Helpful Clues Research Articles

Role of Pap Smear Cervical Cytology in the Diagnosis of Extrauterine Malignancies: Largest Study of 104 Cases from Tertiary Care Cancer Centre in India

Introduction: Extrauterine malignancies in cervical samples are rarely seen. It is important to differentiate these cells from those of primary uterine malignancies to determine appropriate line of further investigations and management. Literature on these lesions is limited largely restricted to case reports. The aim of the present study was to study the spectrum and cytomorphological features of extrauterine malignancies in cervical Pap smears. Materials and Methods: It is a retrospective and descriptive study conducted in Department of Cytopathology from January 2019 to July 2023. All cases of extrauterine malignancies with available cytology material were included in this study. All cases of primary uterine malignancies, i.e., uterine corpus or cervix confirmed by clinical, radiological, and histopathological examination were excluded. Results: 104 out of 11,674 cytology Pap smears were those of extrauterine malignancy. Diagnosis of extrauterine malignancy was given in 47.1% cases, 30.9% were reported as positive for malignancy without giving the possibility of an extrauterine origin, and 22.0% were reported as atypical glandular cells only. In 56 cases where Pap smear was the first investigation which led to the diagnosis. Most common extrauterine malignancy was adenocarcinoma principally from ovarian, colorectal, and vaginal origin. Other epithelial malignancies noted were urothelial carcinoma and invasive breast carcinoma. Among non-epithelial malignancies, we reported vaginal mucosal melanoma, cutaneous melanoma, acute leukaemia, and anaplastic large cell lymphoma. Conclusion: High index of suspicion, presence of squamous and glandular elements with no atypical features, and occasional clusters of cells with marked atypia and usually no necrosis in the background are helpful cytomorphological clues to raise suspicion for extrauterine malignancy. Correlation with serology, radiology, and immunocytochemistry can help in reaching final diagnosis.

A decolonial critical theory of artificial intelligence

In this paper, I argue for a normative reconstruction, from a decolonial perspective of critical theory in Brazil and Latin America, of a democratic ethos that despite its weaknesses and normative deficits is capable of fostering an increasingly deliberative, participatory, and egalitarian democracy by making extensive use of new digital technologies (comprising both AI systems and digital governance). Its argumentative core boils down to the promotion of intersectional egalitarianism (socio-economic, gender, racial-ethnic, environmental) through digital inclusion, which seems only feasible to us from a perspective capable of accommodating the normative claims of a critical decolonial theory combined with a naturalistic view of sustainability, within a research program that I dubbed “mitigated social constructionism” in response to the phenomenological deficit of normative and naturalistic theories (including critical theory and neurophilosophy). If what matters is normativity, then to avoid the divide between naturalism and non-naturalist normativity one nonfoundationalist alternative is to resort to hermeneutical and procedural accounts of normativity as helpful clues to making sense of the naturalism-normativity problem, avoiding reductionist interpretations of both naturalism (Churchland) and normativism (Parfit).

Concomitant Tuberculous and Lepromatous Lymphadenitis: Clues and Pitfalls of Leprosy Concealed by Tuberculosis in Lymph Nodes.

Comorbidities between tuberculosis and leprosy are expected in endemic regions. Pulmonary tuberculosis and cutaneous leprosy are the most prevalent coinfections. One of the common manifestations of tuberculosis is generalized lymphadenopathy. In contrast, leprosy is clinically less suspected to manifest as a generalized lymphadenopathy, and it is pathologically unusual to diagnose leprosy primarily in lymph nodes. Concomitant tuberculous and lepromatous lymphadenitis are unprecedented and clinically unexpected, particularly in nonendemic countries. This imposes diagnostic challenges. We report concurrent tuberculosis and leprosy that were diagnosed in a lymph node in 45-year-old man with generalized lymphadenopathy. The effaced lymph node was predominantly replaced by caseating epithelioid granulomas alternating with foamy histiocytes. Ziehl-Neelsen stain showed positive acid-fast bacilli in the necrotizing granulomas only. The initial differential diagnosis of the nodal foamy macrophages included fungal infections, leishmaniasis, and Whipple disease, for which the special stains were negative. The vacuolated macrophages were disregarded as nonspecific lipogranuloma. A modified acid-fast stain was not considered. The histopathologic clues to nodal lepromatous leprosy included the presence of intracytoplasmic globi, intermixed microabscesses, and lymphoplasmacytic infiltrate and involved pericapsular nerves. Wade-Fite stain was subsequently performed. It revealed numerous lepra bacilli within the foamy histiocytes. The final diagnosis was concurrent disseminated tuberculosis and leprosy. Nodal lepromatous leprosy could be missed when compounded by concurrent nodal tuberculosis, particularly in developed countries. The clinicians and pathologists should have a high index of suspicion, particularly in patients from or with history of travel from endemic regions. Certain histopathologic features are helpful clues to avoid pitfalls.

