bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Necrosis in a Patient with Protein S Deficiency, Warfarin Anticoagulation, and Acute COVID-19 Infection: A Case Report
Authors: Torres C , Eby C
Published: November 2022

Introduction/Objective

Although thrombotic complications from COVID are well documented, the pathophysiology remains poorly understood, especially in patients with comorbid hypercoagulable risk factors and anticoagulant medication use. COVID has several dermatologic manifestations that may occur due to alterations in hemostasis. We present a case of skin necrosis in a patient with protein S deficiency, warfarin anticoagulation, and acute COVID infection.

Methods/Case Report

A 48-year-old female, BMI >50, heterozygous Protein S (PS) deficiency, Factor V Leiden, and history of recurrent venous thromboembolic events on warfarin, tested positive for COVID. Her only symptom was fatigue. Several days later, the patient developed painful ecchymoses and erythematous blisters on her breast, arm, and abdomen. Laboratory results showed INR 3.6, fibrinogen 675-1054 gm/dL, WBC 15k with absolute neutrophilia, and D-dimer 2274 ug/L DDU. The patient confirmed compliance with her maintenance warfarin dose. Biopsy showed thrombotic vasculopathy without leukocytoclastic vasculitis. Wound cultures were negative.

Results (if a Case Study enter NA)

NA.

Conclusion

The patient’s history and presentation were concerning for warfarin induced skin necrosis. However, the patient had taken warfarin for > 20 years and had an INR of 3.6 which substantiated that warfarin was not discontinued or missed. A retrospective review of INR results during acute COVID infection showed a decrease in time in therapeutic range and an increase in supratherapeutic INRs, suggesting COIVD patients may require decreased warfarin doses. Additionally, PS levels decline in patients with COVID; a similar effect is seen with HIV and Varicella infections. It is theorized that this may be mediated by an increase in C4b binding protein, an acute phase reactant that regulates the complement cascade and binds PS. With an infectious source ruled out and the patients’ known comorbid conditions, an acute exacerbation of the patients underlying hypercoagulable state is the likely driver of the patient’s skin necrosis with COVID as the probable precipitator. In summary, inherited and acquired hypercoagulable risk factors should be included in the differential diagnosis as a cause of skin changes in patients with COVID infection. Although histology may be helpful in diagnosing the cause of skin changes with COVID, laboratory results and clinical correlation are key in identifying a etiology.
To Normalize or Not? Dilute Russell Viper Venom Time testing
Authors: Zhang Y , Creer M , Oladipo O
Published: November 2022

Introduction/Objective

Background: Antiphospholipid antibodies bind phospholipid bound proteins. Criteria for diagnosis of the antiphospholipid syndrome includes detection of either a lupus anticoagulant (LA) or anticardiolipin/anti B2GP1 antibodies and thrombotic events or pregnancy loss. Functional LA is detected by prolonged dRVVT clotting time (dCT) of patient plasma in the presence of limited phospholipid (screen) followed by a 1:1 mix of patient and normal pooled plasma to rule out procoagulant deficiency (mix). Confirmation is achieved by addition of excess phospholipid shortening the dCT and increasing the screen/confirm ratio (SCR). Normalization involves testing pooled reference plasma to determine the SCR with an added calculation step to correct for reagent/instrument differences. We compared the SCR in patient plasma with that obtained using reference plasma to determine impact on clinical decision making.

Methods/Case Report

Methods: 404 patients had dRVVT testing (STAGO STA-R Evolution) from 09/2021 to 05/2022. Positive screens (≥51 seconds) underwent mixing studies followed by confirmatory tests (>=46 seconds). The dRVVT of reference pooled plasma was also measured (George King Normal Pooled Plasma). A positive conventional or normalized SCR was defined as an SCR > 1.2 and comparison was by the paired t test.

Results (if a Case Study enter NA)

6.4% (26) of the 404 samples tested were confirmed positive for LA by both methods, out of which 12 had a clinical history of thrombosis. Although a statistically significant difference between the two groups (p=0.0096) was found, the magnitude of absolute SCR differences (0.1s) was within total allowable error limits and there was 100% concordance of positive and negative results between the 2 groups.

Conclusion

There is no clinically significant difference between the two groups. Normalization had no benefit in our patient population, therefore no need for the extra calculation step. Others have reported that normalization is useful for inter-method and inter-laboratory studies and not for within method LA detection consistent with our results.
In-clinic Phlebotomists: A Patient Centered Solution to Improve Care and Quality Scores
Authors: Olson J , Gingrich D , Haynes A
Published: November 2022

Introduction/Objective

Phlebotomists play a central role in health care delivery, as the collection of a sample is the fundamental step in the performance of a laboratory test. Gaps between a patient’s ideal care and the care they are receiving often include unperformed laboratory tests. For pediatric patients, screening for lead levels is recommended, and the percent of patients who complete this screening is a quality metric included in quality and HEDIS scores. The Laboratory Medicine Department, in conjunction with the Pediatric medicine department undertook an effort to increase the number of children compliant with this screening measure.

