vitello-umbilical) veins of the embryo. As a consequence, it might be hypothesized that the AB of the LSPV probably represents a partial remnant either of a pulmonary-cardinal anastomotic mediastinal vein, or of a diverging vessel of the mediastinal plexus from which the PVs originate. In either case the AB became absorbed by the LAu, which, while it was developing on the left side of the primitive truncus arteriosus, drew the AB forward and downward, in the direction of its movement. The influence of such an anomaly of the PVs for altered intracardiac hemodynamics of the oxygenated blood flow has to be emphasized. Furthermore, the particular location of the AB, obstructing the communication between transverse sinus and pericardial cavity, can be a hindrance during cardio-pulmonary surgery.

To clarify the differentiation of the human uterine cervix, fetuses of the 12th, 15th, 18th, 20th, 21st, 22nd, and 31st postmenstrual week were studied by Scanning Electron Microscopy. At the 12th week the endocervical epithelium consisted of microvillous cells, often showing single cilia and anlages of tubular glands. At the 15th week the cervical canal was entirely formed and its surface cells appeared columnar. At the 18th week these cells were replaced by flat or slightly raised cells, provided with thin microplicae. At the 20th week the endocervical epithelium appeared pseudostratified with higher, apically-convex and shorter basal cells; glands developed in form of tubular invaginations of the luminal epithelium. At the 21st week in the lower part of the endocervix polymorphic, globose cells with short and stubby microvilli and others elongated, having short microplicae, were observed. These latter likely corresponded to the so-called columnar cells undergoing squamous metaplasia. Among microvillous and/or metaplastic cells, a number of apoptotic cells, as globose elements with a ruffled and invaginated surface, were also noted. At the 22nd week evident plicae palmatae were found, covered by microvillous secreting cells. These showed smooth bulged apices releasing droplets by a "micro-apocrine" mechanism. These features increased at the 31st week, when many droplets were noted also around the mouth of the cervical glands. Only at this phase of development fully ciliated cells were found often contacting secretory material. Mature squamous exfoliating cells with complex microplicae covered an hypertrophied portio vaginalis. The squamous cells extended toward a squamo-columnar junction in form of flat, tongue-like projections. Their tips consisted of immature squamous metaplastic cells, which were endocervical columnar progressively becoming elongated elements, exhibiting short microvilli. The above features are rather similar to those occurring during the adult reproductive age. Therefore, it might be hypothesized that, during pregnancy, a common gestational hormonal background may induce somewhat similar morpho-dynamic processes in the cells and tissues of the fetal reproductive tract mimicking what occurs in the adult female.

The development of human fetal cervix has been systematically studied by SEM, obtaining a detailed map of its fine structure, particularly concerning the differentiation and maturation of the endocervical epithelium, including its "eversion" and "squamous metaplasia", normally occurring in postnatal life, but not yet observed in detail by electron microscopy in the fetus. Cervices from spontaneous abortion at 12, 15, 18, 20, 21 and 22 weeks and from intrauterine fetal death (hydrocephalus) at 31 weeks of development have been examined. At 12-15 weeks, as the canalization of the cervix proceeded, the endocervical epithelium consisted of high polyhedral cells, with regularly flattened or concave apices exhibiting scarce microvilli and often single primary cilia. Some narrow intercellular infoldings probably corresponded to primordial tubular glands. At the 18th week the epithelium was made up of a mosaic of flat or slightly raised polygonal cells, whose apical surface showed thin microplicae. At the 20th week a pseudostratified epithelium with many apically convex cells lined the cervical canal and the tubular glands. At 21 and 22 weeks "plicae palmatae" developed, covered by cells, often showing a smooth central area surrounded by microvilli, provided with a primary cilium and swollen by secretory material. This also formed rounded masses on the epithelium. In the lower part of the endocervix some very elongated cells showed short microplicae resulting from fusion of microvilli. At the 31st week secretion increased and its products spreading from the bottom of the glands contacted isolated ciliated cells at their openings and diffusely covered the surface epithelium. Most of the ectocervix exhibited squamous elements, with well-developed labyrinthine microplicae. These cells could overlap each other and also desquamate. The zone of the portio vaginalis around the os of the cervical canal appeared infolded and hypertrophic. Here, an indented squamo-columnar junction between the ectocervical and endocervical epithelium, caused by tongue-like prolongations of squamous epithelium directed toward the endocervix, was found. Their tips consisted of elongated cells, rich only in short microvilli. Our data indicate that the features of the microvillous cells are an expression of a hormone-dependent differentiative process. Thus, their secretion might be stimulated by progesterone. Similarly microplicae on the ectocervical epithelium (a sign of squamous maturation) might be promoted by estrogens. Furthermore, two aspects were significative: 1) the finding--in an early phase only (18th week)--of endocervically-located squamous cells, although devoid of microplicae; and 2) the occurrence--in the latest phase (31st week)--of an indented squamo-columnar junction on the surface of the portio. These features are in agreement with the caudal shift of the squamo-columnar junction near the uterine cavity to the ectocervix after cervico-vaginal demarcation; the squamous metaplasia of this everted endocervical epithelium has been reported by some authors. It is likely that these processes, occurring in fetal life as well as in pregnant women, are related to a common hormonal background, arising from the mother to her fetus.

