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цитоплазми фолкулярних тироциив як маркер цитоплазмы фолликулярных тироцитов в качестве маркера
переважаючо! бшьшосп змш !х синтетично! преобладающего большинства изменений их синтетической
активность активности.
Ключовi слова: математичш технологи в Ключевые слова: математические технологии в
медициш, щитоподiбна залоза, тироцит, медицине, щитовидная железа, тироцит, цитофизиология,
цитофiзiологiя, маркери змiн стану. маркеры изменений состояния.
Стаття надшшла 15.07.18р. Рецензент Шеттько В.1.
DOI 10.26724/2079-8334-2018-3-65-185-189 UDC 611.12
MORPHOFUNCTIONAL PURPOSE OF HUMAN ATRIAL AURICLES
E-mail: borius007filenko@ukr.net
The paper is aimed at the topography study of the normal human atrial auricles. Specimens of 24 human hearts of both gender aged 55 to 76 years old with no cardiovascular lesions in the history have been studied. The analysis of the findings has shown that the right atrial auricle area, due to the presence of pectineal muscles and fossae between them, is a special adaptation which, in systole, results in the formation of turbulent streams, overlapping the main blood flow from the right atrium in the ventricles, giving it some turbulence. The longitudinal axis of the left atrial auricle is oriented perpendicular to the axial flow of blood from the left atrium into the ventricle. Generally, this is similar to a special attachment, the purpose of which is to transform the rhythmic reductions of the pectineal muscles of the atrial auricle into the force necessary for lateral shifting of blood flow layers through the atrium to the left ventricle and giving it a turbulent movement. The interior topography of the right and left atrial auricles is irregular and such scalloped surface is formed by the pectineal muscles, trabecules, multiple fossae and rare diverticula-like cavities. The extra and intracorporal models of the artificial heart must have a topography of the plains as close as possible to the human heart to avoid cardiovascular complications. The size of the auricle and its orifice should be considered during surgery on the cardiac valves.
Keywords : atrial auricles, orifice, heart, pectineal muscles, trabeculae.
The study is a fragment of the research project "Age-related aspects of the structural organization of the human immune system organs, glands of gastrointestinal and urogenital system in normal condition and pathology ". State registration number: 0106U004192, prolonged for the period of2016-2020.
Circulatory system diseases take the leading place among the causes of mortality in most industrialized countries [7, 8]. The prevalence of the cardiovascular pathology is constantly increasing worldwide [3, 6]. According to the experts ' predictions, the number of deaths from cardiovascular diseases will rise due to increasing mortality among the male population from 18,1 million people in 2010 to 24,2 million in 2030 worldwide [5]. As a result, there is an increase in the formation of thrombi in the heart, leading to fatal outcomes [1]. According to the publications, they are most frequently formed in the left atrial auricle [4]. In addition, while creating the artificial heart models, cardial cavities should be taken into account to further reduce multiple complications in the contact with the blood flow [10].
The purpose of the work was to study the topography of the normal human atrial auricles.
Materials and methods. Specimens of 24 human hearts of both gender aged 55 to 76 years old with no cardiovascular lesions in the history have been studied.
The methods of anatomic dissection and morphometry have been applied. Morphometric studies of the hearts, fixed in 10% formalin solution have been carried out using the flexible ruler and caliper as the measuring tools. The following measurements were used as morphometric indicators: the length and width of the atrial auricles (the length was determined by the distance from the midpoint of their base to the top, and the width by the mean diameter of its body); the diameter of the atrial auricles orifice. In addition, a count of the number of pectineal muscles on the medial and lateral walls of the left and right atrial auricles.
The resulting metric data has been statistically processed by the Microsoft Office Excel 2003 software and medical morphometry.
The study was performed in compliance with the requirements of major bioethical principals of the "European Convention for Human Rights and Biomedicine" (04.04.1997), Helsinki Declaration of the World Medical Association on Ethical Principles for Medical Research Involving Human Subjects (1964-2008), as well as the MOH of Ukraine Order No. 690 dated 23.09.2009.
Results of the study and their discussion. It has been found that on the anatomical wet
© A.P. Stepanchuk, N.V. Royko, 2018 185
ISSN 2079-8334. Ceim Meöu^Hu ma ôwnozn. 2018. № 3 (65)
specimens of the human hearts, the left and right atrial auricles occupy the anterosuperior portion of the lateral atrial wall. However, it has been noted that the longitudinal axes of the left and right atrial auricles are almost perpendicular to the chambers of the corresponding atria. The longitudinal axis of the left atrial auricle (LAA) descends inferiorly, and in the right atrial auricle (RAA) it is rectilinear. However, the cavity of the LAA is more isolated from the main chamber of the left atrium as compared to the RAA. The orifice of the RAA is merged with the main cavity of the right atrium by more opened form. Noteworthy, the orifice of the RAA is margined by muscle fibers posteriorly in contrast to the LAA. The abovementioned description of the atrial auricles is not presented in publications of other authors.