Methods/Case Report

A pilot effort to increase screening rates was implemented in a large multispecialty ambulatory clinic building. Despite having a phlebotomy collection clinic directly across the hall from the pediatric clinic, an identified barrier to screening completion was patients leaving the pediatric clinic after a well-child exam and bypassing the laboratory collection site. The reasons behind this bypass were multifaceted, but the percieved inconvenience of making a second stop was identified as a major contributing factor. To improve this, a phlebomtist from the ambulatory collection clinic was assigned each day to go to the pediatric clinic whenever a blood draw was requested. The rates of screening were tracked for patients in this clinic pre- and post pilot.

Results (if a Case Study enter NA)

The rates of lead screening for 15 month-old pediatric patients in the population attributed to the pilot clinic went from an average of 38.1% in the pre-pilot phase, to 59.7% in the post-pilot phase, a statistically significant increase p=0.0021 . This workflow was also noted to be a patient satisfier for both patient family and clinic teams.

Conclusion

Phlebotomy performed in a clinic room, immediately after a patient’s clinic visit improved compliance with lead screening. This can be attributed to patient’s willingness to have the care ‘come to them’ rather than needing to make a perceived ‘second stop’. Although this workflow was a slightly less efficient for phlebotomists, the daily number of draws was not overwhelming and the increased satisfaction for patient families was judged a reasonable trade off. This workflow is expected to be utilized at other multispecialty clinics in our health care system. This project demonstrated that by making small improvements in workflow, the laboratory can have a significant impact on quality metrics and satisfaction.
Using Early Exam Results to Predict Online MLS Program Success
Authors: Robertson C , Johnson N , Bird R , Key J
Published: November 2022

Introduction/Objective

The objective of this effort is to demonstrate the impact of early didactic exam results for potential early intervention for students in an online medical laboratory science bridge program.

Methods/Case Report

For this study, we took retrospective data of 299 students from 2018 to 2021 who took MLSC 4312, Hematology, in their first semester. We then analyzed their first exam score and then used this data to evaluate its potential use as an early predictor of overall student success in both this course and the program. Specifically, the exam one score in the course was used to evaluate progression to the second semester, graduation, UAMS GPA, and ASCP Board of Certification total score and Hematology sub-score. Descriptive statistics and 2-sample T-tests were calculated using Number Cruncher Statistical System. Fisher’s exact test was performed using Graphpad software.

Results (if a Case Study enter NA)

Of the 296 students whose records were examined, 49 scored below a 76% on Hematology exam 1. 247 students scored above 75%.35 students who scored below 76% progressed to the second semester and of those, 33 (94.2%) graduated on time. 14 students were dismissed from the program after the first semester. The overall graduation rate of students who started the program and scored less than 76% on the first hematology exam was 67%. Of the 247 students who scored above 76% on exam 1, 229 (93%) progressed to the second semester and of those, 214 graduated on time (93.4%). 18 of these students were dismissed from the program. The overall graduation rate of students who started the program and scored greater than 76% on the first hematology exam was 86.70%. The overall ASCP Board of Certification pass rate was almost 19 percent higher, 81.7% vs. 62.9% in those who scored greater than 76% on the first hematology exam. Each of the comparisons was statistically significant (P=<0.05) using a 2-sample T-test or Fisher’s exact test as appropriate.

Conclusion

This study revealed the importance of doing well on the first major didactic exam in the Medical Laboratory Sciences program. Students who score < 76% on their first exam fail to progress to the second semester at four times the rate of those who score >76%. In addition, those who score <76% and progress fail the ASCP Board of Certification Exam at almost double the rate of those who score >76% on the first hematology exam. In the future, we will reach out earlier and offer targeted help to these students.
Current United States High School Students’ Perceptions of Pathology Professions as Determined by Pathology Outreach Program Survey Results
Authors: Schukow C P , Martinez-Whitman S , Mckinley K , Ahmed A
Published: November 2022

Introduction/Objective

There is a current pathologist shortage in the United States (US) exacerbated by both a retiring population of aging pathologists and limited medical student exposure to formal pathology and clinical laboratory medicine training. This is supported by data from the National Residency Match Program (NRMP) between 2000 to 2019, which shows a “40% decrease in the number of American medical school graduates applying to pathology residency programs”. This limited exposure to pathology has led to a shortage of other lab professionals, too, and has affected more than just medical students. Both undergraduates and high school students have little access to literature discussing the perceptions of pathology professions, which impacts their abilities to consider pathology as a possible future career. Understanding these recent trends, Pathology Outreach Program (POP) was established in 2018 to determine current US high school students' perceptions of pathology and raise awareness towards the importance of careers in lab medicine via interactive PowerPoint sessions.

Methods/Case Report

Before sessions, an online Google Forms (“pre-course”) survey was distributed which students could voluntarily and anonymously complete.

Results (if a Case Study enter NA)

From February 2018 to May 2022, 162 high school students completed the pre- course survey (n=162) in Chicagoland and Michigan Schools. Although 130 students (80.2%) stated they were inclined towards a career in medicine/healthcare and 112 students (69.1%) had admitted to being aware of the pathology field, only 18 students (11.1%) stated “Yes” when asked if they understood the roles of pathologists. Furthermore, 127 students (78.4%) reported they were uninformed to the career pathways of a pathologist or pathology-related professional, and 142 (87.7%) reported not ever meeting a pathologist before.

