Bacteremia detection from complete blood count and differential leukocyte count with machine learning: complementary and competitive with C-reactive protein and procalcitonin tests.

BACKGROUND: Biomarkers, such as leukocyte count, C-reactive protein (CRP), and procalcitonin (PCT), have been commonly used to predict the occurrence of life-threatening bacteremia and provide prognostic information, given the need for prompt intervention. However, such diagnosis methods require much time and money. Therefore, we propose a method with a high prediction capability using machine learning (ML) models based on complete blood count (CBC) and differential leukocyte count (DC) and compare its performance with traditional CRP or PCT biomarker methods and those of models incorporating CRP or PCT biomarkers. METHODS: We collected 366,586 daily blood culture (BC) results, of which 350,775 (93.2%), 308,803 (82.1%), and 23,912 (6.4%) cases were issued CBC/DC (CBC/DC group), CRP with CBC/DC (CRP&CBC/DC group), and PCT with CBC/DC (PCT&CBC/DC group), respectively. For the ML methods, conventional logistic regression and random forest models were selected, trained, applied, and validated for each group. Fivefold validation and prediction capability were also evaluated and reported. RESULTS: Overall, the ML methods, such as the random forest model, demonstrated promising performances. When trained with CBC/DC data, it achieved an area under the ROC curve (AUC) of 0.802, which is superior to the prediction conventionally made with CRP/PCT levels (0.699/0.731). Upon evaluating the performance enhanced by incorporating CRP or PCT biomarkers, it reported no substantial AUC increase with the addition of either CRP or PCT to CBC/DC data, which suggests the predicting power and applicability of using only CBC/DC data. Moreover, it showed competitive prognostic capability compared to the PCT test with similar all-cause in-hospital mortality (45.10% vs. 47.40%) and overall median survival time (27 vs. 25 days). CONCLUSIONS: The ML models using only CBC/DC data yielded more accurate bacteremia predictions compared to those by methods using CRP and PCT data and reached similar prognostic performance as by PCT data. Thus, such models are potentially complementary and competitive with traditional CRP and PCT biomarkers for conducting and guiding antibiotic usage.

Primary cutaneous gamma/delta T-cell lymphoma in Taiwan: A series of six cases with frequent solitary presentation and relatively indolent behavior.

BACKGROUND: Primary cutaneous gamma/delta T-cell lymphoma (PCDG-TCL) is aggressive, frequently presenting as multiple plaques, tumors, and/or subcutaneous nodules. METHODS: In this study, we conducted a retrospective study in a tertiary center in Taiwan to characterize this rare tumor. RESULTS: We identified six patients. Five presented with a solitary lesion, including two with clinical impression of epidermal inclusion cyst or lipoma. Two of four evaluable cases exhibited epidermotropism, with one mimicking Pautrier microabscess. The neoplastic cells were pleomorphic and mostly medium- to large-sized. In all cases, the neoplastic cells expressed T-cell receptor (TCR)-γ and/or TCR-δ, with four co-expressing ßF1. Two of these ßF1+ cases co-expressed TCR-γ but not TCR-δ (two different clones). All were negative for Epstein-Barr virus (EBV), low stage, and treated with radiotherapy alone or combined chemotherapy and radiotherapy. In two patients, lymphoma relapsed in 3 and 7 months, respectively, and one patient died of the disease in 7 months. Four other patients were free of disease for 6 to 126 months. CONCLUSION: PCGD-TCL cases in Taiwan are more commonly solitary, frequently with indolent courses. The two currently available TCR-δ clones alone might be insufficient to detect all tumors.

Macrophage-Mimicking Cellular Nanoparticles Scavenge Proinflammatory Cytokines in Specimens of Patients with Inflammatory Disorders.

Effectively neutralizing inflammatory cytokines is crucial for managing a variety of inflammatory disorders. Current techniques that target only a subset of cytokines often fall short due to the intricate nature of redundant and compensatory cytokine networks. A promising solution to this challenge is using cell membrane-coated nanoparticles (CNPs). These nanoparticles replicate the complex interactions between cells and cytokines observed in disease pathology, providing a potential avenue for multiplex cytokine scavenging. While the development of CNPs using experimental animal models has shown great promise, their effectiveness in scavenging multiple cytokines in human diseases has yet to be demonstrated. To bridge this gap, this study selected macrophage membrane-coated CNPs (MФ-CNPs) and assessed their ability to scavenge inflammatory cytokines in serum samples from patients with COVID-19, sepsis, acute pancreatitis, or type-1 diabetes, along with synovial fluid samples from patients with rheumatoid arthritis. The results show that MФ-CNPs effectively scavenge critical inflammatory cytokines, including interleukin (IL)-6, IL-8, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α, in a dose-dependent manner. Overall, this study demonstrates MФ-CNPs as a multiplex cytokine scavenging formulation with promising applications in clinical settings to treat a range of inflammatory disorders.

