Gestational diabetes mellitus (GDM) can cause histological changes to the placenta. This study analyzed placental samples from 15 GDM pregnancies and 11 normal pregnancies. Optical microscopy revealed varying lesions in GDM placentas, including villous edema, fibrosis, syncytial knots, fibrinoid necrosis, and thickened trophoblast membranes. These changes indicate abnormalities in the fetal-maternal interface and fetal vasculature due to the diabetic milieu. Specifically, increased angiogenesis and vascular dysfunction were observed in GDM placentas. These placental abnormalities may contribute to complications like fetal hypoxia. Therefore, tight glycemic control during pregnancy is important for preventing adverse outcomes.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.
Female gynaecologic conditions arising from the endometrium are common and depend on a woman's age, her menstrual history, and the use of medications such as hormone replacement and tamoxifen.
Both benign and malignant conditions affect the endometrium.
Benign conditions must be distinguished from malignant and premalignant conditions.
The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Additional imaging methods include hysterosonography and magnetic resonance imaging
The Learning Tracker - A Learner Dashboard that Encourages Self-regulation in...Ioana Jivet
Although Massive Open Online Courses (MOOCs) have the potential to make quality education affordable and available to the masses, completion rates are extremely low due to the to the high level of autonomy and self-regulated skills that MOOCs require.
The aim of the present work is to investigate how self-regulated learning skills can be enhanced by encouraging metacognition and reflection in MOOC learners by means of social comparison. To this end, following an iterative process, we have developed the Learning Tracker, an interactive widget which allows learners to visualise their learning behaviour and com-
pare it to that of previous graduates of the same MOOC. Each iteration was extensively evaluated in live TU Delft MOOCs running on the edX platform while engaging over 20.000 MOOC learners.
Our results show that learners that have access to the Learning Tracker are more likely to graduate the MOOC. Moreover, we have observed that the widget has a positive impact on learners’ engagement and reduces procrastination. Based on our results, we argue that the mere fact of receiving feedback on a limited number of learning habits could trigger self-
reflection in learners and lead to improved learner performance.
Female gynaecologic conditions arising from the endometrium are common and depend on a woman's age, her menstrual history, and the use of medications such as hormone replacement and tamoxifen.
Both benign and malignant conditions affect the endometrium.
Benign conditions must be distinguished from malignant and premalignant conditions.
The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Additional imaging methods include hysterosonography and magnetic resonance imaging
The Learning Tracker - A Learner Dashboard that Encourages Self-regulation in...Ioana Jivet
Although Massive Open Online Courses (MOOCs) have the potential to make quality education affordable and available to the masses, completion rates are extremely low due to the to the high level of autonomy and self-regulated skills that MOOCs require.
The aim of the present work is to investigate how self-regulated learning skills can be enhanced by encouraging metacognition and reflection in MOOC learners by means of social comparison. To this end, following an iterative process, we have developed the Learning Tracker, an interactive widget which allows learners to visualise their learning behaviour and com-
pare it to that of previous graduates of the same MOOC. Each iteration was extensively evaluated in live TU Delft MOOCs running on the edX platform while engaging over 20.000 MOOC learners.
Our results show that learners that have access to the Learning Tracker are more likely to graduate the MOOC. Moreover, we have observed that the widget has a positive impact on learners’ engagement and reduces procrastination. Based on our results, we argue that the mere fact of receiving feedback on a limited number of learning habits could trigger self-
reflection in learners and lead to improved learner performance.
Ciro Continisio ha finanziato con successo il suo gioco UFHO2 tramite la crowd, Alessio Ricco invece ha lanciato il suo twinsmatcher senza fare ricorso al crowdfunding.
Obiettivo del workshop è focalizzare le differenze e i punti in comune tra i due approcci per evidenziare problematiche e cercare di arrivare a delle buone pratiche per rendere il finanziamento di un progetto gaming sostenibile a lungo termine.