Conclusion

This data suggests inadequate current US high school student accessibility to pathology professions and supports the continual need for pathology outreach initiatives like POP in increasing pathology exposure to high school students.
Entry-Level Expectations for Pathologists' Assistants
Authors: Kolheffer K M , El Moudden I
Published: November 2022

Introduction/Objective

The aim of this study is to assess expectations for entrustment that exist in the marketplace for entry-level Pathologists’ Assistants (defined as a recent graduate of a Pathologists’ Assistant Program on their first day of employment).

Methods/Case Report

A voluntary, anonymous survey was distributed to Pathologist and Pathologists’ Assistant (PathA) members of the American Society for Clinical Pathology via email invitation. Ninety-eight professional activities of PathAs were assessed utilizing a five-point scale for levels of entrustment. Demographic information was also collected.

Results (if a Case Study enter NA)

A total of 728 participants responded to this survey, including 280 Pathologists and 448 PathAs. Responses allowed categorization of activities to one of three groups: activities with an expectation of entrustment for performance (20/98), activities with no expectation of entrustment (30/98), and activities with a developing expectation of entrustment for performance (48/98).

Conclusion

This study demonstrates that there is an expectation that entry-level PathAs should be entrusted to independently perform only some activities included in the scope of practice, an expectation of developing entrustment for a larger number of professional activities and no expectation for entrustment for certain activities, reflecting more advanced or specialized skills developed during practice.
Predicting Success on ASCP-BOC by Using Existing Data
Authors: Johnson N
Published: November 2022

Introduction/Objective

The MLS Program at tUAMS is housed within the College of Health Professions. Our graduates take the ASCP BOC certification exam as a graduation requirement and the vast majority of students will take the exam.

Methods/Case Report

For this study, we examined online MLT to MLS students who took their ASCP BOC certification exam in late 2019 thru April of 2020 and used this data to build a multiple regression model to predict ASCP scores . This model was used to predict ASCP MLS scores of students graduating in the next cohort in December of 2021.

Results (if a Case Study enter NA)

103 students took the ASCP MLS certification exam in early 2022. In early 2018, the MLS program created a database to store pre-admission information that was routinely collected. In addition, we also gathered academic information as the student progressed thru the program and post-graduation. There were a total of over 50 variables included in the database. The goal of this database was to provide insight to help both faculty and students succeed. We used a simple multiple regression model to determine which variables were correlated with the ASCP BOC score. We also used this data to develop a simple predictive model to prospectively estimate a student’s ASCP BOC score. 6 variables were identified as potentially useful in a simple model. For the initial student ASCP score prediction, a blended model using the average predicted score of the six models in Table 2 was used. The performance of the model is shown in Table 3. At the individual level, the model was accurate 82% of the time.

Conclusion

Based on our initial findings, we believe that this model may be useful to help gauge student readiness for passing the ASCP BOC exam. Several students expressed their gratitude, including one who stated that this information spurred them to study harder. There was one interesting finding. 8 of the 12 students (67%) who were predicted to fail passed the exam on the first attempt. However, only 64% of students (11/17) predicted to pass, but with a predicted score of <430, passed. Subsequently, 2 of these 6 failures passed on their second attempt. We may need to investigate a more powerful way to communicate the results of the model for all of those in the “danger area”. 98% of students with a predicted score of 470 or above passed on their first attempt. The model is currently being refined to include 2021-2 certification scores which should improve the academic utility of the model.
The role of Aspartate Aminotransferase-to-Platelet ratio (APRI) in the Prediction of Liver Fibrosis in Chronic HCV Patients
Authors: Abdelmonem M , Wasim H , Elhusseny A , Eldaly R , Saleh Abdelfattah M , Abdelmageed M
Published: November 2022

Introduction/Objective

Chronic hepatitis C virus (HCV) infection is typically characterized by slowly progressive hepatic fibrosis, with progression from stage 0 (no fibrosis) to stage 4 (cirrhosis). Aspartate aminotransferase-to- platelet ratio (APRI) may be a simple and convenient noninvasive diagnostic test because it is based on the regular laboratory tests and demographic data. However, its overall test performance in various settings remains questionable.

Methods/Case Report

Objectives: This study aimed to evaluate the diagnostic accuracy of APRI in the prediction of hepatic fibrosis. Subjects and Methods: Serum samples were collected from patients recruited from Internal Medicine Dept., Mansoura University Hospitals, Egypt. The study included 118 liver fibrosis patients associated with chronic HCV infection (60 males and 58 females) and 50 age-matched healthy volunteers (27 males and 23 females). The HCV infection was diagnosed based on biochemical, serologic, and histological criteria. All samples of fibrotic liver patients showed a positive result for anti-HCV Abs using ELISA as a confirmatory test. AST, ALT, albumin, and total bilirubin were measured using standard methodologies. Routine blood pictures, including platelets counting were determined. The AST-ALT ratio was calculated as [AST/ ALT]. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100.

Results (if a Case Study enter NA)

There was no statistically significant difference between sex distribution in liver fibrosis patients and healthy volunteers. The mean±SD was (46.1±10.44 and 33.3±11.13) respectively. The medians of the selected laboratory markers in the healthy group and liver fibrotic patients were (41,39), (272.5,167), (36,54), (35.5,51), (0.9,0.98), (0.71,2.5), and (0.34, 0.86) for Albumin, Platelet count, AST, ALT, AST/ALT ratio, Total Bilirubin, APRI respectively. There was a statistically significant difference between the two groups in all laboratory parameters (p<0.001) and for APRI (p<0.0001).