The status of MGMT protein expression is a prognostic factor for meningeal hemangiopericytoma: a clinicopathologic and immunohistochemical study of 12 cases at a single institution.

Meningeal hemangiopericytoma (HPC) is a clinicopathologically well-characterized malignancy with a high tendency to recur locally and to metastasize outside the central nervous system (CNS). We render clinicopathologic features of 12 cases of this uncommon tumor to further elucidate the relationship between the status of the DNA-repair enzyme O(6)-methylguanine-DNA methyltransferase (MGMT) and the prognosis. Twenty-five specimens of meningeal HPC belonging to 12 patients were obtained at a single institution from 1992 to 2001. Correlations of histologic parameters, immunohistochemical study and clinical features were assessed. This series included five men and seven women with a median age of 37.5 years at the first surgery. The median post-operative follow-up period was 7.6 years. Six patients (55%) had single or multiple local tumor recurrences. The mean time to recurrence was 6.7 years. Distant metastasis occurred in three patients (27%) at a mean time of 6.5 years after first operation. The most frequent metastatic sites were liver and lung. Histopathologically, eight primary tumors (67%) belonged to WHO grade II, while four primary tumors (33%) belonged to WHO grade III. Immunohistochemically, 18% primary tumors exhibited 3+ to 4+ nuclear staining for MGMT protein, 18% exhibited 2+ staining, and 64% exhibited 0 to 1+ staining. The overall survival rate was 67 and 33% for primary tumors with 0 to 1+ and 2+ to 4+ MGMT staining, respectively (P = 0.018). The study illustrates aggressive behavior of meningeal HPC and the prognostic value of the status of MGMT protein expression.

Clear cell meningioma with frequent chordoid features and aggressive behavior: a clinicopathologic study of ten cases at a single institution.

Clear cell meningioma is an uncommon variant of meningiomas that often occurs in young patients, shows a proclivity for spinal intradural extramedullary and cerebellopontine angle, and follows an aggressive clinical course. We render clinicopathologic features of ten cases of this rare tumor to further elucidate its behavior. Fifteen specimens of clear cell meningioma belonging to ten patients were obtained at a single institution from 2001 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included eight men and two women with a mean age of 62.1 years at the first surgery. The mean post-operative follow-up period was 3.9 years. Four patients (40%) had single or multiple local tumor recurrences. The mean time to recurrence was 2.3 years. Seven tumors (46.7%) were combined with chordoid features. There was a wide range of MIB-1 labeling indices (4.4-33.5%, mean 15.8%), which were higher in recurrent tumors, tumors with chordoid features, and tumors with necrosis. There was no correlation between MIB-1 labeling indices and brain invasion. The study illustrates aggressive behavior of clear cell meningioma and frequently combined chordoid features in our cases.

Ditetraalkylammonium amino acid ionic liquids as CO2 absorbents of high capacity.

By grafting butyl or ethyl onto tetramethylethylenediamine, quaternary ammonium salts with two positive charge centers were formed at the first step. Metathesis with Ag(2)O followed. Through neutralization with glycine, l-alanine, or valine, a series of new ditetraalkylammonium amino acid ionic liquids (DILs) for CO(2) capture were generated. The structures of DILs, as shown in Figure 1, were verified by using (1)H NMR and EA. These DILs were found to be of quite high viscosity which militated against their industrial application in CO(2) removal. Drawing on the experience of mixed amines' aqueous solutions, these DILs were blended with water or N-methyldiethanolamine (MDEA) aqueous solutions to act as special absorbents of CO(2). Using a Double-Tank Absorption System, the absorption performance of these DIL solutions was investigated in detail. The experimental results indicated that among the three aqueous solutions of DILs (20%, 40%, and 80 wt %), the solution of 40% DIL had a higher absorption rate of CO(2) than the other two, demonstrating the different effects of concentration and viscosity on the absorption. The solution of 40% DIL or the 15% DIL + 15% MDEA had much higher capacity for CO(2) than the corresponding monocation tetraalkylammonium AAILs, due to the special structure of the dication which could influence the solubility of CO(2) in the aqueous solution.

