Seventy-five Cases Research Articles

Incidence of Yq Microdeletion among Chattishgarh Population and Cast based distribution

Abstract Background: Millions of individuals in their reproductive years are affected by infertility on a global scale, potentially exerting a significant influence on their lives and family dynamics. The coexistence of abnormal seminogram and Yq microdeletion synergistically affects infertility. Therefore, the study was designed to determine the frequency of distribution of Yq microdeletion in abnormal semen parametric infertility cases. Methodology: Seventy-five cases of infertility and 78 controls with known fertility were enrolled for the cross-sectional study. In the collected blood sample, DNA was isolated and a polymerase chain reaction (PCR) mix for various markers was prepared. After running in a thermocycler, PCR products were analyzed by gel electrophoresis. Results: The distribution of deletion among different subtypes: azoospermic, severe oligozoospermic, oligozoospermic, and normozoospermic cases was 35%, 33%, 35%, and 33%, respectively. The most common deletion type in the Chhattisgarh population was azoospermia factor c. Caste-based distribution among the study group was quite uniform. Conclusion: Y chromosome microdeletion would be an essential test after seminogram in cases of male infertility, especially to prevent the transmission or inheritance of infertility to offspring. Due to the high frequency of microdeletions, it is a very useful test to identify male infertility in Chhattisgarh.

Chronic respiratory failure negatively affects speech function in patients with bulbar and spinal onset amyotrophic lateral sclerosis: retrospective data from a tertiary referral center

Background: Although dysarthria and respiratory failure are widely described in literature as part of the natural history of Amyotrophic lateral sclerosis (ALS), the specific interaction between them has been little explored. Aim: To investigate the relationship between chronic respiratory failure and the speech of ALS patients. Materials and methods: In this cross-sectional retrospective study we reviewed the medical records of all patients diagnosed with ALS that were accompanied by a tertiary referral center. In order to determine the presence and degree of speech impairment, the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-R) speech sub-scale was used. Respiratory function was assessed through spirometry and through venous blood gasometry obtained from a morning peripheral venous sample. To determine whether differences among groups classified by speech function were significant, maximum and mean spirometry values of participants were compared using multivariate analysis of variance (MANOVA) with Tukey’s post hoc test. Results: Seventy-five cases were selected, of which 73.3% presented speech impairment and 70.7% respiratory impairment. Respiratory and speech functions were moderately correlated (seated FVC r = 0.64; supine FVC r = 0.60; seated FEV1 r = 0.59 and supine FEV1 r = 0.54, p < .001). Multivariable logistic regression revealed that the following variables were significantly associated with the presence of speech impairment after adjusting for other risk factors: seated FVC (odds ratio [OR] = 0.862) and seated FEV1 (OR = 1.106). The final model was 81.1% predictive of speech impairment. The presence of daytime hypercapnia was not correlated to increasing speech impairment. Conclusion: The restrictive pattern developed by ALS patients negatively influences speech function. Speech is a complex and multifactorial process, and lung volume presents a pivotal role in its function. Thus, we were able to find that lung volumes presented a significant correlation to speech function, especially in those with bulbar onset and respiratory impairment. Neurobiological and physiological aspects of this relationship should be explored in further studies with the ALS population.

A Nomogram Model for Predicting the Postoperative Recurrence of Localized Laryngeal Amyloidosis.

To analyze the factors related to postoperative recurrence in patients with localized laryngeal amyloidosis (LocLA) and to construct a nomogram prediction model (NPM). We collected the data for LocLA patients diagnosed from March 2000 to May 2019 and clinical characteristics data were extracted. Factors related to recurrence were analyzed using multivariate logistic regression. The NPM was constructed for predicting the recurrence risk of LocLA. The receiver operating characteristic (ROC) curve evaluated the distinguishing ability using the area under curve (AUC). The calibration curve was created to evaluate the consistency of the NPM. A total of 226 confirmed LocLA cases were included. One hundred seventy-five cases (77.4%) had localized single nodule, and 51 cases had more than one lesions. Sixty-three (27.9%) cases had no multinucleated giant cell (MGC) around amyloid, and 163 (72.1%) cases had MGC around amyloid. Multivariate logistic regression analysis showed that more than one lesions (odds ratio [OR] = 3.206 and 95% confidence interval [CI]: 1.492-6.888; P value: .003), subglottic involvement (OR = 2.926 and 95% CI: 1.300-6.585; P = .010), and no multinucleated giant cell (MGC) around amyloid (OR = 2.503 and 95% CI: 1.173-5.342; P = .018) had a statistically significant effect on postoperative LocLA recurrence (P < .05). The AUC of the ROC curve was 0.753 (95% CI: 0.667-0.832). The bias-corrected curve approached the ideal curve, with an average absolute error of 0.037. More than one lesions, subglottic involvement, and no MGC around amyloid are risk factors for postoperative recurrence of LocLA. The NPM constructed has good applicability.