Conclusion

The evaluation of APRI is uncomplicated, inexpensive, and has a reasonable degree of diagnostic accuracy in determining whether or not patients with chronic HCV have liver fibrosis.
Emergence of SARS-CoV-2 Pango Lineage BA.2.12.1, a Spreading BA.2 Sublineage Detected on Outbreak Sequencing within a Veteran Community Living Center Population
Authors: Petersen J M , Jhala D , Kelly J , Flaherty-Oxler K
Published: November 2022

Introduction/Objective

SARS-CoV-2, the causative agent for COVID-19 disease, has very recently developed an Omicron subvariant BA.2.12.1. The English literature is extremely sparse in discussing the clinical importance of BA.2.12.1 and in fact there are no reports for the unique veteran population which is different than the general population. Since the original Omicron variant, there has been multiple evolutionary branches. BA.2.12.1 specifically is the 12th sublineage to branch off from the second BA.2 branch from the original Omicron and is clade 22C. BA.2.12.1 has been described as having increased transmissibility compared to other subvariants of Omicron and even resistance to neutralization by antibodies elicited by a prior Omicron infection with a different subvariant, thus leading to a significant potential for reinfection. BA.2.12.1 is currently responsible for an increasing number of cases in the North American continent. This study was undertaken to explore the sequencing associated with the COVID-19 disease outbreak at a Veteran Affairs Community Living Center (CLC).

Methods/Case Report

Samples were sent for the sequencing for patients affected during an outbreak of COVID-19 at a CLC from May to June 2022. All samples had a cycle threshold or number below 30 by reverse transcriptase polymerase chain reaction, which was required for the sequencing analysis. The sequencing results and prior immunity history was obtained.

Results (if a Case Study enter NA)

A total of 9 CLC patient specimens were sent for sequencing. Of these 9, 7 had sequencing results and in the remaining 2, no sequencing results could be obtained due to lack of amplification. 6 of these 7 demonstrated Pango Lineage BA.2.12.1 or clade 22C. Only 1 of the 7 patients had a different subvariant (BA.2.9, clade 21L). Interestingly, all seven patients had either been previously vaccinated with a 3rd booster shot (6 of 7) or previously infected with COVID-19 without vaccination (1 of 7), indicating the ability of the two detected subvariants to cause breakthrough reinfection despite prior vaccination or infection earlier in the pandemic.

Conclusion

The only recently described BA.2.12.1 has resistance to neutralization by antibodies produced by a prior infection or vaccination, leading to reinfection. This lineage was detected in nearly all cases of COVID-19 outbreak within a veteran nursing home CLC despite the presence of prior immunity.
Detection of Putative Novel Mutation in Zp1 Gene Causing Empty Follicle Syndrome
Authors: Upadhyay D , Anandt S , Peramo B , Al Safar H
Published: November 2022

Introduction/Objective

Mutations in the zona pellucida glycoprotein genes have been reported to be associated with empty follicle syndrome (EFS) and abnormal zona pellucida (ZP). At our clinic, in a cohort of infertile patients, we found three cases with empty follicle syndrome as a root cause of infertility. Further, we designed a study to identify the disease-causing gene mutations in these patients. At present, there are no citations or functional evidence in ClinVar for NM_207341.3:c.1168del variant indicating the involvement of this variant in empty follicle syndrome. But it has been interpreted to be Likely pathogenic causing female infertility due to zona pellucida defect.

Methods/Case Report

In this prospective study conducted at Al Ain Fertility Center (AAFC), U.A.E, we performed genetic analysis on three patients (first-degree sisters) having a mean age of 31.7 (2.52) years. Patient indications were primary female infertility and IVF failures due to no eggs present in the follicles when egg retrieval was attempted. We characterized these three patients as suffering from empty follicle syndrome. Along with the patient's sample, we also included their common parent's sample for Whole Exome Sequencing and Sanger sequencing, to rule out the inheritance pattern in the family. The effects of this mutation were further characterized through mRNA and protein studies.

Results (if a Case Study enter NA)

N/A.

Conclusion

To our knowledge, this is the first study in the U.A.E. showing the familial novel variant in the ZP1 gene associated with empty follicle syndrome. We identified a novel mutation in these patients (NM_207341.3:c.1168del) in the ZP1 gene in the homozygous state and the same variant in the heterozygous state in the parents. Our findings add to the existing mutational spectrum of the ZP1 gene associated with empty follicle syndrome and abnormal oocytes and provide new support for the genetic diagnosis of female infertility.
Detection of Mutations in SARS-CoV-2 Genomic Clades using COVIDSeq-NGS among International Travelers
Authors: Arshad N , Ammad M , Razzak A , Ullah R , Ul Ain Q , Yousaf M , Sajjad Naqvi S , Ur Rehman M , Noorul Hasan T , Hussain A , Al Yafei Z
Published: November 2022

Introduction/Objective

Numerous SARS-CoV-2 variants/lineages have been identified based on genome sequencing. As of June 15, 2022 almost 11,399,573 whole genome sequences have been deposited in the GISAID-database. Severity and spread of COVID19 is based on their efficiency of infection and to multiply in host. That largely depend upon the structural mutation in spike, ORF and N proteins etc. That happens due to translation of genomic mutations during polypeptide synthesis. Also, the mutations are region/country specific. Specific mutation and combination of mutation causes the emergence of new strains. However, the strains can migrate from one region to other through travelers. The main objective of the current study is profiling of mutations in the genome of SARSCoV2 using Next- Generation-Sequencing (NGS) in international travelers and phylogenetic analysis of the sequences to find out different clades of SARSCoV2.