The analysis showed that lateral and medial walls, the superior and inferior ends, base and apex can be distinguished in each auricle. Exterior surfaces of the auricles are smooth (fig. 1).
2
t; 7 S 9 lO
Fig. 1. Appearance of the atrial auricles. Wet anatomical specimen. 1 - base of the right atrial auricle; 2 - lower edge of the right atrial auricle; 3 - upper edge of the right atrial auricle; 4 - lateral surface of the right atrial auricle; 5 - base of the left atrial auricle; 6 -lower edge of the left atrial auricle; 7 - lateral surface of the left atrial auricle; 8 - apex of the auricle; 9 - upper edge of the left atrial auricle.
Fig. 2. Overall view of the orifice of the left atrial auricle. Wet anatomical specimen. 1 - orifice of the left atrial auricle; 2 - upper edge of the atrial auricle; 3 -medial wall of the atrial auricle; 4 - lower edge of the atrial auricle.
At LAA inferior end the fancy-shaped projections, which were not seen in the RAA, indicating that the exterior shape of the auricles is different. The investigations show that the shape of the LAA is diverse [10]. In 17 cases of 24 observations the ridge-shaped auricles have been found, and in 6 cases they had irregular, scalloped, S-shape and in 1 case the shape of the auricle was oval. The RAA was conical more frequently (18 cases) and triangular less frequently (6 cases). The certain matches of the auricle shape with the heart shape have not been established. However, there is an apparent correlation between the length of the auricles and the size of the heart, which is in concordance with the opinion of other investigators.
The length of the LAA ranges from 2.5 to 4.2 cm, and the width from 1.09 cm to 2.81 cm. Small size of the LAA has been noted less frequently. The length of the LAA was 1.09 cm at its lateral surface only in one case out of 24 observations. The diameter of the LAA orifice ranges from 1 to 1.5 cm (table 1). The LAA orifice was more frequently oval and less frequently rounded (fig. 2).
At its lateral surface the length of the RAA ranges from 2.61 to 4.51 cm, its width from 1.75 to 3.45 cm. The diameter of the RAA orifice is wider than the LAA and ranges within 1.5 - 1.8 cm (table 1). Importantly, the comparison showed that in long auricle there is often greater the size of its width. However, in one case of 24 observation in great lenth (4.51 cm) of the RAA its width was 2.61 cm.
Table 1
Parameters Right atrial auricle Left atrial auricle
Lengh 3.29±0.05 3.34±0.05
Width 3.19±0.05 2.51±0.05
Diameter of the orifice 1.63±0.02 1.33±0.02
The interior topography of the auricles has been studied after dissection at their superior end and pulling apart of the walls. It is visible that the interior topography of the right and left atrial auricles is irregular and such scalloped surface is formed by the pectineal muscles, trabecules, multiple fossae and rare diverticula-like cavities (fig. 3).
The lateral wall of the right atrial auricles contains 10-12 pectineal muscles, while the medial wall has 6-8 pectineal muscles with a width of between 1 mm and 4 mm. The pectineal muscles starts from the base of the auricle as the joint trunk, and then, as they move through the walls to the apex of the auricle, some of them bifurcate and become thinner. Noteworthy, pectineal muscles of the right auricle are of the fan-shaped orientation with respect to the longitudinal axis of the right atrium. Pectineal
muscles are interconnected with trabecules of different lenght and thickness. More trabeculae are found on the medial wall of the right atrial auricle and less on lateral one. In one case out of 24 observations, the cavity of the right atrial auricle was divided into two non-symmetrical cavities by the septum.
In the left atrial auricle the number of pectineal muscles varies from 7 to 9 on the lateral wall and from 4 to 6 on the medial wall. Their width was 1-1.5 mm. the adjacent pectineal muscles are interconnected with trabeculae. The latter divided the space between pectineal muscles on the numerous fossae of different width and depth and rarely observed diverticula-like cavities (fig. 3).
A ) TrJffi - (» L
f ■H A f l X , /1 • ^ '! ' A* k : J Ofc 1' *
6
Fig. 3. The topography of the right (A) and left (B) atrial auricles. Wet anatomical specimen. 1 - upper edge of the atrial auricles; 2 - pectineal muscles and trabeculae of the medial wall of the atrial auricles; 3 - pectineal muscles and trabeculae of the lateral wall of the atrial auricles; 4 - diverticula-like cavities; 5 - part of the atrial lateral wall; 6 - area of the orifice of the atrial auricles.
