Immunohistochemistry for the Proliferation Markers Ki67 and PHH3 in Cell Block Material of Basaloid Salivary Gland Neoplasms is Predictive of Malignancy
Robert Post, Zach Breslin, Yanki Yarman, and Stacey Gargano
Background: Basaloid salivary gland neoplasms (BSGNs) are notoriously difficult to classify in fine needle aspiration (FNA) specimens due to the morphologic overlap shown by the various benign and malignant entities in this category1,2,3. Adenoid cystic carcinoma (AdCC) represents a particular diagnostic challenge, as it typically shows low grade cytologic features despite its aggressive clinical behavior and need for more extensive surgery4. We examined whether the proliferation markers Ki67 and PHH3 could help predict malignancy in BSGNs, thus improving diagnostic accuracy and optimizing patient care.
Online Learning & Medical Education … YOU CAN DO IT!
Carmin Bermudez, MEd and Joanna Chan, MD
- Engaging learners and building community online improves learning and motivation for learners
- Faculty presence incorporates integral feedback and increases student success
- The CTL provides ongoing training and support, you are not alone!
Mindfulness Based Stress Reduction Increases Pathology Resident Self Wellness
Kaitlin Collura, MD, PhD and Joanna Chan, MD
Stress during medical residency is a common, complex issue influenced by time demands, level of social support, and environmental factors. Increased stress levels can lead to resident burnout, and may contribute to the high rates of depression and suicide seen among physicians. In 2015, the ACGME began a campaign to promote resident wellness by calling on programs to implement strategies to develop resiliency, identify problems, and promote wellbeing. Mindfulness based stress reduction (MBSR) strategies have been shown to decrease burnout, improve mood, and increase compassion in healthcare providers. We implemented a wellness retreat to educate residents on the principles of mindfulness and provide them with stress reduction strategies.
Wellness Initiative Program and Effect on Pathology Resident Burnout Rate
Kaitlin Collura, MD, PhD; Michelle Nagurney, MD; and Joanna Chan, MD
Increasing rates of physician burnout are reported across many medical specialties, including Pathology. In 2014, 52.5% of pathologists experienced symptoms of burnout compared to 37.6% in 2011. Suicide and depression rates in physicians are also higher than the average population. As a result, the ACGME began a campaign, in 2015, to foster resident wellness. The campaign calls for strategies to develop resiliency, identify problems, and promote well-being. While wellness initiatives may not change underlying mental illness, they may mitigate environmental factors that can exacerbate mental illness or suicidal behavior. Here we report results from a recently implemented resident wellness initiative (WI).
Incidence rates of critical low glucoses (<40 mg>/dL) by POCT before and after new policies for treatment of clinically significant hypoglycemia (<54 mg>/dL): A comparison between two hospitals
Lilah Evans, Douglas F. Stickle, and Barbara Goldsmith
Glucose <54 mg>/dL was recently defined as Clinically Significant Hypoglycemia (CSH, American Diabetes Association, Standards of Medical Care in Diabetes, 2017). In January 2018, our hospitals instituted a callback policy for inpatient CSH from the central laboratory, and instituted a new nursing procedure for response to CSH. We examined whether the new policies had affected the incidence rate of low glucose critical values (CRITICAL, <40 mg>/dL) among POCT glucose measurements. This was investigated for two hospitals within our system: A, a 950-bed academic medical center hospital, and B, a 200-bed community hospital.
A Horseshoe Kidney with a Unique Constellation of Renal Vasculature - A Case Report
Guiyan Zhang and Richard Schmidt
Horseshoe kidney with variable vascular supply is of interest to clinicians and anatomists due to its immense surgical significance. A horseshoe kidney encountered during cadaveric dissection is reported here. The left kidney is vertical and the right kidney is slightly horizontal. The isthmus is narrow and 1.5cm inferior to the inferior mesenteric artery. The hilum of the right kidney opens anteriorly and the left opens anteromedially. The ureters lie on the anterior surfaces of both kidneys. In addition to renal arteries arising from the aorta described in previous reports, a unique renal artery (Renal Artery 3) was found supplying the right kidney. This RA3 originates from the aorta at L3 vertebral level and takes a long and tortuous course to reach the hilum of the right kidney. Such arterial variation is important for surgical procedures involving the abdominal aorta.
