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Jang S, Kim S, Lee J, Choi WJ, Yoon CH, Yang S, Kim KH. Deep learning framework for automated goblet cell density analysis in in-vivo rabbit conjunctiva. Sci Rep 2023; 13:22839. [PMID: 38129447 PMCID: PMC10739799 DOI: 10.1038/s41598-023-49275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Goblet cells (GCs) in the conjunctiva are specialized epithelial cells secreting mucins for the mucus layer of protective tear film and playing immune tolerance functions for ocular surface health. Because GC loss is observed in various ocular surface diseases, GC examination is important for precision diagnosis. Moxifloxacin-based fluorescence microscopy (MBFM) was recently developed for non-invasive high-contrast GC visualization. MBFM showed promise for GC examination by high-speed large-area imaging and a robust analysis method is needed to provide GC information. In this study, we developed a deep learning framework for GC image analysis, named dual-channel attention U-Net (DCAU-Net). Dual-channel convolution was used both to extract the overall image texture and to acquire the GC morphological characteristics. A global channel attention module was adopted by combining attention algorithms and channel-wise pooling. DCAU-Net showed 93.1% GC segmentation accuracy and 94.3% GC density estimation accuracy. Further application to both normal and ocular surface damage rabbit models revealed the spatial variations of both GC density and size in normal rabbits and the decreases of both GC density and size in damage rabbit models during recovery after acute damage. The GC analysis results were consistent with histology. Together with the non-invasive high-contrast imaging method, DCAU-Net would provide GC information for the diagnosis of ocular surface diseases.
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Affiliation(s)
- Seunghyun Jang
- Department of Biomedical Engineering, Yonsei University, 1 Yonseidae-gil, Wonju-si, Gangwon-do, 26493, Republic of Korea
| | - Seonghan Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, Gyeoungbuk, 37673, Republic of Korea
| | - Jungbin Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, Gyeoungbuk, 37673, Republic of Korea
| | - Wan Jae Choi
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sejung Yang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do, 26426, Republic of Korea.
- Department of Medical Informatics and Biostatistics, Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, Gyeoungbuk, 37673, Republic of Korea.
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Welss J, Punchago N, Feldt J, Paulsen F. The distribution of conjunctival goblet cells in mice. Ann Anat 2021; 234:151664. [PMID: 33400978 DOI: 10.1016/j.aanat.2020.151664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the density and distribution of conjunctival goblet cells in mice without clinical evidence of ocular surface diseases. METHODS Immediately after euthanasia of C57BL/6 wild-type mice, the eyes including eyelids were removed and fixed in paraformaldehyde. Entire eyeballs and eyelids were cut in series along the sagittal axis from nasal to temporal on a microtome and then stained with Periodic Acid-Schiff acid to visualize the goblet cells. At each section stained in this way, the conjunctival goblet cells of the entire upper and lower lid conjunctiva were counted by light microscopy. Additional (transmission electron microscopy) (TEM)-Analysis on ultrathin sections was performed to evaluate morphological differences. RESULTS The total number of conjunctival goblet cells differs markedly between individual animals. Categorisation into upper eyelid (UL) and lower eyelid (LL) and into regions (nasal, middle, temporal) revealed a significant increase of goblet cells from nasal to temporal in the UL and a significant decrease in the LL. CONCLUSION The distribution of conjunctival goblet cells in mice differs considerably from humans and between individual animals. Therefore, precise selection of sampling and methods are needed to obtain comparable data. We recommend to use the middle region of the conjunctiva of UL/LL for goblet cell studies in mice. These findings are of particular interest for dry eye mouse models as well as pharmacological studies on mice with influence on their goblet cells.