Summary During the dissection of an 83 year-old male cadaver, we observed that the left renal vein passed behind the aorta to follow an oblique course before draining into the inferior vena cava. The left renal vein was connected to the left suprarenal, spermatic, lumbar ascending and azygos veins. The left spermatic vein, after collecting the suprarenal vein, crossed in front of the abdominal aorta to reach the inferior vena cava directly. Furthermore, the arterial pedicle of the left kidney was composed of two tortuous and intermingled vessels. Variations in the number and arrangement of the vessels terminating in the renal veins are not uncommon, but so complex a vascular arrangement as this has not to our knowledge been previously described. The ontogenetic explanation and clinico-surgical implications of such a variation are reviewed and discussed.

Purpose Recent data raised concerns regarding the safety of everolimus (EVR) in the early post-operative period in de novo heart transplant (HT) recipients. Thus, we felt appropriate performing an unplanned interim analysis of the first 100 patients (out of 194 planned) completing the multicenter randomized study EVERHEART (NCT01017029), which compares early vs. delayed EVR strategies in de novo HT recipients. Methods and Materials The study was designed to assess the incidence of a safety composite endpoint (pleural/pericardial effusions, wound healing delay, and acute renal failure) over a 6-month period in patients randomized to receive EVR 1-5 days vs. 4-6 weeks after HT. EVR was started at 0.5-1.5 mg daily dose, targeting 3-8 ng/ml through levels. Delayed arm received mycophenolate (MMF) as a bridge to EVR. Study was powered hypothesizing a 60% rate of the endpoint in the early arm vs. 40% in the delayed arm. Results 49 patients were randomized to early EVR and 51 to delayed EVR strategy. 36% received thymoglobuline induction. Primary endpoint occurred in 30 (61.2%) patients in the early arm and in 29 (56.9%) in the delayed arm, with pericardial effusion as the most common contributing event. One patient died in each arm, and serious adverse event rate was similar in the two study groups (36.7 vs. 43.1%). Of note, only 3% of patients had a mechanical assist device before HT. Rejection rate was numerically lower in the early EVR group (30.6 vs. 33.3%), as well as creatinine clearance at month 1 (71.9±25.5 vs. 82.4±30.4ml/min/1.73m 2 ) and at month 6 (64.6±18.2 vs. 67.5±24.3 ml/min/1.73m 2 ). Conclusions Despite the limited sizing, this analysis of the EVERHEART study is reassuring regarding the safety of EVR in the early post HT phase: we did not note excess of EVR-related early adverse events and the two arms similarly influenced the combined endpoint. Smooth introduction of early EVR and a limited number of patients with mechanical assist devices may explain the improved safety profile, as compared with previous studies.

In the cadaver of an 86 year old man the inferior segment of the azygos vein could not be found. Furthermore, a normally developed hemiazygos vein drained the right and left intercostal veins from T 10 to T 6. This vessel finally curved towards the right to reach the superior vena cava after having drained the right superior intercostal veins. The left superior intercostal vein ended in a short vessel draining into the left brachiocephalic vein. This condition may be represented in a standard chest radiograph by the so-called "aortic nipple". Agenesis of the azygos vein, suspected because of the presence of this radiological sign, should be confirmed in the living by means of computerized tomography. This can clarify the anatomy of the mediastinal vessels precisely. Embryological pattern of the azygos system accounting for its possible defects is discussed.