Noteworthy, the thickness of walls in both atrial auricle is different. It is thicker in the are of pectineal muscles location, and thinner in the projection of the diverticula-like cavities. Our observations are confirmed by the findings of the group of authors, who has studied the walls of the human atrial auricles on the histological specimens. Their studies fully and thoroughly describe the structure of the endocardium, myocardium and epicardium of the human atrial auricles walls. The findings show, that the wall of the atrial auricle represents the alternation of thickened (in the area of pectineal muscles) and thin (between the pectineal muscles) sections with a particular structure. In both atrial auricles, the thickness of the wall in the thickened sections is 4-5 times greater than in the thin ones, and constitutes 1176.4 (882.6;1470.0) ^m in the left atrial auricle and 730.8 (548.4; 912.0) ^m in the right one. Accordingly, in the thinning sections the prominence of the wall of the left atrial auricle is 292.0 (219.0; 365.0) ^m and 165.5 (100.0; 205.5) ^m of the right one. The endocardium in the atrial auricles is represented by the well formed four layers: endothelium, sub-endothelial layer (superficial), muscular-elastic (medial) and exterior connective tissue layer (deep), with differences in thickness, density, and composition of their constituent elements in different parts of the wall. Importantly that a great number of elastic fibers are found in the medial layer, whereas their total volume is much smaller in the superficial and deep layers. In contrast, the amount of collagen fibers in them is relatively big. The areas of endocardium, lining the thinned sections of the atrial auricles walls are of particular interest. There is a significant increase in the relative size of the fiber elements. The content of collagen and elastin in these areas is 1.9 and 1.6 times higher, respectively, as compared to the average values.
Myocardium of the atrial auricles is developed relatively poorly. The muscular coat consists of 13 layers that are well expressed. The sections of the atrial auricles wall without myocardium have been detected. Epicardium that covers the heart muscle externally, in the area of pectineal muscles has the same thickness in both auricles (145.3 (112.7; 187.9) ^m in left atrial auricle that is 12.4% of the total thickness of the wall; 140.6 (106.2; 177.0) ^m in the right atrial auricle that is 19.2% of the wall thickness). In the sections of the wall located between the pectineal muscles, its expression is greater in the right atrial auricles (100.0 (90.0; 135.0) ^m or 60.4% of the wall thickness) than in the left one (77.4 (58.0; 95.0) ^m or 26.5% of the wall thickness).
Epicardium is represented by three layers: superficial, medial and deep. The thinnest layer of the epicardium is superficial both in the right and the left atrial auricles, whereas the medial and deep layers are more pronounced. Significantly more collagen and elastic fibres are found in the medial layer of the epicardium. In addition, they are 1.2-1.8 times thicker (up to 0.6-4.0 ^m) than other layers of epicardium and have a more dense spacing. In the superficial layer of the epicardium, near the mesothelium, reticular fibers form a thin reticular supporting plate, i.e., a basal membrane.
Here the fibers are thinner than in the other layers, but are spaced much denser. In the deep layer of the epicardium, no evident dominance of any type of fibers has been detected, but, unlike other layers, they are spaced more porous, largely due to the increase in the basal substance. In the epicardial areas, located between the pectineal muscles, a compression and increased, especially in the medial layer, number of elastic fibers has been noted.
1. The right atrial auricle area, due to the presence of pectineal muscles and fossae between them, is a special adaptation which, in systole, results in the formation of turbulent streams, overlapping the main blood flow from the right atrium in the ventricles, giving it some turbulence.
2. The longitudinal axis of the left atrial auricle is oriented perpendicular to the axial flow of blood from the left atrium into the ventricle. Generally, this is similar to a special attachment, the purpose of which is to transform the rhythmic reductions of the pectineal musclesof the atrial auricle into the force necessary for lateral shifting of blood flow layers through the atrium to the left ventricle and giving it a turbulent movement.
3. The extra and intracorporal models of the artificial heart must have topography of the plains as close as possible to the human heart to avoid cardiovascular complications.
4. During surgery the small size of the atrial auricles width and their orifices hampers the access to the heart valves.
The prospects of further research will encompass the study of the nature of morphological deteriorations in the atrial auricles in cardiac lesion.