Methods/Case Report

A total of 557 SARSCoV2 genomes were sequenced on S4-sequencing flow-cell on NovaSeq 6000. For NGS of SARS-CoV-2 genome, Illumina, COVIDSeq kits and the protocols will be used strictly as recommended by the manufacturer. After NGS the analysis was done followed by FASTA sequences retrieval, mutations recording and phylogeny.

Results (if a Case Study enter NA)

This study reports 11 clades (19A, B, 20A, B, C, D, 20E; EU1, 20G, 20H; Beta V2, 20I: Alpha V1, 21D; and Eta) for the first time in international travelers. To best of our knowledge, this is the first report of the COVIDSeq approach for detection of mutation in SARSCoV2 genomic clades. The study revealed some dominants mutations was (Orf1a: P2018Q, K1053R, E176V, Orf1b: A520V, T2165A, S: D1127G, D614G, L18F etc. in other genes).

Conclusion

Profiling of common mutations among travelers could fill some gaps about the existence of SARS-CoV-2 variants information. However, further studies are needed to consolidate these findings before to be utilized for development of a potential therapeutic strategy.
Differentially Expressed Genes Enrichment Analysis of Pancreatic Ductal Adenocarcinoma and Pancreatic Intraepithelial Neoplasia; an In Silico Study
Authors: Mousavi S , Bereimipour A , Mohammadian M , Farhadihosseinabadi B , Jafari A
Published: November 2022

Introduction/Objective

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related death in the United States. Determining the genetic alterations involved in the formation of PDAC and its precursor, pancreatic intraepithelial neoplasia (PanIN), may lead to earlier detection and new therapeutic options. We performed an analysis of the genetic alterations responsible for the progression of the normal pancreatic tissue to PanIN and ultimately from PanIN to PDAC.

Methods/Case Report

Initially, we used the continuous bioinformatic analysis in such a way that the RNA-seq datasets were extracted from the Biojupies database. We separately analyzed two datasets that included PDAC and PanIN, where their differentially expressed genes (DEGs) were obtained by comparison with controls. A Venn diagram was drawn to visualize the overlapping and non-overlapping DEGs in both groups. Using the Enrichr and ShinyGO databases, we examined the cell signaling pathways and ontologies of up/down-regulated genes. We mapped the protein network of important genes involved in cancer pathways by the STRING database. Finally, the shared and non-shared candidate proteins in the PDAC and PanIN pathways with the GEPIA database were confirmed in human samples.

Results (if a Case Study enter NA)

We found six shared genes in PDAC and PanIN including RAC1, RAP1A, ITGA5, RHOA, FZD2, and FN1, which appear to take part in the transition of PanIN to PDAC. Our result showed that the aforementioned genes are critical in the cell cycle, angiogenesis, and cell death processes. In the next step, the DEGs analysis in both PDAC and PanIN revealed the role of candidate genes (COX5B, NME2, MGLL, and PAICS for PanIN and PRKCA, PLCG2, NOS3, and PTK2 for PDAC) in cellular aging, MAPK, and PI3K/Akt signaling pathways.

Conclusion

Our findings showed that the overexpression of RAC1, RAP1A, ITGA5, RHOA, FZD2, and FN1 may have an important role in PanIN shifting to PDAC.
PD-L1 Expression in Cytological and Histological Lung Cancer Specimens
Authors: Hara N , Tang X , Islam H
Published: November 2022

Introduction/Objective

Several studies have explored the feasibility of measuring PD-L1 in cell block cytology and indicated cytological materials could be a reliable source for PD-L1 evaluation in non-small cell lung carcinoma patients. A few studies have investigated the compatibility and performance of PD-L1 clone SP263 testing between cytology and histology specimens. The study was pursued to evaluate PD-L1 expression in cell blocks from EBUS- TBNA compared to that in biopsied tissues from patients with lung carcinoma in our institution to evaluate a feasibility of PD-L1 clone SP263 in cell blocks and histology samples.

Methods/Case Report

A total of 57 specimens cytologically diagnosed lung carcinoma using endobronchial ultrasound guided transbronchial needle aspiraton (EBUS-TBNA) from Jan 1st, 2020, to Dec 31st, 2021 were screened for enrollment. Among them, 24 patients diagnosed with lung carcinoma using EBUS-TBNA and matched transbronchial biopsy (TBB) specimens were reviewed for study. After careful selection, 13 paired formalin-fixed tissues from lung carcinoma patients, including cell blocks and matched histology samples, were included. PD-L1 expression was assessed using the SP263 assay, and the tumor proportion score (TPS) was evaluated. PD-L1 expression was finally divided into three categories according to the TPS: < 1% (negative), 1–49% (low expression) and ≥ 50% (high expression).

