How do cytopathologists learn fine needle aspiration techniques? An international survey.

INTRODUCTION: Fine needle aspiration cytology (FNAC) is a widely accepted diagnostic technique, but performance varies according to expertise. Little is known about variation in FNAC training practices worldwide. We surveyed pathologists using social media networks to determine FNAC training practices internationally. DESIGN: Pathologists were surveyed on questions related to FNAC simulation training using direct messaging on the Twitter and WhatsApp platforms. Survey responses over a period of 2 weeks were collected. RESULTS: In total, 149 pathologists participated (96.1% response rate). The respondents came from 24 countries and 87 institutions. The majority of the pathologists (63.8%) performed FNAC directly on patients for the first time. Only 36.2% of them had simulation instruction during their training. It was performed on food items such as fruit (64.8%), surgical specimens (37.0%), autopsies (13.0%) and others (9.3%), including commercially available phantom simulators for ultrasound-guided FNAC (US-FNAC) (two pathologists). DISCUSSION: Most pathologists did not receive formal training in a simulated environment, and of the pathologists who had simulation instruction, food items were commonly used for education. A few participants used a commercial US-FNAC simulator, but since most pathologists perform FNAC by palpation, this method of simulation training is not applicable to many practices. Social media is an effective and efficient way to perform survey research, yielding a very high response rate.

Chronic follicular pancreatitis: a space occupying lesion with spontaneous resolution.

Follicular pancreatitis (FP) is an extremely odd entity characterized by the presence of a pseudotumor that histologically presents lymphoid aggregates and germinal centers. The authors present the case of a 67-year-old woman with epigastric pain and jaundice. Endoscopic ultrasonography (EUS) was performed, revealing a 14x15 mm hypoechoic area with irregular edges in the head of the pancreas. The in situ cytological study showed polymorphic lymphoid cellularity, without atypia suggesting neoplasia. The cell block and the immunohistochemical study showed a polyclonal population with a pattern suggestive of FP. The patient presented spontaneous clinical improvement. The EUS follow up three months later shown pancreatic parenchyma with homogeneous echogenicity and no space occupying lesions were indentified. Since the diagnosis of FP has been reached after surgery in most cases, the treatment is not well established. However, no recurrences have been reported after surgery and spontaneous resolution has been observed in incomplete resections, which suggests the indication for conservative management. Diagnostic EUS has a fundamental role in the differential diagnosis between FP and pancreatic neoplasms, two entities with very different prognosis, and makes it possible to avoid, in the case of FP, unnecessary surgeries with the associated morbidity and mortality.

New species of Lepidocyrtus (Collembola, Entomobryidae) from Italy with a discussion of characters defining European Lepidocyrtus lignorum-group.

Springtails are a group of hexapods whose true diversity is currently underestimated. This is because the morphological characters normally used in species diagnosis do not have the necessary resolution. This situation is especially evident in Entomobryidae, which is currently the most diverse family of springtails. The combination of morphological and molecular data has allowed us to describe a new species of the genus Lepidocyrtus, based on specimens from Northern Italy, as well as to redefine the diagnosis of the European Lepidocyrtus lignorum-group.

Collembola of the Cavalum and Landeiro Caves (Madeira, Portugal).

The cave fauna of the Macaronesian archipelagos is rich in endemic species. Unlike the Azores and the Canary Islands, the cave fauna of the Madeira archipelago is little known. The only two cave complexes studied, Machico and São Vicente, lack protection measures. São Vicente is seriously threatened because it is being exploited for touristic purposes, while the Machico complex, the only one in its natural state, is open to the public but without any control. The importance of the conservation of this cave fauna is indisputable. So far, of the 13 cavernicolous species recorded, two of them-genus Centromerus-are critically endangered. Apart from occasional sampling, no monitoring study has ever been carried out. The aim of this work has been to make a species checklist of the cave fauna of the Machico complex, the least studied so far. For this purpose, during 2001-2002, a monitoring study was carried out using traps and manual collections in the lava tubes of Landeiros and Cavalum (I, II, III). Fourteen species of springtails were recorded. Of these, four are new species, Neelus serratus Jordana & Baquero sp. nov., Coecobrya decemsetosa Jordana & Baquero sp. nov., Coecobrya octoseta Jordana & Baquero sp. nov., and Sinella duodecimoculata Jordana & Baquero sp. nov., and one is a new record for the archipelago, Lepidocyrtus curvicollis Bourlet, 1839.