Expression of CD10 and CD15 in colorectal mucinous and signet ring adenocarcinomas and its relation to clinicopathological features and prognosis.

CD10 and CD15 expression has been reported in several tumors. Whether CD10 and CD15 have a role in colorectal mucinous and signet ring adenocarcinoma (MSA) tumorigenesis is not yet known. We aimed to investigate the role of CD10 and CD15 expression in mucinous colorectal adenoma-carcinoma sequence (ACS) and determine if there is any clinical and prognostic significance associated with their expression. Seventy-five cases of colorectal MSA, and 9 cases of adenoma samples were collected. Manual TMA blocks were constructed and immunohistochemistry for CD10 and CD15 was done. Compared to adenomas, CD15 expression was significantly higher in MSA (p= 0.002), in contrast to CD10 expression. CD15 positivity was significantly associated with microsatellite stable (MSS) tumors (p= 0.018). The association between CD10 positivity and fungating tumor growth showed marginal significance. Unlike CD10, CD15 positivity showed significant association with overall survival of colorectal MSA patients. CD15 expression seems to have a role in mucinous colorectal ACS, with significant impact on the survival of MSA patients. Further studies are suggested to identify any genetic alterations that may underlie a potential association with disease progression.

Quantitative assessment of micronuclei in oral exfoliative buccal squamous cells in smokers, chewers and healthy individuals using Giemsa Stain and Papainicolous Stain

Context: The main reason for oral cancer is tobacco consumption in various forms, such as chewing and smoking. Micronuclei in oral exfoliated cells are markers of chromosomal damage caused by toxic genetic agents from tobacco-related substances, alcohol, etc. The number of micronuclei indicates the cell's genotoxic effect and can be used as a biomarker to assess the changes in the cellular changes. Recently research is focused on determining early genotoxicity changes using exfoliative cytology in human buccal epithelial cells. Aim: Quantitative analysis of micronuclei in oral exfoliated oral, buccal mucosal cells using Papainicolous stain with Giemsa stain in tobacco users in the form of chewing and smoking in comparison with healthy individuals. Materials and methods: A total of seventy-five cases were selected for this study. Among seventy-five participants divided into three groups based on habits tobacco smokers (n=25), tobacco chewers (n=25), and healthy individuals (n=25). Results: The mean number of micronuclei in Giemsa stain was 255.2 ± 78 compared with PAP stain155.12 ± 78.5. The increased mean number of micronuclei in chewers 273.24 ± 80.7, and different stain comparison Giemsa stain showed highest in chewers. A mean number of micronuclei showed statistically highly significant (p≤0.05). Pair-wise comparison of micronuclei inter and intra groups in all three groups, smokers and chewers showed highly statistically substantial (p≤ 0.0001) compared with healthy individuals. Conclusion: Micronuclei provide evidence that consumption of smokeless tobacco may be developing oral cancer, and micronuclei assay can be used as biomarkers of genotoxicity and carcinogenesis progression. Key word: Cytological smear, Genotoxicity, Micronuclei, Oral cancer, Tobacco chewers

The suppressive effects of microRNA-139-5p on proliferation and invasion of esophageal squamous cell carcinoma