Results (if a Case Study enter NA)

Of the 13 matched pairs, 12 (92.3%) showed concordant PD-L1 expression. On cytology, 3 cases were positive (2 high expressors and 1 low- expressors) of which 2 were concordant and 1 discordant with matched histology specimens. Ten cytology samples were negative for PD-L1 expression, and they were concordant to histology samples. The correlation coefficient for TPS was 0.75 considered as having good value. Conclusion: With an overall concordance rate of 92.3% between cytology and histology specimen, this study demonstrates the feasibility of PD-L1 IHC with SP263 clone on limited quality and quantity of cytology samples from lung carcinoma in our institute. It is required for further evaluation with additional specimens to conclude that the usefulness of cytology cell blocks for PD-L1 expression analysis.
Langerhans’ Cell Histiocytosis Masquerading as Metastatic Melanoma on Frozen Section
Authors: Walkenhorst M , Hamza A
Published: November 2022

Introduction/Objective

Langerhans’ cell histiocytosis (LCH) involving the lungs usually presents as multiple interstitial, bilateral, peribronchiolar pulmonary nodules. As lungs are a common site of metastatic involvement LHC can masquerade as a metastatic lesion. The distinction can be challenging, especially on a frozen section.

Methods/Case Report

We present a case of a 35-year-old male with history of metastatic melanoma who presented with pulmonary nodules and underwent lung wedge resection. Frozen section was requested at the time of surgery. Grossly there was a 2.8 cm tan-grey irregular lesion abutting the pleura. Frozen section of a representative piece showed a discohesive lesion composed of large cells with prominent nuclei resembling melanocytes. The eosinophilic infiltrate in the frozen slide was extremely scant, and presence of anthracotic macrophages resembled the melanin pigment frequently seen with melanoma. CT imaging prior to the surgery had raised the differential of LCH and metastatic disease. The frozen section was favored to be negative for carcinoma and metastatic melanoma and final diagnosis was deferred to permanent sections. Permanent tissue sections showed classic features of LCH and positivity for CD1a confirming the diagnosis.

Results (if a Case Study enter NA)

NA

Conclusion

This case emphasizes the importance of multidisciplinary approach and knowledge of imaging impression during a frozen section.
Minimal Change Disease Secondary to Either COVID-19 Infection or Pfizer-BioNTech COVID-19 Vaccination
Authors: Pokharel A , Li W , Kanaan H D , Zhang P , Blatt N B
Published: November 2022

Introduction/Objective

Kidney injury has now become one of the known complications following COVID-19 infection and vaccination. Only few cases of minimal change disease following administration of COVID-19 vaccination and infection have been reported. This study was to highlight incidence of minimal change disease following COVID-19 infection or vaccination.

Methods/Case Report

Case 1:15 year-old female with past medical history of asthma and hypercholesterolemia presented for evaluation of periorbital edema, nephrotic-range proteinuria, hypoalbuminemia, elevated serum creatinine, elevated blood pressures, and hematuria after COVID-19 infection. Renal biopsy after 1 week of infection showed unremarkable glomeruli and negative immunofluorescent stains in glomeruli, and 20-30% fusion of foot processes. The biopsy was consistent with a minimal change disease with features of natural remission (her nephrotic-range proteinuria resolved soon after). Case 2: 18 year-old female with no significant past medical history presented with a chief complaint of generalized swelling, which started around the same time she received her 1st dose of Pfizer COVID vaccine (the 2nd dose 2 months later). She had a nephrotic range proteinuria and hypoalbuminemia, but normal level of serum creatinine. A renal biopsy after 4 months of vaccination showed unremarkable glomeruli by light microscopy, negative immunofluorescent study, but diffuse effacement of foot processes involving more than 80% of the examined loops by electron microscopy. This biopsy findings were consistent with a minimal change disease. Both patients did not receive any treatment before the renal biopsies.

Results (if a Case Study enter NA)

NA

Conclusion

Minimal change disease can be a rare complication following COVID-19 infection or Pfizer COVID-19 vaccination, raising a question if there are similar antigens induced by the infection or by the vaccination that trigger the minimal change disease. Further studies are needed to determine the incidence and pathophysiology of minimal change disease either post COVID-19 vaccines or following COVID-19 infections.
Successful Collaboration of a Hospital Based Blood Center and Blood Bank during the Pandemic and Blood Shortage
Authors: Sese G B
Published: November 2022

Introduction/Objective

At the beginning of the SARS-Co-V2 pandemic, many hospitals implemented mitigating strategies to preserve their blood supply in anticipation of a blood shortage. Our health system, Inova (IHS), which includes 5 hospitals supported by our hospital based blood services, was no different. During the pandemic we experienced a decline in donations and available blood products. In anticipation of this shortage, our institution mobilized the Patient Blood Management (PBM) initiative. A multidisciplinary review of transfusion criteria was performed across the system. This included enforcing single unit red blood cell (RBC) transfusions, partial RBC exchanges for sickle-cell disease, and reduction in plasma replacement volume during plasma exchanges for patients with thrombotic thrombocytopenic purpura (TTP). By implementing these strategies, patient outcomes were not impacted despite the constraints to our blood supply.

Methods/Case Report

IHS Executive leaders were identified to participate along with key stakeholders in the PBM committee meetings to ensure proper blood utilization for our patients. Clinical guidelines were updated within the physician order sets. Data was compiled with a focus on hemoglobin metrics along with the percentage of single unit transfusions. Collaborating with IHS Apheresis Services and our providers, we developed a strategy to reduce the number of blood products transfused.

