Cribriform prostate cancer: Morphologic criteria enabling a diagnosis, based on survey of experts.

Among four sub-patterns of Gleason grade 4 prostate cancer, voluminous evidence supports that the cribriform pattern holds an unfavorable prognostic impact, as compared with poorly-formed, fused, or glomeruloid. The International Society of Urological Pathology (ISUP) recommends specifying whether invasive grade 4 cancer is cribriform. Recently, ISUP experts published a consensus definition of cribriform pattern highlighting criteria that distinguish it from mimickers. The current study aimed to analyze morphologic features separately to identify those that define the essence of the cribriform pattern. Thirty-two selected photomicrographs were classified by 12 urologic pathologists as: definitely cribriform cancer, probably cribriform, unsure, probably not cribriform, or definitely not cribriform. Consensus was defined as 9/12 agree or disagree, with ≤1 strongly supporting the opposite choice. Final consensus was achieved in 21 of 32 cases. Generalized estimating equation (GEE) model with logit link was fitted to estimate effect of multiple morphologic predictors. Fisher exact test was used for categorical findings. Presence of intervening stroma precluded calling cribriform cancer (p = 0.006). Mucin presence detracted (p = 0.003) from willingness to call cribriform cancer (only 3 cases had mucin). Lumen number was associated with cribriform consensus (p = 0.0006), and all consensus cases had ≥9 lumens. Predominant papillary pattern or an irregular outer boundary detracted (p = NS). Invasive cribriform carcinoma should have absence of intervening stroma, and usually neither papillary pattern, irregular outer boundary, nor very few lumens. Setting the criteria for cribriform will help prevent over- or undercalling this important finding.

Oral focal mucinosis: A multi-institutional study and literature review.

BACKGROUND: Oral focal mucinosis (OFM) is a rare benign condition of unknown etiology, considered the oral counterpart of cutaneous focal mucinosis. We report the clinicopathologic features of 21 cases of OFM in conjunction with a review of the literature. METHODS: Clinical data were collected from the records of five oral and maxillofacial pathology services. All cases were evaluated by hematoxylin and eosin staining, histochemistry, and immunohistochemistry (vimentin, S-100, α-SMA, CD34, and mast cell). RESULTS: The series comprised 14 females (66.7%) and seven males (33.3%), with a mean age of 48.2 ± 20.7 years (range: 8-77 years) and a 2:1 female-to-male ratio. Most of the lesions affected the gingiva (n = 6, 28.6%) and presented clinically as asymptomatic sessile or pedunculated nodules with fibrous or hyperplasic appearance. All cases were negative for S-100 protein, CD34, and α-SMA and positive for Alcian blue staining. Conservative surgical excision was the treatment in all cases, and there was only one recurrence. CONCLUSION: OFM is a rare benign disorder that is often clinically misdiagnosed as reactive lesions or benign proliferative processes. Dermatologists and pathologists should consider OFM in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located in the gingiva.

Pilomatricoma with florid osseous metaplasia: A common tumor with rare histopathological finding.

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a common benign skin adnexal tumor with differentiation toward hair cortex cells, commonly seen in head and neck region of children. It is usually solitary. Herein, we present a rare case of pilomatricoma with extensive osseous metaplasia as a thigh swelling in an adult female, considered clinically to be a sebaceous cyst. Florid osseous metaplasia is extremely rare in cases of pilomatricoma. To date, fewer than 10 cases of pilomatricoma with extensive osseous metaplasia at different sites have been reported in the English literature.

Impact of clinical photographs on the accuracy and confidence in the histopathological diagnosis of mycosis fungoides.