Pediatric inflammatory bowel disease: What's new and what has changed?

The incidence and prevalence of inflammatory bowel disease (IBD) is on the rise in North America and worldwide, with young children being the fastest growing patient population. It is therefore essential for pediatricians and pediatric sub-specialists to be able to recognize signs and symptoms suspicious for a new diagnosis of IBD, as well as potential complications associated with IBD or its treatment. This article reviews the most recent literature regarding clinical presentation, helpful diagnostic clues, newer monitoring tools being used by pediatric gastroenterologists, and emerging new biologic and small molecule treatments.

Intercellular competitive growth dynamics with microenvironmental feedback.

Normal life activities between cells rely crucially on the homeostasis of the cellular microenvironment, but aging and cancer will upset this balance. In this paper we introduce the microenvironmental feedback mechanism to the growth dynamics of multicellular organisms, which changes the cellular competitive ability and thereby regulates the growth of multicellular organisms. We show that the presence of microenvironmental feedback can effectively delay aging, but cancer cells may grow uncontrollably due to the emergence of the tumor microenvironment (TME). We study the effect of the fraction of cancer cells relative to that of senescent cells on the feedback rate of the microenvironment on the lifespan of multicellular organisms and find that the average lifespan shortened is close to the data for non-Hodgkin's lymphoma in Canada from 1980 to 2015. We also investigate how the competitive ability of cancer cells affects the lifespan of multicellular organisms and reveal that there is an optimal value of the competitive ability of cancer cells allowing the organism to survive longest. Interestingly, the proposed microenvironmental feedback mechanism can give rise to the phenomenon of Parrondo's paradox: When the competitive ability of cancer cells switches between a too-high and a too-low value, multicellular organisms are able to live longer than in each case individually. Our results may provide helpful clues for targeted therapies aimed at the TME.

Therapeutic potential of stem cell extracellular vesicles for ischemic stroke in preclinical rodent models: a meta-analysis

BackgroundExtracellular vesicles derived from stem cells (SC-EVs) have been proposed as a novel therapy for ischemic stroke. However, their effects remain incompletely understood. Therefore, we conducted this meta-analysis to systematically review the efficacy of SC-EVs on ischemic stroke in preclinical rodent models.MethodsUsing PubMed, EMBASE, and the Web of Science, we searched through studies published up to August 2021 that investigated the treatment effects of SC-EVs in a rodent ischemic stroke model. Infarct volume was the primary outcome. Neurological severity scores (mNSS) were the secondary outcome. The standard mean difference (SMD) and the confidence interval (CI) were calculated using a random-effects model. R and Stata 15.1 were used to conduct the meta-analysis.ResultsTwenty-one studies published from 2015 to 2021 met the inclusion criteria. We also found that SCs-EVs reduced infarct volume by an SMD of − 2.05 (95% CI − 2.70, − 1.40; P < 0.001). Meanwhile, our results revealed an overall positive effect of SCs-derived EVs on the mNSS with an SMD of − 1.42 (95% CI − 1.75, − 1.08; P < 0.001). Significant heterogeneity among studies was observed. Further stratified and sensitivity analyses did not identify the source of heterogeneity.ConclusionThe present meta-analysis confirmed that SC-EV therapy could improve neuron function and reduce infarct volume in a preclinical rodent ischemic stroke model, providing helpful clues for human clinical trials on SC-EVs.

