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Whole slide imaging (WSI) adoption has been slower in cytopathology due, in part, to challenges in multifocal plane scanning on 3-dimensional cell clusters. ThinPrep and other liquid-based preparations may alleviate the issue by reducing clusters in a concentrated area. This study investigates the use of Z-stacked images for diagnostic assessment and the experience of evaluating urine ThinPrep WSI.Thirty ThinPrep urine cases of high-grade urothelial carcinoma (n = 22) and cases of negative for high-grade urothelial carcinoma (n = 8) were included. Slides were scanned at 40× magnification without Z-stack and with Z-stack at 3 layers, 1 μm each. Six cytopathologists and 1 cytotechnologist evaluated the cases in 2 rounds with a 2-week wash-out period in a blinded manner. A Cohen's Kappa (CK) calculated concordance rates. A survey after each round evaluated participant experience.CK with the original report ranged from 0.606 to 1.0 (P .05) without Z-stack and 0.533 to 1.0 (P .05) with Z-stack both indicating substantial-to-perfect concordance. For both rounds, interobserver CK was moderate-to-perfect (0.417-1.0, P .05). Intraobserver CK was 0.697-1.0 (P 0.05), indicating substantial to perfect concordance. The average scan time and file size for slides without Z-stack and with Z-stack are 6.27 minute/0.827 GB and 14.06 minute/2.650 GB, respectively. Surveys demonstrated a range in comfort and use with slightly more favorable opinions for Z-stacked cases.Z-stack images provide minimal diagnostic benefit for urine ThinPrep WSI. In addition, Z-stacked urine WSI does not justify the prolonged scan times and larger storage needs compared to those without Z-stack.

Molecular testing (MT) of thyroid fine-needle aspiration (FNA)-derived genetic material is commonly used to assess malignancy risk for indeterminate cases. The Bethesda System for Reporting Thyroid Cytopathology (TBS) provides limited guidance for the appropriate use of category III (atypia of undetermined significance [AUS]). The authors combined MT with cytomorphology to monitor AUS diagnoses in a cytopathology laboratory.Neoplasia-associated genetic alterations (NGAs) were determined by MT of preoperative FNA biopsies or resected malignancies and were categorized as BRAF V600E mutations, RAS-like mutations (HRAS, NRAS, or KRAS mutations or non-V600E BRAF mutations), or other mutations.Among 7382 thyroid FNA biopsies, the AUS rate was 9.3% overall and ranged from 4.3% to 24.2% among 6 cytopathologists (CPs) who evaluated150 cases. The ratio of specimens falling into TBS category III to specimens falling into category VI (malignant) (the III:VI ratio) was 2.4 overall (range, 1.1-8.1), and the ratio of specimens falling into TBS categories III and IV (follicular neoplasm or suspicious for follicular neoplasm) combined (III+IV) to specimens falling into category VI (the [III+IV]:VI ratio) was 2.9 overall (range, 1.4-9.5). MT was performed on 588 cases from 560 patients (79% women) with a median age of 56 years (range, 8-89 years). BRAF V600E mutation was the most common (76% of cases) in TBS category VI and was rare (3%) in category III. RAS-like mutations were most common in TBS categories III (13%), IV (25%), and V (suspicious for malignancy) (17.5%). The NGA rate in AUS cases fell between 5% and 20% for 5 of 6 CPs and did not correlate with the III:VI ratio or the (III+IV):VI ratio.Lack of correlation between the NGA rate and easily calculable diagnostic ratios enables the calibration of diagnostic thresholds, even for CPs who have normal metrics. Specifically, calculation of the NGA rate and the III:VI ratio may allow individual CPs to determine whether they are overcalling or undercalling cases that other CPs might otherwise recategorize.

