The fine needle aspiration of translocation sarcomas.

INTRODUCTION: Soft tissue sarcomas comprise a heterogeneous group of clinically aggressive cancers that are often hard to classify on limited cytological samples. "Translocation sarcomas" (TS) are a diverse subset of such cancers, different from pleomorphic sarcomas, and characterised by unique single chromosomal translocations in each sarcoma subtype. Interestingly, despite their high-grade biological behaviour, TS have deceptively monotonous and bland cytomorphology, therefore creating diagnostic issues on limited samples. MATERIALS AND METHODS: A retrospective search was conducted of the cytopathology archives of The Johns Hopkins Hospital revealing 147 translocation sarcoma cases over a 25-year period. RESULTS: The common morphological denominators for most translocation sarcomas were: hypercellularity, cellular monotony, mostly discohesive and single cells, round-to-oval or short spindled cells and a lack of necrosis. The exceptions were an inflammatory myofibroblastic tumour, in which cellular monotony was not present owing to the prominence of lymphocytes and plasma cells, and low-grade fibromyxoid sarcoma, in which the specimens were generally hypocellular. Ancillary testing, especially immunoperoxidase staining, was often required for primary lesions. CONCLUSION: Distinct morphological clues and subsequent ancillary testing (particularly immunoperoxidase staining) provide an accurate diagnosis on cytological interpretation of both, primary and recurrent/metastatic lesions.

Mask-less deposition of Au-SnO2 nanocomposites on CMOS MEMS platform for ethanol detection.

Here we report on the mask-less deposition of Au-SnO2 nanocomposites with a silicon-on-insulator (SOI) complementary metal oxide semiconductor (CMOS) micro electro mechanical system (MEMS) platform through the use of dip pen nanolithography (DPN) to create a low-cost ethanol sensor. MEMS technology is used in order to achieve low power consumption, by the employment of a membrane structure formed using deep reactive ion etching technique. The device consists of an embedded tungsten micro-heater with gold interdigitated electrodes on top of the SOI membrane. The tungsten micro-heater is used to raise the membrane temperature up to its operating temperature and the electrodes are used to measure the resistance of the nanocomposite sensing layer. The CMOS MEMS devices have high electro-thermal efficiency, with 8.2 °C temperature increase per mW power of consumption. The sensing material (Au-SnO2 nanocomposite) was synthesised starting from SnO nanoplates, then Au nanoparticles were attached chemically to the surface of SnO nanoplates, finally the mixture was heated at 700 °C in an oven in air for 4 h. This composite material was sonicated for 2 h in terpineol to make a viscous homogeneous slurry and then 'written' directly across the electrode area using the DPN technique without any mask. The devices were characterised by exposure to ethanol vapour in humid air in the concentration range of 100-1000 ppm. The sensitivity varied from 1.2 to 0.27 ppm(-1) for 100-1000 ppm of ethanol at 10% relative humid air. Selectivity measurements showed that the sensors were selective towards ethanol when they were exposed to acetone and toluene.

Temperature-modulated graphene oxide resistive humidity sensor for indoor air quality monitoring.

In this paper we present a temperature-modulated graphene oxide (GO) resistive humidity sensor that employs complementary-metal-oxide-semiconductor (CMOS) micro-electro-mechanical-system (MEMS) micro-hotplate technology for the monitoring and control of indoor air quality (IAQ). GO powder is obtained by chemical exfoliation, dispersed in water and deposited via ink-jet printing onto a low power micro-hotplate. Atomic force microscopy (AFM) and transmission electron microscopy (TEM) show the typical layered and wrinkled morphology of the GO. Raman spectroscopy, X-ray photoelectron spectroscopy (XPS) and Fourier transform infra-red (FTIR) spectroscopy indicate that the GO flakes possess a significant number of oxygen containing functional groups (epoxy, carbonyl, hydroxyl) extremely attractive for humidity detection. Electro-thermal characterisation of the micro-hotplates shows a thermal efficiency of 0.11 mW per °C, resulting in a sensor DC power consumption of only 2.75 mW at 50 °C. When operated in an isothermal mode, the sensor response is detrimentally affected by significant drift, hysteretic behaviour, slow response/recovery times and hence poor RH level discrimination. Conversely, a temperature modulation technique coupled with a differential readout methodology results in a significant reduction of the sensor drift, improved linear response with a sensitivity of 0.14 mV per %, resolution below 5%, and a maximum hysteresis of ±5%; response and recovery times equal to 189 ± 49 s and 89 ± 5 s, respectively. These performance parameters satisfy current IAQ monitoring requirements. We have thus demonstrated the effectiveness of integrating GO on a micro-hotplate CMOS-compatible platform enabling temperature modulation schemes to be easily applied in order to achieve compact, low power, low cost humidity IAQ monitoring.