Phylotranscriptomics interrogation uncovers a complex evolutionary history for the planarian genus Dugesia (Platyhelminthes, Tricladida) in the Western Mediterranean.

The Mediterranean is one of the most biodiverse areas of the Paleartic region. Here, basing on large data sets of single copy orthologs obtained from transcriptomic data, we investigated the evolutionary history of the genus Dugesia in the Western Mediterranean area. The results corroborated that the complex paleogeological history of the region was an important driver of diversification for the genus, speciating as microplates and islands were forming. These processes led to the differentiation of three main biogeographic clades: Iberia-Apennines-Alps, Corsica-Sardinia, and Iberia-Africa. The internal relationships of these major clades were analysed with several representative samples per species. The use of large data sets regarding the number of loci and samples, as well as state-of-the-art phylogenomic inference methods allowed us to answer different unresolved questions about the evolution of particular groups, such as the diversification path of D. subtentaculata in the Iberian Peninsula and its colonization of Africa. Additionally, our results support the differentiation of D. benazzii in two lineages which could represent two species. Finally, we analysed here for the first time a comprehensive number of samples from several asexual Iberian populations whose assignment at the species level has been an enigma through the years. The phylogenies obtained with different inference methods showed a branching topology of asexual individuals at the base of sexual clades. We hypothesize that this unexpected topology is related to long-term asexuality. This work represents the first phylotranscriptomic analysis of Tricladida, laying the first stone of the genomic era in phylogenetic studies on this taxonomic group.

Exploring gene sequences and phylogenetic relationships of four terrestrial planarian species (Platyhelminthes; Tricladida; Geoplanidae) in Europe.

Partial mitochondrial cox1 gene sequences from four recently recognised European species of terrestrial planarians, and ribosomal ITS1 sequences for two of them, are presented: Marionfyfea adventor, Artioposthia exulans (both introduced from New Zealand), Australopacifica atrata (from Australia) and specimens putatively identified as Microplana edwardsi, presumed to be native to the UK. The sequences are compared with those from other terrestrial planarian species and analysed phylogenetically. Results indicate that the sister group of M. adventor comprises a clade constituted by at least the genus Arthurdendyus. The phylogenetic position of Ar. exulans remains less certain, Australopacifica atrata might be closely related to the species Parakontikia ventrolineata and Endeavouria septemlineata. The specimens of M. cf. edwardsi are distinct from all other Microplana species for which sequences are available.

Favipiravir and/or nitazoxanide: a randomized, double-blind, 2×2 design, placebo-controlled trial of early therapy in COVID-19 in health workers, their household members, and patients treated at IMSS (FANTAZE).

BACKGROUND: The 2020 pandemic of SARS-CoV-2 causing COVID-19 disease is an unprecedented global emergency. COVID-19 appears to be a disease with an early phase where the virus replicates, coinciding with the first presentation of symptoms, followed by a later 'inflammatory' phase which results in severe disease in some individuals. It is known from other rapidly progressive infections such as sepsis and influenza that early treatment with antimicrobials is associated with a better outcome. The hypothesis is that this holds for COVID-19 and that early antiviral treatment may prevent progression to the later phase of the disease. METHODS: Trial design: Phase IIA randomised, double-blind, 2 × 2 design, placebo-controlled, interventional trial. RANDOMISATION: Participants will be randomised 1:1 by stratification, with the following factors: gender, obesity, symptomatic or asymptomatic, current smoking status presence or absence of comorbidity, and if the participant has or has not been vaccinated. BLINDING: Participants and investigators will both be blinded to treatment allocation (double-blind). DISCUSSION: We propose to conduct a proof-of-principle placebo-controlled clinical trial of favipiravir plus or minus nitazoxanide in health workers, their household members and patients treated at the Mexican Social Security Institute (IMSS) facilities. Participants with or without symptomatic COVID-19 or who tested positive will be assigned to receive favipiravir plus nitazoxanide or favipiravir plus nitazoxanide placebo. The primary outcome will be the difference in the amount of virus ('viral load') in the upper respiratory tract after 5 days of therapy. Secondary outcomes will include hospitalization, major morbidity and mortality, pharmacokinetics, and impact of antiviral therapy on viral genetic mutation rate. If favipiravir with nitazoxanide demonstrates important antiviral effects without significant toxicity, there will be a strong case for a larger trial in people at high risk of hospitalization or intensive care admission, for example older patients and/or those with comorbidities and with early disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04918927 . Registered on June 9, 2021.

The utility of a gross dissection anatomical model for simulation-based learning in pathology.