Hyperparathyroidism is a common endocrine disorder characterized by elevated levels of parathyroid hormone and hypercalcemia and is divided into 3 types: primary, secondary, and tertiary. Distinction between these types is accomplished by correlation of clinical, radiologic, and laboratory findings with pathologic features. Primary hyperparathyroidism occurs sporadically in 85% of cases with the remaining cases associated with multiple familial syndromes. The pathologic manifestations of primary hyperparathyroidism include parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma. Recent advances in the understanding of the pathogenesis of parathyroid disease has helped to refine the diagnosis and classification of parathyroid lesions. The identification of multiple clonal proliferations in traditional multiglandular parathyroid hyperplasia has led to the adoption by the World Health Organization (WHO) of the alternate term of primary hyperparathyroidism-related multiglandular parathyroid disease. Additional nomenclature changes include the adoption of the term atypical parathyroid tumor in lieu of atypical parathyroid adenoma to reflect the uncertain malignant potential of these neoplasms. Clinical and morphologic features characteristic of familial disease have been described that can help the practicing pathologist identify underlying familial disease and provide appropriate management. Use of ancillary immunohistochemistry and molecular studies can be helpful in classifying parathyroid neoplasms. Parafibromin has proven useful as a diagnostic and prognostic marker in atypical parathyroid tumors and parathyroid carcinomas. This review provides an update on the diagnosis and classification of parathyroid lesions considering the recent advances in the understanding of the molecular and clinical features of parathyroid disease and highlights the use of ancillary studies (immunohistochemical, and molecular) to refine the diagnosis of parathyroid lesions.

The authors discuss a case of CD19-negative diffuse large B-cell lymphoma with central nervous system relapse following CD19-directed CAR T-cell treatment. Absence of CD19 expression by the tumour cells presented a challenge for flow cytometry evaluation.

Background: Self-medication practice is widespread in many countries and the irrational use of drugs is a cause of concern. It assumes a special significance among medical students as they are exposed to knowledge about diseases and drugs. Medical students must be able to distinguish about their drugs outcomes on body. Aim: To assess perception and practice of self-medication among undergraduate medical students. Methods: A descriptive study was carried out among 4thyear MBBS students of Lahore Medical & Dental College in January 2019. Students of 4th year MBBS were asked to engage in the study after getting voluntary informed consent. A structured questionnaire was used. Data was entered, analyzed in SPSS 20. Results: In this study respondents 39.1% were male and 60.9% female. It was found that 77(67%) students practiced self-medication. The principal morbidity for seeking self-medication was headache as reported by 96(83.5%) students. NSAIDS were most commonly self-medicated as reported by 67(58.3%) students. Only 31(27%) students advised others for self-medication. Conclusion: Self-medication is widely practiced among under- graduate medical students. In this situation, we should educate the students about advantages and disadvantages of self-medication. Keywords: Self-medication, medical students, perception, practice.

Bile duct brushing (BDB) is used to evaluate pancreatobiliary lesions as it widely samples lesions with a low complication rate. Cytological evaluation of BDB is a specific but insensitive test. There is limited literature on the use of post-cytocentrifuged (PCC) samples, which are usually discarded, for next-generation sequencing (NGS) as an adjunct to cytological diagnosis of BDB. In this study we investigate whether molecular analysis by NGS of PCC specimens improves the sensitivity of diagnosis. PCC samples from 100 consecutive BDB specimens spanning 93 unique patients were retained. DNA was extracted and mutational analysis was performed agnostic of morphologic or clinical findings. Each BDB specimen was characterized as negative, atypical or positive based on morphological analysis by trained cytopathologists. Performance characteristics for mutational profiling and morphological analysis were calculated on the basis of clinicopathologic follow-up. There was sufficient clinicopathologic follow-up to classify 94 of 100 cases as either malignant (n = 43) or benign (n = 51). Based on morphologic analysis of cytology, these 94 cases were classified as either benign (n = 55), atypical (n = 18), or as at least suspicious or positive for malignancy (n = 21). Morphologic analysis of cytology showed a sensitivity of 49% and a specificity of 100% if atypical cases were considered negative. NGS revealed oncogenic alterations in 40/43 (93%) of malignant cases based on clinicopathologic follow-up. The most common alterations were in KRAS and TP53, observed in 77% and 49% of malignant cases respectively. No alterations were observed in the 51 benign cases classified based on clinicopathologic follow-up. Supplementing cytomorphologic analysis with molecular profiling of PCC by targeted NGS analysis increased the sensitivity to 93% and maintained specificity at 100%. This study provides evidence for the utility of NGS molecular profiling of PCC specimens to increase the sensitivity of BDB cytology samples, although studies with larger cohorts are needed to verify these findings.

Succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumors (GISTs) are characterized by the lack of mutations in KIT receptor tyrosine kinase complex and platelet derived growth factor receptor-alpha (PDGFRA) that are commonly found in the majority of GISTs. SDH-deficient GISTs comprise approximately 5%-10% of all GISTs. This subset may be associated with Carney Triad and Carney-Stratakis syndrome. SDH-deficient GISTs show unique demographic, radiologic, morphologic findings, clinical behavior, and treatment response. To our knowledge, the identification and characterization of this subset of GISTs have not yet been described in the cytopathology literature. By understanding the clinical as well as the other unique features of this tumor, in addition to the rapidly evolving identification of specific molecular alterations and targeted therapies, cytopathologists may play an important role in the diagnosis and work-up of these patients to allow clinicians to better manage and treat them. We present a young female with gastric SDH-deficient GIST diagnosed by fine-needle biopsy with supporting surgical pathology follow-up and molecular confirmation. This report suggests that the diagnosis of SDH-deficient GIST can be made on cytology in the appropriate clinical setting by using cytomorphologic features and demonstrating SDH loss by IHC on the cell block. In addition, molecular testing may be possible on the cytology cell block or supernatant to confirm the diagnosis.

We present a comprehensive review of the various challenges that individuals with visual impairment (VI) face during the COVID-19 pandemic. A structured review was done using online databases PubMed, EMBASE, and grey literature databases between 19 April 2021 and 4 August 2021, using search terms ‘COVID-19’, ‘SARS-CoV-2’, ‘Coronavirus’, or ‘pandemic’ combined with ‘visually impaired’, ‘visual impairment’, or ‘Blind’. Studies included were written in English, published after the World Health Organization (WHO) declaration of the COVID-19 Pandemic (11 March 2020), and focused on the VI population during the pandemic. The initial search yielded 702 publications, of which 20 met our inclusion criteria and were included in analysis. Emotional distress from deteriorating mental health and social isolation were considerably higher in the VI population. For a community that relies on spatial awareness and touch, regulations related to social distancing and avoiding contact were considerable barriers. Further challenges were noted in accessing healthcare, care, receiving timely health information and changes in regulations, adequately sanitizing, using technology, and completing activities of daily living. In the unprecedented times of the COVID-19 pandemic, the VI community has faced unique challenges. A more holistic and inclusive approach needs to be adopted to ensure that more vulnerable populations are adequately cared for.

ObjectivesHuman papillomavirus (HPV) is known to be associated with squamous intraepithelial lesions (SILs). However, there is limited and conflicting literature on the relationship between bacterial vaginosis (BV) and SIL. The aim of this study is to determine the prevalence of BV and evaluate the association between BV and SIL.MethodsA retrospective study was performed on 10,546 cases between 2012 and 2017. HPV results were available in 7,081 cases.ResultsBV was present in 17.6% of cases. There was significant association between BV, positive HPV infection, and high-grade SIL. BV patients with negative HPV infection showed more squamous abnormalities than BV-negative HPV-negative patients.ConclusionsWe found there is a significant association between BV and SIL. BV is more common among patients with HPV infection and is independently associated with squamous abnormalities in cervical smears and surgical follow-up.

The International System for Reporting Serous Fluid Cytopathology proposed five diagnostic categories: Nondiagnostic (ND), Negative for Malignancy (NFM), Atypia of Undetermined Significance (AUS), Suspicious for Malignancy (SFM) and Malignant (MAL) (Primary or Metastatic). The indeterminate (AUS/SFM) categories are challenging for management. The goal of this study is to reveal the root causes contributing to indeterminate diagnoses (ID).We searched our archives between 1 January 2017 and 30 June 2019, and performed a root cause analysis (RCA) using the "5 whys" method to determine the contributing factors of ID.Nine hundred eleven specimens were evaluated and diagnosed: ND (9, 1%), NFM (667, 73.2%), AUS (51, 5.6%), SFM (27, 3%) and MAL (157, 17.2%). More than one factor contributed to 38/78 ID. Low volume (50 cc), and low cellularity were identified in 31 and 51 cases, respectively. Three cases were simply deferred to concurrent biopsy. Eleven cases were called atypical, favor reactive mesothelium despite confirmatory IHC. Atypical lymphoid population was reported in seven cases. Cellblocks (CB) were low in cellularity despite volume1000 mL in 13 cases. Two mesotheliomas were underdiagnosed as suspicious.Low cellularity and low volume were the most common contributing factors, highlighting the importance of adequate sample collection. Adequate volume specimens with low cellularity may benefit from a close inspection and a second CB. Some IDs can be switched to NFM or MAL with careful consideration of clinical, radiologic findings and ancillary testing, and concurrent surgical pathology correlation when available.