BACKGROUND: The histopathological diagnosis of MF is challenging, and there is significant overlap with benign inflammatory processes. Clinical features may be relevant in the assessment of skin biopsies. METHODS: We provided photomicrographs to board-certified dermatopathologists and one hematopathologist with and without accompanying clinical photographs and assessed accuracy and confidence in diagnosing MF. RESULTS: We found that access to clinical photographs improved diagnostic accuracy in both MF and non-MF (distractors); the degree of improvement was significantly higher in the non-MF/distractor category. Across all categories, diagnostic confidence level was higher when clinical images were available. CONCLUSION: These findings suggest that clinical images are useful in making an accurate diagnosis of MF, and may be particularly helpful in ruling it out when an inflammatory disorder is clinically suspected.

Micrografía analítica de semillas de Cebil (Anadenanthera colubrina var. Cebil (Griseb.) Altschul, Fabaceae) y Chamico (Datura ferox L., Solanaceae), empleadas como drogas alucinógenas en Argentina / Analytical micrography of seeds of Cebil (Anadenanthera colubrina var. Cebil (Griseb.) Altschul, Fabaceae) and Chamico (Datura ferox L., Solanaceae), employed as hallucinogenic drugs in Argentina

Resumen La micrografía analítica es una herramienta útil para la identificación de restos vegetales en muestras de material trozado o molido que no podrían ser identificadas de forma morfológica. El objetivo de este estudio es conocer los caracteres mi- crográficos de las semillas de Cebil (Anadenanthera colubrina var. cebil (Griseb.) Altschul, Leguminosae) y Chamico (Datura ferox L., Solanaceae), con el fin de proporcionar parámetros empleables para su identificación en un contexto forense y toxicológico. Los caracteres micrográficos relacionados con el tegumento exterior y las esclereidas fueron los más indicados para diferenciar entre ambas especies.

Abstract Analytical micrography is a useful tool for the identification of plant parts that can't be identified for its morphological characters. The aim of this work is to obtain micrographic characters of Cebil (Anadenanthera colubrina var. cebil (Griseb.) Altschul, Leguminosae) and Chamico (Datura ferox L., Solanaceae) seeds for its identification in a toxicological and forensic context. The most suitable micrographic features were the ones related with exterior testa and the stone cells.

Simple non-mydriatic retinal photography is feasible and demonstrates retinal microvascular dilation in Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is associated with an increased risk of myocardial infarction and stroke but it remains unclear how to identify microvascular changes in this population. OBJECTIVES: We hypothesized that simple non-mydriatic retinal photography is feasible and can be used to assess microvascular damage in COPD. METHODS: Novel Vascular Manifestations of COPD was a prospective study comparing smokers with and without COPD, matched for age. Non-mydriatic, retinal fundus photographs were assessed using semi-automated software. RESULTS: Retinal images from 24 COPD and 22 control participants were compared. Cases were of similar age to controls (65.2 vs. 63.1 years, p = 0.38), had significantly lower Forced Expiratory Volume in one second (FEV1) (53.4 vs 100.1% predicted; p < 0.001) and smoked more than controls (41.7 vs. 29.6 pack years; p = 0.04). COPD participants had wider mean arteriolar (155.6 ±15 uM vs. controls [142.2 ± 12 uM]; p = 0.002) and venular diameters (216.8 ±20.7 uM vs. [201.3± 19.1 uM]; p = 0.012). Differences in retinal vessel caliber were independent of confounders, odds ratios (OR) = 1.08 (95% confidence intervals [CI] = 1.02, 1.13; p = 0.007) and OR = 1.05 (CI = 1.01, 1.09; p = 0.011) per uM increase in arteriolar and venular diameter respectively. FEV1 remained significantly associated with retinal vessel dilatation r = -0.39 (p = 0.02). CONCLUSIONS: Non-mydriatic retinal imaging is easily facilitated. We found significant arteriole and venous dilation in COPD compared to age-matched smokers without COPD associated with lung function independent of standard cardiovascular risk factors. Retinal microvascular changes are known to be strongly associated with future vascular events and retinal photography offers potential to identify this risk. TRIAL REGISTRATION: clinicaltrials.gov NCT02060292.

Development and Validation of an Image Analysis System for the Measurement of Cell Proliferation in Mammary Glands of Rats.