Evolution of increased adult longevity in Drosophila melanogaster populations selected for adaptation to larval crowding.

In holometabolous animals such as Drosophila melanogaster, larval crowding can affect a wide range of larval and adult traits. Adults emerging from high larval density cultures have smaller body size and increased mean life span compared to flies emerging from low larval density cultures. Therefore, adaptation to larval crowding could potentially affect adult longevity as a correlated response. We addressed this issue by studying a set of large, outbred populations of D. melanogaster, experimentally evolved for adaptation to larval crowding for 83 generations. We assayed longevity of adult flies from both selected (MCUs) and control populations (MBs) after growing them at different larval densities. We found that MCUs have evolved increased mean longevity compared to MBs at all larval densities. The interaction between selection regime and larval density was not significant, indicating that the density dependence of mean longevity had not evolved in the MCU populations. The increase in longevity in MCUs can be partially attributed to their lower rates of ageing. It is also noteworthy that reaction norm of dry body weight, a trait probably under direct selection in our populations, has indeed evolved in MCU populations. To the best of our knowledge, this is the first report of the evolution of adult longevity as a correlated response of adaptation to larval crowding.

CMOS integration of inkjet-printed graphene for humidity sensing.

We report on the integration of inkjet-printed graphene with a CMOS micro-electro-mechanical-system (MEMS) microhotplate for humidity sensing. The graphene ink is produced via ultrasonic assisted liquid phase exfoliation in isopropyl alcohol (IPA) using polyvinyl pyrrolidone (PVP) polymer as the stabilizer. We formulate inks with different graphene concentrations, which are then deposited through inkjet printing over predefined interdigitated gold electrodes on a CMOS microhotplate. The graphene flakes form a percolating network to render the resultant graphene-PVP thin film conductive, which varies in presence of humidity due to swelling of the hygroscopic PVP host. When the sensors are exposed to relative humidity ranging from 10-80%, we observe significant changes in resistance with increasing sensitivity from the amount of graphene in the inks. Our sensors show excellent repeatability and stability, over a period of several weeks. The location specific deposition of functional graphene ink onto a low cost CMOS platform has the potential for high volume, economic manufacturing and application as a new generation of miniature, low power humidity sensors for the internet of things.

MRI in necrotizing fasciitis of the extremities.

Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed T2 weighted or short tau inversion-recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that T2-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.

Hairy cell leukemia presenting as a peripancreatic mass: cytomorphology and radiographic correlates.

Hairy cell leukemia (HCL) usually presents with peripheral cytopenias, diffuse marrow infiltration, and splenomegaly. This chronic lymphoproliferative disorder is not typically associated with lymphadenopathy or mass lesions. We report a case of HCL first treated by splenectomy, followed by several years of interferon therapy. Twenty-five years later, the patient presented with weight loss, fatigue, and a large PET-avid mass surrounding the head of the pancreas. Fine-needle aspiration was pursued to investigate the unusual and infiltrative appearance of the lesion, which was suggestive of another primary malignancy. Cytology smears showed discohesive lymphoid cells with round nuclei and delicate cytoplasmic projections. Flow cytometry confirmed the presence of a clonal B-cell population with bright expression of CD20 as well as CD25 and CD103, diagnostic of HCL. This is the first report of HCL presenting as a peripancreatic mass. The importance of correlation with radiology and clinical history is emphasized when evaluating such lesions.

