Review of the UK NEQAS (H) digital morphology pilot scheme for continuing professional development accessed via the internet

UK NEQAS (H) developed and instigated a pilot scheme for digital morphology, which was accessed by participants over the internet in order to assess the viability of using high quality images as an educational tool for continuing professional development. The pilot scheme was trialled over a 2-year period with eight releases totalling 16 morphology cases. Digital images allowed participating individuals to examine and comment on exactly the same cells and compare their findings with those of other participants, consensus data from traditional glass slide surveys and expert opinion. Feedback from participants on their experience was then relayed back to the development team by UK NEQAS (H) in order to drive the educational format and to ensure that any new scheme would meet the requirements of the users.     

Coronavirus disease 2019 (COVID-19): Focus on peripheral blood cell morphology

Numerous studies have shown peculiar morphological anomalies in COVID-19 patients' smears. We searched all the peer-reviewed scientific publications that explicitly reference the cytomorphological alterations on peripheral blood smears of patients with COVID-19. We extracted data from sixty-five publications (case reports, patient group studies, reviews, and erythrocyte morphology studies). The results show that frequent alterations concern the morphology of lymphocytes (large lymphocytes with weakly basophilic cytoplasm, plasmacytoid lymphocytes, large granular lymphocytes). Neutrophils display abnormal nuclei and cytoplasm in a distinctive cytomorphological picture. Besides a left shift in maturation, granulations can be increased (toxic type) or decreased with areas of basophilia. Nuclei are often hyposegmented (pseudo-Pelger-Huёt anomaly). Apoptotic or pycnotic cells are not uncommon. Monocytes typically have a large cytoplasm loaded with heterogeneous and coalescing vacuoles. Platelets show large and giant shapes. The presence of erythrocyte fragments and schistocytes is especially evident in the forms of COVID-19 that are associated with thrombotic microangiopathies. Such atypia of blood cells reflects the generalized activation in severe COVID-19, which has been demonstrated with immunophenotypic, molecular, genetic, and functional methods. Neutrophils, in particular, are involved in the pathophysiology of hyperinflammation with cytokine storm, which characterizes the most unfavorable evolution.     

Hepatic granulomas: a 6-year experience in a single center in Greece

BACKGROUND: Hepatic granulomas have been reported in 2-15% of unselected liver biopsies, with a wide clinical profile responsible for their presence. To date, no series concerning the prevalence and the etiology of granulomas from Greece has been reported. OBJECTIVES: To evaluate the prevalence and the etiology of hepatic granulomas and to investigate whether there has been an alteration in distribution of diagnoses in our series compared with those published so far in the literature. STUDY: The results of liver biopsy specimens performed in a Department of Medicine, between 1999 and 2004, were retrospectively reviewed and the cases revealing hepatic granulomas had their medical notes and the liver biopsies recorded. RESULTS: Over the study period, 1768 liver biopsies were performed. Hepatic granulomas were identified in 66 (3.7%). Of those, 51 were female with a mean age of 57 years (range 34-74 years) and 15 were male with a mean age of 42 years (range 18-78 years). Autoimmune liver diseases including primary biliary cirrhosis, overlap syndrome and autoimmune hepatitis accounted for the majority of cases (68%), followed by sarcoidosis (7.5%), chronic hepatitis B virus and hepatitis C virus infection (7.5%), idiopathic (6%), drugs (3%) and other miscellaneous causes (7.5%). CONCLUSIONS: Our series showed that autoimmune liver diseases, mainly primary biliary cirrhosis was the most common cause of granuloma formation, a finding rather similar to that stated in the studies from Western countries. A rather small number of idiopathic cases were recorded. Chronic viral hepatitis and sarcoidosis rates were equal, a finding possibly reflecting a fairly high proportion of viral hepatitis in our sample.     

Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience

Background/Purpose. Day-case laparoscopic cholecystectomy (LC) offers convenience to patients and cost saving to the healthcare institutes. This article reviews our prospectively recorded experience with day-case LC to determine its applicability and safety, as well as patient satisfaction. Methods. Of 744 consecutive patients who underwent LC over a 6-year period, 140 (19%) were scheduled for day-case surgery. Selection criteria included American Society of Anesthesiologists (ASA) score of 1 or 2, absence of morbid obesity, low risk for common bile duct stones, domicile within 50?km of the hospital, age greater than 18 and less than 75, and the ability to admit the patient on the day of surgery for operation during the morning. Patient satisfaction with day-case surgery was assessed by questionnaire at 4–6 weeks after operation. Results. Some 117 of the 140 patients (84%) were discharged home on the same day of the operation. Two patients were re-admitted with abdominal pain, 1 of whom underwent a negative re-laparoscopy. There were no major complications. The reasons for overnight hospital stay were anesthetic in 12 (52%), surgical in 7 (30%), and social or logistic in 4 (18%) patients. There were no conversions. The proportion of patients scheduled for day-case remained static (median, 18.5%; range, 16%–22%). Some 99 of 105 patients (94%) who completed the questionnaire were satisfied with day-case surgery. Conclusions. In carefully selected patients, day-case LC is achievable and safe, and provides good patient satisfaction.     

Re-positioning pretarsal tissue layers for double-eyelid surgery: 6-year experience

Double-eyelid surgery is a very common practice in East Asian patients. The differential distribution of pretarsal tissue layers is considered to be the anatomical mechanism of natural Asiatic single eyelid, it is possible to form double-eyelid crease by re-positioning the pretarsal structure layers. The author presents a new double-eyelid surgery based on re-positioning of the pretarsal structure layers without tissue removal. Over a 6-year period, 1440 patients underwent new double-eyelid surgeries. With the pretarsal orbicularis oculi muscle incised, the pre-pretarsal levator aponeurosis fascia fibroadipose was first dissected to form a fibroadipose flap, and then repositioned with the eyelid lower lip orbicularis oculi muscle flap. The new composite structure was anchored at 3 points on the pretarsal levator aponeurosis fascia; the skin was sutured to form a smooth crease. Post-operative outcome and follow-up data were analyzed. Patients were followed up for an average of 2 years. esthetic outcomes were satisfactory for 97.91% of patients, who enjoyed new double upper eyelids with smooth creases and invisible incision lines. Outcomes were unsatisfactory for 2.08% of patients (double-eyelid regression, 0.76%; asymmetric creases, 1.32%). All patients who were not satisfied with their esthetic outcomes underwent second correction surgery. This new Pan-flap technique focuses on the correct dissection and repositioning of differentially thickened pre-pretarsal levator aponeurosis fascia fibroadipose tissue in East Asian patients. This new technique can generate broader and tighter attachment between pretarsal orbicularis oculi muscle and levator aponeurosis fascia, and form smooth double-eyelid crease without pretarsal soft tissue removal.     

河南省艾滋病筛查实验室质量控制现状分析

目的了解河南省艾滋病（AIDS）筛查实验室质量控制现状,发现并解决技术及管理中存在的问题,提高检测质量。方法以疫情较重县区和工作量较大的实验室为首选,兼顾民办医疗机构及其他机构的实验室,对质量保证及质量控制情况进行现场调查,统计分析存在的问题,提出合理建议。结果共调查了108个实验室,发现45.4%（49/108）的实验室无仪器设备校准,31.5%（34/108）的酶联免疫吸附试验（ELISA）的原始记录不规范,76.9%（83/108）无质控图绘制者及实验室负责人签字,48.2%（52/108）无失控分析及纠错记录,34.3%（37/108）未每次实验使用外部质控品。各实验室对发现的问题进行限期整改。结论河南省AIDS筛查实验室总体运行良好,应加强实验室技术培训及质量控制方面的工作,提高工作质量。     

Results of an autologous noncryopreserved, unmanipulated peripheral blood hematopoietic stem cell transplant program: a single-institution, 10-year experience