Background Fine-needle aspiration (FNA) of the pancreas is considered the primary and least invasive diagnostic method in the evaluation of pancreatic lesions. A nondiagnostic sample may trigger repeat FNA or a more invasive diagnostic procedure. The goal of this study was to identify the root causes of nondiagnostic samples. Methods We performed a retrospective review of FNAs of the pancreas categorized as nondiagnostic at our institution between 2008 and 2019. Medical records and slides were reviewed to identify the features described by imaging, rapid on-site evaluation, fluid chemistry, final cytology diagnosis, and final histology. A root cause analysis was performed using the Ishikawa (or fishbone) diagram and the 5 Whys method. Results A total of 30 cases were identified: 11 adenocarcinomas, 6 cases of pancreatitis, 4 intraductal papillary mucinous neoplasms, 3 serous cystadenomas, 3 neuroendocrine tumors, 1 mucinous cystic neoplasm, 1 retention cyst, and 1 case of Brunner gland hyperplasia. The root causes identified were: man in 8 cases, machine in 1 case, method in 17 cases, and material in 18 cases. In many cases, more than 1 root cause contributed to the problem. Conclusion Material related errors contributed to the majority of nondiagnostic results and were primarily related to fibrotic cancers, chronic pancreatitis, absence of diagnostic criteria of cystic lesions, and technically challenging cases. Only 1 major interpretation error was identified. Sampling and interpretive errors contributed equally to man-related causes. For mucinous cysts, neoplastic mucin was difficult to identify in liquid-based preparations. Pathologists tended to issue a nondiagnostic categorization when epithelial cells are lacking and particularly when the nature and radiological impression of the cyst was not communicated.

Safety concerns and/or the stochastic nature of current transduction approaches have hampered nuclear reprogramming's clinical translation. We report a novel non-viral nanotechnology-based platform permitting deterministic large-scale transfection with single-cell resolution. The superior capabilities of our technology are demonstrated by modification of the well-established direct neuronal reprogramming paradigm using overexpression of the transcription factors Brn2 , Ascl1 , and Myt1l (BAM). Reprogramming efficiencies were comparable to viral methodologies (up to ~9-12%) without the constraints of capsid size and with the ability to control plasmid dosage, in addition to showing superior performance relative to existing non-viral methods. Furthermore, increased neuronal complexity could be tailored by varying BAM ratio and by including additional proneural genes to the BAM cocktail. Furthermore, high-throughput NEP allowed easy interrogation of the reprogramming process. We discovered that BAM-mediated reprogramming is regulated by AsclI dosage, the S-phase cyclin CCNA2 , and that some induced neurons passed through a nestin-positive cell stage. From the Clinical Editor In the field of regenerative medicine, the ability to direct cell fate by nuclear reprogramming is an important facet in terms of clinical application. In this article, the authors described their novel technique of cell reprogramming through overexpression of the transcription factors Brn2, Ascl1, and Myt1l (BAM) by in situ electroporation through nanochannels. This new technique could provide a platform for further future designs.

Multiple sclerosis (MS) is a World-wide spread autoimmune disease that includes episode of demyelination in the central nervous system (CNS). Accumulating evidence has demonstrated that ligand-activated aryl hydrocarbon receptor (Ahr) improves pathological outcomes in experimental autoimmune encephalomyelitis (EAE), an experimental model of MS. Recent evidences have shown that AT-rich interactive domain-containing protein 5a (Arid5a), an RNA-binding protein, is required for development of EAE via stabilizing the mRNAs of interleukin-6 (Il6) and Ox40. To date, there are no reports studying both Ahr and Arid5a as a potential therapeutic strategy for MS. Thus, current work applied in silico, in vitro and in vivo approaches to identify a molecule that interacts with Ahr and Arid5a. The results identified Flavipin (3,4,5-trihydroxy-6-methylphthalaldehyde) as a new Ahr agonist that induces the expression of downstream genes in mice CD4+ T cells and CD11b+ macrophages. Interestingly, Flavipin inhibited the stabilizing function of Arid5a, and impaired its counteracting effects on RNase function of Regnase-1 on 3′ untranslated region (3′UTR) of Il6, Ox40 and signal transducer and activator of transcription 3 (stat3). In EAE, Flavipin ameliorated disease symptoms concomitant with inducing acetylcholinesterase (AChE)-targeting miR-132. It reduced the expression of Ox40 in CD4+ T cells and the number infiltrated CD4+CD45+ T cells in the CNS. Further analysis identified Il23a mRNA as a new target for Arid5a. Taken together, our findings provide first evidences on differential effects of Flavipin on Ahr and Arid5a and pave an avenue for a new therapeutic strategy for autoimmune diseases such as MS.