Manual Therapy Interventions in a Complex Case of Upper Quarter Symptoms in a Professional Violinist
Paul Howard, PT, DPT, PhD, OCS, FAAOMPT
This poster illustrates how knowledge of clinical anatomy, biomechanics, and orthopaedic manual therapy can be applied to the examination and treatment of a violinist.
Effect of Positive Patient Identification on Wrong Blood in Tube Errors: A single Center experience
Faisal Huq Ronny, MD, PhD; Mary Harach, BS, MT(ASCP), CQA(ASQ), SSGB; and Jay H. Herman, MD, FCAP
ATRX mutation in Pineal Parenchymal Tumor of Intermediate Differentiation
Michelle Nagurney, MD; Christopher Farrell, MD; Zi-Xuan Wang, PhD; and Mark T. Curtis, MD
Based on our identification of an ATRX mutation in a PPTID of a 22 year old female, we analyzed the frequency of ATRX loss in pineal parenchymal tumors using ATRX immunohistochemical staining.
Endomembrane-Associated Pre-embedding Immunogold Labeling
Zuzana Nichtova, Celia Fernandez-Sanz, A. Bartok, Sergio De La Fuente, György Hajnóczky, Shey-Shing Sheu, and György Csordás
To optimize the pre-embedding IG in stable cell lines and primary adult cardiomyocytes to get the most effective visualization of endomembrane/associated proteins: endo/sarcoplasmic reticulum Ca2+ release channels IP3 receptors and ryanodine receptors (IP3R, and RyR2) and the mitochondrial fission protein Drp1.
Self-Directed Learning Modules Enhance Mastery of Diagnostic Imaging in Dissection-Based Anatomy Course for Physician Assistant Students
Guiyan Zhang, Bruce Fenderson, and Xuan Zuo
The virtues of using computer-based learning modules as an alternative to traditional didactic lectures were tested in a human anatomy course for Physician Assistant (PA) students. Self-directed learning modules on diagnostic imaging were created using ArticulateTM software and provided online as homework assignments for PA students taking a human anatomy lecture and dissection laboratory course. These interactive self-learning modules replaced the content of traditional didactic lectures on the same topics that had been given in previous years. For the PA class of 2016 (n=103), diagnostic imaging was taught via traditional lectures, whereas for the PA class of 2017 (n=100), students studied the same content online using self-learning modules. An identical set of 21 questions on diagnostic imaging was used for both lecture (2016) and self-learning (2017) groups of students, and student performance on these examinations was compared between the two groups. Our results indicate that PA students with access to online self-learning modules performed as well or significantly better on the diagnostic imaging questions (p<0.05 for 5 of 21 questions). Moreover, the average on the diagnostic imaging questions improved from 86.29 (class of 2016) to 89.19 (class of 2017). The overall course grade for students using self-learning modules for diagnostic imaging was also higher (class mean 87.76) than that of students receiving lectures for diagnostic imaging (class mean 86.08), suggesting that selflearning modules may have a positive influence on students’ overall understanding of the anatomical material. Our results indicate that online self-study modules are highly effective teaching tools for pre-clinical basic science medical education.
A Comparative Analysis of the Paris System and Institutional Reporting System for Urine Cytology in Upper Tract Urothelial Specimens
Kim Hookim, MD; James P. Casey, MD; Rossitza Draganova-Tacheva, MD; Marluce Bibbo, MD; and Charalambos C. Solomides, MD
The authors of this abstract have no conflicts of interest
Cytology is integral in the assessment of urothelial cell carcinoma (UCC). However, upper urinary tract (UUT) specimens are cytologically challenging due to limited tissue and reactive atypia. At our institution UUT biopsies are processed as cell blocks (CB). We compared our institution’s reporting system (IRS) with the recently proposed Paris System for Reporting Urine Cytology (PRS) (Table 1) in UUT specimens and correlated the findings with CB and follow-up resections.