30 autores analisam a educação de Niterói no Estado do Rio de Janeiro. Obra de referência serve para a analisar a situação das redes municipais brasileiras.
Aggiornamento dell’Analisi delle Piattaforme Italiane di Crowdfunding, ad oggi è il più completo rapporto sul mercato del Crowdfunding in Italia, compilato da Ivana Pais dell’Università Cattolica di Milano e Daniela Castrataro di twintangibles, socie fondatrici della Italian Crowdfunding Network
Objective: To investigate the immunohistochemical staining of hypoxia-inducible factor 1-alpha (HIF-1α) and Ki-67 expression in the placenta of pregnant women with placenta previa and placenta accreta.
Study Design: Thirty placentas (10 normotensive, 10 placenta previa, and 10 placenta accreta) were processed for routine histological tissue processing. The biochemical parameters of patients were recorded. Placentas were stained with hematoxylin-eosin and HIF-1α and Ki-67 immunostaining.
Results: Normal histology was observed in placentas of normotensive pregnant women. Placenta previa sections showed increased syncytial knots, intervillous hemorrhage, fibrin accumulation, and hyalinization. In placenta accreta sections, increased syncytial nodes, vascular dilation/congestion, fibrin accumulation, and hyalinization were observed. Normotensive placentas showed no HIF-1α expression. In placenta previa tissues, high HIF-1α expression was observed in vascular endothelial cells, villous stromal cells, and syncytial knots. High HIF-1α expression was recorded in villous stromal cells and cytotrophoblast cells in placenta accreta. In normotensive placental tissues, no Ki-67 expression was observed. In placenta previa sections, high Ki-67 expression was observed mostly in root villi stromal cells and some endothelial cells. High Ki-67 expression was observed mostly in villi stromal cells of placenta accreta.
Conclusion: It is thought that HIF-1α is an important regulatory gene in the development of villus in trophoblast invasion such as placenta accreta and previa, while Ki-67 will play a key role in the development of abnormal placenta with its stimulating effect on inflammatory cell development and angiogenesis in accreta and preeclampsia.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
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1. HISTOLOGICAL FETO-PLACENTAL INTERFACE CHANGES IN THE GESTATIONAL DIABETES
MELLITUS
RODICA ILIE 1), C. ILIE 3), ILEANA ENATESCU 2), M. CRAINA 3), ALEXANDRA NYIREDI 2), RODICA
HEREDEA 1)
1) “Louis Turcanu”, Emergency Children Hospital, Pathology, Timisoara
2) „Victor Babes” University of Medicine and Pharmacy, Timisoara
3) „Bega” Clinic of Obstetrics, Gynecology and Neonatology, Timisoara
Abstract
Introduction. Gestational diabetes mellitus (GDM) is a complication associated with pregnancy
defined as any degree of glucose intolerance that occurs- or is first discovered during pregnancy,
with normal values signaled before, and usually after pregnancy. Material and Method. This
study analyzed the cellular differences that might contribute to the injuries of the feto-placental
interface of insulin-controlled GDM patients. An optical microscopic analysis was performed on 26
full term placentas, of which 15 were of gestational diabetes mellitus and 11 control group. The
histological observation centered upon the: trophoblast, villous stroma and fetal capillary. The
fetal average weight was 3840 g for the studied group vs. 2760 g for the control group. Results.
Through optical microscopy were identified varying degrees of lesions consisting of: villous
edema, proliferation and villous fibrosis of the capillaries, large number of syncytial knots,
important fibrinoid necrosis, moderate fibrin thrombi, hyperplasia of the syncytiotrophoblast,
chorangiosis, slightly thickened of the basement membrane of the feto-maternal interface.
Conclusion. The increased angiogenesis of feto-placental vessels of the terminal villi – considered
to be the cause of the placental abnormalities; and the increased risk of complications for e.g.
miscarriage, stillbirth, macrosomia, and congenital anomalies may be prevented by a good control
over the glycemic levels.
