Clinical Pathological Diagnosis Research Articles

Role of artificial intelligence in staging and assessing of treatment response in MASH patients

Background and AimsThe risk of disease progression in MASH increases proportionally to the pathological stage of fibrosis. This latter is evaluated through a semi-quantitative process, which has limited sensitivity in reflecting changes in disease or response to treatment. This study aims to test the clinical impact of Artificial Intelligence (AI) in characterizing liver fibrosis in MASH patients.MethodsThe study included 60 patients with clinical pathological diagnosis of MASH. Among these, 17 received a medical treatment and underwent a post-treatment biopsy. For each biopsy (n = 77) a Sirius Red digital slide (SR-WSI) was obtained. AI extracts >30 features from SR-WSI, including estimated collagen area (ECA) and entropy of collagen (EnC).ResultsAI highlighted that different histopathological stages are associated with progressive and significant increase of ECA (F2: 2.6% ± 0.4; F3: 5.7% ± 0.4; F4: 10.9% ± 0.8; p: 0.0001) and EnC (F2: 0.96 ± 0.05; F3: 1.24 ± 0.06; F4: 1.80 ± 0.11, p: 0.0001); disclosed the heterogeneity of fibrosis among pathological homogenous cases; revealed post treatment fibrosis modification in 76% of the cases (vs 56% detected by histopathology).ConclusionAI characterizes the fibrosis process by its true, continuous, and non-categorical nature, thus allowing for better identification of the response to anti-MASH treatment.

6625 Adrenocortical Oncocytoma: Illuminating The Clinical And Biological Behavior Of An Extremely Rare Tumor Of The Adrenal Gland

Abstract Disclosure: H. Usmani: None. M. Arguello, MD: None. Background: Only 120 cases of adrenocortical oncocytoma have been reported in English literature (1). Standardized diagnostic criteria, or a typical clinical or biological course, have yet to be established. 58 yo woman with PMH HTN, COPD, CREST syndrome on chronic prednisone, previous 38-pk yr smoker, pulmonary nodule, current vaper, was incidentally found to have a left adrenal mass when she went for CT abd pelvis with IV and oral contrast to evaluate for suspected diverticulosis and anemia. CT showed a mass in the left adrenal gland measuring 5.6 x 4.4 cm in size, heterogeneous in density, with possible areas of necrosis. It is unclear how long the adrenal mass was there since the patient never had a CT scan before. Patient was asymptomatic except 50 lb wt loss in the last couple of years with a feeble appetite, self-reported abnormal hair growth (no hirsutism on exam), voice deepening attributed to smoking, and HTN- well controlled with nifedipine. Patient has no FHx of endocrinopathy. Adrenal function tests wnl except for plasma free normetanephrines slightly high at 1.64 nmol/L, which was unlikely from tumor considering tumor size. Normal adrenal function tests included 11-deoxycortisol, DHEA-S, plasma-free metanephrine, aldosterone, renin, aldosterone: renin ratio, androstenedione, ACTH, 1 mg overnight dexamethasone suppression test.She underwent left-sided lap adrenalectomy 4 mos after discovery of adrenal mass, with no complications. 6 days after surgery, a left in JP drain caught on a door at patient’s home, causing splenic subcapsular tear requiring emergent splenectomy. The path report shows an encapsulated neoplasm consisting of sheet-like proliferation of eosinophilia polygonal cells with nuclear atypia, low mitotic activity, and no capsular or vascular invasion. Immunohistochemical markers show neoplastic cells positive for SF1, Mart1, inhibin (focal), and synaptophysin (focal); negative for CK-OSCAR, CK7, CK20, chromogranin, HMB45, and TTF-1, Ki67 and pHH3 show low proliferative index. The pathology slides were sent to U of M, where the diagnosis of adrenal cortical oncocytoma was made. Removal of oncocytoma has not affected patient’s weight, blood pressure, deep voice, or hair growth on 4 month follow up. Lin-Wiess-bisceglia system (2) suggests a benign lesion. But, as mutation rate for this rare tumor is unclear, plan for CT abd pelvis in 1 yr. Conclusion: This case elucidates the clinical and biological course and pathologic diagnosis of an exceedingly rare adrenal tumor.

