Microscopia confocal ex vivo con método de fusión y tinción digital: cambiando paradigmas en el diagnóstico histológico

The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces images more quickly and with a higher resolution than before. By means of a fusion mode that combines simultaneously scanned fluorescence and reflectance images, it produces digitally stained images that simulate the effect of hematoxylin-eosin staining. Application of this new technology has opened the door to real-time tissue diagnostics.     

Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología

Photographs are necessary in the clinical practice of dermatology, but there are ethical implications to consider. Moreover, dermatologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient autonomy and the physician's obligation to do no harm. The law differentiates between 2 bases for protection: one concerns the photographed person's rights over the image and the other protects personal data. Recent legislation places restrictions on taking photographs and exhibiting them. Photographs taken to be stored with a medical history have not been called into question, but the physician is recommended to inform the patient that they exist. When a photograph is exhibited for the purpose of teaching or illustrating concepts, it is necessary to determine whether or not the patient can be identified. If the answer is yes, the patient must give explicit permission. Caution should be exercised when publishing medical photographs on social media.     

Redefining shared decision-making in the digital era

Perioperative shared decision-making can be improved through the development of novel patient-centered outcome measures made possible by digital phenotyping—“the moment-by-moment quantification of individual-level human phenotype in situ using data from personal digital devices, in particular smartphones.” This Short Report presents data from a patient with breast cancer that illustrates the opportunities of digital phenotyping to better inform patient quality of life while also discussing the challenges to its adoption. With time, effort, and physician engagement, digital phenotyping can help surgeons better understand the patient experience in the postoperative period and in turn, help them provide care that maximizes patient quality of life.     

Influence of implant scanbody material,position and operator on the accuracy of digital impression for complete-arch: A randomized in vitro trial

PurposeTo evaluate the influence of implant scanbody (ISB) material, position and operator on the accuracy of a confocal microscopy intraoral scanning (IOS) for complete-arch implant impression.MethodsAn edentulous maxillary model with 6 internal hexagonal connection analogues was scanned with an extraoral optical scanner to achieve a reference file. Three ISBs made of different materials (polyetheretherketone (Pk), titanium (T) and Pk with a titanium base (Pkt)) were scanned with IOS by 3 operators. The resulting 45 test files were aligned to the reference file with a best fit algorithm. Linear (ΔX, ΔY and ΔZ-axis) and angular deviations (ΔANGLE) were assessed. Absolute values of the linear discrepancies were summed up to obtain a global measure of linear absolute error (ΔASS). Influence of ISB material, position and operator was statistically assessed using the mixed general linear model.ResultsAt multivariate analysis, whenΔASS was considered as response variable, it was identified a significant influence of material (p < 0.0001) and position (p = 0.0009) while no significant operator effect was detected.When ΔANGLE was considered as response variable, material and position significantly influenced the expected ΔANGLE (p = 0.0232 and p < 0.0001) and no operator effect was identified.ConclusionsThe investigated IOS for complete-arch digital impression was influenced by the ISB material with peek reporting the best results on both linear and angular measurements followed by titanium, peek-titanium resulting as the less accurate. Implant angulation affected significantly the linear deviations while implant position the angular deviations. Operator did not show any significant effect on the IOS accuracy.     

Comparison of a quantitative Real-Time PCR assay and droplet digital PCR for copy number analysis of the CCL4L genes