In order to evaluate the morphofunctional pattern of transplanted skin structural and ultrastructural studies on biopsies taken from surgically created neovaginae in three cases of vaginal agenesis were performed one and two years postoperatively. Two of the cases were associated with a rudimentary uterus, while the remaining one involved testicular feminization. Neovaginae were constructed by directly prolonging a pre-existing perineal introitus, to form a vesicorectal pouch, which was lined inside with gluteal skin autografts. All three patients reported satisfactory psychosexual behavior one year after operation. Light microscopy of the bioptic fragments demonstrated, even two years after surgery, features generally similar to those of the normal dermis and epidermis, and a keratinization rate as a rule, that did not range significantly from the norm. Scanning electron microscopy also confirmed the maturation of the cornified cells, since these were often seen to be desquamating and exhibited structures usually found in normal skin, such as double edges on the luminal surface--usually considered to be the morphological expression of squamous cell overlapping--and microwrinkles on disrupted apical and basal cytoplasmic flaps, which are considered reciprocal cell-gearing devices. Our results seem to indicate, therefore, that the transplanted skin, maintaining, on the whole, its integrity and viability despite an environment differing somewhat from the external one with regard to moisture, pH and temperature, shows a good adaptability, at least until the above mentioned time lapses.

In order to suggest a valid experimental model for correlated studies regarding the complex phenomena of reproductive biology in humans, light (LM), transmission (TEM) and scanning electron microscopic (SEM) observations were carried out on vaginae of sexually mature New-Zealand albino rabbits, both in estrus and at 5 h after mating. To avoid artifacts depending upon the operative times for specimen removal and, in particular, to well visualize the inner surface of this organ, vaginal irrigation with fixative was performed prior to the surgical removal. Our data demonstrate that the upper 2/3 of the vaginal duct form a kind of 'cervico-vaginal canal' which shares many histological features with the human endocervix. In fact, this portion is lined within by a monostratified epithelium provided with tall microvillous and ciliated cells and often invaginated in crypts. After mating, the microvillous cells showed evidence of secretory activity, exhibiting dome-like luminal surfaces. Secretory droplets often contacted cilia and spermatozoa present in the mucosal furrows and crypts. Because of these singular features and the morphofunctional interactions between vaginal epithelium and male gametes, we believe the rabbit to be a helpful model for comparative biology in humans, concerning sperm capacitation and the general reactivity of the female genital tract during the reproductive cycle.

In order to obtain a more precise microtopographical surface map of the epithelium of the rabbit vaginal mucosa, investigations by light microscopy (LM), transmission electron microscopy (TEM), and scanning electron microscopy (SEM) have been systematically correlated. The epithelium was examined from the "portio vaginalis cervicis uteri" down to the "vestibulum". This study shows that the upper 2/3 of the vagina--which, in this species, is very long, measuring 13-14 cm--is lined by a single epithelial layer of tall ciliated and microvillous cells closely resembling the endocervical epithelium with which it is continuous. Moreover, these ciliated and microvillous cells also cover mucosal infoldings in the upper part of the vagina, especially those on the ectocervix and in the fornices, and scattered vaginal crypts. In particular, the ciliated elements decrease in number below the fornices, so that in large areas of the middle part of the vagina only microvillous cells are recognizable. Prior to the squamo-columnar junction, however, the ciliated cells increase again. This study also reveals that in the rabbit the squamo-columnar junction is located at the level of the pubic symphysis and that a squamous pluristratified epithelium covers only the lower 1/3 of the inner surface of the vaginal wall. In the estrous, i.e., precoital rabbit, the microvillous cells show little sign of secretion, whereas after mating they exhibit remarkable secretory features. These seem to increase progressively with postcoital stages (5 h, 24 h and 10 days) in the form of extensive mucification. These secretions often come in contact with spermatozoa retained in the mucosal infoldings and crypts, and are similar to those occurring in the endometrium, where they clearly depend upon progesterone activity. These epithelial features, different from those of other mammals, including humans, suggest that the greater part of the rabbit vagina accomplishes functions other than serving for copulation and as a fetal passageway. The present findings support the view that the rabbit vagina also plays a role as a reservoir of spermatozoa and in maintaining their viability, like the endometrium and endocervix.

In this report the authors describe the structural and ultrastructural characteristics of some cells constituting the parietal layer of Bowman’s capsule of the mouse kidney, which are very similar to the epithelial cells of the proximal convoluted tubule (tubule-like cells). These elements are noted in mature and immature mice of both sexes, but their fine morphology and statistical incidence seem related to the sex and the age of the mice, as revealed by the different responsiveness of the same animals to sex hormones experimentally administered. Such substances, directly and/or through an influence on gonadotropins (especially luteinizing hormone), are able to modify (mainly increasing) the percentage of renal corpuscles possessing tubule-like cells.

