Флексибилната ендоскопия при заболявания на горните дихателни пътища – диагностични резултати и ползи

Целите на тази статия са да се проучат и изложат възможностите и предимствата на флексибилната ендоскопия на горните дихателни пътища в оториноларингологичната практика.Върху 191 пациенти с различни заболявания на горните дихателни пътища за периода юни 2008 до юни 2011 г., в УНГ-клиника на УМБАЛ „Св. Георги“ – Пловдив извършихме в амбулаторен порядък или при леглото на болния фиброназо-епифаринголарингоскопии. Изследването извършвахме под местна анестезия, с трансназален достъп като използвахме назални деконгестанти. Показания за ендоскопията на горния дихателен път бяха – дисфония, дисфагия и затруднено носно дишане при пациенти, на които класическата огледална епифаринго и ларингоскопия не даваха изчерпателна информация за поставянето на диагнозата, както и при пациенти с тежки придружаващи заболявания, при които извършването на директна ларингоскопия под обща анестезия беше противопоказано заради тежки придружаващи заболявания и повишен риск от животозастрашаващи инциденти по време на анестезията. Работехме с фибробронхоскоп Olympus с външен диаметър 2,2 мм и работен канал 1,2 мм снабден с фиброщипка, който използвахме за оглед на деца включително и новородени. За възрастни използувахме фибробронхоскоп Karl Storz ф5,2 мм с работен канал 3,2 мм. Фиброендоскопите адаптирахме към ендоскопска видеокамера Olympus свързана с видеомонитор и записващо DVD за фотодокументация. През последната година от нашето проучване изследванията извършвахме със XYON флексибилен назофаринголарингоскоп с видеомонитор.Резултати: На 191 пациенти , от които 151 мъже (80,29%) и 40 жени (20.8%), на средна възраст 48.4 години извършвахме фиброендоскопии на горните дихателни пътища. Най-честите заболявания, които открихме при серията от пациенти бяха следните: бенигнени абнормалитети на ларинкса 51 (26,7%), карциноми на ларинкса 24 (12.3%), карциноми на хипофаринкса 18 (9,2%), карциноми на епифаринкса 14 (7,2%), парези на гласните връзки 26 (13,4%), едем на ларинкса 8 (4,1%), назална патология 28 (14,4%) вродени аномалии 5 (2,5%), смущения в акта на гълтането след частични хоризонтални резекции на ларинкса по повод карцином 8 (4,1%), чужди тела в носа назо,хипофаринкса и хранопровода 6 (3,09%).Заключение: Флексибилната ендоскопия на горните дихателни пътища е изключително ефективно инструментално изследване при пациенти с различна патология на горните дихателни пътища. Процедурата е лесно изпълнима под локална анестезия в амбулаторни условия, както и при леглото на болния. Възможностите за взимане на биопсии под локална анестезия по време на ендоскопския оглед я прави ценен придатък както в образното изследване на горния дихателен път, така и в хистологичната верификация на патологични процеси на горният дихателен път. Технологичният напредък в областта дава възможност за създаване на ендоскопска апаратура, приложима за изследвания дори при новородени

Rhinophyma – a clinical case and literature review

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Ultrazvučne značajke bulbouretralnih žlijezda kunića (Oryctolagus cuniculus).

The aim of the study was to describe some of the ultrasonographic features of domestic rabbit bulbourethral glands, with regard to their relevance to reproductive pathology. The glands of ten sexually mature, clinically healthy, white, male New Zealand rabbits, aged 18 months, with body masses ranging from 2.8-3.2 kg, were investigated following anaesthesia. A perineal sonographic approach was applied. The glands were observed in two planes. They were viewed sonographically as solid, hyperechoic, heterogeneous structures. A hyperechoic gland without a hypoechoic center was visualized in sagittal section. In transverse section, normal bulbourethral glands were visualized dorsolaterally to the bulbar urethra, and a hypoechoic urethra was located ventromedially. As part of the study, the sonographic features of the bulbourethral glands were compared in a liquid isotonic medium. The analogous results of both methods allowed us to propose the use of perineal ultrasonography as a sufficiently definitive, non-invasive method for visualizing rabbit bulbourethral glands.Cilj ovog istraživanja bio je opisati neke ultrazvučne značajke bulbouretralnih žlijezda kunića s obzirom na njihovu važnost u patologiji spolnih organa. Nakon anestezije bile su pretražene žlijezde 10 spolno zrelih, klinički zdravih kunića bijele novozelandske pasmine u dobi od 18 mjeseci, tjelesne mase 2,8 - 3,2 kg. Ultrazvučna pretraga obavljena je u perinealnom području. Žlijezde su bile pretražene u dvije ravnine. Ultrazvučno su se vidjele kao dvije hiperehogene solidne, heterogene tvorevine. Hiperehogena žlijezda bez hipoehogenog centra bila je uočljiva na sagitalnoj ravnini. U poprječnoj ravnini normalne bulbouretralne žlijezde uočavale su se dorzolateralno od bulbarne uretre, a hipoehonogena uretra bila je smještena ventromedijalno.Ultrazvučne značajke bulbouretralnih žlijezda bile su uspoređivane u odnosu na izotonični tekući medij. Na osnovi postignuća sličnih rezultata dvjema metodama može se predložiti perinealni ultrazvučni pristup kao primjerena neinvazivna metoda za vizualizaciju bulbouretralnih žlijezda kunića

