Inflammation and tissue remodeling contribute to fibrogenesis in stricturing Crohn’s disease: image processing and analysis study

Background

Inflammation and structural remodeling may contribute to fibrogenesis in Crohn’s disease (CD). We quantified the immunoexpression of calretinin, CD34, and calprotectin as a surrogate for mucosal innervation, telocytes (interstitial cells playing a role in networking), and inflammation, respectively, and correlated them with bowel alterations in stricturing CD.

Methods

Primary resection specimens for ileal CD (n = 44, 31 stricturing CD, 13 inflammatory CD) were identified. Left-sided ulcerative colitis and trauma cases were used as controls. Proximal and distal margin and middle (diseased) sections were stained for calretinin, CD34, and calprotectin. Microscopic images were captured from the mucosa (calretinin), submucosa (calprotectin), and myenteric plexus (CD34), and the immunostaining was quantified using image processing and analysis. Bowel thickness at the corresponding sections were measured and correlated with the amount of immunoexpression.

Results

A total of 2,037 images were analyzed. In stricturing CD, submucosal alteration/thickening at the stricture site correlated with calprotectin staining and inversely correlated with calretinin staining at the proximal margin. Muscularis propria alteration/thickening at the stricture site correlated with mucosal calretinin staining at the proximal margin. Submucosal alteration/thickening at the proximal margin correlated with calretinin and CD34 staining at the proximal margin and inversely correlated with CD34 staining at the stricture site. Calretinin immunostaining at the distal margin was significantly higher in stricturing CD than the controls.

Conclusions

Inflammation and tissue remodeling appear to contribute to fibrogenesis in stricturing CD. Increased mucosal calretinin immunostaining distal to the diseased segment could be helpful in diagnosing CD in the right clinical context.

Evidence of a positive association between malpractice climate and thyroid cancer incidence in the United States

The incidence of thyroid cancer has risen dramatically in the past few decades. The cause of this is unclear, but several lines of evidence indicate it is largely due to overdiagnosis, the diagnosis of tumors that would have never manifest clinically if untreated. Practices leading to overdiagnosis may relate to defensive medicine. In this study, we evaluated the association between malpractice climate and incidence of thyroid, breast, prostate, colon, and lung cancer in U.S. states from 1999-2012 using publicly available government data. State-level malpractice risk was quantified as malpractice payout rate, the number of malpractice payouts per 100,000 people per state per year. Associations between state-level cancer incidence, malpractice payout rate, and several cancer risk factors were evaluated. Risk factors included several social determinants of health, including factors predicting healthcare access. States with higher malpractice payout rate had higher thyroid cancer incidence, on both univariate analysis (r = 0.51, P = 0.009, Spearman) and multivariate analysis (P<0.001, multilevel model). In contrast, state-level malpractice payout rate was not associated with incidence of any other cancer type. Malpractice climate may be a social determinant for being diagnosed with thyroid cancer. This may be a product of greater defensive medicine in states with higher malpractice risk, which leads to increased diagnostic testing of patients with thyroid nodules and potential overdiagnosis. Alternatively, malpractice risk may be a proxy for another, unmeasured risk factor.

An unusual cause of tonsillar asymmetry

We present the first reported case of tonsillar asymmetry secondary to a mandibular osteoma. Computed tomography rather than tonsillectomy for histology prevented the distress and risk of unnecessary surgery, and the patient was managed conservatively.

Abstract P2-01-25: Upfront immunohistochemistry to evaluate sentinel lymph nodes in breast cancer: Reasonable or not?

This abstract was withdrawn by the authors.

Hand hygiene compliance: universally better post-contact than pre-contact in healthcare workers in the UK and Australia

Objective: To establish whether post-patient contact hand hygiene practice is universally higher than pre-patient contact in two highly resourced countries.

Methods: Observations of medical and nursing staffs' hand hygiene compliance were made by the same observers in two different hospitals in Sydney and Birmingham, in both intensive care units (ICU) and surgical wards, using a standardised data collection tool. Results: Hand hygiene rates pre- and post-patient contact were low for both nurses and doctors in Sydney and Birmingham, with the exception of Sydney ICU doctors (pre-contact 74.8% and post-contact 75.7%, p=0.868). Post-contact compliance was low but significantly better than pre-contact in Sydney ICU nurses (41.3% versus 59.6% p<0.0001), surgical ward nurses (14.9% versus 29.6%, p=0.0019) and Sydney surgeons (10.2% versus 30.2%, p<0.0001). Post-contact compliance rates were low but higher than pre-contact in Birmingham ICU nurses (33.1% versus 52.2%, p=0.0011) and doctors (29.3% versus 70.1%, p<0.0001) but not in the Birmingham surgical ward (nurses: 42.6% versus 43.4%, p=0.89; surgeons: 39.6% versus 48.4%, p=0.187). Handwashing on removal of gloves was extremely low (1.7% to 16.6%), regardless of city, specialties or clinical staff.

Conclusion: The pattern of post-contact compliance and non-compliance associated with glove use strongly suggests hand hygiene practice in both countries is primarily self-protective rather than a patient safety centred practice.