Observations by Scanning electron microscopy (SEM) showed numerous microvilli on the surface of mesothelial cells of different peritoneal areas. In addition a number of saccular invaginations provided with microvilli or small intercellular clefts have been observed between the cells. These superficial invaginations may correspond to the "stomata" of the light microscopy. Because of the number of microvilli projecting inside the clefts it was not possible to determine whether they open directly on the base of the cells. As the light of the Scanning electron microscopy observations and considering the transmission electron microscopy results on the intercellular boundaries in mesothelial cells it is possible to assume that the actual clefts ("stomata") are continuous and open in the main intercellular channels. Then it is not possible to exclude that these intercellular channels with their labyrinthine and tortuous course may open into the subjacent connective tissue.

Rathke’s pituitary cleft represents the original recess of so-called Rathke’s pouch derived in the embryo from the ectodermal evagination of the stomodeum (1,2). In several mammals, for example the rat, dog and cat, this recess persists during postnatal life as a wide fissure separating the pars distalis from the pars intermedia. It is lined by a continuous layer of cells termed ‘marginal cells’, and contains a fluid-like material (colloid) of uncertain function, origin and chemical composition (3).

On treatment with collagenase, brain microvessels, together with several protein components, lose some enzymatic activities such as alkaline phosphatase and gamma-glutamyltranspeptidase, whereas no change occurs in the activities of 5'-nucleotidase and glutamine synthetase. The energy-requiring "A-system" of polar neutral amino acid transport is also severely inactivated, whereas the L-system for the facilitated exchange of branched chain and aromatic amino acids is preserved. In the collagenase-digested microvessels, this leads to loss of the transtimulation effect of glutamine on the transport of large neutral amino acids, because such transtimulation is due to a cooperation between the A- and L-systems. By contrast, NH4+ maintains (and even enhances) its ability to stimulate the L-system of amino acid transport, presumably through glutamine synthesis within the endothelial cells.

The tubule-like cells (TLC) are present also in the parietal layer of the Bowman's capsule of the renal corpuscles in normal female mice kidney. These cells are morphologically similar to the cells of the proximal convoluted tubule. Further, significant variations of the TLC were present according to the phase of the sexual cycle.

Changes occurring on the surface of the uterine luminal epithelium of the rabbit during the estrous and progestational stages of the reproductive cycle were examined by scanning and transmission electron microscopy. The findings demonstrate that the uterine epithelium, or endometrium, contains two cell types: ciliated cells and nonciliated, microvillous cells. In estrous animals, ciliated cells, although not very numerous, were usually observed in small groups. However, at increasing intervals of time following mating, ciliated cells progressively disappeared from the endometrium until approximately eight to ten days post coitum, when they became scare. From several hours to four to five days following mating, extensive changes occurred on the surfaces of microvillous cells. When observed by TEM, these elements contained organelles typical of cells involved in the synthesis and secretion of glycoproteins. Furthermore, microvillous cells during this period displayed numerous apical protrusions of different sizes and shapes and containing material of varying electron density. Parallel SEM examinations of the same material confirmed the presence of these protrusions. Some of the protrusions appeared as spheroidal masses attached to the cytoplasm by means of a cytoplasmic strand. Other surface masses were clearly unattached to the cell surface and were distributed (1) on the surface of microvillous cells, (2) on the cilia of adjacent ciliated cells, and (3) on the surface of spermatozoa.

AIMS: The ESC-HF Pilot survey was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). The pilot phase was also specifically aimed at validating structure, performance, and quality of the data set for continuing the survey into a permanent Registry.METHODS: The ESC-HF Pilot study is a prospective, multicentre, observational survey conducted in 136 Cardiology Centres in 12 European countries selected to represent the different health systems across Europe. All outpatients with HF and patients admitted for acute HF on 1 day per week for eight consecutive months were included. From October 2009 to May 2010, 5118 patients were included: 1892 (37%) admitted for acute HF and 3226 (63%) patients with chronic HF. The all-cause mortality rate at 1 year was 17.4% in acute HF and 7.2% in chronic stable HF. One-year hospitalization rates were 43.9% and 31.9%, respectively, in hospitalized acute and chronic HF patients. Major regional differences in 1-year mortality were observed that could be explained by differences in characteristics and treatment of the patients.CONCLUSION: The ESC-HF Pilot survey confirmed that acute HF is still associated with a very poor medium-term prognosis, while the widespread adoption of evidence-based treatments in patients with chronic HF seems to have improved their outcome profile. Differences across countries may be due to different local medical practice as well to differences in healthcare systems. This pilot study also offered the opportunity to refine the organizational structure for a long-term extended European network.