Ancillary Tests Research Articles

Reliability of lymphoma diagnosis using combined cytologic preparations and core needle biopsy: A single-center analysis

Objectives: The diagnosis of lymphoma on cytologic preparations and core needle biopsies (CNBs) is often challenging due to limited material that precludes additional ancillary testing for accurate classification. We describe our institutional experience with patients who ultimately received a diagnosis of lymphoma using cytologic preparations and CNB material along with additional ancillary testing. Material and Methods: All patients whose cytology material (fluids, cytologic smears, and cell block) and CNB resulted in a diagnosis of lymphoma, atypical lymphoid population, or suspicious for lymphoma were retrieved. Diagnoses of lymphoma followed the established nomenclatures of the World Health Organization (WHO). For all cases, the ancillary test profiles were captured and summarized. Results: Of 389 cases identified, 17 (4.4%) were diagnosed as atypical lymphoid cells and 31 (7.9%) were suspicious for lymphoma resulting in an indeterminate rate of 12.3%. The rest of the malignant cases (341; 87.7%) were classified using 2017 WHO lymphoid classification system. Six low-grade and 26 high-grade B-cell lymphomas were not further classified because of limited tissue. B-cell lymphomas were the largest category (73.0%): Primarily diffuse large B-cell lymphoma (21.4%), followed by follicular lymphoma (17.5%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (10.9%). A total of 140 cases (36.0%) had flow cytometry results, but 30 specimens (21.4%) were insufficient. Cytogenetic and molecular studies were performed for 78 cases (20.0%). Conclusion: Full classification of lymphomas is possible with combined cytologic preparations and CNB material and it is an attractive first sampling modality in the diagnostic process for this disease group.

Ancillary testing: Japanese challenge for brain-death diagnosis after announcement of world consensus

2020年に脳死判定に関する新しい国際コンセンサスが作成された（determination of brain death/death by neurologic criteria: The World Brain Death Project）。これによると，解消できない要因により脳死判定に関わる臨床検査を完遂できない場合に，補助検査を施行するべきとされている。補助検査は主として脳血流検査および電気生理学的検査に大別される。特に脳波検査は本邦の法的脳死判定では必須とされているが，今回の国際コンセンサスにおいては，脳波検査は脳幹機能を検査できないため，これを判断基準とすべきでないとの記載がある。また，脳血流検査においては，近年普及しつつあるCT血管造影やMRIについても言及されているものの，臨床的データの少なさから，現状では脳血流停止を評価するための補助検査として使用しないことが提案されている。我々には，本邦の脳死判定基準の歴史や国際コンセンサスとの整合性を図り，補助検査を活用することが求められている。

Considerations for the management of low vision in retinitis pigmentosa with tunnel vision: A case series

AbstractPurpose: This study discusses considerations for the management of low vision in retinitis pigmentosa patients with tunnel vision.Methods: Diagnoses were based on history taking, anterior segment examination, retinal examination with 78D indirect ophthalmoscope, and ancillary testing. Baseline central macular thickness was measured with spectral‐domain optical coherence tomography (Zeiss Cirrus HD‐OCT 5000). The visual field was measured with the Humphrey field analyser. The retina's electrical activity was measured with an electroretinogram (ERG). Contrast sensitivity was measured with the Pelli‐Robson chart.Results: We discuss three cases of retinitis pigmentosa: An 18‐year‐old male, a 26‐year‐old female, and a 47‐year‐old male with bilateral RP and CME. The diagnosis of RP was based on the clinical features of night‐blindness, narrowing visual field, with characteristic funduscopic findings, which are arteriole attenuation, waxy disc pallor, and “bone spicule” appearance. All three cases indicated tunnel vision and a decrease in scotopic response of ERG results. Decreased photopic response was shown in the second and third case. Decreased contrast sensitivity was found in all cases, especially in the third case. Although all cases showed CME in OCT findings, only the third case had visual acuity less than 6/6 and was treated with spectacles. The management of tunnel vision in all of the cases comprises best visual acuity correction, orientation and mobility (O&M) training, and Trifield glasses, if available.Conclusions: Tunnel vision in patients with RP considered a low‐vision aid (Trifield glasses) with an O&M training to extend their visual field. In the RP‐CME, patient whose visual acuity is less than 6/6 binocularly was given spectacles alongside with therapy for CME secondary to RP.

