Comparison of p16INK4a and ProEx™ C immunostaining on cervical ThinPrep® cytology and biopsy specimens

ProEx? C and p16^INK4a staining of cytology/histology specimens have recently been explored to help distinguish high‐grade squamous intraepithelial lesions (HSIL) from benign mimics. The goal of this study was to evaluate the performance characteristics of p16 and ProEx C in tissue and patient matched ThinPrep® liquid‐based cytology specimens. Residual cervical ThinPrep cytology specimens and tissue blocks (N = 64) from 63 patients were stained with p16 and ProEx C. Review of immunostained material, Papanicolaou and H&E stained slides was performed by two cytopathologists. The cytology slides were evaluated for the presence or absence of squamous atypia as well as immunoreactivity. Histologic specimens were interpreted as negative, indeterminate, or positive for each immunostain. There was 86% agreement (55/64) between the p16 and ProEx C stains on tissue specimens. Eleven specimens were interpreted as positive for both stains. All had a low‐ or high‐grade squamous lesion on the corresponding H&E section. ProEx C was able to identify four low‐grade squamous intraepithelial lesion specimens that were interpreted as negative by p16. All four HSIL specimens demonstrated p16 and ProEx C staining. However, 84% of cytology negative specimens demonstrated false‐positive staining. Clinical utilization of both stains, combined with morphologic features, may be beneficial for confirming HSIL on histologic specimens. ProEx C and/or p16 immunostains may lead to a false‐positive result in cytology specimens due to staining of normal appearing cells. Diagn. Cytopathol. 2010;38:564–572. 2009 Wiley‐Liss, Inc.     

Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome

BACKGROUND: Hyponatraemia is the most commonly identified electrolyte abnormality. Published data on severe hyponatraemia in general medical in-patients is lacking. AIM: To determine the aetiology, adequacy of assessment, and outcome of severe hyponatraemia in general medical in-patients. DESIGN: Retrospective case-note review. METHODS: All general medical in-patients (n = 108) with serum sodium < or =125 mmol/l were identified from the clinical chemistry database, over a six-month period. A full review of notes and computer records was undertaken at the index date and a pre-determined follow-up date. RESULTS: Follow-up data were available in 105 patients. There was a wide range of aetiologies: diuretic therapy (loop and thiazide), congestive cardiac failure and liver disease were the most common, and 75.3% of patients had multiple causes. None of the 48% of patients whose history suggested a possible diagnosis of the syndrome of inappropriate anti-diuretic hormone (SIADH) met the generally accepted diagnostic criteria. Overall mortality was 20% during the index admission and 44.6% at follow-up, vs. 7.1% and 22%, respectively, for other patients admitted to the same directorate over the same time period (p < 0.001). Mortality was linked to aetiology, but not to reduced absolute serum sodium concentration at admission. DISCUSSION: Severe hyponatraemia in general medical patients is associated with a complex, multifactoral aetiology and a very poor prognosis. Outlook is governed principally by aetiology, and not by serum sodium level. Assessment of patients with hyponatraemia requires a practical clinical algorithm for diagnosing SIADH.     

Concept mapping: an effective, active teaching-learning method

Nurse educators, under pressure to prepare graduates who are able to think critically and solve problems in a variety of clinical practice settings, require active teaching strategies to promote meaningful learning, instead of relying on traditional methods that promote rote memorization. A review of the current state of the science with regard to concept mapping demonstrates that this teaching-learning method assists nurse educators to prepare graduates to think critically in the complex health care environment. However, further research is needed to determine the effectiveness of concept mapping on the graduate's performance on the NCLEX exam and on critical thinking and prioritization skills in the clinical environment.     

The putative role of transforming viruses in childhood acute lymphoblastic leukemia

Epidemiological evidence suggests that infection is involved in the etiology of common acute lymphoblastic leukemia, either by stimulating an inappropriate immune response or in the form of a classical transforming agent. In an attempt to elucidate the role that infection is playing in this disease, we used representational difference analysis (RDA) to examine tumor samples for the presence of exogenous genomes. Twenty RDA experiments were carried out, using four different restriction enzymes, but no exogenous sequences were identified within leukemic cells. These results suggest that it is unlikely that a single, direct transforming agent is involved in the pathogenesis of common acute lymphoblastic leukemia.     

Haematopoietic stem cell transplantation as primary therapy of sporadic adult Burkitt lymphoma

High dose chemoradiotherapy and haematopoietic stem cell transplantation (SCT) is used as primary therapy for patients diagnosed with Burkitt lymphoma (BL). Forty-three adults presented with sporadic BL in British Columbia between 1987 and 2003. Twenty patients had bone marrow involvement. Sixteen patients did not proceed to SCT because of chemorefractory disease (n = 9) or other reasons (n = 7). Twenty-seven patients proceeded to SCT and had a 3-year event-free survival of 51%. In conclusion, approximately 50% of patients with chemosensitive BL who undergo SCT can be cured; however, a significant number of patients will not proceed to SCT because of early resistance or recurrence.     

SARS-CoV-2 Infection among Pregnant and Postpartum Women,Kenya, 2020–2021

We determined incidence of severe acute respiratory syndrome coronavirus 2 and influenza virus infections among pregnant and postpartum women and their infants in Kenya during 2020–2021. Incidence of severe acute respiratory syndrome coronavirus 2 was highest among pregnant women, followed by postpartum women and infants. No influenza virus infections were identified.     

Electrophysiological evidence of the capture of visual attention

We investigated the ability of salient yet task-irrelevant stimuli to capture attention in two visual search experiments. Participants were presented with circular search arrays that contained a highly salient distractor singleton defined by color and a less salient target singleton defined by form. A component of the event-related potential called the N2pc was used to track the allocation of attention to lateralized positions in the arrays. In Experiment 1, a lateralized distractor elicited an N2pc when a concurrent target was presented on the vertical meridian and thus could not elicit lateralized components such as the N2pc. A similar distractor-elicited N2pc was found in Experiment 2, which was conducted to rule out certain voluntary search strategies. Additionally, in Experiment 2 both the distractor and the target elicited the N2pc component when the two stimuli were presented on opposite sides of the search array. Critically, the distractor-elicited N2pc preceded the target-elicited N2pc on these trials. These results demonstrate that participants shifted attention to the target only after shifting attention to the more salient but task-irrelevant distractor. This pattern of results is in line with theories of attention in which stimulus-driven control plays an integral role.     

An unusual pathologic feature associated with dermatomyositis

We present a case of juvenile dermatomyositis with unusual histopathologic findings. The child presented with a course consistent with dermatomyositis, a diagnosis confirmed by finding reticulotubular aggregates in endothelial cells on electron microscopy. However, histopathology of his muscle biopsy revealed a striking pattern of glycogen accumulation, to an extent similar to that seen in glycogen storage diseases; this degree of accumulation could potentially confound histopathologic diagnosis.