P–311 Association between serum sex hormones (progesterone and estradiol) and endometrial morphology during the mid-luteal phase

Study question Is there a relationship between the serum progesterone and estradiol levels and certain morphological characteristics of human endometrium during the mid-luteal phase? Summary answer Serum progesterone is associated with the stromal edema and the abundance and size of basal vacuoles in the endometrium of women during the mid-luteal phase. What is known already Progesterone and estrogen are essential hormones that are necessary to prepare the endometrium for pregnancy. Their serum concentrations during the mid-luteal phase are important criteria for prediction of successful embryo implantation. In addition, a variety of endometrial morphological markers, such as the presence of pinopodes, subnuclear and supranuclear vacuoles, glandular secretion, and stromal edema have been applied for determination of the window of implantation and endometrial receptivity. However, the relationship between these endometrial morphological characteristics and serum levels of progesterone and estradiol is still scarcely studied. Study design, size, duration This is an observational study of 98 women, 25 to 46 years of age (mean 37 years), who had a blood sample and an endometrial biopsy during the mid-lutheal phase (LH + 7) in a natural cycle. The study was conducted between August 2020 and November 2020. Participants/materials, setting, methods Serum progesterone and estradiol were measured by electrochemiluminescence immunoassay (ECLIA) on the Cobas e411 analyser (Roche Diagnostics, Germany). The following endometrial morphological characteristics were assessed using light microscopy: (1) basal vacuoles (mean size and percentage of vacuolated glandular cells) (2) apical vacuoles (mean size and percentage of vacuolated glandular cells), (3) pinopodes (percentage of luminal epithelium covered in pinopodes), (4) glandular intraluminal secretion (6-level scoring system), (5) stromal edema (6-level scoring system). Main results and the role of chance The serum progesterone levels ranged between 0.39 and 145.3 ng/ml, with a median of 24.36 ng/ml. The serum estradiol levels varied between 26.91 and 842.89 pg/ml with a median of 124.75 pg/ml. The percentage of cells with basal vaculoles ranged from 0 to 90%, with a median of 38.57%, apical vacuoles (0–50%, 16.83%), pinopodes (0–80%, 23.87%), glandular intraluminal secretion (0–80%, 28.57%), and stromal edema (1–6, 1.42). To examine the association between the serum progesterone and estradiol and the studied endometrial morphological characteristics, the Spearman’s Rho Correlation coefficient for non-paramentric data was used. No correlation was found between serum estradiol levels and the studied morphological variables (p > 0.05). In contrast, the serum progesterone concentration showed a significant negative correlation with the percentage of glandular epithelial cells with basal vacuoles (R= - 0.28; p = 0.03), the mean size of the basal vacuoles (R= - 0.24; p = 0.5) and a significant positive correlation with the stromal edema (R = 0.34; p < 0.01). Limitations, reasons for caution The study was limited in sample size. Wider implications of the findings: The results of this study revealed that serum progesterone is more strongly associated with the occurrence of certain endometrial morphological characteristics during the mid-luteal phase than serum estradiol. These findings are valuable for development of new methods for accurate determination of the window of implantation. Trial registration number Not applicable

Distinct Patterns of Tissue Remodeling and Their Prognostic Role in Chronic Rhinosinusitis

<b><i>Introduction:</i></b> Tissue remodeling refers to structural changes that occur in damaged tissue and is associated with disease severity in asthma. However, the characteristics of tissue remodeling and its prognostic role in chronic rhinosinusitis (CRS) remain unclear. In this report, we evaluated the clinical implications of tissue remodeling in CRS. <b><i>Methods:</i></b> We performed a retrospective cohort study of adult patients who underwent endoscopic sinus surgery for bilateral CRS. The histopathology of sinus mucosa was determined by evaluating the inflammatory cell count and tissue remodeling markers (squamous metaplasia, subepithelial gland proliferation, basement membrane [BM] thickening, stromal edema, and fibrosis). Eosinophilic CRS (ECRS) was defined as an eosinophil count &#x3e;15/high-power field in the biopsied tissue. Patient characteristics, allergy test grade, preoperative Lund-Mackay score (LMS), and pre- and postoperative Lund-Kennedy scores (LKSs) were analyzed. <b><i>Results:</i></b> Of the identified patients, 59.1% were classified as ECRS and the remaining 40.9% as non-ECRS. Regarding tissue remodeling markers, stromal edema was seen in 90.9%, BM thickening in 63.6%, and stromal fibrosis in 34.1% of patients. In cases with stromal edema and BM thickening, greater tissue eosinophilia was observed, while stromal fibrosis decreased tissue eosinophilia (<i>p</i> &#x3c; 0.05). Prognostically, subepithelial gland proliferation alone was an independent risk factor for poor postoperative endoscopic findings (odds ratio: 8.250, 95% confidence interval: 1.128–60.319, <i>p</i> = 0.038). <b><i>Conclusions:</i></b> Tissue eosinophilia was commonly associated with BM thickening and stromal edema. Subepithelial gland proliferation predicted a poor surgical prognosis in CRS. These findings imply that tissue remodeling provides additional information not only on the CRS endotype but also on the postsurgical prognosis.

