Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Evaluation of the Trachea and Bronchi in COVID-19 Patients Using the 3-dimensional Reconstruction Method.

OBJECTIVE: To evaluate changes in the trachea and bronchi of COVID-19 patients using the 3-dimensional reconstruction images obtained from chest CT (computed tomography) scans. STUDY DESIGN: An observational study. Place and Duration of the Study: Departments of Anatomy and Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey, between March 2021 and January 2022. METHODOLOGY: There were 150 COVID-19 patients in the acute period and 150 individuals as the control group. The CT images were transferred to Mimics software, and a 3-dimensional reconstruction was performed. COVID-19 patients were grouped separately by gender, and their total lung severity score was classified as absent (Grade 0), mild (Grade 1), moderate (Grade 2), and severe (Grade 3). RESULTS: The cross-sectional area and diameter of the right upper lobar bronchus decreased as the grade increased (p<0.05 and p<0.001, respectively). The circumference of the right upper lobar bronchus and the cross-sectional area and circumference of the left lower lobar bronchus were found to be narrower in Grade 1-2-3 COVID-19 patients compared to those of the control group (p<0.01, p<0.05, and p<0.05, respectively). The cross-sectional area, circumference, and diameter of the middle lobar bronchus were found to be narrower in Grade 3 COVID-19 patients (p<0.05, p<0.05, and p<0.05, respectively). CONCLUSION: Although mostly independent of the grade increase, narrowing of the trachea and bronchi was observed in COVID-19 patients in the acute period. Further research is required with to reveal whether the narrowings are permanent. KEY WORDS: COVID-19, Trachea, Bronchus, 3-dimensional reconstruction.

Optimal screw positioning in cervical pedicles to avoid complications.

BACKGROUND: Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern procedures for treating cervical instability. Despite the fact that numerous innovative techniques for CPS have been proposed, the appropriate screw entry points and screw directions have yet to be thoroughly established. The aim of this study is to determine the screw insertion angles and screw entry point distances based on reference points, pedicle axis lengths, and pedicle axis intersections for each vertebra from cervical (C) C2 to C7 in both right and left by gender and age groups. METHODS: In this study, computed tomography (CT) images of patients who underwent cervical examination for any reason were evaluated retrospectively. A total of 100 patients (59 men and 41 females), ranging in age from 18 to 79 years (mean 43 years), were randomly selected for the study. Patients with a history of cervical pathology or surgery were excluded. CT images turned into 3D reconstructed images and density settings were made so that bone tissue could be best observed using OsiriX software. Pedicle axis length (PAL), pedicle transverse angle (PTA), pedicle sagittal angle (PSA), distance of screw entry point to lateral notch (DLN), distance of screw entry point to inferior articular process (DIAP), and pedicle axis intersections were measured. RESULTS: According to our findings, the optimal entry point should be 2-4 mm medial to the lateral notch and 8-12 mm superior to inferior articular process. PTA ranges between 30 to 45°, while PSA ranges between 11 to 15°. Except for the C2 pedicles, which were slightly shorter, the pedicle axis lengths (PAL) were similar from C3 to C7 in the total group. The intersection of the right and left pedicle axes was determined to be the most in C4 (51.21% in females and 72.88% in males). DISCUSSION: This study has shown that intersections of the pedicle axis must be considered in both genders, especially in C4. Standardizing optimal entry points and trajectories is crucial for improving the CPS technique's safety and effectiveness.

Investigation of the nerve distribution pattern of leg muscles in rat.