The postnatal period in mammals represents a developmental epoch of significant change in the autonomic nervous system (ANS). This study focuses on postnatal development of the area postrema, a crucial ANS structure that regulates temperature, breathing, and satiety, among other activities. We find that the human area postrema undergoes significant developmental changes during postnatal development. To characterize these changes further, we used transgenic mouse reagents to delineate neuronal circuitry. We discovered that, although a well-formed ANS scaffold exists early in embryonic development, the area postrema shows a delayed maturation. Specifically, postnatal days 0-7 in mice show no significant change in area postrema volume or synaptic input from PHOX2B-derived neurons. In contrast, postnatal days 7-20 show a significant increase in volume and synaptic input from PHOX2B-derived neurons. We conclude that key ANS structures show unexpected dynamic developmental changes during postnatal development. These data provide a basis for understanding ANS dysfunction and disease predisposition in premature and postnatal humans.

The saprophytic nematode Halicephalobus is a rare cause of fatal human meningo-encephalitis, and West Nile virus is neurotropic flavivirus implicated in a variety of clinical neurologic syndromes. Here we report a case of rapidly progressive CNS encephalopathy and death. Serologic, immuno-histochemical, histopathologic and nucleic acid studies demonstrate the presence of active Halicephalobus and West Nile virus in the CNS tissue. This is the first reported case of co-infection with these neurotropic pathogens.

Major depressive disorder (MDD) is the most common non-motor manifestation of Parkinson’s disease (PD) affecting 50% of patients during their course of illness. However, little is known about the cognitive correlates of MDD in PD. Using a computer-based cognitive task that dissociates learning from positive and negative feedback, we tested four groups of subjects: (1) patients with PD who have MDD, (2) patients with PD without MDD, (3) matched patients with MDD alone (without PD), and (4) matched healthy control subjects. Further, we used a mathematical model of decision making to fit both choice and response time data, allowing us to detect and characterize differences between the groups that are not revealed by cognitive results. The groups did not differ in learning accuracy from negative feedback, but the MDD groups (PD patients with MDD, and patients with MDD alone) exhibited a selective impairment in learning accuracy from positive feedback when compared to the non-MDD groups (PD patients without MDD and healthy subjects). However, response time in positive feedback trials in the PD groups (both with and without MDD) was significantly slower than the non-PD groups (MDD and healthy groups). While faster response time usually correlates with poor learning accuracy, it was paradoxical in PD groups, with PD patients with MDD having impaired learning accuracy while PD patients without MDD having intact learning accuracy. Mathematical modeling showed that both MDD groups (PD with MDD and MDD alone) were significantly slower than non-MDD groups in the rate of accumulation of information for stimuli trained by positive feedback which can lead to lower response accuracy. Conversely, modeling revealed that both PD groups (PD with MDD and PD alone) require more evidence than other groups to make responses, thus leading to slower response times. These results suggest that PD patients with MDD exhibit cognitive profiles with mixed traits characteristic of both MDD and PD, furthering our understanding of both PD and MDD and their often-complex comorbidity. To the best of our knowledge, this is the first study to examine feedback-based learning in PD with MDD while controlling for the effects of PD and MDD.

Objectives/Hypothesis To determine speech, eating, aesthetics, social disruption, and overall quality-of-life outcomes over a year period in patients who underwent transoral robotic surgery as part of carcinoma of unknown primary diagnosis and treatment. Study Design Observational prospective study. Methods Twenty-two patients who underwent transoral robotic surgery for the management of carcinoma of unknown primary were included. Patients prospectively completed the Head and Neck Cancer Inventory during a preoperative visit, and at 3-week, 3-month, 6-month, and 12-month postoperative visits. Patients' demographic, pathological, and follow-up information were also collected. Results The mean follow-up time was 19.8 months. There were overall declines in all quality of life scores during treatment period, which was followed by a continuous recovery. The scores immediately after transoral robotic surgery (3 weeks) were significantly higher than the scores after conclusion of adjuvant therapy (3 months) in multiple domains (P

The research reported in this publication was supported by the Office of Sponsored Research (OSR) under the Grant Agreement FCS/1/3321/01 and by baseline funding from the King Abdullah University of Science and Technology (KAUST). M. A. A. is grateful to Saudi Basic Industries Corporation (SABIC) for funding received towards the PhD. H.N.M. thanks the KAUST SRSI program for support.J.I.K. and R.S.A. contributed equally to the work.