Refractive management of a bilateral lens subluxation case in marfan syndrome patient

AbstractPurpose: To report refractive management of bilateral lens subluxation case in Marfan Syndrome patient.Methods: Diagnosis based on a history‐taking, a physical examination, and an ancillary test. The refractive state of the patient was examined by an autorefractometer, streak retinoscopy and best‐corrected visual acuity (BCVA), before and after cycloplegic on each eye.Results: A 7‐years‐old girl diagnosed with Marfan Syndrome by the Department of Paediatric Cardiology complained for blurred vision in both eyes. Initial visual acuity of the patient was 0.027 in her right and left eyes. Anterior segment examination showed phacodenesis in both eyes. After cycloplegic refraction with enlarging pupil diameter and performed streak retinoscopy, BCVA in the right eye was 0.040 with a refractive correction of −22.00 diopters (D) and left eye was 0.021 with −20.00 D. After several follow ups, the refractive state remains highly fluctuates due to severe lens subluxation degree, which is seen through a half pupillary area. Consequently, operative approach using intracapsular lens extraction technique is considered. A month after the surgery, the distance visual acuity in right eye was 0.125 and 0.080 in left eye. With a refractive correction of +5.50 D, visual acuity became 0.500, while for the left eye became 0.125 with +5.00 D. Whereas, binocular distance visual acuity with refractive correction became 0.400. Therefore, spectacle was prescribed to achieve optimal visual acuity.Conclusions: The refractive management steps in lens subluxation associated with Marfan Syndrome case is very challenging depends on patient's condition. The intracapsular lens extraction procedure prior to spectacle prescription should be considered as a management of severe lens subluxation in patient with Marfan syndrome, in order to achieve BCVA.

Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer

Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer (BC), accounting for up to 15% of all invasive BC. Loss of cell adhesion due to functional inactivation of E-cadherin is the hallmark of ILC. Although the current world health organization (WHO) classification for diagnosing ILC requires the recognition of the dispersed or linear non-cohesive growth pattern, it is not mandatory to demonstrate E-cadherin loss by immunohistochemistry (IHC). Recent results of central pathology review of two large randomized clinical trials have demonstrated relative overdiagnosis of ILC, as only ~60% of the locally diagnosed ILCs were confirmed by central pathology. To understand the possible underlying reasons of this discrepancy, we undertook a worldwide survey on the current practice of diagnosing BC as ILC. A survey was drafted by a panel of pathologists and researchers from the European lobular breast cancer consortium (ELBCC) using the online tool SurveyMonkey®. Various parameters such as indications for IHC staining, IHC clones, and IHC staining procedures were questioned. Finally, systematic reporting of non-classical ILC variants were also interrogated. This survey was sent out to pathologists worldwide and circulated from December 14, 2020 until July, 1 2021. The results demonstrate that approximately half of the institutions use E-cadherin expression loss by IHC as an ancillary test to diagnose ILC and that there is a great variability in immunostaining protocols. This might cause different staining results and discordant interpretations. As ILC-specific therapeutic and diagnostic avenues are currently explored in the context of clinical trials, it is of importance to improve standardization of histopathologic diagnosis of ILC diagnosis.

Comparison of Pathology and Immunohistochemistry in Natural and Experimental West Nile Virus Infections in Ruffed Grouse (Bonasa umbellus).

Ruffed Grouse (Bonasa umbellus) populations have declined in much of the eastern US in recent decades. Research suggests that West Nile virus (WNV) contributed to these declines, based on decreasing population indices temporally correlated to WNV introduction into North America, high morbidity and mortality in experimentally infected Ruffed Grouse, and relatively low statewide seroprevalence concurrent with high WNV vector indices. We describe lesions and relevant diagnostic findings in six, free-ranging Ruffed Grouse that directly or indirectly died of natural WNV infection and compare results to experimentally infected Ruffed Grouse. All naturally infected grouse were found moribund or dead from August to December 2015-18 in the northeastern US; 4/6 grouse were subadults. Necropsy, histopathology, immunohistochemistry, and/or ancillary tests contributed to the diagnosis of WNV-associated disease in all cases. The most common lesions in naturally infected grouse were myocardial inflammation, degeneration, and/or necrosis, consistent with lesions in experimentally infected grouse. Evidence of trauma in 6/6 naturally infected grouse suggests the possibility of WNV-associated morbidity as a predisposing factor. Diagnostic findings in 3/6 naturally infected grouse were consistent with experimentally infected grouse with severe disease 7-8 d postinoculation; the remaining naturally infected birds had similar findings to experimentally infected subclinical grouse. Our results further support the notion that WNV contributes to mortality of free-ranging Ruffed Grouse and may be used to improve surveillance strategies and population-level management approaches.