Reliable detection and measurement of cell proliferation are essential in the preclinical assessment of carcinogenic risk of therapeutics. In this context, the assessment of mitogenic potential on mammary glands is crucial in the preclinical safety evaluation of novel insulins. The existing manual counting is time-consuming and subject to operator bias. To standardize the processes, make it faster, and resistant to errors, we developed a semiautomated image analysis system (CEPA software, which is open-source) for counting of proliferating cells in photomicrographs of mammary gland sections of rats labeled with Ki-67. We validated the software and met the predefined targets for specificity, accuracy, and reproducibility. In comparison to manual counting, the respective mean differences in absolute labeling indices (LIs) for CEPA software were 3.12% for user 1 and 3.05% for user 2. The respective regression analysis revealed a good correlation between the CEPA software user and manual counting. Moreover, the CEPA software showed enhanced reproducibility between independent users. The interuser variability is centered around 0 and the absolute difference was about 0.53% LI. Based on validation data, our software has superiority to the manual counting and is a valid and reliable tool for the routine analysis of cell proliferation in mammary glands from rats exposed to insulin analogs.

Descemet's Membrane Biomimetic Microtopography Differentiates Human Mesenchymal Stem Cells Into Corneal Endothelial-Like Cells.

PURPOSE: Loss of corneal endothelial cells (CECs) bears disastrous consequences for the patient, including corneal clouding and blindness. Corneal transplantation is currently the only therapy for severe corneal disorders. However, the worldwide shortages of corneal donor material generate a strong demand for personalized stem cell-based alternative therapies. Because human mesenchymal stem cells are known to be sensitive to their mechanical environments, we investigated the mechanotransductive potential of Descemet membrane-like microtopography (DLT) to differentiate human mesenchymal stem cells into CEC-like cells. METHODS: Master molds with inverted DLT were produced by 2-photon lithography (2-PL). To measure the mechanotransductive potential of DLT, mesenchymal stem cells were cultivated on silicone or collagen imprints with DLT. Changes in morphology were imaged, and changes in gene expression of CEC typical genes such as zonula occludens (ZO-1), sodium/potassium (Na/K)-ATPase, paired-like homeodomain 2 (PITX2), and collagen 8 (COL-8) were measured with real-time polymerase chain reaction. At least immunofluorescence analysis has been conducted to confirm gene data on the protein level. RESULTS: Adhesion of MSCs to DLT molded in silicone and particularly in collagen initiates polygonal morphology and monolayer formation and enhances not only transcription of CEC typical genes such as ZO-1, Na/K-ATPase, PITX2, and COL-8 but also expression of the corresponding proteins. CONCLUSIONS: Artificial reproduction of Descemet membrane with respect to topography and similar stiffness offers a potential innovative way to bioengineer a functional CEC monolayer from autologous stem cells.

Smooth Muscle Alpha Actin Immunoexpression (α-Sma) and CD-117 Antibody (C-Kit) in Capsules Formed by Polyurethane Foam-Coated Silicone Implants and with Textured Surface: A Study on Rats.

BACKGROUND: One of the undesirable complications that might occur after breast augmentation with silicone implants is capsular contracture. In its etiology, the relations between mast cells and myofibroblasts play an important role in collagen synthesis. Mast cells are able to activate fibroblasts into myofibroblasts, through paracrine secretions, inducing collagen production. The objectives of this study were to analyze the myofibroblast concentration through the α-SMA immunomarker and evaluate the intensity of mast cell expression against the C-Kit immunomarker. MATERIAL AND METHOD: Sixty-four Wistar rats were used, divided into two groups (polyurethane foam and textured surface) with 32 animals in each. The animals received silicone implants on the back, below the panniculus carnosus, and after the determined period, they were killed and the capsules formed around the implants were studied. The capsules were analyzed employing the immunohistochemical technique, with the α-SMA and C-Kit immunomarkers in subgroups of 30, 50, 70 and 90 days. RESULTS: The myofibroblast concentration was higher in the polyurethane group when compared to the textured group (30 days p = 0.105; 50 days p = 0.247; 70 days p = 0.014 and 90 days p = 0.536). The intensity of mast cell expression was more pronounced in the polyurethane group when compared to the textured group (30 days p = 0.798; 50 days p = 0.537; 70 days p = 0.094 and 90 days p = 0.536). CONCLUSIONS: Polyurethane-coated implants induced higher concentrations of myofibroblasts and higher expression of mast cells, when compared to the textured surface implants. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diagnosis and Treatment of Lambl's Excrescence on the Aortic Valve.