Rhabdoid papillary meningioma: a clinicopathologic case series study.

World Health Organization (WHO) grade III meningiomas are subclassified on the basis of their architectural pattern into papillary and rhabdoid subtypes. Some meningiomas even combine papillary architecture with rhabdoid cytology. Additionally, they always show malignant histological features, follow an aggressive clinical course and tend to spread through the CSF after frequent local recurrence. We render the first series of rhabdoid papillary meningioma with review of the literature to further elucidate its biological behavior. From six patients (three male, three female), nine specimens of rhabdoid papillary meningioma were obtained between 1994 and 2010. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. The mean age of patients was 44.7 years at their first operation. The mean postoperative follow-up period was 63.2 months. Five patients experienced tumor recurrence, and one of them died from the disease after diffuse leptomeningeal dissemination. The mean time to first recurrence was 28 months. Only one patient was free of tumoral recurrence after an 8-year follow-up. Immunohistochemically, all tumors were positive for vimentin and epithelial membrane antigen. MIB-1 labeling indices were higher following tumor recurrence. The present study expands the clinicopathologic horizon of rhabdoid papillary meningioma and suggests that it will behave aggressively based on its histology and concomitant features of atypia or malignancy or high MIB-1 labeling indices. Close follow-up and aggressive treatments of these tumors are warranted.

Chordoid meningioma: a clinicopathologic study of 11 cases at a single institution.

Chordoid meningioma is an uncommon variant of meningioma, which histologically bears a great resemblance to chordoma and often follows an aggressive clinical course. We examine clinicopathologic features of 11 cases of this rare tumor to further elucidate its behavior. Thirteen specimens of chordoid meningioma belonging to 11 patients were obtained at a single institution from 1995 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included six men and five women with a mean age of 60.8 years at first surgery. Aside from one patient (case 5) who died of disease immediately after the first operation, the mean postoperative follow-up period for the other 10 patients was 41.4 months. Two patients each had a local tumor recurrence. The mean time to recurrence was 10.4 years. No systemic manifestations of Castleman syndrome, such as iron-refractory hypochromic/microcytic anemia and dysgammaglobulinemia, were found. Six tumors (46%) were classified as benign (grade I) and seven tumors (54%) atypical (grade II), if based solely on histologic grading irrespective of chordoid or clear cell components in our cases. Lymphoplasmacytic infiltrate was moderate in one tumor (7%), mild in eight tumors (62%), and absent in four tumors (31%). The inflammatory cells were predominantly T cells (CD3+), with only scarce B cells (CD20+). There was a wide range of MIB-1 labeling indices (0.3-25.8%, mean 7.5%), which increased following tumor recurrence. Our study demonstrates that chordoid meningiomas are not always associated with Castleman's Syndrome, and that this histologic category can be seen in the elderly as opposed to only in younger age groups.

Self-enhancement of CO reversible absorption accompanied by phase transition in protic chlorocuprate ionic liquids for effective CO separation from N2.

An efficient strategy for the high-capacity capture of CO is reported, and a phase change in protic chlorocuprate ionic liquids (PCILs) from liquid to solid is found during CO absorption. The highest CO capacity is 0.96 molCO molIL-1, being at least 150 times higher than that in [BMIM][PF6]. Both absorption and membrane permeation reveal that the PCILs are potential for the selective separation of CO from N2.

Tetraalkylammonium amino acids as functionalized ionic liquids of low viscosity.

Four of nine tetraalkylammonium-based amino-acid ionic liquids prepared in this work show lower viscosities than all amino acid-based ionic liquids found in the literature and their reversible CO(2) absorption approaches 0.5 mol per mol ionic liquid.

Aggressive Angiomyxoma-Report of a Rare Male Buttock Lesion.

Aggressive angiomyxoma is a very rare benign tumor for male population with fewer than 50 cases reported since the description of this tumor. Most documented cases of aggressive angiomyxomas were found in genital, perineal, and pelvic regions in women of child bearing age. We report a case of a massive (> 20 cm) aggressive angiomyxomas in a man who presented with perineal swellings. Macroscopically the mass was highly vascular and lobulated with high similarity to plexiform neurofibroma. Microscopic examination revealed a hypocellular tumor comprising bland oval and spindle-shaped cells along with vessels of varying calibre. The accompanying stroma was myxocollagenous. Immunohistochemical staining showed CD34 and focal estrogen receptors positivity and negative staining for S100, actin, desmin, and progesterone receptors. The histologic and immunohistochemical features favored the diagnosis of aggressive angiomyxoma. Despite the rarity of such tumor in the male population, aggressive angiomyxoma should be considered in the differential diagnosis when encountering chronic para-perineal lesions.