Intraoperative neuropathology of glioma recurrence represents significant visual challenges to pathologists as they carry significant clinical implications. For example, rendering a diagnosis of recurrent glioma can help the surgeon decide to perform more aggressive resection if surgically appropriate. In addition, the success of recent clinical trials for intraoperative administration of therapies, such as inoculation with oncolytic viruses, may suggest that refinement of the intraoperative diagnosis during neurosurgery is an emerging need for pathologists. Typically, these diagnoses require rapid/STAT processing lasting only 20-30 minutes after receipt from neurosurgery. In this relatively short time frame, only dyes, such as hematoxylin and eosin (H and E), can be implemented. The visual challenge lies in the fact that these patients have undergone chemotherapy and radiation, both of which induce cytological atypia in astrocytes, and pathologists are unable to implement helpful biomarkers in their diagnoses. Therefore, there is a need to help pathologists differentiate between astrocytes that are cytologically atypical due to treatment versus infiltrating, recurrent, neoplastic astrocytes. This study focuses on classification of neoplastic versus non-neoplastic astrocytes with the long term goal of providing a better neuropathological computer-aided consultation via classification of cells into reactive gliosis versus recurrent glioma. We present a method to detect cells in H and E stained digitized slides of intraoperative cytologic preparations. The method uses a combination of the ‘value’ component of the HSV color space and ‘b*’ component of the CIE L*a*b* color space to create an enhanced image that suppresses the background while revealing cells on an image. A composite image is formed based on the morphological closing of the hue-luminance combined image. Geometrical and textural features extracted from Discrete Wavelet Frames and combined to classify cells into neoplastic and non-neoplastic categories. Experimental results show that there is a strong consensus between the proposed method’s cell detection markings with those of the pathologist’s. Experiments on 48 images from six patients resulted in F1-score as high as 87.48%, 88.08% and 86.12% for Reader 1, Reader 2 and the reader consensus, respectively. Classification results showed that for both readers, binary classification tree and support vector machine performed the best with F1-scores ranging 0.92 to 0.94.

Postnatal cerebellar folial surface area expansion promotes cerebellar cortical cytoarchitectural lamination. We developed a stream-lined sampling scheme/work-flow to generate objective/unbiased es...

The transcription factor PHOX2B is a master regulator of autonomic nervous system function as well as the specification of noradrenergic neurons. Incomplete maturity and/or absence of noradrenergic...

Mutations in DNA repair genes show peculiar defects in central nervous system morphogenesis characterized by dramatic cerebellar dysmorphia with relatively preserved forebrain development. Loss of ...

In this paper, we present a computer aided diagnosis system focusing on one important diagnostic branchpoint in clinical decision-making: prognostic reporting of p53 expression in glioblastoma patients. Studies in other tumor paradigms have shown that the staining intensity correlates with TP53 mutation status, and that gliomas show inter-tumoral heterogeneity in p53 mutation status. Increasing diagnostic accuracy by computer-aided image analysis algorithms would deliver an objective assessment of such prognostic biomarkers. We proposed a method for the detection and classification of positive and negative cells in digitized p53-stained images by means of a novel adaptive thresholding for the detection, and two-step rule based on weighted color and intensity for the classification. The proposed thresholding technique is able to correctly locate both positive and negative cells by effectively addressing the closely connected cells problem, and records a promising 85% average precision and 88% average recall rate. On the other hand, the proposed two-step rule achieves 81% classification accuracy, which is comparable with neuropathologists’ markings.

Premature babies are at risk for life-threatening autonomic dysfunction, including abnormal CNS control of breathing. These problems arise in part from immaturity of the autonomic nervous system in premature babies. The transcription factor PHOX2B is a master regulator of autonomic nervous system function as well as the specification of noradrenergic neurons. All autonomic afferent and efferent circuits require normal PHOX2B function, and therefore PHOX2B-derived neurons must have attained developmental maturity at birth for normal physiological function. Incomplete maturity and/or absence of noradrenergic and serotonergic neuron networks are a proposed mechanism of infant breathing disorders including apnea of prematurity, sudden infant death syndrome, and congenital central hypoventilation syndrome (CCHS). PHOX2B mutations result in the “chemosensation” loss characteristic of CCHS, resulting in poor respiratory drive secondary to hypercarbia (high pCO2). The developmental processes occurring during late...

