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Advanced glycation end‐products (AGEs) are implicated in the pathogenesis of vascular disease. In previous studies we have found increased deposition of N(e)‐(carboxymethyl)lysine (CML) in intramyocardial vasculature in the heart in acute myocardial infarction and myocarditis. It is known that the process of inflammation plays a role in the formation of AGEs. In this study we have explored the presence of CML (a major AGE) in the heart of patients with epicarditis using a monoclonal anti‐CML antibody. Nine patients with epicarditis (n = 9) died and their hearts were used for this study, control were hearts from patients who died from conditions unrelated to heart disease and without signs of myocarditis or epicarditis CML deposition and complement were significantly increased in patients with epicarditis compared to control hearts. Thus epicarditis increases CML depositions in the intramyocardial vasculature. [ABSTRACT FROM AUTHOR]

Even though entirely digitized microscopic tissue sections (whole slide images, WSIs) are increasingly being used in histopathology diagnostics, little data is still available on the effect of this technique on pathologists' reading time. This study aimed to compare the time required to perform the microscopic assessment by pathologists between a conventional workflow (an optical microscope) and digitized WSIs. WSI was used in primary diagnostics at the Laboratory for Pathology Eastern Netherlands for several years (LabPON, Hengelo, The Netherlands). Cases were read either in a traditional workflow, with the pathologist recording the time required for diagnostics and reporting, or entirely digitally. Reading times were extracted from image management system log files, and the digitized workflow was fully integrated into the laboratory information system. The digital workflow saved time in the majority of case categories, with prostate biopsies saving the most (68% time gain). Taking into account case distribution, the digital workflow produced an average gain of 12.3%. Using WSI instead of conventional microscopy significantly reduces pathologists' reading times. Pathologists must work in a fully integrated environment to fully reap the benefits of a digital workflow. [ABSTRACT FROM AUTHOR]

Case Presentation: A 37-year-old woman presented with a 2-month history of recurrent hemoptysis and coughing. Her symptoms started 2 months after the delivery of her third child. In total, she endured four episodes of hemoptysis. All pregnancies were induced by intracytoplasmic sperm injections. She lacked a pulmonary or smoking history and had no history of foreign body aspiration or intubation. There was no dyspnea, dysphagia, fever, or chest pain, and the patient did not complain of purulent sputum. She currently did not use medication and was generally in good health. [ABSTRACT FROM AUTHOR]

Background: The benefits of digital pathology for workflow improvement and thereby cost savings in pathology, at least partly outweighing investment costs, are being increasingly recognised. Successful implementations in a variety of scenarios have started to demonstrate the cost benefits of digital pathology for both research and routine diagnosis, contributing to a sound business case encouraging further adoption. To further support new adopters, there is still a need for detailed assessment of the impact that this technology has on the relevant pathology workflows, with an emphasis on time‐saving. Aims: To assess the impact of digital pathology adoption on logistic laboratory tasks (i.e. not including pathologists' time for diagnosis‐making) in the Laboratorium Pathologie Oost Nederland, a large regional pathology laboratory in The Netherlands. Methods and results: To quantify the benefits of digitisation, we analysed the differences between the traditional analogue and new digital workflows, carried out detailed measurements of all relevant steps in key analogue and digital processes, and compared the time spent. We modelled and assessed the logistic savings in five workflows: (i) routine diagnosis; (ii) multidisciplinary meeting; (iii) external revision requests; (iv) extra stainings; and (v) external consultation. On average, >19 working hours were saved on a typical day by working digitally, with the highest savings in routine diagnosis and multidisciplinary meeting workflows. Conclusions: By working digitally, a significant amount of time could be saved in a large regional pathology laboratory with a typical case mix. We also present the data in each workflow per task and concrete logistic steps to allow extrapolation to the context and case mix of other laboratories. [ABSTRACT FROM AUTHOR]

Aims: Most validation studies on digital pathology diagnostics have been performed in single institutes. Because rapid consultation on cases with extramural experts is one of the most important uses for digital pathology laboratory networks, the aim of this study was to validate a whole‐slide image‐based teleconsultation network between three independent laboratories. Methods and results: Each laboratory contributed 30 biopsies and/or excisions, totalling 90 specimens (776 slides) of varying difficulty and covering a wide variety of organs and subspecialties. All slides were scanned centrally at ×40 scanning magnification and uploaded, and subsequently assessed digitally by 16 pathologists using the same image management system and viewer. Each laboratory was excluded from digital assessment of their own cases. Concordance rates between the two diagnostic modalities (light microscopic versus digital) were compared. Loading speed of the images, zooming latency and focus quality were scored. Leaving out eight minor discrepancies without any clinical significance, the concordance rate between remote digital and original microscopic diagnoses was 97.8%. The two cases with a major discordance (for which the light microscopic diagnoses were deemed to be the better ones) resulted from a different interpretation of diagnostic criteria in one case and an image quality issue in the other case. Average scores for loading speed of the images, zooming latency and focus quality were 2.37 (on a scale up to 3), 2.39 (scale up to 3) and 3.06 (scale up to 4), respectively. Conclusions: This validation study demonstrates the suitability of a teleconsultation network for remote digital consultation using whole‐slide images. Such networks may contribute to faster revision and consultation in pathology while maintaining diagnostic standards. [ABSTRACT FROM AUTHOR]