FLUID: a fluorescence-friendly lipid-compatible ultrafast clearing method.

Many clearing methods achieve high transparency by removing lipid components from tissues, which damages microstructure and limits their application in lipid research. As for methods which preserve lipid, it is difficult to balance transparency, fluorescence preservation and clearing speed. In this study, we propose a rapid water-based clearing method that is fluorescence-friendly and preserves lipid components. FLUID allows for preservation of endogenous fluorescence over 60 days. It shows negligible tissue distortion and is compatible with various types of fluorescent labeling and tissue staining methods. High quality imaging of human brain tissue and compatibility with pathological staining demonstrated the potential of our method for three-dimensional (3D) biopsy and clinical pathological diagnosis.

Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts.

Survey study. The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries. A survey of individual members of an international study group of spinal oncology surgeons was performed. Participants were provided a clinical vignette, pathologic diagnosis, and pre-operative imaging for three primary spinal oncology cases. Study participants provided a free text surgical plan for resection and were then presented an associated 3D printed model for each case and asked to re-evaluate their surgical plan. Ten spinal oncology surgeons participated in the study, representing nine institutions across five countries. Four of the surgeons (40%) made significant changes to their surgical plan after reviewing the 3D models, including sacrifice of an additional nerve root to obtain negative margins, sparing an SI joint that was originally planned for inclusion in the en bloc resection, adjusting the location of osteotomy cuts, changes to the number of surgical stages and/or staging order, and preservation of neurology that was originally planned for sacrifice. The overall impression of the 3D models was positive, with 90% of the participants stating they found the 3D model useful in developing a surgical plan. Surgical planning for resection of primary spinal column tumors is challenging and time intensive. 3D printed patient specific surgical models may be an additional tool that can augment surgical planning and execution by improving the chance of accomplishing surgical resection goals and minimizing morbidity.

Isolated intraductal carcinoma of the prostate: a clinicopathological and molecular analysis

Objective: To study the clinicopathological features, immunohistochemical phenotypes, molecular changes, differential diagnosis and prognosis of isolated intraductal carcinoma of the prostate (iIDC-P). Methods: Three iIDC-P cases were collected retrospectively from 2016 to 2022 at Ningbo Clinical Pathology Diagnosis Center, Ningbo, China. The clinicopathologic features and immunophenotypic profiles were studied using light microscopy and immunohistochemistry. A targeted next-generation sequencing panel was used to analyze cancer-associated mutations. Follow-up and literature review were also performed. Results: The patients' ages were 61, 67 and 77 years, and their preoperative prostate specific antigen (PSA) levels were 7.99, 7.99 and 4.86 μg/L, respectively. Case 1 and 2 were diagnosed on needle biopsy and radical prostatectomy (RP) specimens, and case 3 was diagnosed on a specimen of transurethral resection of the prostate (TURP). The RP specimen was entirely submitted for histologic examination. In the case 1, iIDC-P was found in one tissue core (involving two ducts) in the biopsy specimen, and in 6 sections (diameter, 0.3-1.1 cm) from the radical prostatectomy specimen, and one section had separate foci of low-grade acinar adenocarcinoma (diameter, 0.05 cm). In the case 2, 6 tissue sections from the biopsy specimens showed iIDC-P, and 13 sections from RP specimen showed iIDC-P (diameter, 0.5-1.6 cm), and the other 3 sections had separate low grade acinar adenocarcinoma (diameter, 0.6 cm). In the case 3, 5 tissue blocks from the TURP specimen showed iIDC-P. The case 1 and 2 showed solid architecture with expansile proliferation of neoplastic cells in native ducts and acini. The case 3 showed dense or loose cribriform pattern, with marked cytological atypia, and frequent mitotic figures. Comedonecrosis was found in solid or dense cribriform glands in the case 2. Immunohistochemically, surrounding basal cells were highlighted using high-molecular-weight cytokeratin (34βE12 and CK5/6) and p63, while P504s was positive in the tumor cells. The tumor cells were also positive for AR and prostate markers (NKX3.1, PSA and PSAP), and negative for GATA3. The iIDC-P and acinar adenocarcinoma both showed weak PTEN expression and no ERG (nuclear) expression. In case 2 and 3, targeted sequencing revealed activated oncogenic driver mutations in MAPK and PI3K pathway genes (KRAS, MTOR and PTEN). In addition, pathogenic mutation in TP53 and FOXA1 mutation were found in the case 2 and 3, respectively. No case demonstrated TMPRSS2::ERG translocation. All cases were microsatellite stable and had lower tumor mutation burdens (range, 2.1-3.1 muts/Mb). The patients showed no biochemical recurrence or metastasis after follow-up of 16-91 months. Conclusions: iIDC-P is a special type of intraductal carcinoma of the prostate and differs from intraductal carcinoma within high-grade prostate cancer. iIDC-P has unique molecular characteristics and may represent as a molecularly unique in situ tumor of prostate cancer.