Cyclin A2 regulates replication origin firing during S-phase. It binds to Cdk1 and Cdk2 to direct phosphorylation of proteins for DNA synthesis. The goals of this study were to determine the role of Cyclin A2 in the prevention of DNA double strand breaks (DSB). We deleted Cyclin A2 in mouse neural stem cells (NSC) using a cre/lox approach. Cyclin A2-null NSC showed increased BrdU incorporation, as well as increased staining for the mitotic marker pH3. However, the growth rate in these Cyclin A2-null cells was slowed. To explain this discordance, we examined the DSB marker γH2AX. Cyclin A2-null NSC show increased levels of γH2AX as compared to Cyclin A2-preserved cells. When a DSB forms, the cell cycle is arrested until the break is repaired. Rad51, a marker of homologous recombination repair, and 53BP1, a marker of non-homologous end joining, both localized to the site of DSB in Cyclin A2-null cells. This indicates that Cyclin A2-null NSC can repair these breaks. Our results suggest that Cyclin A2 does no...

Brain cancer surgery requires intraoperative consultation by neuropathology to guide surgical decisions regarding the extent to which the tumor undergoes gross total resection. In this context, the differential diagnosis between glioblastoma and metastatic cancer is challenging as the decision must be made during surgery in a short time-frame (typically 30 minutes). We propose a method to classify glioblastoma versus metastatic cancer based on extracting textural features from the non-nuclei region of cytologic preparations. For glioblastoma, these regions of interest are filled with glial processes between the nuclei, which appear as anisotropic thin linear structures. For metastasis, these regions correspond to a more homogeneous appearance, thus suitable texture features can be extracted from these regions to distinguish between the two tissue types. In our work, we use the Discrete Wavelet Frames to characterize the underlying texture due to its multi-resolution capability in modeling underlying texture. The textural characterization is carried out in primarily the non-nuclei regions after nuclei regions are segmented by adapting our visually meaningful decomposition segmentation algorithm to this problem. k-nearest neighbor method was then used to classify the features into glioblastoma or metastasis cancer class. Experiment on 53 images (29 glioblastomas and 24 metastases) resulted in average accuracy as high as 89.7% for glioblastoma, 87.5% for metastasis and 88.7% overall. Further studies are underway to incorporate nuclei region features into classification on an expanded dataset, as well as expanding the classification to more types of cancers.

To determine speech, eating, aesthetics, social disruption, and overall quality-of-life outcomes over a year period in patients who underwent transoral robotic surgery as part of carcinoma of unknown primary diagnosis and treatment.Observational prospective study.Twenty-two patients who underwent transoral robotic surgery for the management of carcinoma of unknown primary were included. Patients prospectively completed the Head and Neck Cancer Inventory during a preoperative visit, and at 3-week, 3-month, 6-month, and 12-month postoperative visits. Patients' demographic, pathological, and follow-up information were also collected.The mean follow-up time was 19.8 months. There were overall declines in all quality of life scores during treatment period, which was followed by a continuous recovery. The scores immediately after transoral robotic surgery (3 weeks) were significantly higher than the scores after conclusion of adjuvant therapy (3 months) in multiple domains (P.05) and the 6-month scores in speech (P = .02) and eating (P = .008) domains. All scores, except for eating (P = .01) returned to pretreatment levels at 1 year. Patients with detected primaries displayed similar quality-of-life scores compared to patients with occult primaries. Human papillomavirus status and type of adjuvant treatment had no significant impact on quality of life.Transoral robotic surgery is a promising, minimally invasive procedure for the surgical management of carcinoma of unknown primary. Patients maintain high functional and quality-of-life status at 1 year after surgery.

Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique for TORS supraglottic laryngectomy (SGL).A patient with a T2N0M0 laryngeal cancer limited to the supraglottic larynx was selected for TORS.En bloc tumor resection was accomplished with negative surgical margins together with bilateral selective neck dissection. There was no perioperative or early postoperative complication. The patient was extubated immediately after surgery. Oral supraglottic diet was initiated within the first 24 hours. No gastrostomy or tracheostomy tube placement was required. A video demonstration of the surgical technique is included on HeadNeck's website.TORS SGL is a safe and feasible procedure for the resection of selected supraglottic tumors.