Large cell transformation of mycosis fungoides on fine needle aspiration: an unusual case mimicking classical Hodgkin lymphoma.

Mycosis fungoides (MF), the most common type of primary cutaneous T-cell lymphoma, undergoes large cell transformation in only a minority of cases that present in patch stage. We describe a 52-year-old patient with a history of unilesional patch stage MF treated with localized radiotherapy. He had disease recurrence 5 years later and began psoralen plus ultraviolet A treatment with good response. After inguinal lymphadenopathy was detected on physical examination, a follow-up PET scan showed a fluorodeoxyglucose-avid inguinal node, which was evaluated by fine needle aspiration. Cytomorphology showed numerous Reed-Sternberg-like cells, highly suspicious for Hodgkin lymphoma. Histologic sections revealed isolated sinusoidal involvement by pleomorphic CD30-positive tumor cells, diagnostic of large cell transformation of MF in light of clinical history. The cells were also positive for CD15 and CD4. This case emphasizes morphologic features of an entity with limited description in the cytology literature and adds to the growing number of reported CD15-positive T-cell lymphomas.

Multisectoral development for improved health outcomes: evaluation of community-based initiatives in the Islamic Republic of Iran.

Community-based initiatives (CBI) are based on integrated multisectoral socioeconomic development with community participation and intersectoral support to improve the health and quality of life of the people. During 2005-06 the World Health Organization supported an evaluation of CBI in the Islamic Republic of Iran by collecting information from intervention villages on social capital and other indicators, with validation of the findings. The data showed some positive changes in the intervention areas compared with control villages. The evaluation suggests that the CBI approach is a useful tool for improving health and social indicators and providing mechanisms for community-based participation and intersectoral collaboration for health and development at the local level.

Effect of processing paddy on digestibility of rice starch by in vitro studies.

Paddy (Oryza sativa L) (variety 'IR - 64'), was parboiled, puffed by sand roasting and flaked by edge runner and roller flaker and variations in physical and physicochemical properties were studied. Moisture contents were lower (5.8-10.8%) in processed rice products compared to raw materials (11.8%). Ratio of rice to sand in the case of puffed rice preparation was optimized. The equilibrium moisture content was 27.4% in raw rice while it was much higher (38.9-81.0%) in processed rice. Sedimentation volume was lowest (6.2 ml) in raw rice and highest (18.8 ml) in popped rice. Starch content was 84.8 and 76.5-83% in raw and processed rice, respectively. In vitro starch digestibility was highest in roller flaker flakes and lowest in raw milled rice. Among the ready to eat products, popped rice showed least starch digestibility (∼30%).

Risk factors for extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae acquisition in a neonatal intensive care unit.

This study was made to find the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae in neonatal intensive care unit (NICU) and to identify the risk factors associated with the acquisition of these organisms. Risk factors associated with ESBL-producing E. coli and/or K. pneumoniae acquisition status of neonates were assessed. Of 253 neonates admitted, 238 entered the active surveillance system. ESBL-producing K. pneumoniae was responsible for 7 infections and 51 colonizations while ESBL-producing E. coli was responsible for 9 infections and 88 colonizations. Concurrent isolation of both the organisms occurred in 30 neonates. The logistic regression model identified 'length of stay in the NICU' as the single independent risk factor. Imipenem, cefepime and amikacin can be suggested as the drugs of choice in our study.

Multisectoral development for improved health outcomes: evaluation of community-based initiatives in the Islamic Republic of Iran

Community-based initiatives [CBI] are based on integrated multisectoral socioeconomic development with community participation and intersectoral support to improve the health and quality of life of the people. During 2005-06 the World Health Organization supported an evaluation of CBI in the Islamic Republic of Iran by collecting information from intervention villages on social capital and other indicators, with validation of the findings. The data showed some positive changes in the intervention areas compared with control villages. The evaluation suggests that the CBI approach is a useful tool for improving health and social indicators and providing mechanisms for community-based participation and intersectoral collaboration for health and development at the local level

On-chip deposition of carbon nanotubes using CMOS microhotplates.