Differential evolution of extracted bitumen and solid bitumen in a hybrid shale system

Organic solvent extracted bitumen (EB) and microscopically observed solid bitumen (SB) carry many geological implications in unconventional source-rock reservoirs. EB is a commonly used term in organic geochemistry, and SB is normally used in organic petrology. Although both EB and SB are secondary organic matter initially formed from kerogen degradation and partially describe the same components, they are defined by different physical and chemical criteria and have specific applications, and thus are rarely comparatively investigated. In this study, by taking the shale of the seventh member of the Upper Triassic Yanchang Formation in the Ordos Basin, China, as a case study, we performed an integrated characterization on the two types of bitumen. The characterization was carried out on source rocks and reservoir assemblages at two scales: lamina-scale (organic-rich lamina and silty lamina) and lithofacies-scale (shale and sandstone). Programmed temperature pyrolysis (Rock-Eval 7 pyrolysis), gas chromatography–mass spectrometry (GC–MS), and Raman spectroscopy were used in this study. The samples are distributed within a 12 m interval and therefore should have experienced the same degree of thermal stress. However, maturity parameters derived from GC–MS for EB and Raman spectroscopy for SB exhibit a different inferred thermal maturity between source rocks and reservoirs at both lithofacies- and lamina-scales. The side-chain scission reactions related (non-)biomarker parameters such as Ts/C30H, ΣnC21−/ΣnC22+ alkanes, relative C21 + C22 sterane content and TA(I)/TA(I + II) suggest higher thermal maturity in source rocks (shale and organic-rich lamina) than the corresponding reservoirs (sandstone and silty lamina), while Raman-derived parameters RBS and G-FWHM indicate higher maturity in reservoirs than the corresponding source rocks. It is speculated that the EB measured by GC–MS comprises saturated and aromatic components corresponding to relatively mobile hydrocarbons. The maturation of the source rock exerts greater control over this component than that of the reservoir. In comparison, the SB measured using Raman spectroscopy mainly consists of solid residue left behind after migration and/or decomposition of a once-liquid oil phase that is less readily able to move. It is more intensely altered by the organic–inorganic interactions (mineral dissolution–precipitation processes) in the reservoir than that in the source rock, resulting in a consolidated SB with higher aromaticity. The storage ability of silty lamina in shale may complicate the data interpretation of geochemical differences in EB- and SB-derived parameters. On a practical note, when assessing thermal maturity, taking into the account the lithology or rock texture, which affects the organic–inorganic interactions, as well as specific components detected by different techniques may provide helpful clues to explain some contradictory results.

Phenotypes Associated With the Val122Ile, Leu58His, and Late-Onset Val30Met Variants in Patients With Hereditary Transthyretin Amyloidosis.

Hereditary transthyretin amyloidosis (hATTR) is a rare autosomal dominant systemic disease with variable penetrance and heterogeneous clinical presentation. Several effective treatments can reduce mortality and disability, though diagnosis remains challenging, especially in the United States where disease is nonendemic. Our aim is to describe the neurologic and cardiac characteristics of common US ATTR variants V122I, L58H, and late-onset V30M at presentation. We conducted a retrospective case series of patients with a new diagnosis of ATTRv between January 2008 and January 2020 to characterize features of prominent US variants. The neurologic (examination, EMG, and skin biopsy), cardiac (echo), and laboratory assessments (pro b-type natriuretic peptide [proBNP] and reversible neuropathy screens) are described. A total of 56 patients with treatment-naïve ATTRv with symptoms/signs of peripheral neuropathy (PN) or cardiomyopathy and confirmatory genetic testing presenting with Val122Ile (N = 31), late-onset Val30Met (N = 12), and Leu58His ATTRv (N = 13) were included. The age at onset and sex distributions were similar (V122I: 71.5 ± 8.0, V30M: 64.8 ± 2.6, and L58H: 62.4 ± 9.8 years; 26, 25, 31% female). Only 10% of patients with V122I and 17% of patients with V30M were aware of an ATTRv family history, while 69% of patients with L58H were aware. PN was present in all 3 variants at diagnosis (90%, 100%, and 100%), though neurologic impairment scores differed: V122I: 22 ± 16, V30M: 61 ± 31, and L58H: 57 ± 25. Most points (deficits) were attributed to loss of strength. Carpal tunnel syndrome (CTS) and a positive Romberg sign were common across all groups (V122I: 97%, 39%; V30M: 58%, 58%; and L58H: 77%, 77%). ProBNP levels and interventricular septum thickness were highest among patients with V122I (5,939 ± 962 pg/mL, 1.70 ± 0.29 cm), followed by V30M (796 ± 970 pg/mL, 1.42 ± 0.38 cm) and L58H (404 ± 677 pg/mL, 1.23 ± 0.36 cm). Atrial fibrillation was present among 39% of cases with V122I and only 8% of cases with V30M and L58H. Gastrointestinal symptoms were rare (6%) among patients with V122I and common in patients with V30M (42%) and L58H (54%). Important clinical differences exist between ATTRv genotypes. While V122I is perceived to be a cardiac disease, PN is common and clinically relevant. Most patients with V30M and V122I were diagnosed de novo and therefore require clinical suspicion for diagnosis. A history of CTS and a positive Romberg sign are helpful diagnostic clues.