Broiler chicken response to xylanase and fermentable xylooligosaccharide supplementation

A study was conducted to determine the effect of dietary fiber (DF), xylanase (XYL), xylooligosaccharides (XOS), and a combination of XYL and xylooligosaccharides (STBIO) on chicken growth performance, N-corrected apparent metabolizable energy (AMEn), and nutrient availability, characteristics of the gastrointestinal tract (GIT), and cecal content of short-chain fatty acids (SCFA). A 35-day experiment was performed on 1,920 as hatched Ross 308 broiler chicks, reared in 96 pens and fed ad libitum. Experimental diets were split into 2 phases: starter (0−21 d) and finisher (22−35 d). There were 2 basal diets, first contained 54% maize and in the second, 5% of the maize was replaced by wheat bran as DF. The diets were split into 4 batches: one of them was used as a control, and each of the others were supplemented either with XYL or XOS or with the STBIO. Each diet was fed to 12 pens following randomization. The data were analyzed in GenStat (20th edition) by ANOVA using a 2 £ 4 factorial design. The addition of STBIO improved feed conversion ratio (FCR) and increased weight gain (WG) from 21 to 35 d and from 0 to 35 d (P < 0.05). The inclusion of DF had a negative effect on N and fat retention coefficients at 35 d as well as AMEn and dry matter retention at 21 and 35 d. At 21 d, neutral detergent fiber (NDF) retention was increased when xylanase and STBIO were added to the diet (P < 0.001) and at d 35 the highest retention was noted when the diet was supplemented with DF and XYL or STBIO (P = 0.001). There was no dietary effect on jejunum histomorphometry (P > 0.05). The addition of DF increased the concentration of cecal SCFA in particular valeric and propionic acid at 35-day-old birds (P < 0.05). It can be concluded that addition of STBIO in diet could provide benefits in terms of fiber degradation, WG, and feed efficiency

Direct In Vivo Cell Lineage Analysis in the Retrorsine and 2AAF Models of Liver Injury after Genetic Labeling in Adult and Newborn Rats

BACKGROUNDS AND AIMS:When hepatocyte proliferation is impaired, liver regeneration proceeds from the division of non parenchymal hepatocyte progenitors. Oval cells and Small Hepatocyte-like Progenitor Cells (SHPCs) represent the two most studied examples of such epithelial cells with putative stem cell capacity. In the present study we wished to compare the origin of SHPCs proliferating after retrorsine administration to the one of oval cells observed after 2-Acetyl-Amino fluorene (2-AAF) treatment. METHODOLOGY/PRINCIPAL FINDINGS:We used retroviral-mediated nlslacZ genetic labeling of dividing cells to study the fate of cells in the liver. Labeling was performed either in adult rats before treatment or in newborn animals. Labeled cells were identified and characterised by immunohistochemistry. In adult-labeled animals, labeling was restricted to mature hepatocytes. Retrorsine treatment did not modify the overall number of labeled cells in the liver whereas after 2-AAF administration unlabeled oval cells were recorded and the total number of labeled cells decreased significantly. When labeling was performed in newborn rats, results after retrorsine administration were identical to those obtained in adult-labeled rats. In contrast, in the 2-AAF regimen numerous labeled oval cells were present and were able to generate new labeled hepatocytes. Furthermore, we also observed labeled biliary tracts in 2-AAF treated rats. CONCLUSIONS:Our results strongly suggest that SHPCs are derived from hepatocytes and we confirm that SHPCs and oval cells do not share the same origin. We also show that hepatic progenitors are labeled in newborn rats suggesting future directions for in vivo lineage studies

