Optimisation associated with birdwatcher detection depending on polarizationresolved laserinduced dysfunction spectroscopy

Formalin-fixed paraffin-embedded (FFPE) tissues are an important source for investigation of dengue virus (DENV) infection, particularly when blood or fresh frozen (FF) samples are unavailable. Histopathologic features and immunohistochemistry may have poor sensitivity and serotype determination is not always possible. Viral RNA genome detection tests are faster and considered the most sensitive technique for this kind of analysis, however, the use of molecular methods applied to FFPE tissues is still limited. The authors applied a single-step multiplex reverse transcription-quantitative polymerase chain reaction (RT-qPCR) for the investigation of DENV infection and typing to FFPE samples of 32 fatal cases received during the 2019 outbreak that occurred in São Paulo state, Brazil. The authors compared the results with those obtained using FF tissues. Of the 24 cases with both FF and FFPE samples, 22 (91.67%) of the FF and 19 (76.20%) of the FFPE specimens were positive. Two cases (8.33%) tested negative in both types of samples. All 8 cases with only FFPE samples available were positive. The accuracy (87.5%) of the RT-qPCR for DENV in FFPE samples were satisfactory. Although the cycle quantification (Cq) values were significantly higher in these materials (P less then 0.0001, Wilcoxon signed-rank test) when compared with FF tissues, Spearman's rank coefficient indicated a good correlation between the Cq values from both sample types (P=0.0063; rho=0.576). RT-qPCR applied to FFPE samples improved detection of DENV in fatal cases and represents a useful tool for diagnosis and epidemiologic studies.Immunohistochemical stains have been suggested to aid in diagnostically challenging cases of urothelial carcinoma in-situ (CIS). Although full thickness immunostaining for CK20 is supportive of CIS, a subset of CIS cases is CK20(-), the clinical significance of which was unknown. This study included 43 patients with primary diagnosis of bladder CIS including 32 with only CIS, 5 with CIS and separate noninvasive high-grade papillary urothelial carcinoma, and 6 with CIS and separate high-grade urothelial carcinoma with lamina propria invasion. Digital morphometric image analysis showed that the average nuclear areas of enlarged nuclei were similar in CK20(+) and CK20(-) CIS (26.9 vs. SMIP34 cell line 24.5 µM2; P=0.31). Average Ki67 index for CK20(+) CIS was higher than CK20(-) CIS (31.1% vs. 18.3%; P=0.03). Patients with CK20(+) CIS [28 (65%)] and patients with CK20(-) CIS [15 (35%)] had the same rates of Bacillus Calmete-Guerin (BCG) failure but patients with CK20(-) CIS had higher stage progression [3 CK20(+) (11%) vs. 6 CK20(-) (40%); P=0.02]. Given recent approval of immune checkpoint inhibitors in patients with CIS refractory to BCG, programmed death ligand-1 expression and colocalization with CD8(+) lymphocytes was investigated as signature of adaptive immune response and was seen in 8 patients regardless of CK20 status and exclusively among patients who failed BCG. Our results confirm that negative CK20 IHC does not exclude CIS and that those patients have similar clinical outcomes as patients with CK20(+) CIS. Programmed death ligand-1 and CD8 colocalization seen among patients who failed BCG therapy is an easy assay to perform to identify patients who could potentially benefit from combined BCG therapy and immune checkpoint inhibition.Immunohistochemistry (IHC) plays a key role in the diagnosis of metaplastic breast carcinomas (MBCs), particularly the spindle cell variant. The most efficient immunopanel has yet to be developed. We studied the immunoprofile of 45 MBCs including 23 matrix-producing MBCs, 11 squamous cell carcinomas, 6 spindle cell carcinomas, and 5 mixed-subtypes (2 cases including spindle cell components). Representative sections from mastectomy or core biopsy specimens were subject to IHC using a list of antibodies including OSCAR, a recently developed antibody against pooled cytokeratins. The staining was interpreted as positive when >1% of tumor cells demonstrated unequivocal staining. As a result, OSCAR showed similar sensitivity to AE1/AE3 and CAM 5.2 (89.1% vs. 89.4% vs. 89.4%) for MBCs, but the former showed more diffuse pattern of staining, particularly in spindle cell carcinomas. High molecular weight cytokeratin CK14, CK5, and CK17 were positive in 91.3%, 87.2%, and 73.3% of MBCs, respectively. CK7 was much less likely to be positive in spindle cell carcinomas (37.5%) than in other variants of MBCs (97.4%). P63 and CK14 were the most useful markers for spindle cell carcinomas, positive in 87.5% and 85.7% of cases, respectively. GATA 3 was positive in 63% MBCs, and nonspecific staining for vimentin and smooth muscle actin were common. Random combination of up to 3 antibodies against keratins including p63 showed sensitivities ranging from 80.9% to 97.9%. Our results suggested the combination of OSCAR, CK14 and p63 is the most efficient panel (sensitivity 97.9%) for diagnosing MBCs.
Demonstrate a method for developing rehabilitation service areas. Compare service areas based on post-acute care rehabilitation admissions to service areas based on acute care hospital admissions.
We conducted a secondary analysis of 2013-2014 Medicare records for older patients in Texas (N = 469,172). Our analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. We used Ward's algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. For comparison, we set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions in Texas. Two methods were used to evaluate rehabilitation service areas Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas.
Rehabilitation service areas had a higher ICC (0.081 vs 0.076) and variance in beds (27.8 vs 21.4). Our finding suggest that service area based on rehabilitation admissions capture more variation than those based on acute hospital admissions.
This study suggests the use of Rehabilitation Service Areas would lead to more accurate assessments of rehabilitation geographic variations and their use in understanding rehabilitation outcomes.
This study suggests the use of Rehabilitation Service Areas would lead to more accurate assessments of rehabilitation geographic variations and their use in understanding rehabilitation outcomes.