EYES THAT LOOK DOWN AND OUT A CASE SERIES ON ISOLATED THIRD NERVE PALSY

Introduction:Isolated oculomotor nerve palsy (ONP) is quite common in general practice. Various causes of ONP have been described in several studies, for instance ischemia, compression from aneurysm or tumor, and trauma. Ischemia was the most common etiology with spontaneous recovery, and it was presumed based on some helpful clinical clues before imaging became available. Materials &amp; Methods:This study comprises of 10 patients with oculomotor nerve palsy who attended regional eye hospital, Kurnool, during my study period of 6 months from 01/02/2022 to 31/07/2022. Patients presented to OPD with complaints of diplopia and drooping of upper eyelid. Patients subjected to VA for distant and near vision, slit-lamp examination, pupillary reactions, extraocular motility, fundus examination, diplopia charting for distant and near vision, hess charting, visual field testing and IOP. Blood pressure, blood sugar profile, lipid profiles were monitored and referred to concerned departments. They were advised for CT and MRI scans to know the etiological cause. Results:Out of 10 patients, DM - 3, CVA due to Hypertension - 1, ocular tuberculosis - 1, mucormycosis - 1, pseudotumor - 1, trauma - 1, unknown etiology - 2. Conclusion: Patients with diabetes has a good recovery rate. We recommend that the patients with oculomotor nerve palsy be carefully examined clinically in a multidisciplinary approach for early diagnosis and treatment.

Gene mutations associated with fertilization failure after in vitro fertilization/intracytoplasmic sperm injection.

Fertilization failure during assisted reproductive technologies (ART) is often unpredictable, as this failure is encountered only after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have been performed. The etiology of fertilization failure remains elusive. More and more mutations of genes are found to be involved in human fertilization failure in infertile patients as high throughput sequencing techniques are becoming widely applied. In this review, the mutations of nine important genes expressed in sperm or oocytes, PLCZ1, ACTL7A, ACTL9, DNAH17, WEE2, TUBB8, NLRP5, ZP2, and TLE6, were summarized and discussed. These abnormalities mainly have shown Mendelian patterns of inheritance, including dominant and recessive inheritance, although de novo mutations were present in some cases. The review revealed the crucial roles of each reported gene in the fertilization process and summarized all known mutations and their corresponding phenotypes. The review suggested the mutations might become promising targets for precision treatments in reproductive medicine. Moreover, our work will provide some helpful clues for genetic counseling, risk prediction, and optimizing clinical treatments for human infertility by supplying the useful and timely information on the genetic causes leading to fertilization failure.

What is this bump in my neck? Ultrasonographic evaluation of pediatric neck masses.

Neck masses are common in pediatric patients, with benign etiologies such as congenital or inflammatory lesions accounting most of these masses. Anatomic location (most important), clinical history, and the appearance in ultrasonography (US) are helpful clues to narrow down differential diagnosis. Because of widespread availability, lack of ionizing radiation, and no need for sedation or contrast administration, US is the preferred initial modality for the evaluation. Further evaluation with cross-sectional imagings is needed for more extensive lesions with trans-spatial extension or suspicion of intrathoracic or retropharyngeal extension. This review will focus on US appearance and clinical presentation of masses of the neck in children, to enable radiologist to arrive at a reasonable differential diagnosis. We also briefly discuss more complex pathologies that need to be evaluated with cross-sectional modalities such as CT scan and magnetic resonance imaging.

Changes in the cortical network during sleep stage transitions.