Genetic Abolishment of Hepatocyte Proliferation Activates Hepatic Stem Cells

Quiescent hepatic stem cells (HSCs) can be activated when hepatocyte proliferation is compromised. Chemical injury rodent models have been widely used to study the localization, biomarkers, and signaling pathways in HSCs, but these models usually exhibit severe promiscuous toxicity and fail to distinguish damaged and non-damaged cells. Our goal is to establish new animal models to overcome these limitations, thereby providing new insights into HSC biology and application. We generated mutant mice with constitutive or inducible deletion of Damaged DNA Binding protein 1 (DDB1), an E3 ubiquitin ligase, in hepatocytes. We characterized the molecular mechanism underlying the compensatory activation and the properties of oval cells (OCs) by methods of mouse genetics, immuno-staining, cell transplantation and gene expression profiling. We show that deletion of DDB1 abolishes self-renewal capacity of mouse hepatocytes in vivo, leading to compensatory activation and proliferation of DDB1-expressing OCs. Partially restoring proliferation of DDB1-deficient hepatocytes by ablation of p21, a substrate of DDB1 E3 ligase, alleviates OC proliferation. Purified OCs express both hepatocyte and cholangiocyte markers, form colonies in vitro, and differentiate to hepatocytes after transplantation. Importantly, the DDB1 mutant mice exhibit very minor liver damage, compared to a chemical injury model. Microarray analysis reveals several previously unrecognized markers, including Reelin, enriched in oval cells. Here we report a genetic model in which irreversible inhibition of hepatocyte duplication results in HSC-driven liver regeneration. The DDB1 mutant mice can be broadly applied to studies of HSC differentiation, HSC niche and HSCs as origin of liver cancer

Evidence for a common progenitor of epithelial and mesenchymal components of the liver

Tissues of the adult organism maintain the homeostasis and respond to injury by means of progenitor/stem cell compartments capable to give rise to appropriate progeny. In organs composed by histotypes of different embryological origins (e.g. The liver), the tissue turnover may in theory involve different stem/precursor cells able to respond coordinately to physiological or pathological stimuli. In the liver, a progenitor cell compartment, giving rise to hepatocytes and cholangiocytes, can be activated by chronic injury inhibiting hepatocyte proliferation. The precursor compartment guaranteeing turnover of hepatic stellate cells (HSCs) (perisinusoidal cells implicated with the origin of the liver fibrosis) in adult organ is yet unveiled. We show here that epithelial and mesenchymal liver cells (hepatocytes and HSCs) may arise from a common progenitor. Sca+ murine progenitor cells were found to coexpress markers of epithelial and mesenchymal lineages and to give rise, within few generations, to cells that segregate the lineage-specific markers into two distinct subpopulations. Notably, these progenitor cells, clonally derived, when transplanted in healthy livers, were found to generate epithelial and mesenchymal liver-specific derivatives (i.e. hepatocytes and HSCs) properly integrated in the liver architecture. These evidences suggest the existence of a 'bona fide' organ-specific meso-endodermal precursor cell, thus profoundly modifying current models of adult progenitor commitment believed, so far, to be lineage-restricted. Heterotopic transplantations, which confirm the dual differentiation potentiality of those cells, indicates as tissue local cues are necessary to drive a full hepatic differentiation. These data provide first evidences for an adult stem/precursor cell capable to differentiate in both parenchymal and non-parenchymal organ-specific components and candidate the liver as the instructive site for the reservoir compartment of HSC precursors as yet non-localized in the adult. © 2013 Macmillan Publishers Limited All rights reserved

TFEB regulates murine liver cell fate during development and regeneration

It is well established that pluripotent stem cells in fetal and postnatal liver (LPCs) can differentiate into both hepatocytes and cholangiocytes. However, the signaling pathways implicated in the differentiation of LPCs are still incompletely understood. Transcription Factor EB (TFEB), a master regulator of lysosomal biogenesis and autophagy, is known to be involved in osteoblast and myeloid differentiation, but its role in lineage commitment in the liver has not been investigated. Here we show that during development and upon regeneration TFEB drives the differentiation status of murine LPCs into the progenitor/cholangiocyte lineage while inhibiting hepatocyte differentiation. Genetic interaction studies show that Sox9, a marker of precursor and biliary cells, is a direct transcriptional target of TFEB and a primary mediator of its effects on liver cell fate. In summary, our findings identify an unexplored pathway that controls liver cell lineage commitment and whose dysregulation may play a role in biliary cancer

Liver cell therapy: is this the end of the beginning?

The prevalence of liver diseases is increasing globally. Orthotopic liver transplantation is widely used to treat liver disease upon organ failure. The complexity of this procedure and finite numbers of healthy organ donors have prompted research into alternative therapeutic options to treat liver disease. This includes the transplantation of liver cells to promote regeneration. While successful, the routine supply of good quality human liver cells is limited. Therefore, renewable and scalable sources of these cells are sought. Liver progenitor and pluripotent stem cells offer potential cell sources that could be used clinically. This review discusses recent approaches in liver cell transplantation and requirements to improve the process, with the ultimate goal being efficient organ regeneration. We also discuss the potential off-target effects of cell-based therapies, and the advantages and drawbacks of current pre-clinical animal models used to study organ senescence, repopulation and regeneration