Development of a brief core set for knee dysfunction based on the International Classification of Functioning, Disability and Health: assessing construct validity and measurement potential

BackgroundThe comprehensive core set for knee dysfunction was developed to classify the functioning of people with any knee dysfunction. To be used as a clinical instrument to measure the functioning of people with knee dysfunction, the construct validity of the core set still needs to be assessed. The purpose of this study was to analyze the construct validity of the comprehensive core set for knee dysfunction as an instrument to measure functioning.MethodsA cross-sectional study with 200 participants with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Participants were assessed using the comprehensive core set for knee dysfunction with 25 categories, the subjective form from the International Knee Documentation Committee scale, and measures of self-perceived general health and functioning. The construct validity of the core set was assessed by Rasch analysis, and the external construct validity was assessed by correlation between the score of the brief core set for knee dysfunction with the subjective form from the International Knee Documentation Committee scale, and scores of self-perception of health and functioning.ResultsTwelve categories were consistent with a unidimensional construct, with no difference in the response pattern for age, sex, educational level, and time of complaint. These categories were included in the brief core set for knee dysfunction. The mean score of the brief core set was 37 ± 21 points, a value classified as moderate impairment regarding functioning. Correlations with the subjective form from the International Knee Documentation Committee scale and scores of self-perception were adequate (p < 0.01; r > 0.5).ConclusionThe brief core set for knee dysfunction, a set with 12 categories, can be used as a clinical instrument to measure and score the functioning of people with knee dysfunction, aged between 18 and 89 years, with adequate construct validity.

CENPF May Act as a Novel Marker and Highlight the Influence of Pericyte in Infantile Hemangioma.

Infantile hemangioma (IH), a benign microvascular tumor, is marked by early and extensive proliferation of immature hemangioma endothelial cells (Hem-ECs) that naturally regress through differentiation into fibroblasts or adipocytes. However, a challenge persists, as the unique biological behavior of IH remains elusive, despite its general sensitivity to propranolol treatment. Recent evidence suggests that abnormal volume proliferation in IH is primarily attributed to the accumulation of hemangioma pericytes (Hem-Pericytes), in addition to Hem-ECs. Centromere protein F (CENPF) is involved in regulating mitotic processes and has been associated with malignant tumor cell proliferation. It is a key player in maintaining genomic stability during cell division. Our findings revealed specific expression of CENPF in Hem-Pericytes, with a proliferation index (PI) approximately half that of Ki67 (3.28 vs 6.97%) during the proliferative phase of IH. This index decreased rapidly in the involuting phase (P < .05), suggesting that the contribution of pericytes to IH development was comparable to that of Hem-ECs. Tumor expansion and shrinkage may be due to the proliferation, reduction, and differentiation of Hem-Pericytes. In conclusion, we speculate CENPF as a novel marker for clinical pathological diagnosis and a potential therapeutic target, fostering advancements in drug development.