OBJECTIVE: Our objective is to summarize our experience in the diagnosis and treatment of Lambl's excrescence (LE) on the aortic valve. Methods: The clinical data of 25 patients with LE admitted to our hospital from January 2010 to December 2014 were analyzed retrospectively. There were 17 males and 8 females, with the mean age of 55.7 ± 11.43 years (range: 30 to 70 years). Among the patients analyzed, eight also had cerebral embolism. All of the patients were diagnosed by transesophageal echocardiography (TEE). In seven cases, surgical treatment to remove the excrescence was successfully performed. Results: All 25 patients were cured and discharged. There were no complications or operative mortalities in the seven patients that underwent surgical treatment. Follow-ups were performed for all patients for an average of 2.9 ± 1.5 years. During this time, none had a new cerebrovascular accident (CVA). Conclusions: Most patients with LE are asymptomatic, though some patients showed repeated episodes of stroke. We recommend TEE as the main diagnostic means of the disease. Patients with LE that have experienced two or more CVAs or combined other heart disease and need open heart surgery should be offered surgical excision of the excrescences. Other patients should be treated conservatively with anticoagulation, or monitored closely.

Análise da expressão imunoistoquímica de regy e de proteínas envolvidas na regulação da apoptose em carcinomas epidermoides de língua oral / Analysis of the immunohistochemical expression of regy and of proteins involved in the regulation of apoptosis in oral tongue squamous cell carcinomas

O câncer na cavidade oral é uma das lesões malignas mais frequentes na população mundial. Como o processo de desenvolvimento das neoplasias malignas remete a danos que promovem um desequilíbrio na regulação da divisão e morte celular, nos últimos anos, diversos estudos foram realizados com o intuito de verificar a influência desses danos no comportamento global das células e na evolução da doença. Nesse contexto, pesquisas recentes mostraram que alterações na expressão de REG podem desempenhar um importante papel na progressão tumoral de várias neoplasias malignas, por interferir na regulação da apoptose. Diante disso, o objetivo desse trabalho foi investigar a expressão imunoistoquímica dos marcadores REG, p53, MDM-2, Bcl-2 e Bax em carcinomas epidermoides de língua (CELs) oral, com a finalidade de promover uma análise comparativa da imunoexpressão destas proteínas com os parâmetros clínico-patológicos de agressividade da lesão, no intuito de identificar se o REG contribui para a progressão do tumor e se interfere na expressão das proteínas relacionadas a apoptose. Para tanto, foram coletadas informações clínicas de 58 pacientes acometidos por CELs. Em seguida, foi realizada análise histopatológica e imunoistoquímica dos marcadores supracitados, em amostras de material biológico parafinado da lesão. Os resultados mostraram que os tumores com metástase nodal e de alto grau histopatológico de malignidade apresentavam percentuais significativamente menores de REG (p<0,05). Em adição, a análise da expressão de p53, MDM-2 e Bax nos diferentes parâmetros clínico-patológicos avaliados nesse trabalho, não revelou diferenças significativas nos percentuais de imunopositividade desses marcadores. Com relação ao Bcl-2, foi visto que tumores de alto grau de malignidade e com óbitos relacionados a doença apresentavam percentual significativamente menor de positividade dessa proteína (p<0,05). Por fim, o teste de correlação de Spearman demonstrou existir fraca correlação positiva, estatisticamente significativa, entre os percentuais de REG e das proteínas MDM-2 e Bcl-2. Baseado nesses achados, pode-se concluir que a redução da expressão de REG parece contribuir para a progressão do CEL oral e pode influenciar na expressão das proteínas relacionadas a regulação da apoptose (AU).