Sleep state transitions are closely related to insomnia, drowsiness, and sleep maintenance. However, how the cortical network varies during such a transition process remains unclear. Changes in the cortical interaction during the short-term process of sleep stage transitions were investigated. In all, 40 healthy young participants underwent overnight polysomnography. The phase transfer entropy of six frequency bands was obtained from 16 electroencephalography channels to assess the strength and direction of information flow between the cortical regions. Differences in the cortical network between the first and the last 10 s in a 40-s transition period across wakefulness, N1, N2, N3, and rapid eye movement were, respectively, studied. Various frequency bands exhibited different patterns during the sleep stage transitions. It was found that the mutual transitions between the sleep stages were not necessarily the opposite. More significant changes were observed in the sleep deepening process than in the process of sleep awakening. During sleep stage transitions, changes in the inflow and outflow strength of various cortical regions led to regional differences, but for the entire sleep progress, such an imbalance did not intensify, and a dynamic balance was instead observed. The detailed findings of variations in cortical interactions during sleep stage transition promote understanding of sleep mechanism, sleep process, and sleep function. Additionally, it is expected to provide helpful clues for sleep improvement, like reducing the time required to fall asleep and maintaining sleep depth.

The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic.

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n = 182, 14.9%), pharmacists (n = 161, 13.2%) and dentists (n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge (n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine (n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.

Characterization of hot populations of Melotte 66 open cluster using Swift/UVOT

ABSTRACT Ultraviolet (UV) wavelength observations have made a significant contribution to our understanding of hot stellar populations of star clusters. Multiwavelength spectral energy distributions (SEDs) of stars, including ultraviolet observations, have proven to be an excellent tool for discovering unresolved hot companions in exotic stars such as blue straggler stars (BSS), thereby providing helpful clues to constrain their formation mechanisms. Melotte 66 is a 3.4 Gyr old open cluster located at a distance of 4810 pc. We identify the cluster members by applying the ML-MOC algorithm on Gaia EDR3 data. Based on our membership identification, we find 1162 members, including 14 BSS candidates, 2 yellow straggler candidates (YSS), and one subdwarf B candidate (sdB). We generated SEDs for 11 BSS candidates and the sdB candidate using Swift/UVOT data combined with other archival data in the optical and IR wavelengths. We discover a hot companion of one BSS candidate, BSS3, with temperature of 38 000$_{-6000}^{+7000}$ K, luminosity of 2.99$_{-1.86}^{+5.47}$ L⊙, and radius of 0.04$_{-0.005}^{+0.008}$ R⊙. This hot companion is a likely low-mass WD with an estimated mass of 0.24–0.44 M⊙. We report one BSS candidate, BSS6, as an Algol-type eclipsing binary with a period of 0.8006 d, based on the Gaia DR3 variability classification. We suggest that BSS3 is formed via either the Case A or Case B mass-transfer channel, whereas BSS6 is formed via the Case A mass transfer.

First-principles study on the magnetic and electronic properties of the high-pressure orthorhombic phase of MnSe

Exploring the mechanism of unconventional superconductivity has been one of the most important topics in condensed matter physics, while studying the magnetic and electronic properties of the parent compounds of unconventional superconductors can provide helpful clues. Recently, superconductivity in the orthorhombic-phase MnSe was successfully induced by applying high pressure, which makes MnSe the second Mn-based superconductor after MnP. Based on the spin-polarized density functional theory calculations, we have studied the magnetic and electronic properties of the orthorhombic-phase MnSe under high pressure. We show that there may exist strong antiferromagnetic (AFM) fluctuations in a narrow energy window (less than 3 meV/Mn) among an AFM state dubbed AFM3 and a series of staggered $n$-mer AFM states. Here the $n$-mer means that a set of $n$ adjacent spins on a line are parallelly aligned. In the AFM3 state and the $n$-mer AFM states, the Mn spins show AFM coupling along the $x$ axis and ferromagnetic (FM) coupling along the $y$ axis, but respectively host FM and staggered $n$-mer AFM correlations along the $z$ axis. Our calculations indicate that the orthorhombic-phase MnSe exhibits a metallic behavior in the low-energy magnetic states, in good accordance with the previous experimental observations. We also map the calculated energies onto an effective Heisenberg model and obtain the exchange couplings $J$, whose values can serve as a reference for analyzing the data from magnetic measurements. Two usual mechanisms like Fermi surface nesting and electron-phonon coupling can be ruled out as the origin of superconductivity. The magnetic properties in the orthorhombic-phase MnSe under high pressure need future in-depth experimental examination.