Childhood Posterior Fossa Tumours: Experience from a Tertiary Center in Nepal

Background: Brain tumour is a common problem in paediatric age group and posterior fossa is the commonest location. Treatment of these tumours is difficult due to a confined space and potential involvement of brainstem. The aim of this study is to analyse the clinical features, radiological findings, pathological diagnosis, surgical management, postoperative complications and outcome in 3 months in paediatric patients with posterior fossa tumours. Method: Retrospective chart review of 24 patients treated in the Department of Neurosurgery, TUTH, between 2019 April – 2023 April was done. The variables included were age, sex, clinical features, radiological findings, histopathological diagnosis, management and postoperative complications. Results: Twenty-four patients (30%) out of 80 childhood tumors were located in posterior fossa. The most common presenting symptoms was headache in 83.3% and vomiting in 75%. The most common location of tumour was the fourth ventricle in 66.7% while most common tumour histology was Type IV medulloblastoma in 45%. The commonest mode of treatment in 90% of cases was Ventriculoperitoneal (VP) shunting followed by surgical excision of tumour. Conclusion: Posterior fossa tumours are common tumour occurring in children. Majority of the patients presented with features of raised intracranial pressure and gait ataxia. Fourth ventricle and cerebellar vermis are the most common location. Most common histology types are medulloblastoma followed by pilocytic astrocytoma and ependymoma. Management involves addressing acute hydrocephalus followed by definitive surgery. Keywords: Medulloblastoma, Paediatrics, Posterior fossa, Surgery, Ventriculoperitoneal shunt

Clinicopathologic study of caruncular lesions.

The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic. Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out. The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis. This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management.

Retrospective evaluation of gestational trophoblastic disease - experience with ultrasounds.

Our study aims to determine the frequency and types of GTD (Gestational Trophoblastic Disease) in our clinic, to evaluate its relationship with clinical parameters, and the consistency of clinical prediagnosis and pathological definitive diagnosis. In the present study, hospital records of 120 patients with gestational trophoblastic disease between January 2019 and August 2022 were obtained and evaluated retrospectively. Demographic, hematological, biochemical, and clinical data were collected in detail, and the data were analyzed statistically. Our study included a total of 120 female patients, with an average age of 31.16±9.70. The average number of patients was 3. The average time for women to receive the diagnosis was 9.80±2.45 weeks, with the most frequent complaint on our part being bleeding (85.8%). When the pathology outcomes of the patients we included in our study were examined, it was found that the number of patients diagnosed with incomplete abortion was 34, the number of patients diagnosed with complete abortion was 82, the number of invasive moles diagnosed was 3, and the number of patient diagnosed with choriocarcinoma was 1. Kappa ratio was calculated as 0.419 (p<0.001) when the compliance of the clinical diagnosis was assessed. This value was consistent with median level alignment. In a study that examined the three years of our calism in our bulk, 1.8 per 1,000 births were followed frequently. We should inform patients in detail about gestational trophoblastic diseases and warn patients not to delay their consequences. We should recommend that pregnancy be avoided for 12 months for low-risk patients and 18 months for high-risk patients after GTD.

PATIENTS WITH CKD SECONDARY TO GLOMERULAR DISORDERS HAVE DECREASED ARTERIAL STIFFNESS, AS COMPARED TO HYPERTENSIVE AND DIABETIC CKD

Objective: To compare pulse wave velocity (PWV), a marker of arterial stiffness, between CKD patients of different etiologies: hypertensive and diabetic nephrosclerosis. vs. CKD secondary to glomerular disorders. Design and method: Clinical data were collected on 56 patients followed at the Nephrology and Hypertension Institute in Samson Assuta Ashdod University Hospital. All patients had at least one visit at our Nephrology clinics prior to recruitment. All patients with a glomerular disorder had a clinical-pathological diagnosis based on a recent kidney biopsy. Pulse wave velocity (PWV) was measured using a validated Sphygmocor XCEL® device. Univariate and multivariate analyses were performed to compare PWV between hypertensive/diabetic CKD and CKD secondary to glomerular disorders. Results: PWV was significantly higher in the hypertensive/diabetic CKD group, compared to the CKD-GN group, with an average of. 12.2 m/s vs 8.3 m/s, respectively. In a multivariate linear regression model, having CKD secondary to glomerulonephritis was associated with a significantly lower PWV, compared with CKD secondary to hypertension and diabetes, with adjustment of age, creatinine, and comorbidities. Conclusions: CKD Patients secondary to glomerulonephritis, have lower PWV when compared to CKD patients with diabetes and/or hypertension, even after adjusting for age, renal function, and the presence of comorbidities. It is intriguing to further study the possible protective role of immunosuppression on the arterial properties of CKD patients.