The direct deposition of carbon nanotubes on CMOS microhotplates is demonstrated in this paper. Tungsten microhotplates, fabricated on thin SOI membranes aside CMOS control circuitry, are used to locally grow carbon nanotubes by chemical vapour deposition. Unlike bulk heating of the entire chip, which could cause degradation to CMOS devices and interconnects due to high growth temperatures in excess of 500 °C, this novel technique allows carbon nanotubes to be grown on-chip in localized regions. The microfabricated heaters are thermally isolated from the rest of the CMOS chip as they are on the membranes. This allows carbon nanotubes to be grown alongside CMOS circuitry on the same wafer without any external heating, thus enabling new applications (e.g. smart gas sensing) where the integration of CMOS and carbon nanotubes is required.

The reliability of nipple aspirate and ductal lavage in women at increased risk for breast cancer--a potential tool for breast cancer risk assessment and biomarker evaluation.

PURPOSE: Ductal lavage, a technique used to sample epithelial cells from breast ducts, has potential use in risk assessment and biomarker evaluation among women at increased risk for breast cancer. However, little is known about the reliability of the procedure. METHODS: We evaluated the reliability of nipple aspirate (NAF) and ductal lavage at two time points 6 months apart in women at increased risk for breast cancer. Eligible women had a 5-year Gail risk >or=1.66% or lifetime risk of >20%, and/or a family history or personal history of breast cancer. All ducts that produced NAF were cannulated. The kappa statistic was used to evaluate reliability of NAF production, cellular yield, and cytologic diagnosis. RESULTS: Sixty-nine women (mean age, 47 years) were enrolled over 35 months. Forty-seven returned for a second visit. At baseline, 65% of premenopausal and 41% of postmenopausal women produced NAF (P = 0.05), of which 72% underwent successful lavage of at least one duct. Samples of inadequate cellular material for diagnosis were significantly more likely in postmenopausal women than in premenopausal women (P = 0.04). Of the women who returned for a second visit, 18 of 24 who produced NAF had at least one duct successfully cannulated. Twenty-four ducts in 14 women were lavaged twice. Among these ducts, cellular yield for the two time points was inconsistent (kappa = 0.33 +/- 0.13), and only fair cytologic agreement was observed (kappa = 0.32 +/- 0.15). Ductal lavage was associated with moderate discomfort. CONCLUSION: Currently, the use of ductal lavage is limited by technical challenges in duct cannulation, inconsistent NAF production, a high rate of inadequate cellular material for diagnosis, fair cytologic reproducibility, and low participant return rates.

Effect of supplemental pre-operative fluid on postoperative nausea and vomiting.

In a prospective, double-blind, randomised controlled trial, we studied the effects of pre-operative fluid load on post-operative nausea and vomiting. Eighty patients attending for laparoscopic cholecystectomy or gynaecological surgery were randomly allocated to receive 2 ml.kg-1 (conservative) or 15 ml.kg-1 (supplemental) Hartmann's solution intravenously, shortly before induction of anaesthesia. During the operation, fluid management was identical in both groups. During the first post-operative 24 h, post-operative nausea and vomiting occurred in 29 patients (73%) in the conservative fluid group and nine patients (23%) in the supplemental fluid group (p = 0.01). Supplemental pre-operative fluid is an inexpensive and safe therapy for reducing post-operative nausea and vomiting.

The effect of auricular acupuncture on anaesthesia with desflurane.

In most acupuncture studies it is difficult or even impossible to conduct a truly double-blind trial. However, this is possible when treatments are carried out on anaesthetised patients. Because acupuncture provides analgesia, we tested the hypothesis that needle stimulation of a combination of four ear acupoints would significantly reduce anaesthetic requirement. Ten healthy volunteers were anaesthetised with desflurane and randomly assigned to no treatment or acupuncture; the alternative treatment was given on a subsequent study day. Auricular acupuncture was performed with needles placed at the Shen Men, Thalamus, Tranquiliser and Master Cerebral Points on the right ear. Anaesthetic requirement, determined by the Dixon up-and-down method, was defined by the average desflurane concentration that prevented purposeful movement of the extremities in response to noxious electrical stimulation. Volunteers required a greater desflurane concentration to prevent movement on the control than on the acupuncture day: 4.9 (0.7; SD) vs. 4.4 (0.8) vol. %, p = 0.003. Acupuncture thus reduced anaesthetic requirement by 8.5 (7)%.