Information about the distribution of intramuscular nerve fibres within the skeletal muscles will enhance the understanding of their morphological structure and functions. This study was designed to examine the entire intramuscular nerve distribution pattern in rat leg muscles. The tibialis cranialis, tibialis caudalis, extensor digitorum longus, flexor digitorum longus, gastrocnemius, peroneus longus and brevis muscles were dissected from origo and insertion points under a surgical microscope in seven rats. These skeletal muscles from right hindlimbs were stained with Sihler's stain. The diameter of extramuscular and major nerve branches, number of major and minor nerve branches and anastomoses were measured and photographed under a stereomicroscope. In addition, serial sections were obtained from the left hindlimb muscles with S100 immunohistochemical staining and transferred to the computer to reconstruct images. A significant difference was found between the gastrocnemius and tibialis caudalis (p < 0.001), flexor digitorum longus and tibialis caudalis (p < 0.003), and peroneus longus and tibialis caudalis (p < 0.049) with regard to the diameter of major branches. The gastrocnemius was significantly different from the flexor digitorum longus, peroneus longus, extensor digitorum longus, tibialis caudalis and tibialis cranialis with regard to the number of minor nerve branches (p < 0.001). Knowledge of the branching pattern and some key landmarks, such as the number and diameter of major and minor nerve branches and the number of anastomoses between the nerve branches of skeletal muscles, is helpful in surgical or therapeutic interventions and botulinum toxin injections in areas of high extramuscular and intramuscular nerve density.

The effect of valproic acid and oxcarbazepine on the distribution of adhesion molecules in embryo implantation.

This study was intended to investigate the effect of valproate (VPA) and oxcarbazepine (OXC) on embryo implantation in terms of extracellular matrix protein distribution. Thirty female rats (Wistar albino) were assigned to three groups of 10 animals each. Group 1 was administered two doses of saline solution, group 2, two doses of VPA at 300 mg/kg/day and group 3, two doses of OXC at 100mg/kg/day, for a period of 3 months. Female rats with vaginal plugs mated with males for one night were placed into separate cages. Day of mating was taken as day 0, and implantation areas were obtained with rats being sacrificed on the morning of day 7. Immunohistochemical staining and electron microscopic protocols were then applied. At electron microscopic evaluation, extraembryonic endoderm and ectoderm layers could not be distinguished in semi-thin sections in the VPA group, while they were partially differentiated in the OXC group. At immunohistochemical staining, laminin was observed in the primary embryonic endoderm cell visceral and parietal layers, the uterine luminal epithelial cells and the secondary decidual zone in the control group. In the VPA group, it was weakly expressed in some embryo trophoectoderm cells and uterine luminal epithelial cells and moderately in some decidual cells. In the OXC group, it was moderately expressed in some trophoectoderm and decidual cells. Collagen IV was localized in the ectoplacental cone cells and secondary decidual zone and weak in the luminal epithelial cells in the control group. In the VPA and OXC groups, collagen IV was negative in all embryonic and maternal structures in the VPA and OXC groups. Vimentin was moderately expressed in the luminal epithelium and strongly expressed in the primary decidual zone and ectoplacental cone cells in the control group. In the VPA group, it was negative in the embryo trophoectoderm, decidual and uterine luminal epithelial cells, while in the OXC group it was moderately localized in the ectoplacental cone cells. The use of VPA and OXC has a negative effect on the expression of extracellular matrix proteins that play a key role in embryo implantation in young rats. This may lead to pregnancies ending in failure.

Effects of chronic treatment with valproate and oxcarbazepine on testicular development in rats.

PURPOSE: The aim of this study was to examine the potential effects of valproate (VPA) and oxcarbazepine (OXC) on testicular development in rats. METHODS: Forty-two Wistar rats were randomly divided into three groups of 14 rats each. Each group received the following via gavage over 90 days: group 1, tap water (control group); group 2, VPA (300mg/kg/day); group 3, OXC (100mg/kg/day). After sacrifice, body, testicular and epididymidis weights were measured. Testes were sampled, fixed and processed, and quantitative morphometric analysis of Sertoli cells, spermatocytes and spermatids was performed in stages II, V and XII by histopathological examination. Immunohistochemical staining was performed to transform growth factor beta 1 (TGF-ß1) and p53, and the apoptotic index was assessed using the TUNEL method. RESULTS: Testis and relative testis weights were significantly lower in the VPA group compared to the control group (p<0.05). Spermatogonia, pachytene spermatocyte and round spermatocyte numbers decreased in all stages in both the VPA and OXC groups compared to the control group, though this was not statistically significant (p>0.05). Apoptotic cell counts and p53 immunoreaction were significantly high and TGF-ß1 expression was significantly lower in the VPA group compared to that of the control group (p<0.05). In the OXC group, p53 immunoreaction and TGF-ß1 expression decreased compared to the control group, but this difference did not attain statistical significance (p>0.05). CONCLUSIONS: Our results show that VPA treatment from prepuberty to adulthood significantly negatively affects spermatogenesis, not only by reducing testicular weight, but also by increasing apoptotic death and p53 and decreasing TGF-ß1 activation. OXC has a minimal side effect on testicular development.

