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Mukhopadhyay S, Sansano I. Smoking-Related Interstitial Lung Disease: Historical Perspective and Advances in the Twenty-first Century. Surg Pathol Clin 2024; 17:159-171. [PMID: 38692802 DOI: 10.1016/j.path.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
In the twenty- first century, there is widespread agreement that in addition to lung cancer, emphysema, and chronic bronchitis, cigarette smoking causes accumulation of pigmented macrophages, interstitial fibrosis, and Langerhans cell proliferation in various permutations. These histologic changes remain subclinical in some patients and produce clinical manifestations and imaging abnormalities in others. Debate surrounds terminology of these lesions, which are often grouped together under the umbrella of "smoking-related interstitial lung disease." This review summarizes modern concepts in our understanding of these abnormalities and explains how the recognition of smoking-related interstitial fibrosis has advanced the field.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Irene Sansano
- Department of Pathology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Catalunya, Spain
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2
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Mukhopadhyay S. Differential diagnosis of IgG4-positive plasma cells in the lung. Semin Diagn Pathol 2024; 41:72-78. [PMID: 37993385 DOI: 10.1053/j.semdp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
The recognition of immunoglobulin G4-related disease (IgG4-RD) as an entity in the pancreaticobiliary tract was followed by a slew of papers describing inflammation and fibrosis containing IgG4-positive plasma cells in a variety of sites including the respiratory tract, leading to the hypothesis that these abnormalities were attributable to IgG4-RD. Predictably, pathologists began to see requests from clinicians to perform IgG4 immunohistochemistry in lung biopsies "to rule out IgG4-RD". Several years later, the notion that IgG4-RD would prove to be the underlying cause of a wide array of fibroinflammatory lesions in the lung has not panned out as promised. To the contrary, it has become clear that IgG4-positive plasma cells are not specific for IgG4-RD, and that large numbers of IgG4-positive plasma cells can be encountered in other well-defined entities, including inflammatory myofibroblastic tumor and nodular lymphoid hyperplasia, as well as in lymphoplasmacytic infiltrates in other entities, including connective tissue disease and idiopathic forms of interstitial lung disease. It has also become clear that raised serum IgG4 levels can occur in settings other than IgG4-RD. These observations suggest that true IgG4-RD of the lung is far less common than previously surmised. Pathologists must familiarize themselves with mimics of IgG4-RD in the lung and exercise caution before attributing lymphoplasmacytic infiltrates in the lung to IgG4-RD.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue/L25, Cleveland, OH 44195, United States.
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Roy AS, Banerjee K, Roy P, Shil R, Ravishankar R, Datta R, Sen A, Manna S, Ghosh TK, Mukherjee G, Rana TK, Kundu S, Nayak SS, Pandey R, Paul D, Atreya K, Basu S, Mukhopadhyay S, Pandit D, Kulkarni MS, Bhattacharya C. Measurement of energy and directional distribution of neutron ambient dose equivalent for the 7Li(p,n) 7Be reaction. Appl Radiat Isot 2024; 204:111140. [PMID: 38070360 DOI: 10.1016/j.apradiso.2023.111140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 12/31/2023]
Abstract
Double differential neutron fluence distributions were measured in the 7Li(p,n)7Be reaction for proton beam energies 7, 9 and 12 MeV. Seven liquid scintillator based detectors were employed to measure neutron fluence distributions using the Time of Flight technique. Neutron ambient dose equivalents were determined from the measured fluence distribution using ICRP (International Commission on Radiological Protection) recommended fluence to dose equivalent conversion coefficients. Neutron dose equivalents were also measured using a conventional BF3 detector based REM counter. Ambient dose equivalent measured by the REM counter is found to be in agreement with that determined from the neutron fluence spectra within their uncertainties. Angular distributions of the ambient dose equivalents were also determined from the measured fluence distributions at different angles.