Evaluation of the impact of CSF prion RT-QuIC and amended criteria on the clinical diagnosis of Creutzfeldt-Jakob disease: a 10-year study in Italy

BackgroundThe introduction of the prion Real-Time Quaking-Induced Conversion assay (RT-QuIC) has led to a revision of the diagnostic criteria for sporadic Creutzfeldt-Jakob disease (sCJD).Validation studies are needed for the amended...

Diagnostic Accuracy of Frequency-Doubling Technology and the Moorfields Motion Displacement Test for Glaucoma

Portable perimetric testing could be useful for community-based glaucoma screening programs. Frequency-doubling technology (FDT) and the Moorfields motion displacement test (MDT) are portable perimeters that have shown promise as potential screening tools for glaucoma. This study's goal was to determine the diagnostic accuracy of FDT and MDT for visual field defects and glaucoma. Prospective, cross-sectional, diagnostic accuracy study. A consecutive series of patients aged ≥ 50 years who presented to a glaucoma clinic in South India and had never undergone Humphrey field analyzer (HFA) visual field testing in the past. Participants underwent 24-2 Swedish Interactive Thresholding Algorithm (SITA)Standard HFA perimetry, FDT perimetry, MDT perimetry, and iPad perimetry using visualFields Easy in random order. Ophthalmologist grades of HFA and optic nerve head photographs were used as reference standards for glaucoma and field defect presence. Receiver operating characteristic curves were constructed to assess the diagnostic accuracy of various parameters for each test. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Overall, 292 eyes from 173 participants were included, with 112 eyes classified as moderate or worse glaucoma. For moderate or worse glaucoma detection, the best parameter on FDT was mean deviation (MD) (AUROC, 0.84; 95% confidence interval [CI], 0.79-0.89) and the best parameter on MDT was global probability of true damage (GPTD) (AUROC, 0.87; 95% CI, 0.82-0.91). When specificity was set to 90%, the sensitivity for detection of moderate or worse glaucoma was 55% (95% CI, 39%-68%) for FDT MD and 62% (95% CI 52%-71%) for MDT GPTD. Frequency-doubling technology and MDT perimetry had fair diagnostic accuracy for glaucoma detection when administered to naïve test takers in this South Indian population. Although not appropriate for use as a sole glaucoma screening test, these perimetric tests may be useful as ancillary tests. Proprietary or commercial disclosure may be found after the references.

Sellar masses: diagnosis and treatment.

Sellar mases can cause a variety of neuro-ophthalmic manifestations, including compressive optic neuropathy, chiasmal syndrome, and ophthalmoplegia due to cranial nerve palsy. Diagnosis involves a thorough history, neuro-ophthalmic examination, and ancillary tests and investigations. Visual field testing is critical in diagnosing and localizing the lesion and determining the extent of visual field loss. Appropriate neuro-imaging is essential in characterizing and localizing the lesion. Neuro-ophthalmologic assessment include meticulous clinical examination and ancillary tests including,visual field testing, which is useful in localizing the lesion, and optical coherence tomography, which is helpful in assessing the degree of axonal and neuronal loss and predicting the visual outcome. Treatment requires a multidisciplinary approach by different specialties, including radiologists, neuro-ophthalmologists, and neurosurgeons. The two primary treatment modalities for these tumors are surgery and radiation therapy. We review the main types of sellar lesions, their neuro-ophthalmologic evaluation, and treatment options.

A series of heterogeneous lymphoproliferative diseases with CD3 and MUM1 co-expressed in cats and dogs.