Objective: To investigate the role of microRNA-139-5p (miR-139-5p) in the occurrence and development of esophageal squamous cell carcinoma (ESCC) and its effects on cell proliferation and invasion of ESCC cells and its molecular mechanisms. Methods: Seventy-five cases of ESCC tissues and paired normal tissues were obtained from thoracic surgery of the First Affiliated Hospital of Zhengzhou University from February 2017 to March 2018. Experiment was divided into two group: ESCC (n=75) and normal esophageal tissues (n=75).GEO datasets and real-time quantitative PCR (qRT-PCR) were used to detect the expression of miR-139-5p in ESCC tissues and cells. miR-139-5p inhibitor, miR-139-5p mimic, negative control, control siRNA, T-box transcliption factor 1(TBX1) siRNA, pcDNA3.1 and pcDNA3.1-TBX1 were transfected into ESCC Eca109 and TE1 cells. qRT-PCR was used to detect the expressions of miR-139-5p and TBX1 in transfected ESCC cells. Cell counting kit 8 (CCK-8) and Transwell chamber were employed to detect cell proliferation and invasion of ESCC cells, respectively. Dual-Luciferase Reporter assay was used to analyze the interaction between miR-139-5p with TBX1. qRT-PCR, Western blot and immunohistochemistry were utilized to detect the expression of TBX1 in ESCC tissues. Western blot was used to detect the expressions of E-cadherin, N-cadherin and Vimentin after transfection. Results: The level of miR-139-5p in ESCC tissues was significantly lower than that in normal tissues (1.17±0.43 vs 5.16±3.62,P<0.001). Log-rank test showed that the survival rate of ESCC patients with high miR-139-5p level (n = 43) was significantly higher than that with low miR-139-5p level (n=32) (67.44% vs 25.00%, P = 0.005). The expression level of miR-139-5p in ESCC cells was significantly lower than that of normal esophageal epithelial cell Het-1A (all P<0.001). The proliferation and invasion ability of ECA109 and TE1 cells with high expression of miR-139-5p were significantly lower than those transfected with negative control (NC) (all P<0.05). Dual-Luciferase Reporter assay showed that miR-139-5p could bind to the 3'-untranslated region of TBX1. miR-139-5p mimic or inhibitor suppressed or promoted the expression of TBX1 protein in Eca109 and TE1 cells, respectively (all P<0.05). Downregulation of TBX1 significantly suppressed proliferation and invasion of ECA109 and TE1 cells, while overexpression of TBX1 significantly promoted proliferation and invasion of ECA109 and TE1 cells (all P<0.05). In addition, pcDNA3.1-TBX1 partially reversed the inhibition of miR-139-5p-mediated invasion ability (all P<0.05), while TBX1 siRNA partially reversed the enhancement of miR-139-5p inhibitor-mediated invasion ability (all P<0.05). Conclusion: miR-139-5p suppressed ESCC cell proliferation and invasion by targeting TBX1.

Relationship of DNMT3b expression and SEPT9 methylation in theprogression of colorectal carcinogenesis

Objective: To investigate the relationship between the expression of DNA methyltransferase 3b (DNMT3b) and the methylation of SEPT9 gene, and their application prospects in the diagnosis and treatment of colorectal cancer. Methods: Seventy-five cases of colorectal cancer and adjacent tissues, 68 cases of colorectal high-grade internal neoplasia tissues (referred to as precancerous tissues) and high-grade internal adjacent neoplasia tissues (referred to as adjacent precancerous tissues) were collected. Pyrosequencing was used to detect the methylationlevel of SETP9. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to examine the mRNA expressionof SEPT9 and immunohistochemistry(IHC) was applied to detect the protein expressions of SETP9 and DNMT3b. Liposome-mediated method was used to transfect DNMT3b siRNA and negative control siRNA into HT-29 cells. Five groups including DNMT3b siRNA 15 nmol/L group, DNMT3b siRNA 30 nmol/L group, negative control siRNA 15 nmol/L group, negative control siRNA 30 nmol/L group and blank control group were set up. Pyrosequencing was applied to determine the methylation level of SEPT9 and mRNA expression of DNMT3b in each group. Results: The methylation rates of SEPT9 gene in colorectal cancer tissues, adjacent tissues, precancerous tissues and adjacent precancerous tissues were (76.8±6.5)%, (14.4±2.6)%, (34.6±5.0)% and (7.4±1.2)%, respectively, which was highest in colorectal cancer tissue (P<0.001). The relative expressions of SEPT9 mRNA were 0.18±0.03, 0.89±0.41, 0.69±0.41 and 1.01±0.21, respectively, which was lowest in colorectal cancer tissue (P<0.001), while there were no statistically significant differences in adjacent tissues, precancerous tissues and adjacent precancerous tissues (P>0.05). The positive rates of SEPT9 protein expression were 12.0% (9/75), 53.3% (40/75), 55.1% (38/69) and 62.3% (43/69), which was lowest in the colorectal cancer tissue (P<0.001), while there were no statistically significant differences in the adjacent group, precancerous group and adjacent precancerous group (P>0.016 7). The positive rates of DNMT3b protein expression were 56.3% (45/75), 26.7% (20/75), 46.4% (32/69) and 33.3% (23/69), respectively, which was highest in colorectal cancer tissue (P<0.001), while without statistically significant difference from the precancerous tissue (P>0.016 7). Experiments in vitro showed that DNMT3b mRNA expression was lowest in DNMT3b siRNA 30 nmol/L group among five groups and was statistically different from other groups (all P<0.05). Meanwhile, the methylationrate of SEPT9 gene was lowest in this group, but without statistically significant difference from the DNMT3b siRNA 15 nmol/L group (P>0.05). Conclusions: The expression of DNMT3b is significantly correlated with the methylation level of SEPT9 gene in different stages of colorectal cancer. The high expression of DNMT3b may be an important molecular event before SEPT9 gene methylation and it may have an important potential application value in the diagnosis and treatment of early colorectal cancer.