Methylphenidate has dose-dependent negative effects on rat spermatogenesis: decreased round spermatids and testicular weight and increased p53 expression and apoptosis.

In the present study, we aimed to evaluate the possible effects of methylphenidate on rat testes. Forty-two Wistar rats were randomly distributed into three experimental groups of 14 rats each. For 90 days, each group via gavage received the following: group 1 = tap water (control group), group 2 = 5 mg/kg/day of ritalin (methylphenidate, MPH), and group 3 = 10 mg/kg/day of ritalin. After sacrificing the animals, the body weights as well as the absolute and relative testicular weights were measured. Testes were sampled, fixed, and processed and, by histopathological examination, quantitative morphometric analysis of Sertoli cells, spermatocytes, and spermatids was performed in stages II, V, and XII. Immunohistochemistry was performed for transforming growth factor (TGF)-ß1 and p53, and the apoptotic index was assessed through the TUNEL method. Group 2 had a reduction of round spermatids in stage II. Group 3 had reduction in both stage II and stage V spermatids, as well as lower testicular weight. The p53 expression was increased in group 3. In groups 2 and 3, the TGF-ß1 expression was reduced and the apoptotic index by TUNEL was increased. Body weights remained stable on either group. Our results showed that methylphenidate might negatively affect spermatogenesis not only by reducing testicular weight and amount of round spermatids but also by increasing apoptotic death and p53 activation. The findings of the study, however, must be cautiously interpreted.

The prevalence and effects of Pectus Excavatum and Pectus Carinatum on the respiratory function in children between 7-14 years old.

The study involved 1342 primary school students aged 7-14 years who applied to Ankara, a primary care center for general health check-up between 2006 and 2007. Forty-three students, 35 of whom had PE and 8 of whom had PC, were subjected to thorax measurement. All 43 students underwent pulmonary function tests (PFT).The prevalence rate of PC was 0.6%, and of PE, 2.6%. The thorax widths of the groups were similar (P = 0.273). The thorax circumference and depth of PE group were lower than those of the controls (P < 0.05). The probability rate of abnormality in PFT scores of PE group was statistically significantly higher than that of the controls (P = 0.022) whereas absence of normal PFT scores the difference between PC group and the controls was not statistically significant (p = 0.095). The results indicate that more than half of the individuals with pectus deformity do not have any physical complaints and do not have statistically significant differences in their PFT parameters.

Is there any possible genotoxic effect in exfoliated bladder cells of rat under the exposure of 1800 MHz GSM-like modulated radio frequency radiation (RFR)?

People are exposed to many carcinogenic and mutagenic chemicals in their everyday lives. These include antineoplastic drugs, Polycyclic aromatic hydrocarbons (PAH)s, aromatic amines, nitrosamines, metals, and electromagnetic radiation. Based on the state of knowledge acquired during the last 50 years of research on possible biological effects of electromagnetic fields (EMF), the majority of the scientific community is convinced that exposure to EMF below the existing security limits does not cause a risk to the health of the general public. However, this position is questioned by others, who are of the opinion that the available research data are contradictory or inconsistent and, therefore, unreliable. In this study, we aimed to investigate if there is any effect of 1800 MHz GSM modulated radio frequency radiation (RFR) on the number of micronucleus in exfoliated bladder cells of rat which will be informative about the genotoxic damage. Exposure period was 20 min/day, 5 days/week during a month. Six female Wistar rats were used for two groups: Group I (n=6): controls; Group II (n=6): 1.8 GHz exposed animals. 1800 MHz RFR did not showed a significant MN frequencies in rat bladder cells when compared with the control group (p>0.05). 1800 MHz RFR-exposed animals did not produce any genotoxic effect when compared with the control group ( p>0.05). Kinetic studies are important for any biomarker, especially those in which tissue differentiation and maturation processes will heavily influence the time between induction of damage and collection of damaged cells for micronucleus analysis.