Background Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique for TORS supraglottic laryngectomy (SGL). Methods A patient with a T2N0M0 laryngeal cancer limited to the supraglottic larynx was selected for TORS. Results En bloc tumor resection was accomplished with negative surgical margins together with bilateral selective neck dissection. There was no perioperative or early postoperative complication. The patient was extubated immediately after surgery. Oral supraglottic diet was initiated within the first 24 hours. No gastrostomy or tracheostomy tube placement was required. A video demonstration of the surgical technique is included on Head & Neck's website. Conclusion TORS SGL is a safe and feasible procedure for the resection of selected supraglottic tumors. © 2014 Wiley Periodicals, Inc. Head Neck 37: 125–126, 2015

PURPOSE: To explain the use of the mixed-cylinder approach in treating moderate to high astigmatism with the NIDEK EC-5000 excimer laser system. METHODS: Retrospective case series report. RESULTS: Three patients with bilateral moderate to high astigmatism were treated successfully using the mixed cylinder approach. CONCLUSIONS: The use of the mixed-cylinder approach with the NIDEK EC-5000 excimer laser may be a safe and predictable option for treating moderate to high astigmatism. [J Refract Surg. 2006;22:S1073-S1078.]

Hamza N Aboud. Evaluation of new reduction technique for acute anterior shoulder dislocation. The New Iraqi Journal of Medicine (ISSN:1817-5562, 1998037X) 2006; 2(1): 12-26. Doi: 10.5281/zenodo.3882067 https://journals.indexcopernicus.com/search/journal/issue?issueId=all&journalId=34418 https://www.scimagojr.com/journalsearch.php?q=19500157035&tip=sid&clean=0 https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22New+Iraqi+J+Med%22[Title+Abbreviation https://publicationethics.org/members/new-iraqi-journal-medicine&nbsp

Purpose: To evaluate the effect of removal and/or exchange of intrastromal corneal ring segments (ICRS, Intacs); specifically the risk factors, degree of reversibility, and visual outcomes. Setting: Gimbel Eye Centres, Calgary, Edmonton, and Vancouver, Canada. Methods: Prospective cohort data were collected on 71 eyes that had ICRS placement by 3 surgeons at the Gimbel Eye Centres between August 1998 and July 1999. Data included patient symptoms, best spectacle-corrected visual acuity, uncorrected visual acuity (UCVA), manifest refraction, reason for removal or replacement, keratometry, corneal topography, and complications. Results: Twenty-four eyes (33.8%) had exchange or removal procedures because of underresponse, 20 eyes; overresponse, 2 eyes; and induced astigmatism and shallow placement, 1 eye each. Secondary procedures were removal and replacement, removal with subsequent laser in situ keratomileusis, and segment repositioning. Two risk factors for secondary surgery were identified: high preoperative refractive astigmatism and postoperative spherical equivalent greater than ±0.5 diopter (D). The 6 eyes that had ICRS removal stabilized to within ±0.25 D of the original refractive error with no surgically induced astigmatism within 1 to 7 weeks (mean 4 weeks) and had a final UCVA of 20/20 or better. In the 15 eyes that had ICRS exchange procedures, the UCVA improved by at least 1 line and median UCVA improved from 20/40 to 20/20. Conclusion: Preliminary data from this study indicate that removal of segments resulted in reversal of the refractive effect.

HIV nephropathy (HIVAN) is markedly racially biased in its distribution, occurring in about 10% of HIV infected African Americans according to some studies. Based upon previous laboratory and epidemiological studies, the Duffy promoter polymorphism, which occurs almost exclusively in individuals of African descent, has been postulated to be the predisposing factor. We aimed to explore that relationship by directly genotyping individuals with HIV nephropathy to determine the proportion homozygous for this mutation to test the hypothesis it was responsible for the genetic component of this disease. We anticipated that if the polymorphism was associated with HIV nephropathy all individuals would be homozygous for this mutation.Individuals with HIVAN proven on biopsy were identified from previous studies and a pre-existing clinical database. This diagnosis was confirmed by an experienced pathologist examining the biopsies in a blinded fashion. PCR and RFLP strategies were used on the biopsy samples to genotype for the Duffy promoter polymorphism. The cases were compared to a control population of HIV seronegative African Americans.Twenty African American individuals with HIV nephropathy were successfully genotyped. Only nine were homozygous for the promoter mutation. Nine were heterozygous and two homozygous wild type. Furthermore, the frequency of the polymorphism did not differ from the background rate in the African American population (OR = 0.788 95% confidence intervals 0.378-1.64).The Duffy promoter polymorphism was not disproportionately represented in persons with HIVAN calling into question any significant role in the pathogenesis of HIVAN.