Biliary Duct Hamartomas: A Systematic Review.

Biliary duct hamartomas are benign intrahepatic bile duct lesions. Despite being primarily incidental findings on imaging, these lesions can provide a diagnostic conundrum due to their shared characteristics with malignant tumors. The goal of this systematic review is to offer a thorough clinical profile of biliary duct hamartomas. There were 139 cases of biliary duct hamartomas identified in a structured systematic review of the literature. Patient demographics, clinical presentation, significant laboratory and imaging data, diagnostic modalities, treatment choices, and outcomes were all studied and reported. Biliary duct hamartomas present with mild symptoms and laboratory abnormalities, and while being visible on imaging, the results are non-specific and may require biopsy in case of red flag signs such as weight loss and a progressive increase in the size of the lesion. Furthermore, there are currently no published guidelines for the treatment of biliary duct hamartomas, and many people have had surgery despite the clinically benign nature of these abnormalities. As per the findings of the study, individuals who exhibit signs of malignancy should be investigated further. Eyeballing for red flag symptoms, followed by a specialized imaging scan and invasive treatment, is the three-step approach to biliary duct hamartomas. Since our recommendations include a shift in strategy and do not contradict existing rules, there are likely to be few roadblocks to improvement; the key barriers being technological equipment and image quality. In this study, we intended to pave the way for future research in the field. In our opinion, the next decade will bring a better understanding of the characteristics of biliary hamartomas, disease symptoms, and better recognition of any suspicious features. These indications will aid in reducing the number of unneeded surgical or invasive operations. Finally, the findings of these future studies will allow the medical community to improve and provide the best care possible.

Myoepithelial Carcinoma Ex-Pleomorphic Adenoma: A Rare Pathology Misdiagnosed as Pleomorphic Adenoma; With a Novel TERT Promoter Mutation and High PD-L1 Expression.

Myoepithelial carcinoma (MECA) is a rare salivary gland (SG) neoplasm (0.1-0.45% of all SG tumors) that often presents with bland cytomorphology and can be misclassified as cellular pleomorphic adenoma (PA) or myoepithelioma. This is particularly challenging in MECA ex-PA cases, especially if tumor shows minimal to no capsular invasion. We report a rare case of a 76-year-old female; history of left superficial parotidectomy with diagnosis (outside hospital) of cellular PA, who re-presented 9 months post surgery with enlarging left parotid mass, neck lymphadenopathy and facial nerve deficits. FNAB of parotid and neck lymph node revealed cellular aspirates with loosely cohesive clusters of myoepithelial cells with occasional chondromyxoid stroma. Prior resection slides were reviewed, and diagnosis of MECA ex-PA was made. Patient underwent left radical parotidectomy, selective neck dissection, with facial nerve sacrifice (due to extensive encasing by tumor). Histology showed a multinodular tumor with pushing borders, zonal arrangement comprising of a hypocellular, necrotic/myxoid center, and a peripheral rim of myoepithelial cells, confirmed by positive S100, and p63. Tumor extensively infiltrated peri parotid soft tissues with multiple foci of lymphovascular and perineural invasion; and metastatic neck lymph nodes. Next generation sequencing revealed a novel TERT promoter mutation (c.-124C > T), not usually described in SG neoplasms. Further, PD-L1 immunohistochemistry showed positive expression, making patient eligible for anti-PDL-1 immunotherapy. This case highlights importance of recognizing the subtle malignant features of MECA in distinguishing it from benign mimics like PA. In addition, presence of TERT mutation opens a new arena for future research to explore potential treatment targets.

Socially distanced teaching: The mental health impact of the COVID-19 pandemic on special education teachers.

Little is known about the impact of the COVID-19 pandemic on special education teachers. Of 468 surveyed across the United States, 38.4% met clinical criteria for generalized anxiety disorder, a rate 12.4 times greater than the U.S. population, and 37.6% for major depressive disorder, a rate 5.6 times greater than the population. Race/ethnicity, gender, or school funding was not related to mental health. The impact of the pandemic was moderate to extreme on stress (91%), depression (58%), anxiety (76%), and emotional exhaustion (83%).

Utility of the Milan System for Reporting Salivary Gland Cytology, with focus on the incidence and histologic correlates of atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP): A 3-year institutional experience.

BACKGROUND: Fine-needle aspiration (FNA) is the preferred diagnostic test for salivary gland lesions. The purpose of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is to standardize salivary gland cytology reporting and guide treatment decisions. The objective of the current study was to evaluate the utility and performance of the MSRSGC, with a focus on the cytomorphology of lesions diagnosed as atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP). METHODS: In total, 123 salivary gland FNAs were included in the study. FNA diagnoses for all cases were reviewed and recategorized, as applicable, according to the MSRSGC. Cytohistologic correlation was performed in 51 cases that had available surgical follow-up, and the risk of malignancy (ROM) was calculated. RESULTS: Most FNA samples were from the parotid gland. The mean patient age was 61.4 years, and the male-to-female ratio was 1.3:1. The ROM was 0% (categories I and II; nondiagnostic and benign nonneoplastic, respectively), 50% (category III; AUS), 0% (category IVA; benign neoplasm), 40% (category IVB; SUMP), 100% (category V; suspicious for malignancy), and 100% (category VI; malignant). Sensitivity, specificity, positive predictive value, and negative predictive value were 100% each. In addition, the primary factors for an AUS diagnosis were identified as low cellularity and/or the presence of lymphocytes. The presence of oncocytes followed by cellular atypia in an otherwise classic pleomorphic adenoma were principal factors for a SUMP diagnosis. CONCLUSIONS: The authors report an ROM comparable to that reported in the literature, with a sensitivity and specificity of 100%, supporting adaptation of the MSRSGC into the system for reporting salivary gland cytology. In addition, the findings emphasize the need to refine criteria for AUS and SUMP, thereby improving the predictive capability and subsequent management of salivary gland lesions.

Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management.

BACKGROUND: Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms. SUMMARY: BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease. KEY MESSAGES: In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.

Impact of Etch Processes on the Chemistry and Surface States of the Topological Insulator Bi2Se3.

The unique properties of topological insulators such as Bi2Se3 are intriguing for their potential implementation in novel device architectures for low power and defect-tolerant logic and memory devices. Recent improvements in the synthesis of Bi2Se3 have positioned researchers to fabricate new devices to probe the limits of these materials. The fabrication of such devices, of course, requires etching of the topological insulator, in addition to other materials including gate oxides and contacts which may impact the topologically protected surface states. In this paper, we study the impact of He+ sputtering and inductively coupled plasma Cl2 and SF6 reactive etch chemistries on the physical, chemical, and electronic properties of Bi2Se3. Chemical analysis by X-ray photoelectron spectroscopy tracks changes in the surface chemistry and Fermi level, showing preferential removal of Se that results in vacancy-induced n-type doping. Chlorine-based chemistry successfully etches Bi2Se3 but with residual Se-Se bonding and interstitial Cl species remaining after the etch. The Se vacancies and residuals can be removed with postetch anneals in a Se environment, repairing Bi2Se3 nearly to the as-grown condition. Critically, in each of these cases, angle-resolved photoemission spectroscopy (ARPES) reveals that the topologically protected surface states remain even after inducing significant surface disorder and chemical changes, demonstrating that topological insulators are quite promising for defect-tolerant electronics. Changes to the ARPES intensity and momentum broadening of the surface states are discussed. Fluorine-based etching aggressively reacts with the film resulting in a relatively thick insulating film of thermodynamically favored BiF3 on the surface, prohibiting the use of SF6-based etching in Bi2Se3 processing.

Dislocation driven spiral and non-spiral growth in layered chalcogenides.

Two-dimensional materials have shown great promise for implementation in next-generation devices. However, controlling the film thickness during epitaxial growth remains elusive and must be fully understood before wide scale industrial application. Currently, uncontrolled multilayer growth is frequently observed, and not only does this growth mode contradict theoretical expectations, but it also breaks the inversion symmetry of the bulk crystal. In this work, a multiscale theoretical investigation aided by experimental evidence is carried out to identify the mechanism of such an unconventional, yet widely observed multilayer growth in the epitaxy of layered materials. This work reveals the subtle mechanistic similarities between multilayer concentric growth and spiral growth. Using the combination of experimental demonstration and simulations, this work presents an extended analysis of the driving forces behind this non-ideal growth mode, and the conditions that promote the formation of these defects. Our study shows that multilayer growth can be a result of both chalcogen deficiency and chalcogen excess: the former causes metal clustering as nucleation defects, and the latter generates in-domain step edges facilitating multilayer growth. Based on this fundamental understanding, our findings provide guidelines for the narrow window of growth conditions which enables large-area, layer-by-layer growth.

High-Mobility Helical Tellurium Field-Effect Transistors Enabled by Transfer-Free, Low-Temperature Direct Growth.

The transfer-free direct growth of high-performance materials and devices can enable transformative new technologies. Here, room-temperature field-effect hole mobilities as high as 707 cm2 V-1 s-1 are reported, achieved using transfer-free, low-temperature (≤120 °C) direct growth of helical tellurium (Te) nanostructure devices on SiO2 /Si. The Te nanostructures exhibit significantly higher device performance than other low-temperature grown semiconductors, and it is demonstrated that through careful control of the growth process, high-performance Te can be grown on other technologically relevant substrates including flexible plastics like polyethylene terephthalate and graphene in addition to amorphous oxides like SiO2 /Si and HfO2 . The morphology of the Te films can be tailored by the growth temperature, and different carrier scattering mechanisms are identified for films with different morphologies. The transfer-free direct growth of high-mobility Te devices can enable major technological breakthroughs, as the low-temperature growth and fabrication is compatible with the severe thermal budget constraints of emerging applications. For example, vertical integration of novel devices atop a silicon complementary metal oxide semiconductor platform (thermal budget <450 °C) has been theoretically shown to provide a 10× systems level performance improvement, while flexible and wearable electronics (thermal budget <200 °C) can revolutionize defense and medical applications.

Fermi Level Manipulation through Native Doping in the Topological Insulator Bi2Se3.

The topologically protected surface states of three-dimensional (3D) topological insulators have the potential to be transformative for high-performance logic and memory devices by exploiting their specific properties such as spin-polarized current transport and defect tolerance due to suppressed backscattering. However, topological insulator based devices have been underwhelming to date primarily due to the presence of parasitic issues. An important example is the challenge of suppressing bulk conduction in Bi2Se3 and achieving Fermi levels ( EF) that reside in between the bulk valence and conduction bands so that the topologically protected surface states dominate the transport. The overwhelming majority of the Bi2Se3 studies in the literature report strongly n-type materials with EF in the bulk conduction band due to the presence of a high concentration of selenium vacancies. In contrast, here we report the growth of near-intrinsic Bi2Se3 with a minimal Se vacancy concentration providing a Fermi level near midgap with no extrinsic counter-doping required. We also demonstrate the crucial ability to tune EF from below midgap into the upper half of the gap near the conduction band edge by controlling the Se vacancy concentration using post-growth anneals. Additionally, we demonstrate the ability to maintain this Fermi level control following the careful, low-temperature removal of a protective Se cap, which allows samples to be transported in air for device fabrication. Thus, we provide detailed guidance for EF control that will finally enable researchers to fabricate high-performance devices that take advantage of transport through the topologically protected surface states of Bi2Se3.