Cancer of the oral cavity is one of the most common malignancies in the world. Since the development of malignant neoplasms is related to damage that causes an imbalance in the regulation of cell division and cell death, many studies have been conducted in recent years to verify the influence of this damage on overall cell behavior and on the progression of the disease. Within this context, recent studies suggest that changes in the expression of REG play an important role in the progression of different malignant tumors by interfering with the regulation of apoptosis. Therefore, the objective of the present study was to investigate the immunohistochemical expression of REG, p53, MDM-2, Bcl-2 and Bax in oral tongue squamous cell carcinoma (OTSCC), correlating the immunoexpression of these proteins with clinicalpathological parameters of tumor aggressiveness, in order to determine whether REG contributes to tumor progression and interferes with the expression of apoptosisrelated proteins. For this purpose, the clinical data of 58 patients with OTSCC were collected and paraffin-embedded tumor specimens were submitted to histopathological analysis and immunohistochemistry using the markers cited above. The results showed significantly higher expression of REG (p<0.05) in low-grade tumors and without lymph node metastases. In addition, comparison of the expression patterns of p53, MDM-2 and Bax according to the clinical-pathological parameters studied revealed no significant differences in the percentage of immunostaining for these markers. Regarding Bcl-2, a significantly lower percentage of immunostaining for this protein was observed in tumors with a high grade of malignancy and tumors associated with deaths related to the disease (p<0.05). Finally, Spearman's correlation test demonstrated a significant weak positive correlation between the percentages of REG and of MDM-2 and Bcl-2. These findings suggest that the reduced expression of REG contributes to the progression of OTSCC and may influence the expression of proteins related to the regulation of apoptosis (AU).

Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO).

Breathing difficulties during exertion may be caused by exercise-induced laryngeal obstruction (EILO). The diagnosis depends on visualization of the larynx during exercise, i.e. by continuous laryngoscopic exercise (CLE) test. In case of severe supraglottic collapse and pronounced symptoms during strenuous exertion, surgical treatment (supraglottoplasty) has been suggested. The aims of this study were to evaluate outcome and patient satisfaction after supraglottoplasty for EILO and to compare our results with previously reported data. During the period December 2010 to October 2013, 17 patients diagnosed with moderate to severe supraglottic EILO were treated by supraglottoplasty with microlaryngoscopic laser technique at our institutions. The severity of patients symptoms (VAS score) and CLE scores was evaluated pre- and postoperatively. We found a decrease in patients symptoms from median 80 points VAS score preoperatively to 20 points postoperatively (p < 0.001) and a decrease in CLE sum score from median 4.0 points to 2.5 points (p < 0.05). Several previous studies have recommended surgery for selected patients with supraglottic involvement, but these have mainly been based on case reports or on very few patients. This study is the second larger-scale study that documents the positive effect of supraglottoplasty as treatment of EILO in terms of reduced respiratory symptoms and decreased laryngeal obstruction assessed by post-operative CLE test. We suggest that surgery is a well-tolerated and effective treatment option for selected EILO patients with moderate to severe supraglottic obstruction during exercise and a high level of physical activity.

Ultrastructure of the surface of dental enamel with molar incisor hypomineralization (MIH) with and without acid etching / Ultraestructura de la superficie del esmalte dental con hipomineralización molar incisiva (mih) con y sin grabado ácido