Application of virtual microscopy in clinical cytopathology.

Virtual microscopy (VM) refers to the use of an automated microscope and digital imaging technology to scan, store, and view glass slides. VM systems allow the user to view a scanned image of the entire slide at multiple magnifications on a computer screen. We tested VM to evaluate its possible utility in diagnostic cytopathology. Ten cervical-vaginal monolayered preparations (AutoCyte preparation) were scanned using a BLISS (Bacus Laboratories Inc. Slide Scanner) system. Approximately 20-30% of the cellular area of each slide was imaged. The cases were randomly chosen to include examples ranging from benign cellular changes (BCC) to high-grade squamous intraepithelial lesions (HSIL). The computer performed image tiling and fusing of multiple JPEG images to create a high-quality VM slide. Six examiners (two each of cytopathologists, senior residents, and cytotechnologists) blindly evaluated the VM slides using an image server program (WebSlide Browser thin client software). The cytopathologic diagnoses made on the VM slide were then compared to the original glass slide diagnoses. BLISS took 36-100 min (avg. 58.4 min) to scan the selected fields in a glass slide with file sizes ranging from 23.1-83.6 MB. Time taken by the examiners to render a diagnosis ranged from 1-15 min (avg. 4.1 min) per case. The combined diagnostic accuracy was 98.3%. Only one case of LSIL was missed by one examiner. VM is a promising new tool, which gives a user the feel and simulated experience of an actual microscopic examination and provides a useful alternative to a glass slide in diagnostic cytopathology. Possible applications include: 1) second opinion consultation without transporting the glass slide, 2) education, 3) VM proficiency tests / board exams, and 4) telepathology. Shortcomings include 1) expensive initial setup, 2) inability to maintain an adequate focus in a thick smear with multiple levels, 3) large storage size of the VM slide, and 4) relatively long time needed to scan a slide.

Chordoma: a cytologic study with histologic and radiologic correlation.

BACKGROUND: Chordoma is a rare malignant tumor of fetal notochord origin that occurs along the spinal axis. The fine-needle aspiration biopsy (FNAB) findings are described, correlated with histology and radiology, and compared with previously reported descriptions of chordoma. METHODS: Fine-needle aspiration biopsies of 12 cases of chordoma with histologic confirmation were reviewed. Imaging studies were reviewed in seven cases. Cytologic material included smears, ThinPrep, and cell blocks. Immunostains were performed on selected cytologic and histologic specimens. Multiple cytologic parameters were studied. RESULTS: Eleven specimens were from the spinal axis, and one was from a chest wall metastasis. Ten cases were diagnosed as chordoma on cytologic material, one was positive for malignancy with a differential diagnosis of chordoma and well differentiated chondrosarcoma, and one was positive for malignancy, not further classified. Most smears were moderately to highly cellular and demonstrated typical physaliphorous cells and a myxoid background. Two of the 10 cases diagnosed as chordoma showed pleomorphic physaliphorous cells, nuclear inclusions, and binucleation. Nuclear inclusions were observed in three other cases diagnosed as chordoma. Histologic follow-up of one case with pleomorphic physaliphorous cells showed conventional chordoma with focal areas of increased cellularity and pleomorphism. Pleomorphic sarcomatous cells were the predominant cell type in one case that showed dedifferentiated chordoma histologically. Mitotic figures were rarely observed in cytologic material. CONCLUSIONS: Cytomorphologic features of chordoma allow accurate diagnosis by FNAB. Features associated with dedifferentiation include increased pleomorphism of physaliphorous cells and may include nuclear inclusions, bi- or multinucleation, and rarely, mitotic figures. Cancer (Cancer Cytopathol)