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Affiliation(s)
- A S Roy
- Health Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - K Banerjee
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India.
| | - Pratap Roy
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - R Shil
- Visva Bharati University, Santiniketan, Bolpur, West Bengal 731235, India
| | - R Ravishankar
- Health Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - R Datta
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; RP&AD, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - A Sen
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - S Manna
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - T K Ghosh
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - G Mukherjee
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - T K Rana
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - S Kundu
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - S S Nayak
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - R Pandey
- Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - D Paul
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - K Atreya
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - S Basu
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - S Mukhopadhyay
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - Deepak Pandit
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
| | - M S Kulkarni
- Health Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - C Bhattacharya
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India; Variable Energy Cyclotron Centre, 1/AF, Bidhannagar, Kolkata 700064, India
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Wang AY, Lin S, Tran C, Homer RJ, Wilsdon D, Walsh JC, Goebel EA, Sansano I, Sonawane S, Cockenpot V, Mukhopadhyay S, Taskin T, Zahra N, Cima L, Semerci O, Özamrak BG, Mishra P, Vennavalli NS, Chen PHC, Cecchini MJ. Assessment of Pathology Domain-Specific Knowledge of ChatGPT and Comparison to Human Performance. Arch Pathol Lab Med 2024:498573. [PMID: 38244054 DOI: 10.5858/arpa.2023-0296-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/22/2024]
Abstract
CONTEXT.— Artificial intelligence algorithms hold the potential to fundamentally change many aspects of society. Application of these tools, including the publicly available ChatGPT, has demonstrated impressive domain-specific knowledge in many areas, including medicine. OBJECTIVES.— To understand the level of pathology domain-specific knowledge for ChatGPT using different underlying large language models, GPT-3.5 and the updated GPT-4. DESIGN.— An international group of pathologists (n = 15) was recruited to generate pathology-specific questions at a similar level to those that could be seen on licensing (board) examinations. The questions (n = 15) were answered by GPT-3.5, GPT-4, and a staff pathologist that recently passed their Canadian pathology licensing exams. Participants were instructed to score answers on a 5-point scale and to predict which answer was written by ChatGPT. RESULTS.— GPT-3.5 performed at a similar level to the staff pathologist, while GPT-4 outperformed both. The overall score for both GPT-3.5 and GPT-4 was within the range of meeting expectations for a trainee writing licensing examinations. In all but one question, the reviewers were able to correctly identify the answers generated by GPT-3.5. CONCLUSIONS.— By demonstrating the ability of ChatGPT to answer pathology-specific questions at a level similar to (GPT-3.5) or exceeding (GPT-4) a trained pathologist, this study highlights the potential of large language models to be transformative in this space. In the future, more advanced iterations of these algorithms with increased domain-specific knowledge may have the potential to assist pathologists and enhance pathology resident training.
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Affiliation(s)
- Andrew Y Wang
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Wang, Wilsdon)
| | - Sherman Lin
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada (Lin, Tran, Walsh, Goebel, Cecchini)
| | - Christopher Tran
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada (Lin, Tran, Walsh, Goebel, Cecchini)
| | - Robert J Homer
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Homer)
| | - Dan Wilsdon
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Wang, Wilsdon)
| | - Joanna C Walsh
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada (Lin, Tran, Walsh, Goebel, Cecchini)
| | - Emily A Goebel
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada (Lin, Tran, Walsh, Goebel, Cecchini)
| | - Irene Sansano
- Department of Pathology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Sansano)
| | - Snehal Sonawane
- Department of Pathology, University of Illinois at Chicago, Chicago (Sonawane)
| | - Vincent Cockenpot
- Department of Pathology-Genetics and Immunology, Institut Curie, PSL Research University, Paris, France (Cockenpot)
| | - Sanjay Mukhopadhyay
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Mukhopadhyay)
| | - Toros Taskin
- Department of Pathology, Agri Training and Research Hospital, Agri Ibrahim Cecen University, Agri, Turkey (Taskin)
| | - Nusrat Zahra
- Department of Pathology, Specialized Healthcare and Medical Education, Punjab, Pakistan (Zahra)
| | - Luca Cima