El objetivo del presente trabajo fue analizar la ultraestructura y composición mineral de la superficie del esmalte de un molar con MIH, con y sin tratamiento de grabado ácido. Se analizaron una pieza dentaria permanente sin lesiones clínicas de MIH (controles) y una pieza con diagnóstico clínico de MIH leve y moderada, con indicación de extracción con y sin grabado acido (H3PO4 37 por ciento, 20”). Fueron procesadas para su observación con microscopio electrónico de barrido (SEM) ZEISS (Supra 40) y análisis de la composición mineral con detector EDS (Oxford Instruments). El esmalte del control mostró superficie prismática y patrón de grabado normales. El esmalte clínicamente sano en la pieza con MIH reveló una pérdida parcial del patrón prismático. La lesión leve se presentó porosa con ocasional esgrietas. La moderada presentó mayor porosidad, con grietas de mayor tamaño y presencia de gran cantidad de escamas. La composición mineral de las superficies afectadas mostró menor contenido de Ca y P y aumento de O y C. En la muestra con MIH, inclusive con aspecto normal, las desmineralizaciones no responden a un patrón de grabado, mostrando exposición de cristales con redondeamiento en los extremos de las varillas y menor desmineralización en los espacios interprismáticos. El grabado ácido incrementó la aparición de grietas y profundos poros en la estructura adamantina del esmalte con lesión. La composición mineral mostró en las lesiones moderadas una mayor disminución del contenido de Ca, P y Cl.El esmalte con MIH, inclusive en la superficie adamantina clínicamente intacta, presenta severas alteraciones ultraestructurales y cambios en la composición iónica afectando el patrónde grabado ácido, que podría interferir con los mecanismos de adhesión.

The aim of the present work was to analyze the ultrastructure and mineral composition of the surface of the enamel on amolar with MIH, with and without acid etching. A permanent tooth without clinical MIH lesions (control) and a tooth with clinical diagnosis of mild and moderate MIH, with indication for extraction, were processed with and without acid etching(H3PO437%, 20”) for observation with scanning electron microscope (SEM) ZEISS (Supra 40) and mineral composition analysis with an EDS detector (Oxford Instruments). The control enamel showed normal prismatic surface and etching pattern. The clinically health y enamel on the tooth with MIH revealed partial loss of prismatic pattern. The mild lesion wasporous with occasional cracks. The moderate lesion was moreporous, with larger cracks and many scales. The mineral composition of the affected surfaces had lower Ca and Pcontent and higher O and C. On the tooth with MIH, even on normal looking enamel, the demineralization does not correspond to an etching pattern, and exhibits exposure of crystals with rods with rounded ends and less demineralization in the inter-prismatic spaces. Acid etching increased the presence of cracks and deep pores in the adamantine structure of the enamel with lesion. In moderate lesions, the mineral composition had higher content of Ca, P and Cl. Enamel with MIH, even on clinically intact adamantine surfaces, shows severe alterations in the ultrastructure and changes in ionic composition, which affect the acid etching pattern and may interfere with adhesion.

The use of guideline images to improve histological estimation of hepatic steatosis.

BACKGROUND & AIMS: Guideline images of specific fat proportionate area (FPA) percentages have recently been published to aid the histological assessment of liver steatosis as subjective estimates of FPA are usually overestimated. To assess, (i) the effect of guideline images on accuracy and concordance of estimated FPA (eFPA), (ii) experience of steatosis grading systems on eFPA, (iii) the effect of magnification on assessment of FPA (iv) and produce a range of guideline images at x4 objective magnification (OM). METHODS: Two circulations of sample images (C1 and C2) were circulated to UK liver external quality assessment histopathology scheme members who were asked to independently evaluate steatosis. Each circulation consisted of 15 images taken at both x20 and x4OM representing the full range of steatosis. C1 was distributed first, then C2 with guideline images of FPA 6 weeks later. RESULTS: Participants overestimated FPA in C1. In C2, there was significant improvement in accuracy (P < 0.001) of eFPA for sample images with mFPA >5%. Concordance of x4OM eFPA was substantial in both circulations (C1 K = 0.878, C2 K = 0.724). CONCLUSION: The tendency to overestimate eFPA has been corroborated and can be largely corrected with the use of guideline images (without needing digital image analysis). There is a need to redefine steatosis grades that are clinically significant and validated using an accurate quantification of steatosis.