Abstract 7607: Single-cell genomics study before and after neoadjuvant therapy for triple-negative breast cancer

Abstract Breast cancer has become the most common malignant tumor globally. Neoadjuvant chemotherapy (NAC) has become an important treatment option for locally advanced breast cancer, capable of eliminating circulating tumor cells (micrometastases) and achieving downstaging objectives. However, even after completing neoadjuvant chemotherapy or receiving local treatment, some patients may still have residual lesions, which are a key factor in distant recurrence and metastasis. The existing clinical biomarker tests such as CEA, CA-153, and imaging methods are unable to accurately assess the condition early on. Although tissue pathology biopsy of tumor specimens is the gold standard for clinical pathological diagnosis, it also has certain limitations. Traditional high-throughput sequencing technology for breast cancer primarily identifies "driver genes" associated with the occurrence and development of breast cancer. However, it has limitations in identifying genomic structural changes and subclones of breast cancer, and it overlooks the heterogeneity among tumor cells. The emergence of single-cell RNA sequencing (scRNA-seq) technology can detect these heterogeneous individuals, decode the heterogeneity of breast cancer cells, refine molecular subtypes, and open up new pathways to overcome drug resistance. We collected samples from 6 patients with locally advanced triple-negative breast cancer (ER-, PR-, HER2-negative, defined as HER2 immunohistochemistry 0, 1+ or 2+ but FISH-negative). We compared the cell subgroups and their gene expression in biopsy specimens before neoadjuvant chemotherapy with those in post-treatment specimens obtained during surgery, analyzing changes in cell composition in the tumor microenvironment before and after immunotherapy to identify specific cell types potentially contributing to the outcome of immunotherapy, particularly cell subtypes associated with T-cell clonal proliferation. We found that in the group with good neoadjuvant treatment response (Miller-Payne grade 4-5), B cells, CD4+ T cells, CD8+ T cells, and Tregs cells were all significantly downregulated, while endothelial cells and aSMA-positive fibroblast cells were significantly upregulated. By comparing changes in the immune microenvironment between patients with and without T-cell clonal proliferation before and after treatment, we revealed the differentiation patterns of various immune cells in immunotherapy and potential mechanisms of action. Citation Format: Yingkuan Shao, Kailun Xu. Single-cell genomics study before and after neoadjuvant therapy for triple-negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7607.

Clinicopathological and molecular characteristics of esophageal carcinoma with ductal differentiation: analysis of 17 cases

Objective: To investigate the clinicopathological features and molecular genetic characteristics of esophageal carcinoma with ductal differentiation, and to summarize the experiences in its diagnosis and treatment. Methods: A total of 17 cases of esophageal carcinoma with ductal differentiation diagnosed in Ningbo Clinical Pathological Diagnosis Center, Ningbo, China from June 2011 to December 2022 were collected. The clinical information and pathological diagnosis was reviewed. The tumor histological features and immunohistochemical results were analyzed. The next-generation sequencing was performed to detect and analyze the gene mutations in tumor samples. Results: The 17 patients included in this study were 54-77 years old, with a median age of 66 years. There were 16 males and 1 female. Among them, 9 cases were mainly carcinoma with ductal differentiation. The squamous epithelium on the tumor's surface was accompanied by high-grade intraepithelial neoplasia. The tumor and atypical squamous epithelium were transitional, and the focus was accompanied by various proportions of squamous cell carcinoma component (less than 10%). The other 8 cases were mostly squamous cell carcinoma, basaloid squamous cell carcinoma or sarcomatoid carcinoma with various degrees of tumor specific differentiation and focal area of carcinoma with ductal differentiation (less than 10%). The tumor cells in the area with ductal differentiation were mainly arranged in small tubes, while the tubes showed a double-layer structure, including the inner cells and outer cells of the lumen. Immunohistochemical results showed that the outer cells of the tumorous tubules expressed p63, p40, CK5/6 and CK34βE12, while the inner cells expressed CK7. Compared with esophageal squamous cell carcinoma reported in the literature, the frequency of gene mutations such as MYC (P=0.002), TP63 (P=0.002), CDKN1C (P=0.002) and NFE2L2 (P=0.045) was significantly lower in this group of cases. At the signaling pathway level, the mutation frequency of NOTCH signaling pathway (P=0.041) was significantly higher, while the mutation frequencies of NRF2 pathway (P=0.013) and PI3K pathway (P=0.009) were significantly lower than that of esophageal squamous cell carcinoma. Conclusion: Esophageal carcinoma with ductal differentiation is a type of esophageal carcinoma with unique morphology, and its molecular changes are also significantly different from those of conventional esophageal squamous cell carcinoma.