Ex vivo delivery of Mirococept: A dose-finding study in pig kidney after showing a low dose is insufficient to reduce delayed graft function in human kidney.

The complement system plays a pivotal role in the pathogenesis of ischemia-reperfusion injury in solid organ transplantation. Mirococept is a potent membrane-localizing complement inhibitor that can be administered ex vivo to the donor kidney prior to transplantation. To evaluate the efficacy of Mirococept in reducing delayed graft function (DGF) in deceased donor renal transplantation, we undertook the efficacy of mirococept (APT070) for preventing ischaemia-reperfusion injury in the kidney allograft (EMPIRIKAL) trial (ISRCTN49958194). A dose range of 5-25mg would be tested, starting with 10mg in cohort 1. No significant difference between Mirococept at 10mg and control was detected; hence the study was stopped to enable a further dose saturation study in a porcine kidney model. The optimal dose of Mirococept in pig kidney was 80mg. This dose did not induce any additional histological damage compared to controls or after a subsequent 3hours of normothermic machine perfusion. The amount of unbound Mirococept postperfusion was found to be within the systemic dose range considered safe in the Phase I trial. The ex vivo administration of Mirococept is a safe and feasible approach to treat DGF in deceased donor kidney transplantation. The porcine kidney study identified an optimal dose of 80mg (equivalent to 120mg in human kidney) that provides a basis for further clinical development.

FOXD1, negatively regulated by miR-186, promotes the proliferation, metastasis and radioresistance of nasopharyngeal carcinoma cells.

Foxhead box D1 (FOXD1) is validated to be over-expressed in a variety of human malignancies and promotes cancer progression. Nevertheless, the role of FOXD1 and the associated mechanism in nasopharyngeal carcinoma (NPC) remain largely unknown. A total of seventy-five cases of NPC tissue samples were collected. FOXD1 expression in NPC tissues and cells (SUNE1, CNE1, CNE2, and HONE1) was detected using immunohistochemistry and Western blot, respectively. The relationship between FOXD1 expression and clinicopathological parameters of NPC patients was analyzed. FOXD1 mRNA and miR-186 expression in NPC tissues and cells was detected using quantitative polymerase chain reaction (qPCR). The cell viability of NPC cells was detected using CCK-8 assay. Colony survival of NPC cells exposed to different doses of radiation was detected using colony formation assay. Transwell assay was used to evaluate the migration and invasion of NPC cells. The dual-luciferase reporter gene assay was employed to verify the targeting relationship between miR-186 and FOXD1. FOXD1 was over-expressed in NPC tissues (average fold change on mRNA level = 4.72), and its high expression was correlated to NPC positive lymph node metastasis and tissue differentiation. The over-expression of FOXD1 promoted the proliferation, migration, invasion and radio-resistance of NPC cells. On the contrary, the knock-down of FOXD1 inhibited the malignant phenotypes of the above cells. It was verified that FOXD1 was one of the downstream targets of miR-186 and was negatively regulated by it. FOXD1, which is negatively regulated by miR-186, acts as a novel oncogene in NPC and serves as potential biomarker and therapeutic target for NPC. The research will provide great theoretical basis for further clinical diagnosis and therapy.

Reported Adherence to Antihypertensive Treatment and Outcome at Postmortem in Southwestern Nigerians.