Lymphoma diagnosis in dogs and cats is continually evolving as new subtypes and human correlates are being recognized. In humans, T-cell lymphomas with MUM1 expressed and plasma cell neoplasia or B-cell lymphomas with CD3 expressed aberrantly are reported only rarely. We report here a case series of tumors in dogs and cats with CD3 and MUM1 co-expressed as determined by immunocytochemistry or immunohistochemistry. Lineage was assigned for these tumors by 3 board-certified pathologists and a veterinary immunologist based on review of clinical and cellular features and the results of ancillary testing including PCR for antigen receptor rearrangements, flow cytometry, and serum protein electrophoresis with immunofixation. In cats, 7 of 7 tumors, and in dogs, 3 of 6 tumors with CD3 and MUM1 co-expressed had clonal rearrangement of the immunoglobulin gene or serum monoclonal immunoglobulin, consistent with a diagnosis of a plasma cell neoplasia or myeloma-related disorder with CD3 expressed aberrantly. Disease was often disseminated; notably, 3 of 7 feline cases had cutaneous and/or subcutaneous involvement in the tarsal area. In dogs, 3 of 6 cases had a clonal T-cell receptor gamma result and no clonal immunoglobulin gene rearrangement and were diagnosed as a T-cell tumor with MUM1 expressed. The use of multiple testing modalities in our series of tumors with plasma-cell and T-cell antigens in dogs and cats aided in the comprehensive identification of the lymphoproliferative disease subtype.

Optimal Assessment of Metastatic Breast Carcinoma: The Value of Cytopathology Combined with Molecular Analysis

Metastatic breast cancer (MBC) remains in most cases an incurable disease with genetic complexity and heterogeneity. Improvements in classification and management have been introduced, in addition to the development of endocrine and anti-HER2 targeted therapies. Currently, efforts are being made to delineate the best approach for the genomic landscape of MBC and, as result, molecular therapeutic targets. Here, we highlight the recent developments in the cytopathology of MBC, discussing cytological diagnostic approaches in the characterization of hallmarks, such as immunocytochemistry and genomic biomarkers. Cytological material can be processed for ancillary testing for diagnostic and therapeutic purposes. Reassessment of receptor status is indicated due to changes in tumor biology and metastatic presentation. PD-L1 expression is the only approved biomarker for predicting immune checkpoint inhibitor response in metastatic TNBC, evaluated by immunostaining. The feasibility of applying PD-L1 assays in MBC cytological samples can be recommended, with the adoption of a combined positive score. Non-formalin cytological samples provide higher purity, cellular yield, and better tumor fraction for single-multi gene assays. In MBC, molecular tests enable personalized therapy such as PIK3CA, NTRK fusion genes, and MSI. Cytopathology combined with molecular analysis must be performed effectively in routine clinical practice, through procedure standardization and experience dissemination.

Cell pellet from fixative medium of transbronchial lung biopsy sample improves lung cancer ancillary test

ObjectivesLung cancer tissue obtained using small biopsies are relatively fragile, leaving behind some tiny tissue fragments or cell clusters in the fixative medium that are difficult to collect for processing as a paraffin-embedded tissue block. Usually, the cellular component of the residual fixative medium is discarded as medical waste as per routine laboratory protocol. No protocol exists for utilizing the cellular component of the residual fixative medium after processing the tissue blocks to improve lung cancer ancillary testing. This study aimed to undercover the potential value of these samples for lung cancer diagnosis and targeted therapy development. Materials and MethodsA protocol was developed for cell pellet sample collection from the residual fixative medium of a transbronchial forceps lung biopsy sample. Tumour cell number and fraction in a paired cell pellet and matching formalin-fixed paraffin-embedded tissue section were evaluated from 324 non-smallcell lung carcinoma (NSCLC) cases. We defined the adequacy of the cell pellet for molecular analysis as ≥ 200 tumour cells and ≥ 10 % tumour cells. Real-time polymerase chain reaction and next-generation sequencing were performed on adequate cell pellet samples. ResultsWe discovered that the fixative medium of most transbronchial forceps lung biopsy samples was enriched in tumour cells. Among 324 biopsy samples, 70 (21.6%) exhibited inadequate formalin-fixed paraffin-embedded tissue sections, whereas 53 (75.7%) yielded adequate cell pellet samples. Somatic mutations detected in the formalin-fixed paraffin-embedded tissue section samples were also detected in the matching cell pellets. ConclusionsCell pellets collected from the fixative medium of thoracic small biopsies are a beneficial supplemental material for ancillary testing. Combined use of cell pellets with traditional tissue-based samples can enhance the detection rate of informative mutations in patients with advanced NSCLC.

Next-generation Sequencing as a Potential Diagnostic Adjunct in Distinguishing Between Desmoplastic Melanocytic Neoplasms.