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4. Ikorkin MR, Zharinov OI, Levchuk NP i dr. Diagnosticheskie vozmozhnosti chrespischevodnoy ehokardiografii u bolnyih s fibrillyatsiey predserdiy. Ukrayinskyi kardiolohichnyi zhurnal (osnovnyi vypusk). 2008; 3: 102 - 110. [in Russian]
5. Oganov RG. Serdechno-sosudistyie zabolevaniya v nachale XXI veka: meditsinskie, sotsialnyie, demograficheskie aspekty i puti profilaktiki. Federalnyi spravochnik. Zdravohranenie Rossii. Moskva: Izdatelskiy tsentr "Prezident". 2010; 13: 257 - 264. [in Russian]
6. Pisaruk AV, Koshel NM, Voytenko VP. Smertnost ot serdechno-sosudistykh zabolevaniy i obraz zhizni v stranah Evropy (mediko-demograficheskoe issledovanie). Krovoobih ta hemostaz. 2014; 1(2): 43 - 50. [in Russian]
7. Shalnova SA, Karpov AO, Kontsevaya YuA i dr. Analiz smertnosti ot serdechno-sosudistykh zabolevaniy v 12 regionakh rossiyskoy federatsii, uchastvuyushchikh v issledovanii "epidemiologiya serdechno-sosudistykh zabolevaniy v razlichnykh regionakh". Rossiyskiy kardiologicheskiy zhurnal. 2012; 5(97): 6 - 11. [in Russian]
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9. Stepanchuk AP, Tihonova OA, Soldatov AK. Stroyenie ushek serdtsa v norme i pri kombinirovannom mitralnom poroke. Visnyk problem biolohiyi i medytsyny. 2012; 2 1(92): 149 - 153. [in Russian]
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МОРФОФУНКЦЮНАЛЬНЕ ПРИЗНАЧЕННЯ ВУШКА ПЕРЕДСЕРДЯ ЛЮДИНИ Степанчук А.П., Ройко Н.В., Фшенко В.М., Пришляк А.М.
Робота спрямована на вивчення топографп вушок передсердь людини в норм^ Дослщжено 24 серця людей обох статей у вщ вщ 55 до 76 роюв без серцево-судинних уражень в анамнеза
Анайз отриманих даних показав, що область правого вушка передсердя через наявшсть гребшчастих м^в та ямки мiж ними е спещальною адаптащею, яка в систхот призводить до утворення турбулентних потоюв, що перекривають основний кровоток вщ правого передсердя у шлуночках, що надае йому певну турбулентшсть. Продольна вюь вушка лiвого передсердя орiентована перпендикулярно осьовому потоку кровi вщ лiвого передсердя до шлуночка. Взагалi це схоже на спещальне кршлення, метою якого е перетворення ритмiчних
МОРФОФУНКЦ1ОНАЛЬНОЕ ПРЕДНАЗНАЧЕНИЕ УШКА ПРЕДСЕРДИЯ ЧЕЛОВЕКА Степанчук А.П., Ройко Н.В., Филенко В.М., Пришляк А.М.
Анализ полученных данных показал, что область ушка правого предсердия из-за наличия гребенчатых мышц и ямки между ними является специальной адаптацией, которая в систоле приводит к образованию турбулентных потоков, перекрывающих основной кровоток от правого предсердия в желудочках, что придает ему определенную турбулентность. Продольная ось ушка левого предсердия ориентирована перпендикулярно к осевому потоку крови от левого предсердия к желудочкам. Вообще это похоже на специальное крепление, целью которого является превращение ритмических сокращений гребенчатой мускулатуры ушка предсердия в силу, необходимую для бокового перемещения слоев кровотока через предсердие
скорочень гребшчасто'1 мускулатури вушка передсердя в силу, необхщну для 6i4Horo перемщення шарiв кровоплину через передсердя до лiвого шлуночка i надання йому турбулентного руху. Внутрiшня топографй правого та лiвого вушок передсердь неправильна, та така зубчаста поверхня утворюеться гребiнчастими м'язами, трабекулами, множинними ямками та рщюсними дивертикулоподiбними порожнинами. Екстра- та штракорпоральш моделi штучного серця повиннi мати рiвнинну топографiю, максимально наближену до будови серця людини, щоб уникнути серцево-судинних ускладнень. Розмiр вушок передсердь та ïx отворiв слiд враховувати пiд час операци на серцевих клапанах.
Ключовi слова: вушка передсердь, отвiр, серце, гребiнчастi м'язи, трабекули.
Стаття надшшла 25.06.18 р.