Pulpectomía lateral: una técnica de micro-odontología para desarrollar habilidad en el manejo de microscopios dentales / Lateral pulpectomy: a microtechnique to develop competency in the use of the dental microscope

Con la aparición de cada nuevo sistema de diagnóstico o tratamiento dental, es necesario capacitar a los cirujanos dentistas para su correctoempleo; los microscopios dentales no escapan a esta regla. En las últimasdos décadas el uso de microscopios dentales se ha incrementado, pero aún no se establece una reglamentación respecto a su empleo y son muy pocos los profesionistas que cuentan con estos equipos para su práctica privada, es por ello que no se han estandarizado técnicas para que los clínicos desarrollen las habilidades necesarias que les permitan utilizar los equipos de microscopia en su práctica cotidiana en forma segura y con facilidad. La técnica de ®pulpectomía lateral¼ es un ejerciciode micro-odontología que se realiza en dientes extraídos, que no tiene aplicación clínica como tal, pero es parte de una serie de procedimientos que tienen la fi nalidad de desarrollar las habilidades de orientación, movimientoy aplicación de presión. Estas habilidades son indispensablescuando se trabaja en la boca de los pacientes con microscopios dentales

As new diagnostic and dental treatments emerge, dental surgeons need to be trained in their correct use. Dental microscopes are no exception to this rule. In the last two decades, the use of dental microscopes has increased, though no set rules for their use have been defi ned. Moreover, few professionals have this equipment in their private practice, which is why techniques have not been standardized for clinicians to develop the skills required for them to be able to use dental microscopes easily and safely in their daily practice. The ®lateral pulpectomy¼ technique is a microdentistry training exercise that is performed on extracted teeth. Though it has no clinical application as such, it forms part of a series of procedures that are designed to develop directional, motion, and pressure skills, all of which are essential when working with dental microscopes in the mouths of patients.

[Research on WiFi-based wireless microscopy on a mobile phone and its application].

We proposed and realized a new device that acquires microscopic image wirelessly based on mobile phone and WiFi system. The mobile terminals could record, display and store the image from the far end via the wireless LAN. Using this system, a series of conceptual experiments on monitoring the microscopic images of common objects and liver cancer cells were successfully demonstrated. This system is expected to have important value in the experimental investigations on wirelessly monitoring the cell culture, and small insect etc.

Reproducibility of histopathologic diagnosis of skin diseases by digital photomicrographs versus conventional optical microscopy.

BACKGROUND: Telepathology is considered a good alternative for a second opinion consultation. Its implementation is desirable, but studies to confirm its practical application are required. OBJECTIVES: To evaluate the reproducibility of histopathologic diagnoses of skin diseases obtained through digital photomicrographs compared with conventional microscopy. METHODS: We evaluated the surgical specimens of 135 patients using an optical microscope. After 4 weeks, the same consultants independently evaluated a total of 1,738 digital photomicrographs obtained from the histopathological slides. We estimated the overall rate of intra and interobserver agreement, and the Kappa coefficient was obtained with the categorization of the skin diseases: neoplastic skin diseases, infectious-contagious skin diseases and non-infectious-contagious skin diseases. RESULTS: Consultant 1 obtained an agreement of 88.1% (95% CI = 81.5% - 93.1%) between conventional microscopy and images. Consultant 2 obtained an agreement of 80.7% (95% CI = 73.1% - 87%). The interobserver agreement for the microscopy analysis was 81.5% (95% CI = 73.9% - 87.6%). The same analysis using microphotography showed an agreement of 85.9% (95% CI = 78.9% - 91.3%). The Kappa coefficient, which evaluated the categorized skin diseases, was 98.6% for Consultant 1, 93.1% for Consultant 2, 95.8% for interconsultant analyses of images and 95.9% for interconsultant analyses using conventional optical microscopy. All of these values are considered optimal. CONCLUSION: The evaluation of microphotographs shows a good level of reproducibility when compared to traditional microscopy and, therefore, is a viable option for a second opinion consultation in dermatopathology.