SO2 gas separation using supported ionic liquid membranes.

Measurements of permeability of sulfur dioxide (SO2) in five imidazolium-based ionic liquids supported on the polyethersulfone microfiltration membranes at temperatures from 25 to 45 degrees C and atmospheric pressure indicate that under the same conditions, the SO2 selectivity of separations using supported ionic liquid membranes are 9-19 times that of CO2.

Catalyst-free N-formylation of amines using BH3NH3 and CO2 under mild conditions.

The catalyst-free N-formylation of amines using CO2 as the C1 source and BH3NH3 as the reductant has been developed for the first time. The corresponding formylated products of both primary and secondary amines are obtained in good to excellent yields (up to 96% of isolated yield) under mild conditions.

Overexpression of Transient Receptor Protein Cation Channel Subfamily A Member 1, Confers an Independent Prognostic Indicator in Nasopharyngeal Carcinoma.

BACKGROUND: Detection of oncogenes provides chances to understand tumor development and progression. Transient receptor protein cation channel subfamily A, member 1 (TRPA1) transcript was significantly upregulated in nasopharyngeal carcinoma (NPC) with a stepwise upregulation from low- to high-stage NPCs from a preliminary data analysis in the Gene Expression Omnibus database. The TRPA1 gene is a member of the TRP channel family, encoding integral membrane proteins that functions as cation channels. Loss of calcium homeostasis takes place in cancer cells. METHODS: Immunostaining of TRPA1 was analyzed on 124 biopsies from NPC patients retrospectively. The H-score method was used to evaluate the immunoexpression of TRPA1. The correlations between H-score of TRPA1 protein level and clinicopathological factors, as well as the significances of TRPA1 protein level for disease-specific, distal-metastasis-free and local recurrence-free survivals were assessed. RESULTS: These patients were characterized to be no initial metastasis and medicated with the traditional procedure. The TRPA1 score was found to be associated with clinicopathological parameters and patient survivals. Along with the guideline of 7(th) edition of the American Joint Committee on Cancer, we found that TRPA1 upregulation (50%) was associated with advanced primary tumor (P = 0.009) and overall clinical stage (P = 0.019). In univariate log-rank testing, primary tumor, nodal status, stage and TRPA1 protein level significantly contributed to worse disease-specific survival, distal metastasis-free survival and local recurrence-free survival. In multivariate analysis, high TRPA1 protein level and tumor stage emerged as independent prognostic indicators for inferior disease-specific survival (P = 0.014; P = 0.003), distal metastasis-free survival (P = 0.004; P = 0.034) and recurrence-free survival (P = 0.017; P = 0.015). CONCLUSIONS: The upregulation of TRPA1 protein level is frequently correlated to unfavorable prognosticators and gives rise to cancer progression in NPC patients.

An efficient low-temperature route to nitrogen-doping and activation of mesoporous carbons for CO2 capture.

An innovative strategy for post-synthesis nitrogen-doping of mesoporous carbons (MCs) with high yields (>90%) at low temperatures (230-380 °C) by using a strong base, sodium amide (NaNH2), was developed. The as-prepared N-doped MCs exhibit a significantly enhanced CO2 adsorption performance in terms of capacity and selectivity when compared to their parent MCs.

Dual Lewis Base Functionalization of Ionic Liquids for Highly Efficient and Selective Capture of H2 S.

Three dual Lewis base functionalized ionic liquids (DLB-ILs) tethered with both carboxyl and tertiary amine groups on their anions were designed for highly efficient and selective absorption of H2 S. It was found that the DLB-ILs could reversibly absorb 0.39-0.84 mol of H2 S per mole of IL at 1 bar and 60 °C, which is significantly higher than that of other ILs. On the contrary, the CO2 absorption in this class of DLB-ILs was shown to be quite limited relative to H2 S owing to the coupling effect of the two Lewis base groups. It is the dual Lewis base functionalization that enables the significantly high values calculated for the ideal absorption selectivity for H2 S/CO2 , that is, 13-26 at 1 bar and 29-70 at 0.1 bar (60 °C). The selectivity even goes up to >100 at low pressures and high temperatures. It was further illustrated from DFT calculations and spectroscopy studies that the cooperation interaction of carboxyl⋅⋅⋅H2 S⋅⋅⋅amine and the reduced binding with CO2 were the major contributions to the high H2 S absorption capacity and H2 S/CO2 selectivity.