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Affiliation(s)
- Jessica Welss
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Nichapa Punchago
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Anatomy, Khon Kaen University, Thailand
| | - Jessica Feldt
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Operative Surgery and Topographic Anatomy, Sechenov University Moscow, Russia
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de Oliveira Garcia D, Estrela GC, Soares RTG, Paulino D, Jorge AT, Rodrigues MA, de Castro Sasahara TH, Dos Santos Honsho C. A study on the morphoquantitative and cytological characteristics of the bulbar conjunctiva of the maned wolf (Chrysocyon brachyurus; Illiger, 1815). Anat Histol Embryol 2020; 50:439-447. [PMID: 33340413 DOI: 10.1111/ahe.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/29/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
The maned wolf, Chrysocyon brachyurus, is a near-threatened carnivore inhabiting the Brazilian Cerrado. Few studies have been conducted on this species, and even fewer have explored its ophthalmological characteristics. Vision is critical to wild canids; thus, this study aimed to provide a morphoquantitative description of the bulbar conjunctiva of the maned wolf using cytological and histological analyses. Ten healthy maned wolves from a conservational centre, including 4 females and 6 males aged 1-12 years (6.5 ± 2.8), were included in the study. The samples for cytological analysis were collected from the inferior conjunctival sac using a cytobrush, and conjunctival tissue was collected for histological analysis from the temporal canthus zone. The cytological samples were stained using the Papanicolaou method, and the histological sections were stained using haematoxylin and eosin, Periodic acid-Schiff, picrosirius red and Masson's trichrome stains. The cytological samples were studied for stain quality, and the different cell types were counted. Histological examination was used to determine tissue types in the conjunctiva and their proportions. Analyses revealed a stratified squamous epithelium with some goblet cells and eventual pigmentation in the basal layer. Loose connective tissue with the presence of some mononuclear and polymorphonuclear cells was also observed. The epithelium of the maned wolf's bulbar conjunctiva resembles that of dogs and other carnivore species; furthermore, its physiological and pathological responses were similar to those of other carnivore species.
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Araújo RLS, Corrêa JR, Galera PD. Ultrastructural morphology of goblet cells of the conjunctiva of dogs. Vet Ophthalmol 2019; 22:891-897. [PMID: 30938063 DOI: 10.1111/vop.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/09/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the morphology of goblet cells of the eyelid conjunctiva in dogs using transmission and scanning electron microscopy. ANIMAL STUDIED Ten dogs, both male and female of different breeds, with no ocular changes were examined (20 eyes). PROCEDURES Ten samples of conjunctiva were collected and processed for scanning and transmission electron microscopy (SEM and TEM), while another 10 samples were stained with Schiff's periodic stain (SPA) and alcian blue, pH 2.5, and analyzed using light microscopy. RESULTS Scanning electron microscopy revealed several points of mucus extrusion in the free apical portion of the goblet cells as well as a wide distribution of lymphoid follicles and macrophages intermingling with the microvilli of palpebral epithelium cells. TEM revealed normal goblet cells that were predominantly oval with wide cytoplasm of different diameters, and large vesicles with heterogeneous granules and free edges, suggesting the release of mucus content onto the conjunctival surface. Cytoplasmic organelles, such as the Golgi apparatus, endoplasmic reticulum, and a high number of mitochondria were also observed. All the samples were positive for SPA and alcian blue staining. CONCLUSION This is the first study to evaluate the goblet cells of the eyelid conjunctiva in healthy dogs using electron microscopy techniques. These results are useful for comparing the palpebral conjunctiva of dogs without ocular changes to palpebral conjunctiva of dogs and other species with ocular changes.