Reprodutibilidade do diagnóstico histopatológico de dermatoses por fotomicrografias digitais versus microscopia óptica convencional / Reproducibility of histopathologic diagnosis of skin diseases by digital photomicrographs versus conventional optical microscopy

FUNDAMENTOS: A telepatologia é considerada boa alternativa para consultas de segunda opinião. Sua implementação é desejável, mas estudos que confirmem sua aplicação prática são necessários. OBJETIVOS: Analisar a concordância entre os diagnósticos histopatológicos de dermatoses feitos com base em microfotografias digitais em comparação com a microscopia convencional. MÉTODOS: As lâminas de 135 pacientes foram avaliadas por dois consultores por meio de microscópio. Após quatro semanas, os mesmos consultores avaliaram 1.738 microfotografias digitais obtidas dessas lâminas. Estimou-se a taxa geral de concordância intraobservadores e interobservadores e obteve-se o índice Kappa com a categorização das dermatoses: dermatoses neoplásicas, dermatoses infectocontagiosas e não infectocontagiosas. RESULTADOS: A concordância do Consultor 1, que analisou lâminas ao microscópio versus imagens, foi de 88,1 por cento (IC 95 por cento = 81,5 por cento - 93,1 por cento). O Consultor 2 obteve concordância de 80,7 por cento (IC 95 por cento = 73,1 por cento - 87 por cento). A concordância interconsultores ao microscópio foi de 81,5 por cento (IC 95 por cento = 73,9 por cento - 87,6 por cento). A mesma análise por meio de microfotografias mostrou concordância de 85,9 por cento (IC 95 por cento = 78,9 por cento - 91,3 por cento). O índice Kappa, que avalia as dermatoses categorizadas, foi de 98,6 por cento para o Consultor 1, de 93,1 por cento para o Consultor 2, de 95,8 por cento para interconsulta por imagens e de 95,9 por cento para interconsultas ao microscópio óptico. Todos esses valores são considerados ótimos. CONCLUSÃO: A avaliação das microfotografias apresentou ótimo nível de reprodutibilidade quando comparada à microscopia tradicional, sendo uma opção viável para consultas de segunda opinião em dermatopatologia.

BACKGROUND: Telepathology is considered a good alternative for a second opinion consultation. Its implementation is desirable, but studies to confirm its practical application are required. OBJECTIVES: To evaluate the reproducibility of histopathologic diagnoses of skin diseases obtained through digital photomicrographs compared with conventional microscopy. METHODS: We evaluated the surgical specimens of 135 patients using an optical microscope. After 4 weeks, the same consultants independently evaluated a total of 1,738 digital photomicrographs obtained from the histopathological slides. We estimated the overall rate of intra and interobserver agreement, and the Kappa coefficient was obtained with the categorization of the skin diseases: neoplastic skin diseases, infectious-contagious skin diseases and non-infectious-contagious skin diseases. RESULTS: Consultant 1 obtained an agreement of 88.1 percent (95 percent CI = 81.5 percent - 93.1 percent) between conventional microscopy and images. Consultant 2 obtained an agreement of 80.7 percent (95 percent CI = 73.1 percent - 87 percent). The interobserver agreement for the microscopy analysis was 81.5 percent (95 percent CI = 73.9 percent - 87.6 percent). The same analysis using microphotography showed an agreement of 85.9 percent (95 percent CI = 78.9 percent - 91.3 percent). The Kappa coefficient, which evaluated the categorized skin diseases, was 98.6 percent for Consultant 1, 93.1 percent for Consultant 2, 95.8 percent for interconsultant analyses of images and 95.9 percent for interconsultant analyses using conventional optical microscopy. All of these values are considered optimal. CONCLUSION: The evaluation of microphotographs shows a good level of reproducibility when compared to traditional microscopy and, therefore, is a viable option for a second opinion consultation in dermatopathology.