Acute Hydrops and Its Management

Acute hydrops is a well-known complication of keratoconus. It usually manifests as sudden onset loss of vision. Mostly presents in the pubertal age group. Allergic conjunctivitis associated with eye rubbing is the most substantial risk factor. Primary pathology being stromal lysis, which triggers the progression of cone, causing an undue stretch on Descemet Membrane, eventually resulting in its splitting and stromal imbibition of aqueous through these ruptures. Clinical signs are circum-cillary congestion and thick/edematous cornea with obscuration of the anterior segment. Conservative therapy delays wound healing; hence early surgical intervention is recommended globally for faster resolution of stromal edema. Long-standing corneal edema mounts to corneal perforation and neovascularisation of cornea. Compressive suture, non expansile intracameral gas injection, Deep anterior lamellar keratoplasty, and mini Descemet membrane keratoplasty are various management modalities reported in literature. Acute hydrops could be well prevented with early identification of progressive keratoconus and halting its progression.

Cattle (Bos Taurus) endometrium morphology on the seventh day of the estrous cycle

The aim of our study was to describe the histopathological and cytological characteristic of the cow endometrium on the seventh day of the estrous cycle. In this study, 11 different breeds’ dairy cows (78.18 ± 37.46 months old, in 3.6 ± 2.17 lactation, the mean body condition score 3.4 ± 0.72 (5 points scale)) from Research and Study farm ‘Vecauce’ were selected. All cows were more than 210 days postpartum. Overall health and reproductive tract examination was performed, progesterone (P4) and estradiol (E2) concentration in blood serum were established and the biopsy and cytology samples of endometrium were taken. Mean E2 concentration was 14.92 ± 7.92 pg mL-1, mean P4 concentration was 13.64 ± 9.44 nmol L-1. The mean percentage in the cytology slides was established: epithelial cells 89 ± 9%, polimorphonuclear leukocytes (PMN) 6 ± 5%. Cytological subclinical endometritis (SE) was confirmed in 5 cows. Histopathological findings (out of 22 samples): endometrium stromal edema in 14, hemosiderin and hemosiderophages in 8, supranuclear vacuolization in 12, pseudodecidual reaction in 12 samples. No subnuclear vacuolization and mitosis in the glandular epithelium were detected. Histopathological examination did not reveal SE. Morphology between the uterine horns with and without corpus luteum (CL) and between cows with serum P4 level higher than 15 nmol L-1 and lower than 15 nmol L-1 were not statistically different (p>0.05). In conclusion, histopatological examination is more reliable diagnostic method for SE. Future investigation should be performed to establish cut-off values for the diagnosis of SE in cows more than 210 days postpartum.

Low-grade oncocytic tumour of kidney (CD117-negative, cytokeratin 7-positive)

Background The term low-grade oncocytic tumour of kidney is an emerging entity describing CD117-negative and cytokeratin 7-positive indolent tumors with overlapping morphological features between oncocytic tumors. Case presentation We present herein the case of a 77-year-old female with a 3.2-cm nodule in mid pole of the left kidney. The tumor was uniformly oncocytic with solid, compact nested and trabecular growth patterns. There was common areas of transition to central zones of stromal edema with marked tumor hypocellularity and growth in cords. Some of these areas had adjacent fresh hemorrhage. Immunohistochemistry showed strong and diffuse expression of cytokeratin 7 and negativity for cKIT/CD117. Conclusion The proper use of this new diagnostic category avoids labeling such tumors as unclassified renal cell carcinoma – a broad category with different morphologic features and heterogenous prognosis.

Twist and shout: magnetic resonance imaging findings in ovarian torsion

Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic “whirlpool sign”. The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.