Desmoplastic melanomas (DMs) are often challenging to diagnose and ancillary tests, such as immunohistochemistry, have limitations. One challenge is distinguishing DM from benign desmoplastic melanocytic neoplasms. In this study, we explored the utility of next-generation sequencing data in the diagnosis of DMs versus desmoplastic Spitz nevi (DSN) and desmoplastic nevi (DN). We sequenced 47 cases and retrieved 12 additional previously sequenced clinical cases from our dermatopathology database. The 59 total cases were comprised of 21 DMs, 25 DSN, and 13 DN. The DMs had the highest tumor mutation burden at 22 mutations/megabase (m/Mb) versus the DSN (6m/Mb) and DN (8m/Mb). Truncating mutations in NF1 resulting in a loss-of-function were exclusive to the DM cohort, identified in 8/21 (38%) cases. Importantly, missense mutations in NF1 were nonspecific and seen with similar frequency in the different cohorts. Other mutations exclusive to the DMs included truncating mutations in TP53 , CDKN2A , and ARID2 . Among the DSN, 17/25 (68%) had an HRAS mutation or receptor tyrosine kinase fusion consistent with other Spitz tumors. Two cases in the DN cohort had missense mutations in BRAF without additional progression mutations and 2 other cases had mutations in GNAQ , supporting a diagnosis of a sclerosing blue nevus. The remainder of the DN had nonspecific mutations in various signaling pathways with few progression mutations. Overall, our study provides preliminary data that next-generation sequencing data may have the potential to serve as an ancillary diagnostic tool to help differentiate malignant and benign desmoplastic melanocytic neoplasms.

A pragmatic randomized controlled trial of rapid on-site influenza and respiratory syncytial virus PCR testing in paediatric and adult populations

BackgroundRapid/point-of-care respiratory virus nucleic acid tests (NAT) may improve oseltamivir, antibiotic, diagnostic test, and hospital bed utilization. Previous randomized controlled trials (RCT) on this topic have not used standard procedures of an accredited healthcare and laboratory system.MethodsWe conducted a parallel RCT at two hospitals [paediatric = Alberta Children’s Hospital (ACH); primarily adult = Peter Lougheed Centre (PLC)]. Patients with a respiratory viral testing order were randomized to testing at either a central accredited laboratory (standard arm) or with a rapid polymerase chain reaction test at an on-site accredited laboratory followed by standard testing [rapid on-site test (ROST) arm] based on day of specimen receipt at the laboratory. Patients and clinicians were blinded to assignment.The primary outcome for ACH was inpatient length of stay (LOS) and for PLC was the proportion of inpatients prescribed oseltamivir.Results706 patient encounters were included at ACH; 322 assigned to ROST (181 inpatients) and 384 to the standard arm (194 inpatients). 422 patient encounters were included at PLC; 200 assigned to ROST (157 inpatients) and 222 to the standard arm (175 inpatients).The rate of oseltamivir prescription and number of doses given was reduced in PLC inpatients negative for influenza in the ROST arm compared to standard arm [mean 14.9% (95% CI 9.87–21.9) vs. 27.5% (21.0–35.2), p = 0.0135; mean 2.85 doses (SEM 2.39–3.32) vs. 4.17 doses (3.85–4.49) p = 0.022, respectively]. ROST also significantly reduced oseltamivir use at ACH, reduced chest radiographs (ACH), and laboratory test ordering (PLC), but not antibiotic prescriptions. ROST also reduced the median turnaround time by > 24 h (ACH and PLC).The LOS at ACH was not significantly different between the ROST and standard arms [median 4.05 days (SEM 1.79–18.2) vs 4.89 days (2.07–22.9), p = 0.062, respectively].No adverse events were reported.ConclusionsIn a RCT representing implementation of ROST in an accredited laboratory system, we found that a ROST improved oseltamivir utilization and is the first RCT to show reduced ancillary testing in both paediatric and adult populations. A larger study is required to assess reduction in paediatric LOS as ACH was underpowered. These findings help justify the implementation of rapid on-site respiratory virus testing for inpatients.Trial registration ISRCTN, number 10110119, Retrospectively Registered, 01/12/2021.