Background:Systemic hypertension is referred to as a silent killer. Knowledge of disease and religious use of medication could mitigate against complications in hypertensives. This study evaluated outcome among decedent essential hypertensive patients in southwestern Nigeria in relation to their compliance with prescribed antihypertensive medication.Materials and Methods:This is a 10-year retrospective review of routine postmortem data. Archival postmortem records from January 1, 2008 to December 31, 2017 in the Department of Pathology, University College Hospital, Ibadan, Nigeria, were reviewed. Data extracted from the records included age, gender, knowledge of hypertension status, systolic and diastolic blood pressure at time of diagnosis, reported adherence to medications, complications of systemic hypertension, duration of survival from diagnosis to demise, cause of death, body length, and heart weight at autopsy. Descriptive, Students t-test, Chi-square test, Pearson correlation and Cox proportional-hazards model statistics was conducted using SPSS version 20 (IBM SPSS Statistics for windows, IBM Corp., Armonk, N.Y., USA).P < 0.05 was considered significant.Results:Eighty-one cases met the inclusion criteria, consisting of 60 males and 21 females with overall mean age of 55.65 ± 12.1 years. Seventy-five (91.7%) cases were known hypertensives prior to admission or demise while 6 (8.3%) were not known hypertensives. The duration of survival from diagnosis to death ranged from 1-month (0.08 years) to 31 years with overall mean duration of 5.2 years. Fifty-two (63.4%) of the 75 known hypertensive cases had documented medication compliance. Medication noncompliant cases had lower mean survival interval (5 vs. 8 years), died younger (53.5 ± 10.8 years vs. 54.8 ± 15.5 years), had higher mean blood pressures (systolic blood pressures: 197 ± 45.8 mmHg vs. 180 ± 55.4 mmHg; diastolic blood pressures: 117 ± 27.2 mmHg vs. 101 ± 32.8 mmHg) and heavier heart weights (476 ± 142 g vs. 390.8 ± 107.6 g). However, only the difference in heart weight was statistically significant (P < 0.036). Age and mean systolic blood pressures were correlated with interval from diagnosis to death (r = 0.5, P < 0.000; r = −0.4,P < 0.017, respectively). Death from complications of hypertension and all-cause mortality occurred with higher frequencies among medication noncompliant cases (40 vs. 12).Conclusion:Noncompliance with antihypertensive medication is associated with more cardiovascular and all-cause mortality among Southwestern Nigerians with essential hypertension.

The Association of Parametrial Invasion with the Expression of Vascular Endothelial Growth Factor-C and Other Factors in Squamous Cell Cervical Carcinoma Stage IB and IIA

BACKGROUND: The presence of parametrial invasion in early stage squamous cell cervical cancer (SCCC) indeed indicates worse prognosis and need more adjuvant treatment. This study aimed to investigate the association between parametrial invasion and clinicohystopathology variables.METHODS: This retrospective study used specimens of squamous cell carcinoma stage IB-IIA. The inclusion criteria were cervical cancer stage IB-IIA and post radical hysterectomy with lymph node dissection and exclusion criteria was damaged and or insufficient histological preparations. The clinicohystopathology variables included age, tumour size and stage, differentiation and inflammation grade, lymphatic vascular and parametrial invasion, and lymph node metastasis. Histopathology staining, immunohistochemistry examination, and vascular endothelial growth factor-C (VEGF-C) expression were evaluated according to the standard procedure. The independent-T, Chi square, and Fisher’s exact test were applied to evaluate the association. The significance was set at p&lt;0.05.RESULTS: Seventy-five cases were eligible. Parametrial invasion was found in 15 cases (20%). Three variables demonstrated a significant association with parametrial invasion, tumor size &gt;4 cm (OR 4.32, 95% CI 1.29-14.38, p=0.01), lymphatic node metastasis (OR 3.90, 95% CI 1.17-13.03, p=0.02), and VEGF-C (OR 0.75, 95% CI 0.65- 0.87, p=0.03).CONCLUSION: Tumor size of &gt;4 cm and lymph node metastasis (LNM) had a higher risk of parametrial invasion in SCCC stage IB-IIA.KEYWORDS: cervical carcinoma, parametrial invasion, vascular invasion, peritumoral stroma, VEGF-C expression

Retrospective Analysis of Cases with Imported Malaria in Hatay Province of Turkey: Seventy-Five Cases in Ten Years