Objective: An increase of circulating secretory Phospholipase A2 (sPLA2) is a risk factor for coronary artery disease. We hypothesized that this reflects participation of sPLA2 in local inflammatory reactions ensuing in ischemic myocardium. Therefore, we studied the course of circulating sPLA2, in patients with acute myocardial infarction (AMI) or unstable angina pectoris (UAP), and investigated the presence of sPLA2 in infarcted myocardial tissue. Methods: Plasma samples of 107 patients with AMI or UAP, collected on admission and at varying intervals thereafter, were tested for the presence of sPLA2 and C-reactive protein (CRP). Cumulative release values of these parameters were calculated, which allowed for comparison of the results rearranged in time according to the onset of symptoms. By immunohistochemistry we studied the presence of sPLA2 and CRP in myocardial tissue of 30 patients who died subsequent to AMI. Results: Levels of sPLA2 became elevated during the disease course in 66 of the 87 patients with AMI, and were higher than those of the patients with UAP of whom 8 of the 20 had elevated levels. By immunohistochemistry sPLA2 was found to be localized in the infarcted myocardium, particularly in its borderzone, from 12 h after the onset of AMI. Positive staining for sPLA2 was more extensive than that for CRP. Conclusions: The localization pattern of sPLA2 in infarcted myocardium as well as its plasma course, in relation to those of CRP, are in line with a supposed pro-inflammatory role during AMI for sPLA2 as a generator of lysophospholipids serving as ligands for CRP. [ABSTRACT FROM PUBLISHER]

A melanoma can originate at the subcutis without any visible skin lesion. A 73-year old patient came to the outpatient clinic with a subcutaneous nodule on the right thigh without any visible lesion of the skin. It turned out to be a primary subcutaneous melanoma that could be classified as a primary dermal melanoma (PDM). A PDM is a very rare subtype of melanoma that stands out for its excellent prognosis in comparison to cutaneous melanomas. No valid reliable staging system or treatment guideline exists for this entity, Breslow depth might overestimate the clinical aggressiveness possibly leading to overtreatment. It is of great importance for the clinician to be familiar with a primary dermal melanoma. It deserves an appropriate place in the current AJCC system and a treatment guideline for this unique melanoma subtype with relativity excellent prognosis would be beneficial. • A melanoma can originate at the subcutis without any visible skin lesion. • This entity can be classified as a primary dermal melanoma and stands out for its excellent prognosis. • There is no adequate staging system yet for patients with a primary dermal melanoma. • Breslow depth might overestimate the clinical aggressiveness in patients with a primary dermal melanoma, possibly leading to overtreatment. [ABSTRACT FROM AUTHOR]

Background In 2004–05, Georgia experienced large-scale concurrent measles and rubella outbreaks. We analysed measles and rubella epidemiology in Georgia to describe disease trends, determine the cause of the outbreaks, identify challenges to achieving disease elimination goals and propose interventions to overcome them. Methods We reviewed national measles and rubella surveillance and vaccination coverage data, focusing on the 2004–05 outbreaks, and conducted a measles vaccine effectiveness (VE) study using data from a 2004 school-based outbreak. Results Before 2004, the last large measles outbreak after measles vaccination was introduced (in 1966) in Georgia, was in 1988 (incidence rate, 36/100 000); the highest year for rubella was 1985 (110/100 000). During 2004–05, 8391 measles cases and 5151 rubella cases were reported (most of them diagnosed clinically). Of 358 suspected measles cases tested, 181 (51%) were positive for measles-IgM antibody; of 240 suspected rubella cases tested, 50 (21%) were positive for rubella-IgM antibody. Over 90% of measles cases were in persons born after 1979; 90% of rubella cases were in persons born after 1987. Approximately 41% of measles cases and 88% of rubella cases were unvaccinated. Estimated measles VE (≥1 vs 0 doses) was 86% (95% CI, 58–96%). Conclusions The outbreak likely resulted from failure to vaccinate rather than vaccine failure. Susceptible persons likely accumulated due to the long absence of large outbreaks and decreased coverage after the collapse of Soviet Union. To interrupt measles and rubella transmission in Georgia and achieve disease elimination goals by 2010, supplementary immunization activities should target children and young adults. [ABSTRACT FROM AUTHOR]

Objectives: The effect of topical vascular endothelial growth factor (VEGF) on post-surgical tracheal healing using various reconstruction materials was studied, with particular regard to prevention of granulation tissue or fibrosis. Methods: Twenty-four New Zealand White rabbits underwent survival surgery using autograft patches (n=6), xenopericardium patches (n=6), intraluminal Palmaz wire stents (n=6), and controls (n=6). Autograft and pericardial half-patches were soaked in topical VEGF (5 μg/ml over 30 min) and saline before reimplantation. Stents and controls received circumferential injections of VEGF and saline in the tracheal wall. At 1–4 months postoperatively, specimens of sacrificed animals were stained with anti-VEGF antibody, followed by morphological and immunohistochemical examination. Results: Rabbits with autografts and controls fared well until planned sacrifice. After xenopericardium repair, obstructive intraluminal granulation tissue led to early sacrifice in three rabbits. Stent insertion led to earlier death from airway obstruction in all six rabbits. Topical VEGF reduced granulation tissue after pericardial repair and fibrosis in all repairs except in stents. Remarkably, VEGF-pretreated half-patches and saline half-patches stained similarly high for VEGF, suggesting also local production of VEGF, probably in plasmacells, and in submucosal glands. Conclusions: Autograft repair induces the least granulation tissue and fibrosis, and the best healing pattern. Stents rapidly induced critical airway obstruction, unhindered by VEGF, leading to premature death. Tracheal pretreatment with topical VEGF reduces postoperative fibrosis after autograft and pericardial patch repairs, and reduces granulation tissue after xenopericardium repair. In time, VEGF is probably locally produced, although its potential role in tracheal healing remains to be established. [Copyright &y& Elsevier]