INTRODUCTION: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. METHODS: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). RESULTS: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). CONCLUSIONS: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.

The utility of a gross dissection anatomical model for simulation-based learning in pathology

Introduction: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. Methods: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). Results: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1–5) (range 3.4–4.7, σ0.89). The categories ‘knowledge of resection margins’ and ‘macroscopic diagnosis’ received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by ‘understanding of handling and gross examination of the surgical specimen’ (4.5, σ0.49), ‘prognosis’ (4.3, σ0.67) and ‘understanding of a tumor resection’ (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15′39″ (σ2′12″), 16′50″ (σ3′45″), and 17′52″ (σ2′12″), respectively (p<0.05). Gross dissection marks (0–5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). Conclusions: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.(AU)

Introducción: En Anatomía Patológica el examen macroscópico y la disección resultan fundamentales para alcanzar un diagnóstico correcto. Los métodos tradicionales de enseñanza de esta habilidad presentan limitaciones, como el riesgo de enfermedad transmisible, la exposición al formol y la disponibilidad de especímenes. Describimos aquí un método de enseñanza en disección utilizando simuladores anatómicos. Material y métodos: Se usaron modelos anatómicos neoplásicos artesanales que utilizan silicona líquida. Ochenta y cinco estudiantes de medicina participaron en una experiencia de examen macroscópico y disección y cumplimentaron un cuestionario sobre su percepción de aprendizaje adquirido. Además, se organizó un taller para comparar 3 metodologías distintas: imágenes estáticas (Grupo 1), vídeo (Grupo 2) y observación directa de un patólogo tallando (Grupo 3). Resultados: El cuestionario de conocimientos adquiridos mostró una valoración media de 4,4 sobre 5 (1-5) (rango 3,4-4,7, σ=0,89). Las categorías de «conocimiento sobre márgenes quirúrgicos» y «diagnóstico macroscópico» obtuvieron las mejores valoraciones (4,8, σ=0,11 y 4,7, σ=0,32, respectivamente), seguidas del «manejo de una pieza quirúrgica y su disección» (4,5, σ=0,49), el «pronóstico» (4,3, σ=0,67) y la «comprensión de una cirugía tumoral» (3,9, σ=0,96) (p<0,05). En relación con el método de enseñanza, el Grupo 3 realizó la disección en menos tiempo que el Grupo 2 y el Grupo 1, con unos tiempos medios de 15′39″ (σ=2′12″), 16′50″ (σ=3′45″), y 17′52″ (σ=2′12″), respectivamente (p<0,05). Por otra parte, se encontraron resultados estadísticamente significativos en función de la metodología utilizada (0-5) (p<0,05). El Grupo 2 obtuvo mejores resultados (3,7; σ=0,54) comparado con el Grupo 3 (3,4; σ=0,94) y el Grupo 1 (3,1; σ=0,8). Conclusiones: Este estudio preliminar demuestra que es posible implementar un módulo de simulación en disección en el Grado en Medicina, permitiendo esta metodología adquirir la habilidad en un entorno seguro.(AU)

Integrative taxonomy reveals three new species of European Lepidocyrtus lignorum-group (Collembola, Entomobryidae).

Lepidocyrtus is one of the genera of springtails with the largest number of species in the world. Molecular studies carried out to date on this genus have revealed the existence of a large number of cryptic species. Molecular and morphological studies done with four European populations of the genus have allowed us to describe three new species within the L. lignorum-group: L. fuscocephalus sp. nov., L. milagrosae sp. nov. and L. semicoloratus sp. nov. One of these species is made up of two geographically separate populations that represent two clearly separate but morphologically indistinguishable haplotypes.

COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study.

BACKGROUND: In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 "lockdown" period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow-up worldwide survey collecting data from the post-lockdown period (2020). METHODS: Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post-lockdown period (2020), which ranged from April 4 to October 31. Differences between the post-lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses. RESULTS: A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001). CONCLUSIONS: The data showed a persistent reduction in the cytological specimen volume during the post-lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post-lockdown is a promising finding of a slow return to normality.

Comparison of muscle activity while using different input devices in digital pathology.

INTRODUCTION: The high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use. MATERIAL AND METHODS: A comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts' Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography. RESULTS: Statistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization. CONCLUSION: We designed a system based on Fitts' Law to compare input devices in digital pathology. Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns. Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.