Cases with imported malaria have increased complication and mortality rates because of delayed diagnosis and treatment in non-endemic countries. This study aimed to investigate the incidence and clinical features of imported malaria in our clinic during the past 10 years. This retrospective study included 75 cases diagnosed as having imported malaria in our clinic between January 2008 and December 2017. The epidemiological data, laboratory findings, treatment data and clinical course of the cases were obtained from system records. Patients were predominantly male (%98.6) with a median age of 51 (23-64) years. All cases were infected with Plasmodium falciparum, had a recent travel history to Sub-Saharan African countries and none had received chemoprophylaxis before travel. The incidence of imported malaria showed a declining trend after 2015. The most common findings were fever (100%), thrombocytopenia (84%) and anemia (72%). Although 8% of patients had presented with severe malaria, none of them died. Despite increasing incidence of imported malaria in our country in recent years, there is a decrease in this number in our region. Since Turkey is one of the countries with the highest prevalence of imported malaria in the world, patients with fever and thrombocytopenia should be questioned whether or not they had a history of travel to malaria-endemic area.

Differential vaginal wall dosing in high-dose rate brachytherapy for endometrial cancer: The potential for superior coverage of at-risk areas while preserving organs at risk—An analysis of simulated data.

e17121 Background: The treatment of curable endometrial cancer (EC)involves surgery with adjuvant radiotherapy. Histology of EC is a major determining factor for intracavitary brachytherapy (ICRT) treatment volume in early stage EC. Many guidelines recommend ICRT treatment of an extended volume up to the whole length of the vaginal stump (VS) for cases of high risk histologies (HRH) wherein a differential dosing of proximal and distal VS has the potential to achieve targeted therapeutic doses to at risk areas without compromise to critical structures.We present a simulated novel way to treat the VS by ICRT in cases of EC with HRH. Analysis of the simulated and approved plans allow us to compare the doses to organs at risk (OAR’s). Methods: Seventy-five cases from July 2017-August 2018 were reviewed and twenty-five (25) met the criteria for inclusion in this study. All these cases received External Beam Radiation Therapy (EBRT) dose of 50.4Gy/28. The ICRT simulation CT data-set was subsequently used to generate the study plan which was then compared to the actual treatment plan. In order to treat the whole VS but spare OARs a club-shaped design was proposed. This technique involved treating the upper 1/3 with a prescription point at 0.5cm lateral to the applicator surface and the lower 2/3 with a prescription point at the applicator surface. The length of the VS was defined from the tip of the applicator to 2cm superior to the introitus. The D2cc values for the contoured bladder and rectum were extracted from the treatment plan and used along with the D2cc values from the EBRT treatment to calculate OAR EQD2. QUANTEC Constraints used were (ICRU 83): EQD2 bladder: 90Gy; EQD2 rectum: 75Gy. Once calculated, the results were analyzed and the percent deviation between the proposed plan and the constraints as well as the approved plan were determined. Results: Twelve (12) of twenty-five (25) cases were HRH cases. The club-shaped design to treat the whole VS didn't further compromise the OAR (EQD2: 22% below constraints) or the rectum (EQD2: 1% below constraints). There was only a 2% difference between the final constraints in both treatment techniques. Conclusions: This technique to treat the full VS length can be used without adversely affecting OAR toxicities with superior coverage to at risk areas while maintaining dose constraints to OAR. Results, however, are limited by the small sample size.

Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury

BackgroundIsolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature.Case reportA 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found.MethodsA search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR.ResultsForty-five reports comprising seventy-five (n = 75) cases of IRAR.ConclusionIRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients’ hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.

(F)Utility of the physical crossmatch for living donor evaluations in the age of the virtual crossmatch

Flow cytometric crossmatches (FCXM) are routinely performed to support living-donor renal transplantation. While long a laboratory mainstay, a physical crossmatch is costly, time consuming, and frequently poses interpretative conundrums with both false-positive and false- negative results. Given the increased utilization of the virtual crossmatch (vXM) in the deceased donor setting, our aim was to assess its utility in living donor evaluations. We reviewed 100 living donor FCXMs and retrospectively performed a vXM for each pair. Seventy-five (75) cases were concordant, (i.e., FCXM−/vXM− or FCXM+/vXM+) while 25 cases were discordant; Five were vXM+/FCXM− and 20 were FCXM+/vXM−. Since donor-specific antibodies (DSA) were not detected in the 20 FCXM+/vXM− cases, these were interpreted as false-positive, i.e., due to non-HLA antibodies. Importantly, none of these patients, when transplanted across a positive FCXM, experienced early antibody mediated rejection or subsequently developed HLA DSA. These data reveal that, for the vast majority of living donor evaluations, a vXM is an acceptable vetting procedure.