Increased Density of Axonal Spheroids in the Nucleus Gracilis of the Lower Brainstem in Diabetic Versus Non-Diabetic Patients
Tiffany Morrison, MSIV and Lawrence C. Kenyon, MD, PhD
The presence of axonal spheroids is unusual in the absence of a clinical history of CNS injury. Nevertheless, increased numbers of axonal spheroids in the lower brainstem have been consistently observed in autopsied diabetic patients. A prospective comprehensive investigation of the density, size, and distribution of axonal spheroids in the brainstem and spinal cord was undertaken in 22 patients and correlated with comorbidities, age, and gender. In most cases, an increased density of axonal spheroids was identified within the nucleus gracilis of the lower brainstem. Moreover, the highest densities (p = 0.013) and circumferences (p = 0.002) of axonal spheroids were present in the lower brainstem of diabetics when compared to non-diabetics. Whereas the pathology of peripheral neuropathy in diabetics is well described, this study is the first demonstration of specific CNS pathology in diabetic patients.
Gaining Competencies During Early Medical Training: Medical Students as Teaching Assistants in Dissection-Based Anatomy Course
Martin T. Brown, Bruce Fenderson, and Guiyan Zhang
Introduction and Objectives
- In 2002, ACGME identified six ACGME Core Competencies: patient care; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism; and systems-based practice.
- AAMC recommended lists of similar competencies for the curricula of medical schools. Competency based curricula have been widely implemented in medical schools.
- Effective shifting in the graduate medical educational programs has been reported in various clinical specialties.
- There is a lack of reported efforts and development on competency training in early preclinical years of medical education.
- To explore methods for strengthening medical students’ competency training during preclinical undergraduate medical education.
- To measure improvement in five out of the six ACGME Core Competencies, namely: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, and professionalism.
- To establish a foundation for implementation of future programs aimed at improving pre-clinical medical student competency training.
Calcium uptake hotspots in the mitochondria of cardiac muscle at the interface with dyadic SR
Sergio De La Fuente, Celia Fernandez-Sanz, Caitlin Vail, Elorm J. Agra, Kira Holmstrom, Junhui Sun, Jyotsna Mishra, Toren Finkel, Elizabeth Murphy, Suresh K. Joseph, Shey-Shing Sheu, and György Csordás
• Control of the mitochondrial ATP production by SR-derived Ca2+ signals includes local, nanodomain Ca2+ transfer from ryanodine receptors (RyR2) to the mitochondrial matrix (excitation-bioenergetics coupling).
• Ca2+ crosses the inner mitochondrial membrane (IMM) via the mtCU, a low-affinity Ca2+-activated Ca2+ channel complex.
• The surface area of cardiac IMM is extensively enhanced by cristae folding; however, mitoplast patch clamp studies showed mtCU current density the lowest amongst a range of tissues (Fieni 2012. Nat Commun).
Activated Clotting Time (ACT): Comparison of the Hemochron Signature Elite and the Abbott i-STAT
Lilah Evans; Susanne Gallo; Joseph J. Leo; and Barbara Goldsmith, PhD, FACB
ACT is commonly used for heparin anticoagulation monitoring during procedures including cardiopulmonary bypass surgery, coronary angioplasty, and interventional radiology. To prevent thrombosis, moderate to high levels of heparin anticoagulation are required. The Hemochron Signature Elite (HSE, Accriva Diagnostics, formerly ITC, San Diego, CA) was implemented at TJUH as a replacement for the older model Hemochron Response (Accriva/ITC Model HRS.110, San Diego, CA). Operating room (OR) perfusionists reported irreproducible high results using HSE that could not be explained clinically. In consideration of use of i-STAT analyzers (Abbott Point of Care, Princeton, NJ) as an alternative to HSE, we performed a comparison of ACT results as analyzed by HSE and i-STAT (Abbott Point of Care, Princeton, NJ) analyzers.
Poster presented at: American Association for Clinical Chemistry Annual Scientific Meeting in Philadelphia PA.
Performance of Creatinine and Chloride on the epoc Analyzer
Lilah Evans; Susanne Gallo; Stacey K. Mardekian; and Barbara Goldsmith, PhD, FACB
The epoc Blood Analysis System (Alere, Orlando, FL) performs blood gases, electrolytes, and metabolites using a Blood Gas Electrolyte and Metabolite (BGEM) Test Card panel on 92 uL of whole blood. The BGEM test card uses potentiometric sensors to measure sodium, potassium, ionized calcium, pH, pCO2; amperometric sensors to measure pO2, glucose, and lactate; and a conductometric sensor to measure hematocrit. Results are available in 3-10 minutes, depending upon the time between calibration and patient testing. TJUH implemented the epoc in its ICUs in 2012 to provide Point of Care (POC) results. Alere recently added creatinine and chloride sensors to its BGEM cartridge. At the request of our Emergency Department, we evaluated creatinine and chloride on the epoc.