A systematic analysis of and recommendations for public health events involving brucellosis from 2006 to 2019 in China

Brucellosis is a severe public health problem in China. However, analysis on related infection events is lacking. We performed a systematic analysis of brucellosis laboratory infection and vaccine infection events from 2006 to 2019 in China based on the published literatures. Our analysis showed that most laboratoryBrucellainfections in hospitals were found in Southern China. The identification and handling of suspected samples ofBrucellainfection without following the recommended biosafety protection was the main risk factor. It is important to strengthen the preventive awareness of clinical laboratory staff and physicians, while highlighting the compulsory handling and identification of suspectedBrucella-infected samples in biosafety facilities and following biosafety practices. However, a severe Brucella infection accident at the Northeast Agricultural University, with 28 positive cases, showed that strengthening the management in teaching experiments of students in the veterinary-related profession is essential. However, cluster S2 vaccine strain infection events caused by vaccination and production were mainly observed in Northern China. Strengthening vaccination skills, personal protection, and improving the biosafety management of vaccine production and implementing regular risk surveillance is mandatory. Our analysis provides helpful clues for control of public health events involving brucellosis, as well as implementing intervention strategies is urgent.

Foreign Bodies in Sinonasal Tissues: A Potential Pitfall yet a Hint to Oroantral Fistulas.

Foreign bodies in the maxillary sinus are infrequent findings with various organic and inorganic materials have been reported. Most are iatrogenic due to abnormal communications between the oral cavity and the sinus cavity, predominantly secondary to dental and oral procedures. Oroantral fistulas might be asymptomatic incidental findings or may present with sinusitis-related symptoms. Even though oroantral fistulas are frequently encountered iatrogenic complications, most studies focused on radiologic findings and surgical closure procedures. A few cases reported the histopathologic findings of foreign body-related antral sinusitis. Our aim is to report three cases of chronic maxillary sinusitis induced by various foreign bodies of oral and dental origin associated with oroantral fistulas. Our focus is to highlight the different histopathologic patterns, potential pitfalls and helpful clues of foreign body-induced maxillary sinusitis. Altered foreign bodies in procured sinus specimens might be missed, misinterpreted or ignored by pathologists. Obvious vegetable food remnants were detected, but subtle vegetable residuals showed pulse granuloma, rings and sheet-like patterns embedded in the granulation tissue and fibrous stroma. Some materials mimicked fungal hyphae while others were ignored as nonspecific debris. Periodic acid Schiff stain and polarizing light helped delineate their nature. Other helpful hints included the presence of oral-type squamous epithelium, crystals, hemosiderin pigments, dental materials such as alvogyl, and microorganisms of oral origin for example Actinomyces. Our series emphasizes the importance of correct recognition of foreign bodies of oral and dental origin in paranasal specimens to guide clinicians to the possibility of oroantral fistula-associated odontogenic sinusitis versus conventional rhinosinusitis.

The Milan System classification of Warthin tumor: A large institutional study of 124 cases highlighting cytologic features that limit definitive interpretation.