Clinicopathological Analysis of Densely and Sparsely Granulated Somatotroph Tumors of Pituitary

ObjectiveSomatotroph tumors are the second most common type of pituitary neuroendocrine tumors (PitNETs) that can be further classified into two subtypes, namely densely granulated somatotroph tumors (DGSTs) and sparsely granulated somatotroph tumors (SGSTs). The aim of this study is to investigate the clinical significance of the two subtypes by conducting a retrospective analysis. MethodsFrom the database of the Ningbo Clinical Pathology Diagnosis Center, we collected cases diagnosed with pituitary somatotroph tumors. We then compiled pertinent clinical and radiological data and proceeded with histopathological examination involving HE staining and immunohistochemical staining. Subsequent tumor analysis comparing the two subtypes used either the Chi-square test or Fisher's exact test. ResultsIn this study, we analyzed a total of forty cases of somatotroph tumors, with 18 cases classified as DGSTs and 22 cases as SGSTs. The male-to-female ratio was 5:4 for DGSTs and 4:7 for SGSTs. The mean age was 52.83 years for DGSTs and 47.18 years for SGSTs. Statistically significant differences were observed between the DGSTs and SGSTs groups concerning invasiveness (P=0.0267) and postoperative remission (P=0.007). Both DGSTs and SGSTs cells exhibited co-expression of PIT1, GH, and CAM5.2, although the patterns of CAM5.2 expression differed between the two subtypes. ConclusionsThe efficacy of CAM5.2 staining in distinguishing between DGSTs and SGSTs was demonstrated. SGSTs, with their increased invasiveness and lower remission rate, emerge as a high-risk subtype. The histological subtype of somatotroph tumors plays a crucial role in guiding treatment decisions and prognostic evaluation in affected patients.

Conjugated Oligoelectrolyte with DNA Affinity for Enhanced Nuclear Imaging and Precise DNA Quantification.

Precise DNA quantification and nuclear imaging are pivotal for clinical testing, pathological diagnosis, and drug development. The detection and localization of mitochondrial DNA serve as crucial indicators of cellular health. We introduce a novel conjugated oligoelectrolyte (COE) molecule, COE-S3, featuring a planar backbone composed of three benzene rings and terminal side chains. This unique amphiphilic structure endows COE-S3 with exceptional water solubility, a high quantum yield of 0.79, and a significant fluorescence Stokes shift (λex = 366 nm, λem = 476 nm), alongside a specific fluorescence response to DNA. The fluorescence intensity correlates proportionally with DNA concentration. COE-S3 interacts with double-stranded DNA (dsDNA) through an intercalation binding mode, exhibiting a binding constant (K) of 1.32 × 106 M-1. Its amphiphilic nature and strong DNA affinity facilitate its localization within mitochondria in living cells and nuclei in apoptotic cells. Remarkably, within 30 min of COE-S3 staining, cell vitality can be discerned through real-time nuclear fluorescence imaging of apoptotic cells. COE-S3's high DNA selectivity enables quantitative intracellular DNA analysis, providing insights into cell proliferation, differentiation, and growth. Our findings underscore COE-S3, with its strategically designed, shortened planar backbone, as a promising intercalative probe for DNA quantification and nuclear imaging.