A clinicopathological study of the significance of the proportion of choroid morphology in chordoid meningioma.

Chordoid meningiomas (CM) account for approximately 0.5% to 1.0% of intracranial meningiomas. This tumor has a strong risk of recurrence and aggressive growth (World Health Organization grade II). Histological analysis of CM tumors shows that the tissue is often dominated by chordoid morphology; however, the exact relationship between the percentage of the chordoid component and other clinicopathological features is unknown. We collected 26 surgical specimens from 17 patients who had a histological diagnosis of CM between January 1986 and June 2010. The chordoid elements constituted 30% to 98% of the area of the tumor. In 12 of 17 (70.6%) primary tumors, over 50% of the area displayed the chordoid pattern. Recurrence was noted in nine of these patients and five underwent a second operation. These five patients showed a histopathological progression of aggressive features. The proportion of chordoid elements in each recurrent tumor also increased. Thus, the chordoid proportion in CM is associated with a greater likelihood of recurrence.

The prognostic impact of O6-methylguanine DNA methyltransferase and epidermal growth factor receptor expressions on primary gliosarcoma: a clinicopathologic and immunohistochemical study of seven cases at a single institution.

CONTEXT: Gliosarcoma is an uncommon variant of glioblastoma characterized by a biphasic tissue pattern of glial and mesenchymal differentiation. O6-methylguanine DNA methyltransferase (MGMT) is a DNA repair protein that removes mutagenic and cytotoxic adducts from O6-guanine in DNA. Lack of MGMT protein expression immunohistochemically is related to drug responses in patients of malignant glioma treated with alkylating agents. Epidermal growth factor receptor (EGFR) is the most frequently amplified gene in glioblastoma and associated with tumor invasiveness, angiogenesis, poor survival, and resistance to radiation therapy. AIMS: To elucidate the relationship between the statuses of the MGMT as well as EGFR proteins and the prognosis. The study was undertaken on samples received at the Department of Pathology from 2003 to 2009. MATERIALS AND METHODS: Clinicopathologic and immunohistochemical study of seven cases was performed. RESULTS: This series included three men and four women with a mean age of 49.3 years at first surgery. The median progression-free survival (PFS) was 22.2 months and 8.6 months for primary tumors with 0 to 1+ and 2+ to 3+ MGMT staining, respectively; the median overall survival (OS) was 27.5 months and 14.2 months for primary tumors with 0 to 1+ and 2+ to 3+ MGMT staining, respectively. The median PFS was 17.2 months and 11.2 months for primary tumors with 0 to 1+ and 2+ to 3+ EGFR staining, respectively; the median OS was 20.4 months and 17.7 months for primary tumors with 0 to 1+ and 2+ to 3+ EGFR staining, respectively. CONCLUSIONS: The series showed that MGMT and EGFR protein expressions were both unfavorable prognostic factors for patients with gliosarcoma.

Primary orbital meningioma: a study of six cases at a single institution.

Primary orbital meningioma is a rare tumor of the anterior visual pathway and constitutes approximately 2% of all orbital tumors and 1-2% of all meningiomas. The differentiation from secondary orbital meningioma of intracranial origin is sometimes difficult on image. As the tumor often leads to visual loss if left untreated and surgical intervention inevitably causes morbidity, the timing and modality of treatment are very important. We carried out the study involving six cases (mean age: 42.7 years, male to female ratio: 1:5) of primary orbital meningioma to further elucidate its behavior. The clinical signs and symptoms, diagnosis, treatment strategies, and follow-up information are recorded for all cases. The most frequent initial symptoms were visual complaints (100%) and proptosis (67%). In five cases, the diagnosis was based on pathologic findings and the tumors were all grade I meningiomas. In one case, however, the diagnosis was based on radiographic and clinical findings, lacking histologic confirmation. Five patients were operated on, four underwent tumor removal, and one received eyeball exenteration. One patient was treated with Novalis radiotherapy. The mean follow-up period was 8.8 years (range from 9 months to 15 years). All patients experienced loss of vision during the course without exception. No recurrent tumor was found in five cases during follow-up. In case 5, whose eyeball was exenterated, developed recurrent meningioma 7 years later. She received radiotherapy but the tumor was out of control. She expired 8 years after eyeball exenteration. The primary orbital meningioma is aggressive in behavior despite its benign histopathologic features. Loss of vision is frequently seen even after treatment. The tumor could be fatal if surgery and radiotherapy fail to control its intracranial extension.