Results (if a Case Study enter NA)

Although there was decline in donor blood collections during the pandemic due to significant concerns of SARS-CO-V2 exposure, the implementation of Patient Blood Management strategies at our institution proved to be beneficial for product management and resource allocation. Although there was a decline in the number of donations (6.5%) we were able to transfuse more patients.

Conclusion

The SARS-Co-V2 pandemic significantly reduced the blood inventory nationwide. By implementing a robust Patient Blood Management program, we were able to successfully utilize our blood inventory while maintaining transfusion practices that aligned with standards of care. The collaborative efforts between our hospital based blood center and the blood bank led to the optimal use of a reduced blood supply during the pandemic. Incorporating Patient Blood Management principles and safe implementation of novel treatment plans for certain apheresis patient population during the pandemic enabled our system to have more available blood products and care for more patients with improved patient outcomes.
A Holistic Approach for an Efficient Day to Day Operation for Blood Bank Market Withdrawals and Recalls Using Departmental Electronic Occurrence System: A CMCVAMC Experience
Authors: Patel S , Patel V , Petersen J M , Jhala D
Published: November 2022

Introduction/Objective

Donor centers and reagent manufacturers may issue recalls or market withdrawals. Donor center withdrawals of blood components involve units that have a reason that may present a risk to the patient, that subsequently require discarding the product if not transfused or appropriate clinical notification and follow-up if already transfused prior to the notification. Reagent recalls involve problems with reagents that require appropriate corrective action as per the circumstances. Patient safety event reporting systems are universal in hospitals and are a backbone of efforts to detect patient safety events and quality problems. Pathology and Laboratory Medicine (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) has established an electronic occurrence reporting (EOR) program to track and respond to these in the blood bank. The authors explored the usefulness of the holistic approach of this initiative.

Methods/Case Report

EOR is available to all the employees of Blood Bank in P&LMS, who regularly report all received recalls and market withdrawals into the system. These are reviewed by the supervisor and blood bank medical director and co-director to ensure appropriate steps are taken. Information on all market recalls and withdrawals affecting blood bank were compiled from January 1st, 2021, to June 1st, 2022, for quality assurance review.

Results (if a Case Study enter NA)

The EOR plays a significant role in organizing the data from all the recalls and market withdrawals to guide improvement in patient care. There were seven market withdrawals during the study period, all from the donor center for blood product component withdrawals. All seven cases were recorded efficiently with review by the blood bank supervisor and blood bank medical director and co-director. Appropriate follow-up action was performed and recorded for all seven cases in the EOR.

Conclusion

The EOR for withdrawals recalls in Blood Bank is highly effective, successful program in terms of electronic organized monitoring. This monitoring is part of ensuring quality care in real time, and plays an important role as part of Veteran Affairs position as a High reliability Organization (HRO).
Six-Year Evaluation of Motiva Round and Ergonomix SmoothSilk Surface Silicone Breast Implants: A Two-Center, Two-Surgeon Outcome Analysis of 1053 Primary and Secondary Breast Augmentations and Augmentation Mastopexy
Authors: Randquist Charles , Jaeger Marie , Stavrou Demetris
Published: November 2022

Background

The emerging concerns around breast implant-associated anaplastic large cell lymphoma and other chronic inflammatory-related conditions have instigated a wider use of smooth devices.

Objectives

The authors aimed to present 6-year data following the introduction of Motiva implants (Establishment Labs Holdings Inc.; Alajuela, Costa Rica) into their previously texture-dominated practice. Additionally, the authors aimed to provide technical recommendations on how to efficiently incorporate these devices into surgical practice and minimize the learning curve.

Methods

Data of 1053 primary and secondary breast augmentations conducted between April 2015 and December 2020 in 2 centers (Victoriakliniken in Sweden and the European Institute of Plastic Surgery in Cyprus) were retrospectively evaluated to obtain data on chosen implant characteristics and complications that led to reoperation, prior to and following modifications to surgical practice in 2018.

Results

The data from 6 consecutive years demonstrate a low device-related complication rate with Motiva implants. In 2018, following adaptions in surgical practice, the complication rate significantly declined.

Conclusions

Motiva implants demonstrate a low complication rate and safety profile for women undergoing primary and secondary breast augmentation procedures. However, to reap the benefits of the antifibrotic profile, technical adaptions and optimal patient planning based on the patient and device characteristics are instrumental. Employing the key principles laid out in this study provides a means for delivering both clinically safe options to patients with aesthetically pleasing long-term results.

Level of Evidence: 4
Major adverse cardiovascular events and all-cause mortality after emergency general surgery among kidney failure patients
Authors: Anderson Benjamin , Zou Xiaoxu , Evison Felicity , Gallier Suzy , Inston Nicholas , Sharif Adnan
Published: November 2022

Background

Emergency general surgery (EGS) is associated with increased mortality, with kidney failure a contributing risk, but comparative outcomes between patients with kidney failure and the general population are lacking.

Methods

In this retrospective population-cohort study, data were analysed for all EGS procedures performed in England between 1 April 2004 and 31 March 2019. EGS was defined as partial colectomy, small bowel resection, cholecystectomy, appendicectomy, lysis of peritoneal adhesions, surgery for peptic ulcer, or laparotomy. The main outcome measure was major adverse cardiovascular events (MACEs) and all-cause mortality after surgery.