Patterns of Lymphoproliferative Disorders in Ethiopia, Based on Single-Center Experience

Background: Similar to other resource-poor countries, the patterns of lymphoproliferative disorders (LPD) in Ethiopia and in our setup are not clearly known. Here, we describe our experience based on conventional histopathology diagnosis. Method: This is a retrospective data-based cross-sectional study from August 2018 to December 2021 at St. Paul's Millennium Medical College, Addis Ababa, Ethiopia. Histopathology reports of cases with diagnoses of LPDs were retrieved from the department of pathology electronic report archive. The diagnostic sample included excisional lymph node and or core tissue biopsy. The diagnosis was based on conventional histopathology (hematoxylin and eosin staining) of the sample. Pertinent data were extracted using a data collection sheet. It was reviewed and analyzed using SPSS-24. Result:A total of 168 patients with necessary documented information were identified; 109(64.9%) were males; the mean (range) age was 46 (16-86) years. The majority of the patients, 139 (82.7%) had Non-Hodgkin lymphomas (NHL) with major histological sub-types being Small lymphocytic lymphoma (24.5%) and Diffuse large cell lymphoma (15.8%). Hodgkin Lymphoma (HL) accounted for 17(10.1%) cases. Sub-classification as a Classical HL was possible in 13 (76.5%) cases(fig.1). But it was not able to sub-classify NHLs histologically in 48(34.5%) and HLs in 3(17.6%) of the cases. Specific lymphoma diagnosis was not possible in 12(7.1%) patients with lymphoproliferative disorders on which an atypical LPD diagnosis was rendered. The most common biopsied lymph node area was the cervical lymph node (33.3%) (table 1) while the most common extranodal site was gastrointestinal (11.9%). Conclusion: Our study indicates that accurate diagnosis and classification of lymphoproliferative disorders is limited in our setup. Therefore, Capacity building in ancillary tests as limited panel immunohistochemistry and quality improvement projects may help to alleviate the shortcomings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Concordance of diagnostic modalities in atypical skin and soft tissue infections in hospitalized patients.

Skin and soft tissue infections (SSTIs) have high rates of morbidity and mortality worldwide but lack reliable standards for diagnostic workup. As a result, atypical infections, more prevalent among immunocompromised patients, can be missed due to deviance from classic features only to be revealed later through inconsistently performed ancillary studies. Our objectives included to evaluate the sensitivities of clinical impression, histopathology, tissue culture, and molecular and non-molecular ancillary tests in diagnosing inpatient SSTIs, as well as to qualitatively discuss the unusual features making a subset of infections "atypical." To do so, we retrospectively reviewed the histopathologic reports and charts of inpatient dermatologic consults at a single tertiary care institution over a 3-year period. We identified a total of 111 cases of SSTIs evaluated by the inpatient dermatology consultation service with concurrent skin or soft tissue biopsy, with 32.4% representing atypical infections. Among these, clinical impression suggested infection in 9(25.0%), routine histopathology in 21(58.3%), specialized stains for microorganisms in 22(68.8%), and tissue culture in 15(68.2%). Due to incomplete picture that each modality by itself creates, we conclude that clinicians and pathologists should carry a low threshold for including SSTIs in their differential diagnoses and should evaluate with skin biopsy, special stains for microorganisms, and ancillary studies, particularly in critically ill individuals who necessitate timely diagnoses.

Physicochemical Evaluations of Diets, Rumen Fluid, Blood and Faeces of Beef Cattle under Two Different Feedlot Systems.

The physicochemical characteristics of diets and faeces were evaluated in combination with data of rumen fluid and blood lactate collected from two distinct feedlot systems in Brazil to understand the causes and correlations to digestive disorders in these production systems. The data were collected during two visits to a finishing system which fed about 80,000 head per year, and four visits to two properties that fed 150 to 180 straight bred Nellore bulls per year to be sold as stud cattle. The findings suggest that ruminal acidosis occurred when there was high intake of starch-rich concentrate, and that subacute rumen acidosis (SARA) most likely occurred in situations where more than 4% of faecal dry matter was excreted as particles larger than 4 mm. The latter were associated with diets having less than 15% of particles smaller than 8 mm and faecal pH under 6.30. It is concluded that ancillary tests, such as ruminal and faecal pH, and particle size distribution in the faeces, can potentially be used in combination with information on diet nutritional composition and a series of best practice management protocols to increase not only animal productivity but to reduce the risks of SARA and ensure the welfare of animals.