Interpretation of histiocytic/dendritic cell neoplasms and stromal-derived neoplasms of lymphoid tissues in the 5th edition of WHO classification of haematolymphoid tumors

The 5th edition of the World Health Organization classification of hematolymphoid tumors (WHO Blue Book) is soon to be published. Significant revisions have been made in the chapters on histiocytic/dendritic cell neoplasms and stroma-derived neoplasms of lymphoid tissues, leading to the reclassification and renaming of specific diseases. This article provides a concise interpretation and summary of these updates, highlighting the differences from the fourth edition. Pertinent changes from clinical pathological diagnosis to treatment and prognosis are explored, with an emphasis on recent advancements in molecular genetics. Newly introduced disease classifications are discussed, and the section on follicular dendritic cell sarcoma contributed by the author is detailed to assist readers in quickly understanding and assimilating the new classification standards.

Differential Diagnostic Value of Two-dimensional Ultrasound Combined with Three-dimensional Ultrasound Imaging Technology for Cesarean Scar Pregnancy.

Cesarean scar pregnancy (CSP) refers to the phenomenon in which a fertilized egg implants and develops in the scar of the uterus in a woman with a history of cesarean section. The study aimed to explore the differential diagnostic value of two-dimensional ultrasound (2D US) combined with three-dimensional ultrasound (3D US) for CSP. Clinical data of 89 patients with CSP admitted to our hospital from January 2022 to January 2023 were retrospectively analyzed. Of them, 65 patients met the inclusion criteria. Patients underwent 2D US, 3D US, and combined 2D and 3D US imaging. Using the clinical pathological diagnosis as the "gold standard", the differential diagnostic value of 2D US, 3D US, and 2D US combined with 3D US for CSP was compared. The detection rate of CSP using a combined 2D US and 3D US was 98.46%, which was higher than 84.62% and 89.23% achieved with 2D US and 3D US alone, respectively (P<0.05). The pathological results showed that among 65 patients, CSP type I accounted for 24.62%, type II accounted for 55.38%, and type III accounted for 20.00%. The coincidence rate of 2D US combined with 3D US was 98.46%, which was higher than that of 2D US (83.08%) and 3D US 89.23%) alone (P<0.05). The accuracy, specificity, and sensitivity of 2D US combined with 3D US in diagnosing CSP were higher compared to the two methods alone (P<0.05). The combination of 2D US and 3D US can accurately detect and classify CSP, further improving diagnostic efficiency.

Clinical Analysis and Nursing Points of Gynecological Endocrine Disorders

Objective: To explore the clinical manifestations and nursing points for gynecological endocrine disorders. Methods: A total of 120 patients with gynecological endocrine disorders admitted to the Affiliated Hospital of Hebei University from January 2019 to January 2021 were selected as research subjects. The patients were divided into two groups: 60 in the control group and 60 in the research group, using a randomized numerical table. The control group received conventional nursing methods, while the research group received personalized nursing methods. The changes in clinical symptoms and quality of life scores of the patients before and after treatment were observed and analyzed. Results: The clinical symptom evaluation scores in the research group were significantly lower than those in the control group (P &lt; 0.05). Additionally, the quality of life scores in the research group were significantly higher than those in the control group (P &lt; 0.05). Conclusion: Gynecological endocrine disorders exert a considerable impact on women’s health. Healthcare professionals should conduct a comprehensive assessment of clinical manifestations, pathological diagnosis, and etiological analysis during the treatment process. Formulating personalized care plans is essential for addressing the unique needs of patients with gynecological endocrine disorders.