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Affiliation(s)
- Rosélia L S Araújo
- Faculty of Agronomy and Veterinary Medicine, University of Brasília, Brasília, Brazil
| | - José R Corrêa
- Microscopy and Microanalysis Laboratory, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Paula D Galera
- Faculty of Agronomy and Veterinary Medicine, University of Brasília, Brasília, Brazil
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Doughty MJ. On the Variability in Goblet Cell Density in Human Bulbar Conjunctival Samples Collected by Impression Cytology with Millicell-CM Biopore Membrane Units. Curr Eye Res 2016; 41:1393-1399. [PMID: 27159248 DOI: 10.3109/02713683.2015.1133832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess whether or not the numbers of goblet cells were different across regions of a conjunctival impression cytology (CIC) specimen. METHODS CIC specimens were obtained from the exposed nasal bulbar conjunctiva from 22 healthy young Caucasian adults, stained with Giemsa and evaluated at a final magnification of 200× (medium power fields). Up to 14 different non-overlapping microscope fields, depending on whether or not a field was without goblet cells, were randomly selected. RESULTS A microscope field could contain between 0 and 145 goblet cells. If only fields that included goblet cells were analyzed, the mean goblet cell counts (22 specimens, 10 fields/specimen) ranged from 37.8 to 44.8/field (equivalent to 259-313 goblet cells/mm2). When 3, 5 or 10 fields were used to calculate average goblet cell counts for each specimen, the standard deviation values were between 15.8/field and 21.7/field, with the lower values obtained if 10 fields were used. The resultant averaged inter-sample variability, as the coefficient of variation (COV), ranged from 40.0% to 57.5%, while the averaged intra-sample variability in counts ranged from 52.1% to 73.9%. If fields without goblet cells were also used, the resultant mean goblet cell count (from 10 fields/specimen) was statistically lower at 33.1/field (232 goblet cells/mm2). CONCLUSIONS These analyses confirm various subjective comments made by early CIC investigators; the distribution of goblet cells across a CIC filter may be highly variable.
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Affiliation(s)
- Michael J Doughty
- a Department of Vision Sciences , Glasgow-Caledonian University , Glasgow , UK
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Sebbag L, Reilly CM, Eid R, Maggs DJ. Goblet cell density and distribution in cats with clinically and histologically normal conjunctiva. Vet Ophthalmol 2016; 19 Suppl 1:38-43. [PMID: 26799820 DOI: 10.1111/vop.12343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate goblet cell density (GCD) and distribution in cats without clinical evidence of ocular surface disease and without histologic evidence of conjunctival disease. ANIMALS STUDIED Fourteen Domestic Shorthair cats euthanized for reasons unrelated to this study. PROCEDURES Before euthanasia, cats were verified using slit-lamp biomicroscopy and fluorescein staining to be free of eyelid or ocular surface abnormalities. Immediately after euthanasia, bilateral conjunctival specimens including third eyelid (TEL) were collected, routinely processed, and stained with periodic acid-Schiff and hematoxylin and eosin. Thirteen conjunctival regions were identified. For each region, GCD was expressed as the percentage of goblet cells/200 basal epithelial cells. RESULTS Mean GCD ranged widely by region: anterior surface of the TEL = 48.8%, fornicial regions = 47.0%, palpebral regions = 38.5%, bulbar regions = 19.6%, and posterior surface of the TEL = 12.6%. The anterior surface of the TEL had significantly higher GCD than did the bulbar and the palpebral regions, but not the fornicial regions. Bulbar conjunctiva had significantly lower GCD than did all other conjunctival regions except the posterior surface of the TEL. No significant difference was noted between GCD of male versus female cats, dorsal versus ventral regions, or lateral versus medial regions. CONCLUSIONS Although conjunctival GCD ranged widely by region, the anterior surface of the TEL appears to be an excellent location for assessing conjunctival goblet cells in cats because this area has high GCD and is more readily accessible than is the palpebral, fornicial, or bulbar conjunctiva.