Comparison of muscle activity while using different input devices in digital pathology

Introduction: The high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use. Material and methods: A comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts’ Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography. Results: Statistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization. Conclusion: We designed a system based on Fitts’ Law to compare input devices in digital pathology. Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns. Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.(AU)

Introducción y objetivos: La alta prevalencia de trastornos musculoesqueléticos entre patólogos y el cambio hacia la digitalización de la Anatomía Patológica, nos ha hecho plantear un estudio comparativo de dispositivos de entrada al manejar preparaciones histológicas digitalizadas, evaluando el patrón y la actividad muscular durante su uso. Material y métodos: se realizó una comparación entre 10 dispositivos: ratón convencional y vertical, 3 trackballs, Ergopointer™, Rollermouse™, lápiz óptico, touchpad, Leap Motion™. Seis estudiantes de medicina realizaron un circuito estandarizado empleando una matriz tisular digitalizada, basada en la ley de Fitts. Se registró con electromiografía superficial la actividad eléctrica de 7 músculos del brazo dominante (aductor y extensor largo del pulgar, extensor y flexor común de los dedos, deltoides medio, y trapecios superior y medio). Resultados: se encontraron diferencias estadísticamente significativas en la actividad muscular, absoluta y relativizada (respecto al reposo), entre los dispositivos (p<0,001); Rollermouse™ (0,1027mV;139%), trackball Logitech M570 (0,1053mV/145%), Ergopointer™ (0,1151mV/167%), ratón convencional (0,1251mV/191%) y ratón vertical (0,1312mV/205%) fueron los que demandaron menor actividad, mientras que el lápiz óptico (0,1717mV/299%), Leap Motion™ (0,1803mV/319%), trackball Expert Mouse (0,1845mV/329%), trackball EIGIIS (0,2442mV/468%) y touchpad (0,2560mV/496%) fueron los que mayor movilización muscular requirieron. Conclusiones: Hemos diseñado un sistema basado en la ley de Fitts para comparar dispositivos de entrada. Se encontró variabilidad entre los dispositivos comparados y la actividad muscular demandada, lo que podría traducirse en diferentes patrones de fatiga muscular a largo plazo. Aunque la elección de un dispositivo es una cuestión de preferencia personal, es importante analizar su impacto desde el punto de vista ergonómico.(AU)

Testicular Pain as A Warning Symptom of a Symptomatic Abdominal Aortic Aneurysm: Case Report and Review of The Literature.

BACKGROUND: Isolated testicular pain is an unusual clinical presentation of symptomatic abdominal aortic aneurysms (AAA). We present two patients hemodynamically stable with an isolated acute testicular pain related to an AAA and a review of the published literature up to present. METHODS: Two adult-old males with an acute isolated testicular pain presented to the emergency department. Although both cases had their symptoms for more than 24 hours and were hemodynamically stable, the misdiagnosis of a urological condition in one case and a delay of the intervention in the second resulted in a sudden drop of vital signs and the need of an urgent open surgery. RESULTS: A bibliographic review of the 15 published cases is presented. Most cases occurred without a previous diagnosis of AAA. Aneurysms were characteristically very large (mean 10 cm). The initial diagnosis was frequently wrong, attributing the pain mostly to genito-urinary conditions. The testicular pain presented days and even weeks before rupture, which may offer a convenient window of hemodynamic stability for repair. CONCLUSIONS: Acute testicular pain in adult-old patients with aneurysm risk factors and specially with a first urological evaluation discarding a genitourinary disorder should alert clinicians to consider the diagnosis of a symptomatic abdominal aortic aneurysm. The early and accurate recognition of these cases may increase the survival.

Towards understanding Lepidocyrtus Bourlet, 1839 (Collembola, Entomobryidae) II: new Australian species.

The genus Lepidocyrtus Bourlet is currently considered to consist of eight subgenera of which Setogaster Salmon is one. Here we describe three new species in this subgenus, L. agricolus sp. nov., L. coorongensis sp. nov., and L. nashi sp. nov. It appears to be the most widespread and numerically dominant subgenus of Lepidocyrtus in Australia. The three new species live in different habitats and in different parts of the continent. It is assumed they are endemic species, one is likely to be a short range endemic. The characters and a list of species of the Lepidocyrtus praecisus-group, and an identification key for the Australian species of genus Lepidocyrtus are provided.

A rare cause of intra-abdominal cysts: pancreatic cystic lymphangiomas.

Echenique et al. described a lymphangioma as a rare cystic neoplasm of the pancreas. We present a similar intra-abdominal lesion diagnosed by endoscopic ultrasound (EUS)-fine-needle aspiration (FNA) cytology.