Fine-needle aspiration (FNA) is highly accurate for the diagnosis of Warthin tumor (WT). However, there is a minor subset of WT cases that are more challenging to interpret. The goal of this study is to identify factors that limit definitive diagnosis of WT on FNA. All WT surgical specimens diagnosed during a 6.5-year study period were retrospectively identified and the preceding cytologic specimen diagnostic categories were analyzed. Of particular interest were WT cases with indeterminate or malignant interpretations. Cases that noted squamous or mucinous change in either the surgical or cytologic reports were also reviewed. A total of 157 WT surgical specimens were identified, with 124 (79.0%) having prior FNAs. The distribution of cytologic diagnostic categories was 12 (9.7%) nondiagnostic, 10 (8.1%) nonneoplastic, 13 (10.5%) atypia of undetermined significance (AUS), 82 (66.1%) neoplasm: benign, 4 (3.2%) salivary gland neoplasm of uncertain malignant potential (SUMP), 2 (1.6%) suspicious for malignancy, and 1 (0.8%) malignant. Of the 20 cases in indeterminate/malignant categories, a majority noted either squamoid (9 of 20) or mucinous (2 of 20) changes. The remainder noted scant cellularity as a limiting factor to interpretation. Additionally, 27 cases mentioned squamous or mucinous change in the surgical or cytology report, with a wide spectrum of cytologic categorization including 2 (7.4%) nondiagnostic, 2 (7.4%) nonneoplastic, 7 (25.9%) AUS, 8 (29.6%) neoplasm: benign, 4 (14.8%) SUMP, 2 (7.4%) suspicious for malignancy, and 1 (3.7%) malignant. This study identified 2 key causes for indeterminate or misclassification of WT on FNA: specimen hypocellularity and metaplastic changes. Recognition of the potential for squamous and mucinous metaplastic changes combined with observance of some helpful diagnostic clues such as the presence of crystalloids may aid in preventing diagnostic pitfalls.

Specific urban units identified in tuberculosis epidemic using a geographical detector in Guangzhou, China

BackgroundA remarkable drop in tuberculosis (TB) incidence has been achieved in China, although in 2019 it was still considered the second most communicable disease. However, TB’s spatial features and risk factors in urban areas remain poorly understood. This study aims to identify the spatial differentiations and potential influencing factors of TB in highly urbanized regions on a fine scale.MethodsThis study included 18 socioeconomic and environmental variables in the four central districts of Guangzhou, China. TB case data obtained from the Guangzhou Institute of Tuberculosis Control and Prevention. Before using Pearson correlation and a geographical detector (GD) to identify potential influencing factors, we conducted a global spatial autocorrelation analysis to select an appropriate spatial scales.ResultsOwing to its strong spatial autocorrelation (Moran’s I = 0.33, Z = 4.71), the 2 km × 2 km grid was selected as the spatial scale. At this level, TB incidence was closely associated with most socioeconomic variables (0.31 < r < 0.76, P < 0.01). Of five environmental factors, only the concentration of fine particulate matter displayed significant correlation (r = 0.21, P < 0.05). Similarly, in terms of q values derived from the GD, socioeconomic variables had stronger explanatory abilities (0.08 < q < 0.57) for the spatial differentiation of the 2017 incidence of TB than environmental variables (0.06 < q < 0.27). Moreover, a much larger proportion (0.16 < q < 0.89) of the spatial differentiation was interpreted by pairwise interactions, especially those (0.60 < q < 0.89) related to the 2016 incidence of TB, officially appointed medical institutions, bus stops, and road density.ConclusionsThe spatial heterogeneity of the 2017 incidence of TB in the study area was considerably influenced by several socioeconomic and environmental factors and their pairwise interactions on a fine scale. We suggest that more attention should be paid to the units with pairwise interacting factors in Guangzhou. Our study provides helpful clues for local authorities implementing more effective intervention measures to reduce TB incidence in China’s municipal areas, which are featured by both a high degree of urbanization and a high incidence of TB.Graphical

A new potential aphicide against Myzus persicae: Design, synthesis and 3D-QSAR of novel phenoxypyridine derivatives containing 4-aminopyrimidine

Aphids are destructive insect pests that can cause substantial damage to crops due to their sap-sucking and transmission of plant virus. To find a new aphicide candidate, using the substituted phenoxypyridine alkyl amines as key intermediates, 31 novel phenyloxypyridine derivatives containing 4-aminopyrimidine were designed and synthesized by Intermediate Derivatization Method (IDM). The insecticidal activity of all target compounds were evaluated, and the bioassay results indicated that some compounds showed significant insecticidal activity against Myzus persicae (M. persicae) in vivo. Especially, the activity of T11 (LC50 = 0.34 mg⋅L − 1) was higher than that of Pymetrozine, Flufenerim and other derivatives, indicating that this compound was a promising aphicide candidate for further development. The structure-activity relationship (SAR) of these derivatives was also analyzed qualitatively. Furthermore, a three-dimensional quantitative structure-activity relationship (3D-QSAR) model was established with valuable guidelines that the electrostatic and steric fields played important roles on aphicidal activity. The present work provides helpful clues for the rational design of potential aphid control agents.