Validation and comparison of diabetic retinopathy-based diagnostic models for diabetic nephropathy

To validate and compare the efficacy of two noninvasive diagnostic models for diabetic nephropathy (DN) based on diabetic retinopathy (DR). A total of 565 patients with type 2 diabetes undergoing kidney biopsy in the Department of Nephrology, PLA General Hospital from January, 1993 to December, 2014 were studied. The patients were divided into DN group and non-diabetic nephropathy (NDRD) group according to renal pathological diagnosis. The data from the 22-year period were divided into 3 stages based on chronological order: early stage (from 1993 to 2003), middle stage (from 2004 to April, 2012), and late stage (from May, 2012 to December, 2014). The changes in clinical features and pathological diagnosis of the patients with renal biopsy over the 22 years were analyzed. The published DNT model and JDB model, both based on DR, were validated and compared for diagnostic effectiveness of DN, and the characteristics of the misdiagnosed cases were analyzed. The incidences of hypertension and DR and levels of glycosylated hemoglobin (HbA1c), creatinine and 24-h urinary protein were all significantly higher, while hemoglobin and triglyceride levels were lower in DN group than in NDRD group (P<0.05). The proportion of NDRD cases increased gradually over time, with IgA nephropathy and membranous nephropathy as the main pathological types. The AUC of JDB model was 0.946, similar to that of NDT model (0.925; P=0.198). The disease course of diabetes, hematuria and incidence of DR were important clinical features affecting the diagnostic accuracy of the models. The clinical features and pathological diagnosis of DR change over time. The non-invasive diagnostic models based on DR have good diagnostic efficacy for DN.

Cone-beam CT imaging features of common cystic lesions associated with the impacted mandibular third molar

Objective: To analyze the imaging features of cone-beam CT (CBCT) of ameloblastoma (AB), odontogenic keratocyst (OKC) and dentigerous cysts (DC) associated with the mandibular impacted third molars,so as to provide useful information for differential diagnosis of these lesions. Methods: The patients who were with complete clinical data, pathological diagnosis and CBCT images from AB, OKC and DC around the mandibular impacted third molars were collected in Peking University Hospital of Stomatology from August 2016 to December 2021. A total of 109 patients (14 were diagnosed as AB, 23 were diagnosed as OKC and the others were diagnosed as dental cysts) were collected, including 73 males and 36 females. The age ranged from 11 to 70. The analyzed imaging features included location and internal density of the lesions, bone expansion, root resorption of adjacent teeth and types of the impacted teeth. The Chi square test was used to compare the gender of different lesions, and the Fisher's exact test was used to compare imaging features of lesions. When P<0.05, there was a significant difference among the three. Logistic regression analysis was performed to determine the imaging features that significantly contribute to correct imaging diagnosis. Corresponding P-values were calculated for all factors from multivariate models. Results: In the 23 cases of OKC, no special location was observed for the center of the lesion, heterogeneous high-density were seen in 21.7% of the cases, 56.5% of the cases had no significant bone expansion and the impacted teeth were not specially oriented. Among the 14 AB, 7 cases (7/14) were mainly located in the ramus of the mandible, and all cases (14/14) had buccal/lingual expansion of the jaw, 8 cases (8/14) presented root resorption of the adjacent teeth, and mesial impacted mandibular third molar were seen in 6 cases (6/14). Among the 72 DC, 88.9% (64/72) of the cases were mainly limited to the crown of the impacted third molar, 72.2% (52/72) of the cases had no obvious bone expansion, inverted impacted teeth were shown in 56.9% (41/72) of the cases. There was a significant difference among the three groups (χ2=7.30, P=0.026) in gender. AB and odontogenic cyst were more common in men than in women, while the incidence of OKC was roughly equal between men and women.There were significant differences in the location (P<0.001), internal density (P=0.001) of the lesions, bone expansion (P<0.001) and types of the impacted teeth (P<0.001), while no statistical difference was found for root resorption of adjacent teeth (P=0.153). Logistics regression analysis showed that the location of the lesion, internal density, bone expansion, root resorption of adjacent teeth and the types of impacted teeth had significant effects on the accurate diagnosis of the three kinds of lesions. Conclusions: Location, internal density, bone expansion and types of the impacted teeth played an important role in the correct imaging diagnosis. Further analysis indicates that when the classification of impacted teeth and the location of lesions are considered synchronously, DC can be differentiated from AB and OKC.