Systemic and Ocular Determinants of Choroidal Structures on Optical Coherence Tomography of Eyes with Diabetes and Diabetic Retinopathy

Knowledgeof the choroidal structures in eyes with diabetes and diabetic retinopathy (DR) should provide information on the pathogenesis of DR. A prospective study was performed to determine the systemic and ocular factors that affect the choroidal structures in eyes with diabetes. Two-hundred consecutive diabetic subjects consisted of 160 treatment-naïve patients with different stages of DR and 40 patients with proliferative DR with prior panretinal photocoagulation (PRP). All underwent blood and urine tests and enhanced depth imaging optical coherence tomography (EDI-OCT). The cross-sectional EDI-OCT images of the subfoveal choroid were binarized to measure the total choroidal area (TCA), luminal area, and stromal area. Multivariate regression analyses were performed to determine the systemic and ocular factors that were significantly correlated with the choroidal structures. The subfoveal choroidal thickness, TCA, luminal area, and stromal area were larger at more advanced stage of DR, and smaller in eyes with PRP than those without (P < 0.001). The TCA and stromal area were significantly and positively correlated with the degree of albuminuria (P = 0.034, P = 0.025, respectively). The choroidal lumen and stroma may increase as the stages of DR progress and decrease after PRP. Albuminuria may be associated with the choroidal stromal edema.

Evaluating the Effectiveness of Accelerated and Accelerated Cornea Pulsing Crosslinking Based on the Presence of a Demarcation Line

Purpose of the study is to assess the state of the demarcation line of the stroma after accelerated and pulsed accelerated ultraviolet cornea crosslinking. Patients and methods. Clinical observations included 24 patients (31 eyes) with keratoconus (KC), aged 18–46 years, men — 11 (45.9 %), women — 13 (54.1 %). Accelerated (a-CXL) crosslinking was carried out in continuous mode with a power of 18 mW/cm2 for 5 minutes (13 eyes), pulsed accelerated (i-ACXL) with a power of 18 mW/cm2 for 10 minutes, in mode 1 sec light / 1 sec pause (18 eyes). Conducted generally accepted and additional methods of ophthalmic research. The follow-up periods were 1, 3, and 6 months after surgery. Results. According to optical coherent tomography, the demarcation line was detected in all cases after a-CXL and i-ACXL. At 1 month after the crosslinking, there were no significant differences between the a-CXL and i-ACXL groups in terms of uncorrected visual acuity, corrected visual acuity, maximal correction. The average depth with demarcation at 1 month after the procedure in the central zone of the cornea was 216.41 ± 36.67 μm in the a-CXL group and 236.41 ± 37.08 μm in the i-ACXL group. Using confocal microscopy in vivo in both groups 1 month after surgery apoptosis of keratocytes and stromal edema were detected. A gradual restoration of the cornea to its original state was observed after 6 months. Conclusion. Research results have shown that accelerated and pulsed accelerated cross-linking are safe and effective technologies to stabilize the progression of keratoconus. Both crosslinking protocols provide a significant reduction in the duration of the procedure compared to the traditional one. Revealed deeper arrangement of the demarcation line when performing pulsed accelerated crosslinking compared to the accelerated. Further long-term and more extensive studies of accelerated and pulsed accelerated cornea ultraviolet crosslinking will provide improved information on their effectiveness in the long-term.

ACUTE CORNEAL HYDROPS IN KERATOCONUS – A CASE REPORT

Keratoconus is observed in cases of impaired corneal biochemical activity, leading to secondary thinning and ectasia. Usually the onset is in the second – third decade of life. The acute corneal hydrops occurs when intraocular aqueous passes through a rupture of Descemet membrane (DM) and is characterized with stromal edema. Estimated frequency is 2.5 – 3.0% among the keratoconus patient. Eye rubbing is the major risk factor. In most cases the hydrops persists for 2 -4 months. The resolution is cicatrix/scar formation, but there is a risk for complications such as vascularization, infection and corneal perforation. We present a case of a 23 year old male patient, presenting with complains of reduced and blurry vision in the right eye and photophobia. Visual acuity and full ophthalmological examination was done. UBM was performed of the right eye. The patient received conservative therapy. The acute corneal hydrops occurs when intraocular aqueous passes through a rupture of Descemet membrane (DM) and is characterized with stromal edema. The treatment could be conservative or surgical. The conservative therapy includes topical lubricants, antibiotics, cycloplegics, hyperosmotic solutions, antiglaucoma drugs, topical corticosteroids and non-steroid anti-inflammatory drugs. Surgical treatment includes intracameral injection of air or gas, but the definitive treatment is penetrating keratoplasty. We describe a newly diagnosed patient with keratoconus, who presents with rare complication - acute corneal hydrops. Differential diagnosis in cases of young patients with acute onset of keratitis, especially young males, should be made with acute corneal hydrops.