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Affiliation(s)
- Lionel Sebbag
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, School of Veterinary Medicine, Davis, 95616, CA, USA
| | - Christopher M Reilly
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, 95616, CA, USA
| | - Ramzi Eid
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, School of Veterinary Medicine, Davis, 95616, CA, USA
| | - David J Maggs
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, 95616, CA, USA
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Xie C, Li XY, Cui HG. Potential candidate cells for constructing tissue-engineered lacrimal duct epithelium: a histological and cytological study in rabbits. J Zhejiang Univ Sci B 2015; 16:904-13. [PMID: 26537208 DOI: 10.1631/jzus.b1500113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Injury and deficiency of the lacrimal duct epithelium (LDE) can lead to a variety of lacrimal diseases. The purpose of this study was to characterize potential candidate cells for constructing a tissue-engineered LDE. METHODS Different areas of the conjunctiva and lacrimal duct tissue were removed from male adult New Zealand white rabbits for histological evaluation. Hematoxylin and eosin staining and immunohistochemical staining of cytokeratin AE1+AE3, cytokeratin 4, Ki-67, and MUC5AC were observed by light microscopy. The surface morphologies of different epithelial tissues and cellular structures were examined using field-emission scanning electron microscopy and transmission electron microscopy. Epithelial cells were isolated from tissues and identified by specific markers. In vitro, proliferative ability and Western blot analyses of the proliferating cell nuclear antigen (PCNA) of different epithelial cells cultured in identical environments were investigated and compared. RESULTS Histologically, the epithelial specific markers, cytokeratin AE1+AE3 and cytokeratin 4, were expressed in the conjunctiva epithelium and the LDE. Notably, highly proliferative cells stained with Ki-67 were concentrated under the epithelium in a dome structure of the posterior palpebral conjunctiva. Differentiated goblet cells were also found to a lesser extent in this region. Primary palpebral and fornical conjunctival epithelial cells (PFCECs), bulbar conjunctival epithelial cells (BCECs), and lacrimal duct epithelial cells (LDECs) were successfully separated from tissues. In vitro, rabbit PFCECs and LDECs grew faster and expressed more PCNA than BCECs. CONCLUSIONS PFCECs are anatomically similar to LDECs. They also have similar morphological characteristics, immune phenotypes, and proliferation features. PFCECs are therefore potential candidate cells to replace LDECs in tissue engineering to treat lacrimal duct diseases.
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Affiliation(s)
- Chen Xie
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiu-yi Li
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong-guang Cui
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Doughty MJ. A systematic assessment of goblet cell sampling of the bulbar conjunctiva by impression cytology. Exp Eye Res 2015; 136:16-28. [PMID: 25887294 DOI: 10.1016/j.exer.2015.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/30/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to assess the apparent goblet cell density (GCD) from conjunctival impression cytology (CIC) samples in relation to the number of conjunctival cells collected onto the filters. CIC specimens were collected from the superior-temporal bulbar conjunctiva of 16 pigmented rabbits onto Biopore (Millicell-CM) membranes, fixed with buffered glutaraldehyde and stained with Giemsa. Different numbers of microscope fields of view in each of the specimens were imaged by light microscopy using a 20× magnification objective lens (200× final magnification), and the goblet cells marked and counted. The GCD values/sq. mm were calculated. The same conjunctival region of 3 other rabbits was also prepared for transmission electron microscopy (TEM) by fixation, in situ, with the same buffered glutaraldehyde. Mean values for GCD estimates were found to vary from 399 to 1576 cells/sq. mm, depending on the image sampling and analysis strategy chosen, with the lowest inter-sample variance of around 10% being found if a maximum goblet cell count was taken on substantially multilayered regions of the CIC specimens. Counts of the number of goblet cells per 1000 visible conjunctival epithelial cells yielded a value of close to 90 (range 36-151), with modest inter-sample variability of around 30%. A three or ten 200× microscope field and random sampling strategy yielded mean GCD values between 542 and 670 cells/sq. mm, but with very high intra- and inter-sample variance of at least 60% and sometimes higher than 100%. TEM confirmed the multilayered organization of the conjunctiva and the deeper lying goblet cells. The general use of a goblet cell count as an objective marker for conjunctival normality or health is likely to be highly variable unless a more specific strategy is adopted. Beyond providing details of exactly the counting strategy used, it would be very useful to provide full details of the actual microscope field size used as well as information on the intra-sample variability in goblet cell counts.