Drugs and Conditions That May Mimic Hemolysis.

Visual inspection of posttransfusion plasma for hemolysis is a key laboratory method in the investigation of possible acute hemolytic transfusion reactions (AHTRs). Many substances and physiologic conditions can mimic hemolysis in vitro. Isolated reports describe specific cases of interference, but a comprehensive listing is lacking. Using an illustrative case, we summarize available literature on substances and conditions that may mimic hemolysis in vitro. We further describe other substances and conditions that may discolor plasma but are unlikely to be mistaken for hemolysis on visual inspection. At least 11 substances and conditions have been reported to discolor plasma, in colors ranging from orange to red to brown, including relatively common therapies (eg, eltrombopag, hydroxocobalamin, iron dextran). Other substances are unlikely to be encountered in everyday practice but may mimic hemolysis in particular patient populations. Additional substances may cause plasma discoloration, ranging from blue to green to white, and are associated with a wide variety of therapies and conditions. An awareness of the possible preanalytic confounding factors that may mimic hemolysis can aid in the workup of a suspected AHTR. Review of the medical record, use of ancillary testing, and consideration for nonimmune causes of hemolysis can aid in ruling out AHTR.

Linear Identification of 8 or More Plasma Cells (PCs) in the Interfoveolar Areas (IFAs) of Sleeve Gastrectomies Is Highly Predictive ofHelicobacter pylori (H. pylori) Infection

Abstract Introduction/Objective Bariatric surgery for morbid obesity is dramatically increasing, and large number of sleeve gastrectomies is examined histopathologically. The GIPS guidelines recommend using a visual gestalt to identify substantial inflammation for prompting further ancillary testing for H. pylori microorganisms, and a recent study proposed an “Objective Visual Analog Scale” that justifies additional work-up for H. Pylori infection in gastric biopsies. Our study aims to establish a potential correlation between the number of plasma cells in the IFAs and the presence of H. pylori infection in sleeve gastrectomy specimens. Methods/Case Report We retrospectively reviewed 338 patients who underwent sleeve gastrectomy for morbid obesity at our institution from 2016-2021. Only 105 of 338 cases were included which demonstrated mild to marked lymphoplasmacytic infiltrate in the IFAs of the lamina propria on H&E stain. The number of plasma cells identified in the more expanded IFAs of the lamina propria was assessed by “drawing an imaginary horizontal line” and the number of plasma cells under the “line” were counted. H. pylori immunostain was performed in all cases. Statistical analyses were performed using IBM SPSS statistics Version 26. Results (if a Case Study enter NA) H. pylori like organisms were identified in 49 of 105 cases (20 cases on H&E stain and 29 cases on H. pylori immunostain). Receiver operator characteristic curve (ROC) showed that the identification of 8 or more plasma cells in expanded IFAs is both highly sensitive (93.9%; 46/49) and specific (83.9%; 47/56) for predicting H. Pylori infection with a positive predictive value of 83.6% (46/55) and area under the curve (AUC) of 0.94 (CI:0.89-0.99, p-value= 0.00). Conclusion In the light of above results, we propose that in sleeve gastrectomies specimens, in which H. pylori is not identified on H&E sections, the linear identification of 8 or more plasma in the more expanded IFAs is highly predictive of H. pylori infection and justify additional workup for H. pylori infection.

Solute carrier transporter disease and developmental and epileptic encephalopathy.

The International League Against Epilepsy officially revised its classification in 2017, which amended "epileptic encephalopathy" to "developmental and epileptic encephalopathy". With the development of genetic testing technology, an increasing number of genes that cause developmental and epileptic encephalopathies are being identified. Among these, solute transporter dysfunction is part of the etiology of developmental and epileptic encephalopathies. Solute carrier transporters play an essential physiological function in the human body, and their dysfunction is associated with various human diseases. Therefore, in-depth studies of developmental and epileptic encephalopathies caused by solute carrier transporter dysfunction can help develop new therapeutic modalities to facilitate the treatment of refractory epilepsy and improve patient prognosis. In this article, the concept of transporter protein disorders is first proposed, and nine developmental and epileptic encephalopathies caused by solute carrier transporter dysfunction are described in detail in terms of pathogenesis, clinical manifestations, ancillary tests, and precise treatment to provide ideas for the precise treatment of epilepsy.