к левому желудочку и придания ему турбулентного движения. Внутренняя топография правого и левого ушек предсердий неправильная, и такая зубчатая поверхность образуется гребенчатыми мышцами, трабекулами, множественными ямками и редкими дивертикулоподобными полостями. Экстра- и интракорпоральные модели искусственного сердца должны иметь равнинную топографию, максимально приближенную к строению сердца человека, чтобы избежать сердечно-сосудистых осложнений. Размер ушек предсердий и их отверстий следует учитывать при операции на сердечных клапанах.
Ключевые слова: ушки предсердий, отверстие, сердце, гребенчатые мышцы, трабекулы.
Рецензент Шеттько В.1.
DOI 10.26724/2079-8334-2018-3-65-189-196 УДК 611.818.5:611.81.013
МОРФОЛОГ1ЧНА ХАРАКТЕРИСТИКА ЕПЕНДИМНОГО ШАРУ ЧЕТВЕРТОГО ШЛУНОЧКА ТА ВОЛОКОН РАД1АЛБНО1 ГЛ11 ДОВГАСТОГО МОЗКУ В ПРЕНАТАЛЬНОМУ ПЕР1ОД1 ОНТОГЕНЕЗУ ЛЮДИНИ
E-mail: tikholaz.vo@gmail.com
У робой представлен результати морфолопчного та пстолопчного дослщження довгастого мозку у 230 ембрюшв та плодiв людини вщ 6-7 до 39-40 тижшв внутршньоутробного розвитку. Препарати довгастого мозку забарвлено гематоксилш-еозином, метиленовим сишм по Нiсслю та iмуногiстохiмiчними маркерами (S100, синаптофiзин, Ki-67, Bcl-2, вiментин). Проведено комп'ютерну морфометрiю та статистичну обробку отриманих даних. Встановлеш рiзнi вiковi перiоди змiни структури та кл^инного складу епендимного шару четвертого шлуночку, виявленi особливостi експресп iмуногiстохiмiчних маркерiв в клiтинах епендимного шару та вивчена топографiя волокон радiальиоI глil довгастого мозку в ембрюшв та плодiв людини рiзного гестацiйного вiку.
Ключов! слова: епендимний шар, нейральш стовбуров1 юнтини, танщити, епендимоцити, нейроонтогенез.
Робота е фрагментом НДР «Встановлення закономiрностей органо- та г^тогенезу i топографй внутрштх оргатв грудной, черевноi порожнин, а також структур центральноi нервовоi системы плодiв людини (макроскотчне, гiстологiчне, iмуногiстохiмiчне та УЗ-дождження). Порiвняння отриманих даних з аналогiчними у nлодiв з вродженими аномалiямирозвитку», № держреестрацн 0113U05070.
Усе бшьш актуальным постае питания дослщження механ1зм1в внутршньоутробного розвитку оргашзму людини з розвитком мшроскошчних оптичних прилащв та вдосконаленням 1мунопстох1м1чних метод1в забарвлення пстолопчних препарапв.
Одшею з найважливших стадш нейроонтогенезу е нейронна прол1ферац1я. До початку процешв мпрацй иейроепiтелiальиi кл1тини розташовуються у веитрикуляриiй зош i под1ляються симетрично, збiльшуючи кiлькiсть нейронних прогеиiториих клiтии. Надалi клiтиии переходять до асиметричного подшу, виаслiдок якого з одше! иейроепiтелiальиоI клiтиии утворюеться одна стовбурова i друга, яка може диференщюватися в нейробласт, кттину радiальиоI глiI, короткий попередник нейрона або ж базальну прогеиiториу кттку. Короткi попередники нейрона i кттини радiальиоI глiI не залишають вентрикулярно! зони, а базальиi прогеиiториi кл^ини вiдокремлюються вiд reI i формують субвентрикулярну зону [5]. Виаслiдок процешв пролiферацiI цилiидричиий иейроепiтелiй иервовоI трубки стае псевдобагатошаровим.
У веитрикуляриiй та субвентрикулярнш дiляиках иервовоI трубки концентруються основш пули стовбурових клiтии, що верифшовано забарвленням зрiзiв ембрiоиальиого мозку мишей i щурiв аититiлами до нестину. Кiлькiсть нестинпозитивних клiтии експоненщально зростае у всiх дiляиках в процес росту мозку. Аититiла до нестину забарвлюють новоутворенш клiтиии радiальноI гли [0].
Швидкий рют иервовоI тканини зародка здiйсиюеться за рахунок пролiферацiI та мiграцiI прогешторних клiтии. В мозковому сегмеитi нервовоI трубки людини мiграцiя прогеиiториих кттин починаеться пiсля першого мiсяця гестацй i завершуеться в постнатальному перiодi [0].
У зв'язку з пошуком можливих дiляиок ембрiогеиезу у мозку дорослоI людини иауковцi в
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