Results

From 691 064 procedures, 0.16 per cent (n = 1097) and 0.23 per cent (n = 1567) were performed on kidney transplant and dialysis recipients respectively. Laparotomy was the most frequent EGS procedure for kidney transplant (46 per cent of procedures, n = 507) and dialysis (45 per cent of procedures, n = 704) recipients, with the highest 30-day and 1-year mortality. In logistic regression analysis, both kidney failure cohorts had higher risk for experiencing MACEs in the postoperative interval after emergency laparotomy; within 3 months (dialysis; OR 2.44 (95 per cent c.i. 2.08 to 2.87), P < 0.001 and transplant; OR 2.05 (95 per cent c.i. 1.57 to 2.68), P < 0.001) and within 1 year (dialysis; OR 2.39 (95 per cent c.i. 2.06 to 2.77), P < 0.001 and transplant; OR 2.21 (95 per cent c.i. 1.76 to 2.77), P < 0.001); however, in a propensity-score-matched cohort, increased risk for MACEs was observed among dialysis patients after emergency laparotomy (HR 2.10 (95 per cent c.i. 1.82 to 2.43), P < 0.001) but not kidney transplant recipients (HR 1.17 (95 per cent c.i. 0.97 to 1.41), P = 0.096).

Conclusion

Mortality after emergency surgery is higher for patients with kidney failure and dialysis is worse than kidney transplantation, with cardiovascular deaths more common than the general population.
Uncovering hidden opinions: social norms and the expression of xenophobic attitudes
Authors: Álvarez-Benjumea Amalia
Published: November 2022

Social norms against prejudice are widespread and generally supported by society, yet examples of bigotry are often found. I propose that anti-prejudice norms can quickly erode when individuals are exposed to hate content, therefore, facilitating the expression of prejudice. To test this, participants were invited to participate in an experimental online forum discussing immigration. I compare the comments of participants exposed to xenophobic content to those not exposed. The empirical results show that exposure to hateful content erodes norm compliance: the more hateful content participants could observe, the more hateful their subsequent comments were. The effect is primarily driven by those more likely to hold anti-immigrant views. This points to an ‘emboldening effect’ whereby prejudiced individuals refrain from expressing prejudiced opinions in the absence of offensive speech. Otherwise, hidden attitudes are revealed. The results confirm that the expression of prejudice is context dependent and that preserving a ‘norm environment’ requires sustained reinforcement of the norm. Furthermore, the results show that the composition of the population in terms of individual beliefs is paramount for the dynamics of erosion of the social norm. On the whole, these findings can inform effective public strategies against the spread of hate speech and offer a new methodological approach for studying hate speech in online contexts.
Cardiovascular mortality trends in Switzerland 1995–2018
Authors: Sorrentino Lisa , Chiolero Arnaud , Carmeli Cristian
Published: November 2022

Mortality rates due to coronary heart disease (CHD) and stroke have declined in the last century in high-income countries, including Switzerland. However, these rates have plateaued in several countries. We assessed CHD and stroke mortality trends (1995–2018) in Switzerland. We estimated annual rate changes via JoinPoint regression. Rates decreased steadily in most sex and age groups; however, in those aged 60–74, stroke rates plateaued after 2012 among men and CHD rates plateaued after 2015 among women. Cardiovascular mortality continues to decrease in most of the Swiss population. Prevention efforts should be maintained, especially in individuals aged 60–74.
Cyto-nuclear incompatibilities across a bluebell hybrid zone in northern Spain do not prevent genome-wide introgression of neutral markers
Authors: Marquardt Jeannine , Blanckaert Alexandre , Nichols Richard A , Ansell Steve W , Ruhsam Markus , Hollingsworth Peter M , Metzler Dirk , Schneider Harald , Leitch Andrew R
Published: November 2022

The bluebells Hyacinthoides hispanica (Mill.) Rothm. and H. non-scripta (L.) Chouard ex Rothm. form a hybrid zone in Spain and represent a natural experiment for the study of gene flow between species. The results of this study provide not only important insights to obtain empirical evidence regarding the mechanisms of gene flow enabled by hybridization but also to improve conservation assessment of the anthropogenic hybridization zone amongst bluebells occurring in Britain. We developed genome-wide genetic markers for amplicon-based resequencing from individuals across the hybrid zone, mapped morphological changes across the zone and determined the fitness of hybrids in laboratory crosses. We revealed significant clines across the zone at 61% of single nucleotide polymorphisms of the nuclear genes, most of which have a relatively shallow slope (mean slope 0.051 km–1, mean width of 78.4 km). In contrast, there was a rapid change in organellar haplotypes (slope = 0.238 km–1, mean width of 16.78 km). Thirteen nuclear genes had clines coincident with the organellar transition, and a subset had products directly involved in cyto-nuclear interactions. The location of this hybrid zone, the wide transitions in morphology and allele frequency all suggest that the zone is long established, and probably formed after the last glacial maximum. The high fitness of interspecific crosses is consistent with ongoing gene flow across the zone, although cyto-nuclear incompatibilities appear to prevent the movement of some alleles and coordinated activity between cellular compartments.