Key words : Gestational diabetes mellitus, angiogenesis, feto-maternal interface abnormalities ,
trophoblast, villous stroma, fetal capillary.
Introduction
1
2. In diabetes there is an altered balance of substances such as nutrients, hormones, leptin and other
cytokines which have been well documented as contributors to the potential regulation of placental
function in GDM (1). The study is centered upon the analysis of histopathological modifications in
placentas originating from pregnancies associated with gestational diabetes mellitus, given the lack
of information on the histological pathognomonic lesions of the feto–maternal interface
abnormalities.
Material and Method
The samples used in this study were collected in between January 2009 – December 2011 from the
26 placentas collected immediately after delivery at „Bega” Clinic of Obstetrics, Gynecology and
Neonatology, Timisoara. 15 were from patients with gestational diabetes mellitus and 11 from the
control group. The placental pathological examination was performed by the same pathologist, who
was blinded to the clinical data. Placental tissue samples were dissected from the central part of the
placental bed.
Specimens
Two samples were collected from the middle–sections, from both – maternal and fetal – sides of
the placenta. They were fixed in 4% buffered formalin, for 24 – 48 hours. Then 2 types of
histological stains were used – Hematoxylin–Eosin and Masson's Trichrome. The histological
examination of the slides was performed with an AmScope optical microscope in order to
observe mainly the feto–maternal interface changes. The placental histopathological analyses
were performed on images obtained by a digital camera. From each slide, 7 fields were randomly
selected.
Hematoxylin–Eosin technique
- fixation in a 10% formalin solution
- dehydration in ethanol gradated series
- sedimentation in xylene
- sections
- paraffining
- deparaffining
- hydration and coloring with hematoxylene–eosine
Masson's Trichrome technique
- deparaffinize and hydrate to distilled water
- slides in 40 ml of Bouin's solution contained in a plastic coplin jar and microwave
2
3. mix solution with beral pipet
- incubate slides in heated Bouin's solution for 15 minutes in a fume hood
- wash slides in tap water until sections are clear
- stain in working Weigert's hematoxylin 5 minutes
- wash slides thoroughly in tap water
- 0.5% Hydrochloric acid alcohol for 5 seconds
- wash in running tap water for 30 seconds and rinse in two changes of distilled water
- stain in Trichrome solution for 15 minutes and wash slides in tap water
- rinse in 0.5% Acetic acid 10 seconds and in distilled water
- dehydrate through graded alcohols
- mount with resinous mounting media
Results
The differences between the histological changes of the placentas from the control group (of normal
pregnancies) and those from the group of gestational diabetes pregnancies can be seen in Table 1.
Tabel 1 - Histological changes of the placentas
Histopathological changes
Normal
Pregnancy = 11
GD
Pregnancy = 15
Number % Number %
Inflammatory
Villitis 0 0 0 0
Amnionitis 0 0 1 0,11
Degenerative
Villous fibrosis and edema 0 0 1 0,11
Fibrinoid necrosis 1 0,11 3 27,27
Trophoblastic basic membrane thickening 0 0 4 36,36
Hyaline degeneration 2 18,18 3 27,27
Calcification 2 18,18 4 36,36
Proliferative
Syncytial knots 1 0,11 3 27,27
Hofbauer hyperplasia 0 0 2 18,18
Peri- and intervillous fibrosis 0 0 4 36,36
3
4. Chorioangiosis 1 0,11 1 0,11
Circulatory
Chorial and intimal edema 0 0 0 0
Interstitial hemorrhage 1 0,11 3 27,27
Nucleated red cells 0 0 4 36,36
After a general optical microscopic examination there were found varying degrees of lesions to the
feto-maternal interface, trophoblast, villous stroma and fetal capillary such as:
capillary proliferation and interstitial hemorrhage – Figure 1
villous capillaries fibrosis – Figure 2
syncytiotrophoblast hyperplasia – Figure 3
trophoblastic basic membrane thickening of the feto-maternal interface – Figure 4
peri– and intervillous fibrosis – Figure 5
a large number of syncytial knots and Hofbauer cells hyperplasia – Figure 6
fibrinoid necrosis – Figure 7
nucleated red cells – Figure 8
We consider that the cause of fetal hypoxia in diabetic pregnancy remains still unknown, however
the lesions at these levels are connected to the abnormalities in the structure of capillaries and the
perivascular space may be an essential factor in the explanation of fetal hypoxia in diabetic pregnant
women. The relationship between the vascular surface of the terminal villi to its total surface,
evaluation of the endothelial structure, perivascular space and basal membrane of the trophoblast
could show us the injuries constituted to the fetal–maternal interface, leaving this research area
opened for further studies.