Poster presented at: American Association for Clinical Chemistry Annual Scientific Meeting in Philadelphia PA.
Use of Propensity Score Matching to Identify a Strong Association Between Strategic concentration to mitochondria-SR associations of the mitochondrial Ca2+ uniporter: Ca2+ uptake hotspots in the cardiac mitochondria
Sergio De La Fuente, Caitlin Vail, Elorm J. Agra, Kira Holmstrom, Junhui Sun, Jyotsna Mishra, Toren Kinkel, Elizabeth Murphy, Suresh K. Joseph, Shey-Shing Shen, and György Csordás
- Control of the mitochondrial ATP production by SR-derived Ca2+ signals includes local, nanodomain Ca2+ transfer from ryanodine receptors (RyR2) to the mitochondrial matrix (excitation-bioenergetics coupling).
- Ca2+ crosses the inner mitochondrial membrane (IMM) via the mtCU, a low-affinity Ca2+-activated Ca2+ channel complex.
- The surface area of cardiac IMM is extensively enhanced by cristae folding; however, mitoplast patch clamp studies showed mtCU current density the lowest amongst a range of tissues (Fieni 2012. Nat Commun).
In-silico identification of Prognostically Inversely Correlated miRNAs and mRNAs (PIC’s) in multiple cancers
Chirayu Pankaj Goswami and Zi-Xuan Wang
Despite numerous methods available to identify potential mRNA targets for miRNAs, prognostic relationship of these molecules in diseases like cancers where deregulation of gene expression is a major pathogenic factor, has not yet been emphasized. We performed in-silico identification of prognostically inversely correlated miRNA - mRNA pairs (PIC’s) in multiple cancers using expression data from The Cancer Genome Atlas. Partners in a PIC show inverse correlation of expression and opposite hazard implication. Using a three step approach, we identified a total of 1,253,443 PIC’s from 23 cancer types, several of which have previously been shown to have a predicted or experimentally validated relationship. A maximum 375,621 PICs were identified in Lower Grade Gliomas, while a minimum 300 PICs were identified in Prostate adenocarcinoma. Four miRNA-mRNA pairs were identified as PICs in 7 different cancer types. Two miRNA-mRNA pairs were identified as PICs in 5 different cancer types where the mRNA is also a validated target of miRNA. Organ specific analysis was performed to identify PICs common to cancers from same or related tissue of origin. We have also developed a database PROGTar for hosting our analysis results. PROGTar is available freely for non-commercial use at www.xvm145.jefferson.edu/progtar. We believe our method and analysis results will provide a novel prognostically relevant, pan-cancer perspective to study of miRNA-mRNA interactions and miRNA target validation.
PROGTar: A database of Prognostically Inversely Correlated miRNAs and Genes (PICs) in multiple cancers
Chirayu Pankaj Goswami
PROGTar is a database of Prognostically Inversely Correlated miRNA-mRNA pairs (PIC’s) in 23 cancer types. Partner miRNA and mRNA in a PIC show inverse correlation of expression and opposite hazards. We analyzed miRNA and mRNA expression data downloaded from The Cancer Genome Atlas (TCGA) in a 3 step approach to identify PICs in different cancer types. In first step we performed correlation analysis between miRNAs and mRNAs for each cancer type. This was followed by performing hazard analysis separately for miRNAs and mRNAs using expression data and survival related clinical variables. In the third step we merged the correlation and hazard result sets. Resultant miRNA and mRNA pairs were filtered to retain only pairs that had negative correlation between miRNA and mRNA expression and opposite hazards for miRNA and mRNA, at a statistically significant level (p
Results from our pan cancer analysis are available on the web based application PROGTar. Users can search for miRNA/mRNA of interest on the database to find inversely correlated partners. Users can also create prognostic plots for the PICs of interest. Prognostic plots created with PROGTar show arms for high and low expression of target molecule and its corresponding partner in the PIC, bifurcated at median of expression. The plots also show arms for a combined prognostic signature calculated using expression levels of both partners in the PIC. The application is available freely for non-commercial use at www.xvm145.jefferson.edu/progtar
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