A ten-year epidemiology of cancers managed at the hematology and oncology unit of a Haitian tertiary hospital from 2006 to 2015.

e13061 Background: The recent epidemiology of cancers in Haiti is poorly known, since there is no national cancer registry. The data from GLOBOCAN 2012 are estimations that do not reflect the real cancer epidemiology in countries such as Haiti. The aim of this study was to determine the ten-year epidemiology of cancer cases managed at a Haitian tertiary hospital. Methods: A retrospective study based on the chart review of cancer cases aged 18 years old or more with histologic diagnosis was conducted at the Hematology and Oncology Unit of the State University Hospital of Haiti (HUEH) from 2006 to 2015. Variables such as age, gender, year of diagnosis and cancer type were collected. Results: Eight hundred seventy-five cancer cases out of 1191 (73.47%) were selected for this study. The mean age of the study population is 51 years-old [18 – 91] and there were 13.6% males and 86.4% females. Breast cancer is the most common type (70.74% [95% CI, 67.58% - 73.71%]) followed by gastrointestinal cancers (5.6% [95% CI, 4.21% - 7.39%]), leukemias/multiple myeloma (4.69% [95% CI, 3.43% - 6.36%]), skin cancers (4.57% [95% CI, 3.32% - 6.23%]), gynecological cancers (4% [95% CI, 2.84% - 5.58%]), lymphomas (3.77% [95% CI, 2.65% - 5.31%]), sarcomas (3.31% [95% CI, 2.27% - 4.78%]) and ear, nose and throat (ENT) cancers (1.14% [95% CI, 0.58% - 2.16%]). Breast cancer is the most common type among women (80.6%) and the gastrointestinal cancers the most diagnosed among men (21.9%). Conclusions: Breast cancer is by far the most prevalent cancer in this retrospective cohort. Gynecological and lung cancers are underestimated and urology cancers not represented in this sample possibly because they are not systematically referred to the unit.This study can hopefully lead to more advocacy for all patients to be evaluated at the Hematology and Oncology Unit for a better management.

Informal, Inquisitorial, and Accurate: An Empirical Look at a Problem-Solving Housing Court

Substantive justice is often seen as elusive in courts dominated by low-income individuals. Complex court rules, coupled with pervasive lack of counsel, can make it difficult for the traditional adversary process to identify and redress legitimate grievances. This article takes on the social problem of substandard housing and examines whether inquisitorial procedure has the potential to produce accurate outcomes in a tribunal dominated by the unrepresented. Relying on in-court observations of nearly 300 hearings, and a longitudinal review of nearly seventy-five cases, this article surfaces the regularized procedures utilized by a purported “problem-solving” housing court, and theorizes that the inquisitorial features of judicially controlled investigation and enforcement may motivate landlords to repair substantiated housing code violations. This article adds nuance to our understanding of informal justice by identifying the hidden procedural formalisms that may guide alternative decision-making processes. Furthermore, it evaluates the relationship of one iteration of experimental formalism to substantive justice, and suggests that inquisitorial procedures may be correlated with improved accuracy in case outcomes.

Histopathological study of Round Cell tumors - A retrospective study

Background: Round Cell Tumors are heterogeneous malignancy featuring primitive undifferentiated small cell morphology. Small round cell tumors mostly occur in children, adolescents, and young adults. Because of their significant morphological overlap, have become a paradigm for an integrated approach to diagnosis. Immunohistochemistry (IHC) is the most common ancillary technique used for differential diagnosis of round cell tumors. Finding from all these studies are reviewed and interpreted in respect with clinical history, laboratory investigations, and diagnostic imaging finding. Objectives: (i) To study the incidence, and age vs. sex wise distribution of round cell tumors. (ii) To study the Immunohistochemical (IHC) pattern of these different round cell tumors and correlate the morphological diagnosis with IHC to determine its role as a confirmatory or diagnostic marker of the round cell tumors. Materials and Methods: As a part of study 75 (seventy-five) cases were selected during the year 2013-2015. Relevant findings were obtained. Biopsy tissues/ samples were fixed, paraffin embedded, sectioned and, stained with hematoxylin and eosin. IHC was performed on each case. Results were analyzed and compared. Results: Out of 75 cases, there were 22 cases (29.33%) of Non-Hodgkin’s lymphoma with the highest incidence. According to age wise distribution, the highest incidence was observed in 0-10 years of age group. According to sex wise distribution, a higher incidence was observed in males. There were 50 cases (66.66 %) of Males and 25 cases (33.33%) of Females. Overall M:F ratio was 2:1. Based on IHC, 22 cases of NHL were further classified into Burkitt’s lymphoma, Lymphoblastic lymphoma, and Diffuse Large B-cell lymphoma. IHC study of PNET and Rhabdomyosarcoma showed CD 99(86.7%), NSE(73.3%) and Vimentin(100%) positivity and Desmin, Actin, CD 99 and Vimentin positivity respectively. IHC study of Neuroblastoma and medulloblastoma showed NSE, NF, Chromogranin, S 100 and Synaptophysin positivity and GFAP, Synaptophysin, Vimentin, and Ki67 positivity respectively. Conclusion: Most frequent Round Cell Tumors are Non-Hodgkins Lymphoma, Neuroblastoma, Ewing/PNET and Rhabdomyosarcoma. Neuroblastoma, Retinoblastoma, Wilms Tumor, Hepatoblastoma show presentation in early childhood while Rhabdomyosarcoma is seen throughout childhood. The majority of round cells tumors have male predominance. This study emphasizes the role of immunohistochemistry (IHC) to arrive a definite diagnosis.

