Pathologic features and expression of heat shock protein 47 in the nasal mucosa and lacrimal sac: does it influence the surgical outcome of endoscopic endonasal dacryocystorhinostomy?

Anatomical requirements for dacryocystorhinostomy ostium patency

PURPOSE

To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR).

METHODS

The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05.

RESULTS

Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004).

CONCLUSION

The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium.

Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis

BACKGROUND

Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking.

OBJECTIVE

The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD).

METHODS

This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system.

RESULTS

The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005).

CONCLUSION

Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.

Specific locations and amounts of denatured collagen and collagen-specific chaperone HSP47 in the oviducts and uteri of old cows as compared with those of heifers

Collagen, the most abundant extra-cellular matrix in oviducts and uteri, performs critical roles in pregnancies. We hypothesised that the locations and amounts of both denatured collagen and the collagen-specific molecular chaperone 47-kDa heat shock protein (HSP47) in the oviducts and uteri of old cows are different compared with those of young heifers because of repeated pregnancies. Since detecting damaged collagen in tissues is challenging, we developed a new method that uses a denatured collagen detection reagent. Then, we compared damaged collagen in the oviducts and uteri between post-pubertal growing nulliparous heifers (22.1±1.0months old) and old multiparous cows (143.1±15.6months old). Further, we evaluated the relationship between denatured collagen and HSP47 by combining this method with fluorescence immunohistochemistry. Picro-sirius red staining showed collagen in almost all parts of the oviducts and uteri. Expectedly, damaged collagen was increased in the oviducts and uteri of old cows. However, damaged collagen and HSP47 were not located in the same area in old cows. The number of fibroblasts increased, suggesting the presence of fibrosis in the oviducts and uteri of old cows. These organs of old cows showed higher HSP47 protein amounts than those of heifers. However, the uteri, but not oviducts, of old cows had lower HSP47 mRNA amounts than those of heifers. These findings revealed the specific location and amounts of denatured collagen and HSP47 in the oviducts and uteri of old cows compared with those of heifers.

Anti-Müllerian hormone stimulates expression of the collagen-specific chaperone 47-kDa heat shock protein in bovine uterine epithelial cells

Uterine collagen is the most abundant component of the uterine extracellular matrix and plays a critical role in pregnancy. The 47-kDa heat shock protein (HSP47) is the sole collagen-specific molecular chaperone. We investigated the mechanisms regulating the expression of HSP47 in the uterus by assessing the effect of anti-Müllerian hormone (AMH) stimulation on HSP47 expression in cultured bovine uterine epithelial cells. AMH receptor type 2 (AMHR2), AMH, and HSP47 expression was assessed by fluorescence immunocytochemistry in uterine epithelial layers of the uteri of Japanese Black cows. The effect of AMH on HSP47 expression was assessed in cultured epithelial cells. The effect of MEK/ERK inhibitor on AMH-induced HSP47 expression was also assessed. We confirmed the expression of AMHR2, AMH, and HSP47 in the uterine epithelial layers. We confirmed the expression of AMHR2, AMH, HSP47, and type IV collagen in cultured uterine epithelial cells. AMH treatment at 10 or 100 ng/ml promoted significant HSP47 expression (p < 0.05). MEK/ERK inhibitor U0126 pretreatment suppressed such AMH stimulation on HSP47. These findings indicate that AMH induced HSP47 protein expression through the ERK pathway in bovine uterine epithelial cells.

Expression of LIGHT/TNFSF14 and Its Receptors, HVEM and LTβR, Correlates with the Severity of Fibrosis in Lacrimal Sacs from Patients with Lacrimal Duct Obstruction

Introduction

Fibrosis is one of the factors contributing to the development of primary acquired lacrimal duct obstruction (LDO). LIGHT (homologous to lymphotoxins, exhibiting inducible expression and competing with herpes simplex virus glycoprotein D for herpes virus entry mediator [HVEM]), a receptor expressed by T lymphocytes, has recently emerged as a new regulator of connective tissue remodeling and fibrotic response. The purpose of this study was to evaluate the role of LIGHT in the pathogenesis of LDO through: (1) assessment of expression of LIGHT and its two receptors, HVEM and LTβR (lymphotoxin β receptor), and (2) investigation of potential relationships between expression of LIGHT and its receptors and clinical and histopathologic features.

Methods

Lacrimal sacs of 30 patients undergoing endoscopic dacryocystorhinostomy because of LDO were assessed intraoperatively and histopathologically with respect to inflammation and fibrosis. Expression of LIGHT, HVEM and LTβR was assessed by immunohistochemistry using specific antibodies and evaluated semiquantitatively using a four-grade scoring system.

Results

All investigated molecules, LIGHT/TNFSF14, HVEM and LTβR, were expressed in biopsies from all patients. The most prominent expression was seen within inflammatory infiltrates. Expression of LIGH, HVEM and LTβR correlated significantly with the intensity of fibrosis and duration of the disease. In multivariate analysis only LIGHT showed a significant relationship with fibrosis (β coefficient = 0.759, p = 0.02). There was no significant correlation between expression of any molecule and other demographic or clinical features.

Conclusion

We assume that LIGHT along with its receptors may be a factor contributing to fibrosis and synechiae formation in the lacrimal sac. This assumption needs to be proven in a future study in a group of patients who fail to improve after the first operation.