Therapeutic Potential and Mechanisms of Rosmarinic Acid and the Extracts of Lamiaceae Plants for the Treatment of Fibrosis of Various Organs

Fibrosis, which causes structural hardening and functional degeneration in various organs, is characterized by the excessive production and accumulation of connective tissue containing collagen, alpha-smooth muscle actin (α-SMA), etc. In traditional medicine, extracts of medicinal plants or herbal prescriptions have been used to treat various fibrotic diseases. The purpose of this narrative review is to discuss the antifibrotic effects of rosmarinic acid (RA) and plant extracts that contain RA, as observed in various experimental models. RA, as well as the extracts of Glechoma hederacea, Melissa officinalis, Elsholtzia ciliata, Lycopus lucidus, Ocimum basilicum, Prunella vulgaris, Salvia rosmarinus (Rosmarinus officinalis), Salvia miltiorrhiza, and Perilla frutescens, have been shown to attenuate fibrosis of the liver, kidneys, heart, lungs, and abdomen in experimental animal models. Their antifibrotic effects were associated with the attenuation of oxidative stress, inflammation, cell activation, epithelial-mesenchymal transition, and fibrogenic gene expression. RA treatment activated peroxisomal proliferator-activated receptor gamma (PPARγ), 5' AMP-activated protein kinase (AMPK), and nuclear factor erythroid 2-related factor 2 (NRF2) while suppressing the transforming growth factor beta (TGF-β) and Wnt signaling pathways. Interestingly, most plants that are reported to contain RA and exhibit antifibrotic activity belong to the family Lamiaceae. This suggests that RA is an active ingredient for the antifibrotic effect of Lamiaceae plants and that these plants are a useful source of RA. In conclusion, accumulating scientific evidence supports the effectiveness of RA and Lamiaceae plant extracts in alleviating fibrosis and maintaining the structural architecture and normal functions of various organs under pathological conditions.

Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band

Background: Unroofed coronary sinus is a congenital cardiac anomaly usually associated with persistent left superior vena cava. Premature restriction or closure of foramen ovale is described in association with hypoplastic left heart syndrome. Abdominal peritoneal bands when present manifest clinically. Case report: A 27 years, gravida 2, presented with intrauterine fetal death at 24 weeks gestation due to fetal congestive cardiac failure, cardiomegaly and hydrops. Perinatal autopsy showed absent coronary sinus with cardiac veins draining directly into the heart. There was no persistent left superior vena cava. The foramen ovale was restricted prematurely. The ductus arteriosus was present and non-restrictive. Abdomen showed a cysto-colic peritoneal band. Conclusion: This is the first report showing a triad of (1) complete absence of coronary sinus without left superior vena cava (type-II); (2) premature restriction of foramen ovale without hypoplastic left heart; and (3) a cysto-colic peritoneal band between the gall bladder and colon.

What is the precaecocolic fascia?

The precaecocolic fascia, previously known as Jackson's membrane, is a variable vascular peritoneal fold between the ascending colon and the right posterolateral abdominal wall. First described in 1913, it was originally thought to be of developmental or inflammatory origin and associated with abdominal pain. This investigation aimed to review its frequency, form and structure and look for evidence of association with malformation of the bowel, or previous inflammation. 26 dissecting room cadavers were studied to identify the precaecocolic fascia, any malrotation of the colon or signs of previous inflammation: adhesions, surgical scars, or absence of the appendix. Its structure was examined histologically and latex injections were used to trace the arteries. Membranes comparable with previous descriptions of the precaecocolic fascia occurred in 12 of 26 abdomens. They varied in form and size from long and translucent to short, thick, and opaque. In structure, the fascia resembled a fold of peritoneum containing a thickened fibrous lamina. Large thin-walled arteries in the fascia crossed the arteries in the wall of the colon at the point of attachment. No significant association with colonic malrotation or markers of previous inflammation were found. Attention should be paid to the definition of the precaecocolic fascia and "membrane" seems a more appropriate term than "fascia". It is one of a recognized group of peritoneal folds/bands, doubtful in origin but unlikely to be post-inflammatory. It may modify colonic mobility or complicate colonic operations.

Appendix muscle bands, a forgotten entity

INTRODUCTION

Appendix muscle bands (AMB) develop from the appendix muscle layer into the mesoappendix. There are few recent publications on this forgotten entity. The objectives of this study were to assess the morphological features of AMB as detected at microscopy examination of appendectomy specimens.

METHODS

Sixty-six cases of AMB as detected on appendectomy specimens were assessed for microscopy features on routine hematoxilin and eosin stained tissue slides. The morphological features were analyzed with regard to the main clinico-pathological parameters.

RESULTS

AMBs were multiple in 35 cases. Most AMBs were located between the tip and cecal limit, 7 at the tip, and 1 at the cecal limit of the appendectomy specimen. Associated appendix lesions were: acute appendicitis, neuroma, mesoappendix cyst, muscle hiatus, and diverticulae (60,6,2,45, and 1, respectively). In 24 appendices, the AMB developed from the perihiatus muscle. Two microscopy types of AMBs were detected: muscle-AMB and mesoappendix-AMB.

CONCLUSION

AMB may be detected incidentally at microscopy of appendectomy specimens. Acute appendicitis was associated in most cases, independently on the microscopy type of AMB. Appendix abnormalities as neuroma, mesoappendix cyst, muscle hiatus, and diverticulae can be associated to AMBs.

Meconium Peritonitis: A Case Study

Meconium peritonitis is a sterile chemical peritonitis preceded by bowel perforation, resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The presentation can range from simple failure of the neonate to pass meconium to complications such as persistent pulmonary hypertension, lung hypoplasia, and systemic inflammatory syndrome. The purpose of this article is to review a case of meconium peritonitis while considering its etiology, diagnosis, management, and multidisciplinary team care.

Segmental colonic length and mobility

INTRODUCTION

Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility.

METHODS

The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson's membrane (a congenital peritoneal band of the right colon) was also documented.

RESULTS

The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson's membrane was present in 66% of the subjects.

CONCLUSIONS

This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson's membrane was identified in most colons.