Clinical and histopathological characteristics of patients with incidental and nonincidental thyroid cancer.

IntroductionThyroid nodules (TNs) are a common pathology. Their prevalence increases with age. Some of them are suspected of malignancy and qualified for surgery. Sometimes their malignant nature is detected incidentally after a surgical procedure. The aim of the study is to analyze clinical and histopathological characteristics of patients with incidental and nonincidental thyroid carcinoma (ITC vs. NITC).Material and methodsThe case records of 3,241 patients with solitary and multiple TNs who were treated consecutively between 2008 and 2014 were analyzed retrospectively. After the final selection 235 (7.25%) patients were included in the study (202 females and 33 males, mean age: 52.9 +16.5 years). Seventy-five (31.91%) cases were incidentally diagnosed and 160 (68.09%) were diagnosed before surgery.ResultsWe did not observe any differences in age, gender or stage of disease at the time of diagnosis between the patients with ITC and NITC (p = 0.366, p = 0.850, p = 0.226 respectively). The occurrence of solitary nodules in patients with NITC was significantly higher compared to patients with ITC (p < 0.0001). There were no differences in histopathological types of thyroid cancer (TC). The logistic regression analysis showed that solitary TC was an independent predictor of NITC (p < 0.0001).ConclusionsThere are no differences in gender, age or histopathological type of cancer in patients with ITC and NITC. Papillary TC is the predominant type in both groups. Incidence of TC in a solitary nodule is significantly higher in NITC than ITC. Solitary type of TC is an independent predictor of NITC. The prevalence of ITC is associated with multifocal type of TC.

St. Gallen's molecular subtypes in primary breast carcinoma in Indian population

Aim: Immunohistochemical (IHC) markers have been used as surrogates for DNA-microarray in subtyping breast cancer, which lead to new biological insights and eventually to better-targeted therapies. Our study aimed at studying the distribution of the St. Gallen's molecular subtypes in our population and to evaluate their association with traditional prognostic features. Materials and Methods: Seventy-five cases of primary breast cancer undergoing radical or modified radical mastectomy were classified into five subtypes based on their IHC profile using estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (Her2)/neu, and Ki-67 as per St. Gallen's guidelines. IHC subtypes were correlated with various clinicopathologic prognostic parameters including age, tumor size, tumor type, axillary lymph node status, and histologic tumor grade. Results: The proportion of each subtype in our population was: luminal A 28%, luminal B Her2− 18.7%, luminal B Her2+ 9.3%, Her2/neu+ 17.3%, basal cell-like (BCL) 26.7%. The majority of luminal A cases were well differentiated (Grade I) whereas luminal B Her2− was mostly moderately differentiated (Grade II) and luminal B Her2+ constituted mainly well differentiated and moderately differentiated tumors. Both subtypes of luminal B showed lymph node metastasis in majority of the cases. Her2/neu+ and BCL subtype were high-grade tumors comprising mainly of moderately differentiated and poorly differentiated tumors. The majority of luminal A cases were negative for Ki-67 whereas all the luminal B Her2− tumors expressed Ki-67, 50% being highly positive. BCL subtypes revealed highest proliferation index with 80% of the cases being high positive Ki-67. A statistically significant difference of modified Bloom–Richardson grade and Ki-67 distribution (χ2 = 42.974; P< 0.001) between various IHC subtypes was observed.