4
5. Figure 1 – capillary proliferation and Figure 2 – villous capillary fibrosis
interstitial hemorrhage (H.E. x 100) (Masson's Trichrome x 200)
Figure 3 – syncytiotrophoblast hyperplasia Figure 4 – trophoblastic membrane thickening
(H.E. x 200) of the feto-maternal interface (Masson's
Trichrome x 400)
5
6. Figure 5 – peri– and intervillous fibrosis Figure 6 – a large number of syncytial knots and
(H.E. x 100) Hofbauer cells hyperplasia (H.E. x 200)
Figure 7 – fibrinoid necrosis (H.E. x 40) Figure 8 – nucleated red cells (Masson's
Trichrome x 200)
Discussions
Optic microscopy analysis revealed various degrees of injuries consisting of numerous syncytial
nuclei in the placentas of GDM, chromatin clumping, a feature of senescence, and most of them
were arranged in clusters known as syncytial knots. In diabetics’ placentas 25% of the villous
surface is taken up by the capillary, while in normal placenta about 50% of the villous surface is
taken up by the capillary bed (2). Diabetic milieu causes vascular dysfunction, increasing
angiogenesis. Maternal (and fetal) hyperglycemia may impact on placental vascular permeability.
The rise in blood glucose has several effects on the surrounding vasculature (3) demonstrated by the
proliferation of small fetal vessels, partial or total obstruction of the vascular lumen was also seen in
6
7. the vessels of the villous trunk having hemodynamic consequences (4). Fibrinoid necrosis, villous
edema and villous fibrosis were observed, these being a result of hyperglycemia, as it acts as a pro-
constrictor, pro-coagulator, pro-inflammatory, pro-angiogenic and pro-permeability agent (4);
fibrinoid necrosis, peri– and inter-villous fibrosis, villous edema, crowding of villi and trophoblastic
basement membrane were present being a real consequence of the metabolic disturbances which
leads to accumulation of carbohydrate and fat in the placenta (5). These abnormalities in the fetal
microcirculation are due to the microvascular changes associated with fibrinoid necrosis and villous
immaturity and can also affect oxygen exchange leading to chronic fetal hypoxia (6).
Conclusions
Histological changes in the placentas of pregnant women with gestational diabetes –
disarrangements distention and proliferation of the cells of the fetal–maternal interface, or perivas-
cular space and cells, thickening and separation of membranes of trophoblast and capillaries – are
significant factors contributing to fetal anoxia with impact on placental vascular permeability. We
were able to demonstrate that the diabetic milieu causes vascular dysfunction, increasing
angiogenesis in pregnancy complicated with gestational diabetes mellitus. No significant relations
were shown between various injuries of the fetal-maternal interface and neonatal condition, in
diabetic pregnant women with fetal eutrophy.
The studies performed during the last few years brought increasing evidence to the theory that in
addition to sugars, other metabolic fuels, from ketones to deranged lipid peroxidation, may be
responsible for the pathomechanisms of congenital malformations. Metabolic fuels may play a
crucial role and besides the classical theories about the strict glucose control, manipulations or
replacements for deficient substracts, free oxygen radical scavengers and antioxidants, might
become a huge promise for the near future (7).
References
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