Functional Morphology of the Human Uterine Tubes in the 21st Century: Anatomical Novelties and Their Possible Clinical Applications

The uterine tube (UT) pathologies account for 25-35 % of female factor infertility. Although these peculiar organs were first studied several hundred years ago, they have become overlooked and neglected mainly due to the successes of reproductive medicine. Nevertheless, reproductive medicine still faces many challenges regarding the fertility outcomes of in vitro fertilization (IVF). Many obstacles and problems can be resolved by a more detailed understanding of the UT morphology and function during normal reproduction. Over the course of the 21st century, many new insights have been obtained: the presence of a population of telocytes in the tubal wall responsible for normal motility and hormone sensory function, the demonstration of lymphatic lacunae of the mucosal folds necessary for oocyte capture and tubal fluid recirculation, or a thorough profiling of the immune makeup of the UT epithelial lining with the discovery of regulatory T cells presumably important for maternal tolerance towards the semi-allogenic embryo. New discoveries also include the notion that the UT epithelium is male sex hormone-sensitive, and that the UT is not sterile, but harbors a complex microbiome. The UT epithelial cells were also shown to be the cells-of-origin of high-grade serous ovarian carcinomas. Finally, yet importantly, several modern morphological directions have been emerging recently, including cell culture, the development of tubal organoids, in silico modelling, tissue engineering and regenerative medicine. All these novel insights and new approaches can contribute to better clinical practice and successful pregnancy outcomes.

The Overview of Anatomical Variations and Congenital Anomalies of the Uterine Tubes and Their Impact on Fertility

Anatomical variations and congenital anomalies of the uterine tubes (UTAVsCAs) are rare conditions, which are often undiagnosed, or accidentally diagnosed upon imaging, laparotomy, laparoscopy for unrelated condition, or during the Cesarean section. UTAVsCAs are often asymptomatic, but their clinical relevance lies in their possibly adverse impact on fertility. Since their rare occurrence, they are usually published as case reports. The most typically described are: agenesis of the uterine tubes (UTs), accessory UT (UT duplication), accessory UT ostium, and paratubal cysts (e.g. the hydatid cyst of Morgagni). UTAVsCAs are classified into an umbrella category of Müllerian duct anomalies (MDAs) which comprises anomalous development of all the organs developing from the paramesonephric (Müllerian) ducts, i.e., UTs, uterus and upper portion of the vagina. Interestingly, most of the classification systems of MDAs discuss solely the uterine and vaginal anomalies, while the UTs are often utterly ignored. This probably originates from the fact that UTs are no longer interesting for many clinicians as they think of UTs as superfluous organs whose function can be easily replaced in the in vitro fertilization (IVF) laboratory. Indeed, the modern reproductive medicine has been helping enormously with the conception of infertile couples. In many instances, the UTs are in fact successfully bypassed and a “test-tube” baby is born. Nevertheless, the UTs are still absolutely unique in providing suitable environment for fertilization and early embryo development - processes that hasn´t been still completely understood. This fact could partially explain why the success rate of IVF is “only” around 30-50 % depending on age. Therefore, the research of the UTAVsCAs is still clinically relevant in the context of reproductive medicine and should not be omitted from research endeavors.

From a Passive Conduit to Highly Dynamic Organ. What are the Roles of Uterine Tube Epithelium in Reproduction?

It is well known that the mammalian uterine tube (UT) plays a crucial role in female fertility, where the most important events leading to successful fertilization and pre-implantation embryo development occur. The known functions of these small intra-abdominal organs are: an uptake and transport of oocytes; storage, transportation, and capacitation of spermatozoa, and finally fertilization and transport of the fertilized ovum and early embryo through the isthmus towards the uterotubal junction. The success of all these events depends on the interaction between the uterine tube epithelium (UTE) and gametes/embryo. Besides that, contemporary research revealed that the tubal epithelium provides essential nutritional support and the most suitable environment for early embryo development. Moreover, recent discoveries in molecular biology help understand the role of the epithelium at the cellular and molecular levels, highlighting the factors involved in regulating the UT signaling, that affects different steps in the fertilization process. According to the latest research, the extracellular vesicles, as a major component of tubal secretion, mediate the interaction between gametes/embryo and epithelium. This review aims to provide up-to-date knowledge on various aspects concerning tubal epithelium activity and its cross-talk with spermatozoa, oocytes and preimplantation embryo and how these interactions affect fertilization and early embryo development.

Assessment of microalbuminuria and ankle-brachial index in outpatients with schizophrenia treated with antipsychotics - a possible predictors of cardiovascular disease

Schizophrenia and related psychoses are associated with excess morbidity and mortality from cardiovascular (CV) disease. Microalbuminuria (MA) is associated with an increased risk of CV disease and mortality. This association is independent of other known CV risk factors such as hypertension, dyslipidemia, obesity, smoking, and impaired renal function. The ankle brachial index (ABI), which is the ratio of systolic pressure at the ankle to that in the arm, is quick and easy to measure and has been used to confirm the diagnosis and assess the severity of peripheral artery disease. Low ABI has been related to an increased incidence of total and CV mortality and CV events. The objective of prospective pilot study was to determine MA and ABI as well as the prevalence of CV risk factors (glucose tolerance status, lipids levels, obesity, hypertension, smoking) and assessment of Framingham risk score in patients with schizophrenia treated with antipsychotic drugs. The study included thirty-three outpatient subjects (female, n = 16), aged 21–66 years. The exclusion criteria included urinary infection and presence of diabetes mellitus. Three patients (7,7%) has abnormal (>26 mg/d) levels of MA, non of ABI.In conclusion, stratification by MA can help identify a high-risk subset of nondiabetic patients with schizophrenia in risk of CV events.