The controversy surrounding the findings that copy number variation, of the CCL3 encoding genes, influences HIV-1 infection and disease progression has been in part attributed to the variable results obtained from methods used for copy number evaluation. Like CCL3, the genes encoding the CC chemokine CCL4, also a natural ligand of the CCR5 receptor, are found to occur in population-specific multiple copy number and have been shown to play a protective role against HIV-1. This study evaluated the standard method of quantitative Real-Time PCR (qPCR) and droplet digital PCR (ddPCR) for CCL4L gene copy number determination. The CCL4 encoding genes are CCL4, occurring in two copies per diploid genome (pdg), and the non-allelic CCL4L genes, comprised of CCL4L1 and CCL4L2, which are both found in multiple copies pdg. Copy number of CCL4L, CCL4L1 and CCL4L2 was determined in a cohort of HIV-1-uninfected individuals from the South African Black (n = 23) and Caucasian (n = 32) population groups using qPCR and ddPCR. A stronger correlation between the number of CCL4L copies and the sum of CCL4L1 and CCL4L2 copies generated by ddPCR (r = 0.99, p < 0.0001) compared to qPCR (r = 0.87, p < 0.0001) was observed. Real-Time qPCR exhibited greater inaccuracy at higher copy numbers which is particularly relevant to our cohort of Black individuals who have a higher range of CCL4L copies (3–6) compared to Caucasians (0–4) and a higher population median (4 and 2, respectively). Medians and ranges of CCL4L1 (Black: 2, 0–4, Caucasian: 0, 0–2) and CCL4L2 (Black: 2, 1–5, Caucasian: 2, 0–3) were also higher in the Black population. Droplet digital PCR was shown to be a far superior method to qPCR for assessment of CCL4 gene copy number variation, the accuracy of which is essential for studies of the contribution of variable gene copy number to phenotypic outcomes of host infection and disease course.     

Internet-delivered psychoeducation for older adolescents and young adults with autism spectrum disorder (SCOPE): An open feasibility study

BackgroundThere is a paucity regarding interventions in general, and especially internet-delivered treatment options, for adolescents and young adults with autism spectrum disorder (ASD), despite the group´s capacity and willingness to utilize computer-mediated communication. This open feasibility study evaluated the new internet-delivered, psychoeducational intervention, SCOPE (Spectrum COmputerized PsychoEducation), for adolescents and young adults aged 16–25 years with ASD in the normative IQ range.MethodThe participation in SCOPE was facilitated by weekly contacts with disability service professionals (trained coaches) and the intervention consisted of eight ASD-themed modules. In an open feasibility study we evaluated treatment completion, treatment credibility and satisfaction, as well as preliminary efficacy. We assessed feasibility in an outpatient disability services context, regarding both participants’ and coaches’ experiences.ResultsTwenty-three out of the 29 included participants (79%) completed the intervention. The participants’ experience of treatment credibility was increased during the SCOPE web course and the overall satisfaction with the treatment was high. The coaches reported high treatment credibility and good clinical feasibility of the internet-based delivered intervention. The participants’ knowledge of ASD increased significantly from pre-intervention to post-intervention. The increased knowledge of ASD was not associated with negative effects on psychological well-being.ConclusionsOur results suggest that the internet-delivered psychoeducational intervention SCOPE is a feasible intervention and could contribute to youth’s sense of empowerment through increased knowledge of ASD and themselves. An ongoing randomized controlled study will generate further evidence concerning the SCOPE intervention.     

Digital volume tomography (DVT) as a diagnostic modality of the anterior skull base

Conclusion. Because of high resolution and the relatively lower costs in comparison with modern helical CT scanners, digital volume tomography (DVT) can be recommended in the diagnosis of the nasal cavity and paranasal sinuses. Objectives. DVT is an advancement of panoramic tomography and is based on the principles of rotational tomography. It enables high resolution visualization of osseous structures. The slices can be displayed in three orthogonal planes that can be changed in angle arbitrarily. Data volumes of up to 12×17 cm can be examined with a new generation of the DVT. The aim of this study was to point out the potential of DVT in the anterior skull base. Subjects and methods. DVT scans with a cylindrical size of 10 cm in diameter and 10 cm in height were performed in 23 patients. The identification of surgical key landmarks (uncinate process, middle turbinate, ethmoidal bulla, agger nasi cells, Haller cells, frontal recess, anterior ethmoidal artery in its relationship to the skull base, the cribiform plate of the sphenoidal sinus in relation to the optic nerve, and the internal carotid artery) was evaluated. Results. Display of the essential surgical key landmarks was possible in all patients