BACKGROUND: Methods to simplify the stem cell transplantation procedures are needed mainly in developing countries. We have previously shown that unprocessed leukapheresis material is useful to restore hematopoiesis after high-dose chemotherapy. METHODS: Over a 10-year period in a private practice setting, we prospectively performed autotransplants using noncryopreserved and unmanipulated peripheral blood stem cells mobilized from the bone marrow to the peripheral blood by means of filgrastim and using a single-day conditioning regimen with high dose (200 mg/m2) melphalan. RESULTS: Forty-six individuals were given 50 autografts. The median age of the patients was 33 years (range 8-69). Twenty-two patients with acute leukemia (13 with myeloblastic and 9 with lymphoblastic leukemia), 4 with chronic myelogenous leukemia, 6 with multiple myeloma, 7 with Hodgkin's disease, 3 with non-Hodgkin's lymphoma and 4 with metastatic breast carcinoma were included. The median time to achieve >0.5 x 10(9)/l granulocytes was 14 days (range 0-86), whereas the median time to achieve >20 x 10(9)/l platelets was 25 days (range 0-102). The 3,300-day posttransplant survival was 63%, the median posttransplant overall survival was over 3,300 days, the 3,300-day disease-free survival was 50% and the transplant-related mortality was 2%. The procedure was performed entirely on an outpatient basis in the case of 48 autografts (96%). The approximate cost of each graft was 7,500 USD. CONCLUSION: This simplified method to autograft patients, avoiding in-hospital stays, purging procedures and cryopreservation of the cells, is feasible and results in a substantial decrease in the cost of the autologous hematopoietic stem cell transplantation methods.     

Quality management and accreditation in laboratory hematology: Perspectives from India

Quality management (QM), including quality assurance and quality control, was developed in clinical laboratories in North America and Western Europe, but must be implemented worldwide to ensure accurate, reproducible, and clinically useful results. India, a middle income country with a population of over 1.34 billion, has limited budget allotted to health care. As yet accreditation for clinical laboratories is not mandatory, which contributes to challenges in implementing good laboratory practice. This review provides a summary of internationally laid down QM principles and their application in a middle income country like India.     

Sezary cell morphology induced in peripheral blood lymphocytes: re- evaluation

In this study we examined the effect of mitogens and epidermal cells in inducing a Sezary cell morphology in normal peripheral blood lymphocytes. Peripheral blood mononuclear cells from six healthy volunteers were stimulated with the mitogens phytohemaglutinin and concanavalin A, and also cocultivated with human epidermal cell cultures. Incubation times with mitogens and epidermal cells were four days and stimulation of the lymphocytes by mitogens was confirmed by standard 3H-thymidine uptake. Standard transmission electron microscopy showed that in the mitogen-driven system 20% to 60% (33 +/- 15%) and in the epidermal cell-driven system 5% to 15% (8 +/- 4%) of the lymphoid cells exhibited mild to moderate indentation of the nuclei with nuclear contour indices (NCI) of 4.6 to 6.5 but no Sezary cells were observed (cells with NCI greater than 6.5 and up to 19.2). In the mitogen- stimulated preparation 2% to 5% (3 +/- 1%) of the lymphoid cells showed nuclear multilobulation resembling the cells seen in adult T cell lymphoma/leukemia. Incubation of mononuclear cells for longer periods of up to 4 weeks with mitogens and exogenous IL-2 resulted in no further morphologic changes. Using an indirect immunogold technique at the electron microscopic level, the cells showing nuclear indentation or lobulation were shown to bear both T helper (CD4) and T suppressor (CD8) cell phenotypes in a similar ratio to the total numbers of T helper and T suppressor cells present. Mitogens and epidermal cells are thus not able to induce a morphologic change to Sezary cells in normal peripheral blood lymphocytes.     

广州市2009年性病实验室室间质评分析

目的通过对广州市性病实验室开展室间质评活动,提高实验室检测质量,完善全市三级性病监测网络。方法发放衣原体（Ct）抗原样本、梅毒螺旋体血清样本、性病常规阅片,共计990份,要求做Ct抗原检测、梅毒血清学试验和性病常规阅片。结果 58家实验室室间质评成绩平均分90.09分,各质控项目得分由高到低分别为梅毒血清特异性抗体定性试验100分,非特异性抗体定性检验97.24分,非特异性抗体定量检验90分,衣原体抗原检测86.55分,分泌物涂片阅片86.38分。全市成绩优秀实验室39家（67.24%）,操作水平（SI）≥0有39家,占67.24%。通过性病规范化建设的实验室成绩优秀面达到90.91%。结论通过性病规范化建设的实验室,检测能力明显高于其他医疗单位。通过这次质评活动还发现,部分单位使用试剂不合理,检验报告不规范等问题,需加强专业技术人员培训和室内、室间质控,提高检测水平。