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Affiliation(s)
- Michael J Doughty
- Glasgow Caledonian University, Department of Vision Sciences, Cowcaddens Road, Glasgow G4 OBA, Scotland, UK.
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Doughty MJ. Assessment of size and nucleo-cytoplasmic characteristics of the squamous cells of the corneal epithelium. Clin Exp Optom 2015; 98:218-23. [PMID: 25676043 DOI: 10.1111/cxo.12253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/18/2014] [Accepted: 10/18/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim was to objectively assess size, nucleus and nucleo-cytoplasmic ratio features of squamous cells from the corneal epithelium METHODS The corneas of recent post-mortem sheep eyes were either glutaraldehyde-fixed for transmission electron microscopy or impression cytology samples taken, glutaraldehyde-fixed and stained with Giemsa. From the specimens for impression cytology, a representative region was photographed from 12 different samples taken from the central region and 16 different samples taken from mid-peripheral regions of the corneal epithelium. Images were subjected to morphometry after overlays were generated. RESULTS Electron microscopy revealed a very distinctive stratified corneal epithelium with several superficial layers, confirming the squamous phenotype. Impression cytology from such superficial layers revealed a cell size of 60.1 ± 4.8 μm, nucleus dimension of 12.3 ± 1.5 μm, cell area of 2,419 ± 416 μm(2) and nucleus area of 131 ± 31 μm(2) . A nucleo-cytoplasmic ratio based on nucleus-to-cell length had a mean of 0.207 ± 0.022, while a cytoplasm-to-nucleus length ratio was 3.975 ± 0.474. Estimates of the nucleo-cytoplasmic ratio based on areas had a mean value of 0.059 ± 0.011. Very similar results were found for mid-peripheral corneal epithelium. CONCLUSIONS The results strongly indicate that the squamous phenotype of the superficial corneal epithelial cells is characterised by a large size, large nucleus and low nucleo-cytoplasmic ratio. These morphological characteristics show a notable resemblance to data obtained from impression cytological studies on human conjunctival epithelial cells showing severe squamous metaplasia.
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Affiliation(s)
- Michael J Doughty
- Department of Vision Sciences, Glasgow-Caledonian University, Glasgow, G4 OBA, UK.
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Functional morphology of mucosal goblet cells based on spatial separation of orifice openings to the surface--application to the rabbit bulbar conjunctiva. Tissue Cell 2014; 46:241-8. [PMID: 24881502 DOI: 10.1016/j.tice.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/03/2014] [Indexed: 01/13/2023]
Abstract
The purpose of the study was to assess spatial separation of goblet cell orifices observed at the surface of the rabbit bulbar conjunctiva by scanning electron microscopy (SEM) specimens of the bulbar conjunctiva from 8 healthy pigmented rabbits were obtained using a special preparation technique by which the tissue was carefully stretched out during glutaraldehyde fixation. On high magnification prints of SEM images of the conjunctival surface, the locations of goblet cell openings (orifices) to the apical surface were marked and the centre-to-centre spacing between all such orifices measured. Across the regions of interest (ROI), with averaged dimensions of 322 μm × 230 μm (adjusted for tissue shrinkage), the averaged value for the distances between all orifices was 196 μm (range 141-241 μm), with the calculated density of orifices being 412 mm(-2). A sequential order-based analysis of the spatial separation between orifices indicated a predictable value of 6 μm, a separation that showed a nearly linear inter-dependence over distances of at least 200 μm. The openings of goblet cells to the surface of unstimulated bulbar conjunctiva have a organized spatial distribution that is consistent with there being an organized control of goblet cell secretion.
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Doughty MJ. Fluorescein-Tear Breakup Time as an Assessment of Efficacy of Tear Replacement Therapy in Dry Eye Patients: A Systematic Review and Meta-Analysis. Ocul Surf 2014; 12:100-11. [DOI: 10.1016/j.jtos.2013.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/26/2013] [Accepted: 11/01/2013] [Indexed: 12/16/2022]
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