[The prepancreatic course of superior mesenteric vein--a case report]

A case of a prepancreatic course of the superior mesenteric vein found at post-mortem is described and a possible hypothesis of its development is offered. The prepancreatic course of the superior mesenteric or portal vein is not frequent, but in abdominal surgery it is necessary to take these anomalies into the consideration because of possible severe sequelae in the case of an inadvertent ligature of important vessels.

Clonal expansion of epithelial cells from primary human breast carcinoma with 3T3 feeder layer technique

3T3 feeder layer technique provided support for clonal growth and serial propagation of two apparently single epithelial cells isolated from a peroperative biopsy of a primary ductal breast carcinoma. The total culture lifetime was estimated to be more than 30 doublings, 21 of which took place during the primary culture. The two cells were the only survivors of two-week exposure to stressing conditions that resembled the microenvironment in a tumour (low pH, depleted nutrition and accumulation of metabolic waste). The epithelial character of the cells was proved by positive immunostaining for keratins 7/17. The majority of growing cells did not express keratin 19. Only quiescent cells in some colonies, which appeared to reach a more advanced stage of differentiation, expressed keratin 19. These features correspond with the characteristics of mammary luminal cells which in vivo undergo differentiation from the stem K19- to secretory K19+ cells. The luminal cells are supposed to be the target of malignant transformation in the mammary gland. The described technique opens a regular way for the in vitro clonal growth of individual primary cells from breast tumours. Such an approach can improve our understanding of the biology of breast cancer cell populations and also simplify the predictive chemosensitivity assay on breast cancer cells from individual patients.

Effect of pH on proteinase secretion by transformed fibroblast populations

Effect of pH on secretion of proteolytic enzymes in cell cultures of three clonal lines of transformed fibroblasts (K2, T15 and K4) was studied by using 14C-labelled denatured proteins as substrate. One line of malignant macrophages derived from mouse reticulum cell sarcoma (J774.1) was used for comparison. The relative motility index of all cell lines was derived by computer analysis of quantitative estimations of cell dispersion in single-cell-derived colonies. Cultivation at pH 6.5 decreased the growth rate in most experiments as compared with that at pH 7.4, and stimulated cell motility to a different extent. The population of mouse malignant macrophages produced several-fold higher extracellular proteolytic activity than the fibroblast lines. Secretion of proteinases by the malignant macrophages was significantly stimulated by the lower pH. Enzyme secretion by two of the three fibroblast derivatives was also stimulated by acidic pH but to a lesser extent than the secretion of the malignant macrophages. The assessment of motility done by measurement of dispersion of cells in colony proved a positive correlation between motility and proteinase secretion in J774.1 cells and one transformed fibroblast clone (T15) but not in the two other clonal lines.

[The first selective coronarographies in the former Czecho-Slovakia]

The study observes the history and the beginning of selective coronarographies performed in the territory of the Slovak Republic. The first aortocoronary bypass in Slovakia was performed in Bratislava. It was realized by the team of the Surgical Clinic of Academician Dérer in november 1969, namely on the basis of coronarographic examinations which were performed by Smrecanský, Cagán and Krajcovic. Coronographies have been performed in the Central X-ray Department of the Hospital and Clinic of Academician Dérer since the end of the year 1968. During the period of december 1968 to june 1970 selective coronographies were realized in 70 patients and they represented the first performances of this method in former Czechoslovakia. (Ref. 8.)

[History of the Surgery Clinic at the Slovak University Medical School in Bratislava during the war years (1941-1945)]

The aim of the present study was to contribute to a good and objective understanding of the development of the Department of Surgery of the Medical School in Bratislava over the war years of 1941-1945. After Prof. MUDr. Kostlivý had left Slovakia, his student, Prof. MUDr. Konstantín Cársky was appointed head of the Clinic of Surgery, as it was officially named. Already during the period of World War II, Prof. Cársky became a remarkable and reknown personality of the School of Medicine of the Slovak University in Bratislava. The first Slovak school of surgery developed under his guidance. On the basis of archival sources and documents, the paper presents statistical data concerning some aspects of the pedagogical activities of the Clinic of Surgery, its staffing, and the complicated process of competence growth, particularly appointments to the highest academic ranks.

[The activities of Professor Alojz Chura at the Comenius University Medical School in Bratislava]

One of the most outstanding personalities of Slovak nationality acting at the Medical Faculty of Comenius University in the first two decades of its existence was Prof. MUDr. Alojz Chura. He was among the first students of the Faculty and was then its active member until 1945. The aim of the present study was to contribute to a better understanding and unbiased evaluation of the importance and impact of the activities of this remarkable personality of Slovak pediatrics. In 1925 MUDr. Chura started to work at the Teaching Hospital of Pediatrics and in 1945 he was forced to leave both his position of Director of the Hospital and that of Full Professor of Pediatrics. As Director he had succeeded Prof. Brdlík who on leaving for Prague had suggested Prof. Chura for this responsible position. The contribution of Prof. Chura to the development of pediatrics in Slovakia was exceptional. His extensive sociological study "Slovakia without the Young Generation" laid the basis of social pediatrics in Slovakia. The Teaching Hospital of Pediatrics experienced considerable development under his guidance and that in all its areas of activity, i.e. teaching, prevention, therapy, and research. Besides his manifold activities at the Hospital and Medical Faculty, Prof. Chura was involved in many pursuits, particularly those which were related to the car of the youngest generation. He was Chairman of the Association of Pediatricians in Slovakia for many years. The study analyzes also the Memorandum issued in 1935 which is an important document of the actual social and health conditions in the Slovak country.(ABSTRACT TRUNCATED AT 250 WORDS)