- Pathology Unit, Department of Laboratory Medicine, Santa Chiara University Hospital, APSS, Trento, Italy (Cima)
| | - Orhan Semerci
- Department of Pathology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey (Semerci)
| | - Birsen Gizem Özamrak
- Department of Pathology, Izmir Provincial Directorate of Health, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Turkey (Özamrak)
| | - Pallavi Mishra
- Department of Pathology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom (Mishra)
| | | | | | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada (Lin, Tran, Walsh, Goebel, Cecchini)
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Siefker-Radtke AO, Matsubara N, Park SH, Huddart RA, Burgess EF, Özgüroğlu M, Valderrama BP, Laguerre B, Basso U, Triantos S, Akapame S, Kean Y, Deprince K, Mukhopadhyay S, Loriot Y. Erdafitinib versus pembrolizumab in pretreated patients with advanced or metastatic urothelial cancer with select FGFR alterations: cohort 2 of the randomized phase III THOR trial. Ann Oncol 2024; 35:107-117. [PMID: 37871702 DOI: 10.1016/j.annonc.2023.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Erdafitinib is an oral pan-fibroblast growth factor receptor (FGFR) tyrosine kinase inhibitor approved to treat locally advanced/metastatic urothelial carcinoma (mUC) in patients with susceptible FGFR3/2 alterations (FGFRalt) who progressed after platinum-containing chemotherapy. FGFR-altered tumours are enriched in luminal 1 subtype and may have limited clinical benefit from anti-programmed death-(ligand) 1 [PD-(L)1] treatment. This cohort in the randomized, open-label phase III THOR study assessed erdafitinib versus pembrolizumab in anti-PD-(L)1-naive patients with mUC. PATIENTS AND METHODS Patients ≥18 years with unresectable advanced/mUC, with select FGFRalt, disease progression on one prior treatment, and who were anti-PD-(L)1-naive were randomized 1 : 1 to receive erdafitinib 8 mg once daily with pharmacodynamically guided uptitration to 9 mg or pembrolizumab 200 mg every 3 weeks. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. RESULTS The intent-to-treat population (median follow-up 33 months) comprised 175 and 176 patients in the erdafitinib and pembrolizumab arms, respectively. There was no statistically significant difference in OS between erdafitinib and pembrolizumab [median 10.9 versus 11.1 months, respectively; hazard ratio (HR) 1.18; 95% confidence interval (CI) 0.92-1.51; P = 0.18]. Median PFS for erdafitinib and pembrolizumab was 4.4 and 2.7 months, respectively (HR 0.88; 95% CI 0.70-1.10). ORR was 40.0% and 21.6% (relative risk 1.85; 95% CI 1.32-2.59) and median duration of response was 4.3 and 14.4 months for erdafitinib and pembrolizumab, respectively. 64.7% and 50.9% of patients in the erdafitinib and pembrolizumab arms had ≥1 grade 3-4 adverse events (AEs); 5 (2.9%) and 12 (6.9%) patients, respectively, had AEs that led to death. CONCLUSIONS Erdafitinib and pembrolizumab had similar median OS in this anti-PD-(L)1-naive, FGFR-altered mUC population. Outcomes with pembrolizumab were better than assumed and aligned with previous reports in non- FGFR-altered populations. Safety results were consistent with the known profiles for erdafitinib and pembrolizumab in this patient population.
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Affiliation(s)
- A O Siefker-Radtke
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - N Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - R A Huddart
- Section of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E F Burgess
- Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, USA
| | - M Özgüroğlu
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - B P Valderrama
- Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - B Laguerre
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - U Basso
- Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - S Triantos
- Janssen Research & Development, Spring House, USA
| | - S Akapame
- Janssen Research & Development, Spring House, USA
| | - Y Kean
- Janssen Research & Development, Spring House, USA
| | - K Deprince
- Janssen Research & Development, Beerse, Belgium
| | | | - Y Loriot
- Department of Cancer Medicine, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Xing J, Yadav R, Ntiamoah P, Gillespie CT, Mehta AC, Raymond DP, Mukhopadhyay S. Airway Injury Caused by Aspiration of Iron Sulfate Pills: A Series of 11 Cases. Mod Pathol 2023; 36:100347. [PMID: 37769995 DOI: 10.1016/j.modpat.2023.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
It is not widely recognized that iron (ferrous sulfate) pill aspiration causes airway damage. Clinical diagnosis is challenging because patients are often unaware that they have aspirated a pill. The literature on this entity consists mainly of case reports. The aim of this study is to describe the clinical and pathologic features of iron pill aspiration in a series of 11 patients. A retrospective review of our pathology archives was performed to identify cases of iron pill aspiration (2013-2023). All available histologic and cytologic material was rereviewed. Clinical information was collected from the electronic medical record, and imaging studies were rereviewed. Eighteen endobronchial biopsies were identified from 11 patients (7 women and 4 men; mean age, 70 years; range, 44-82 years). Eight patients had corresponding cytology (20 specimens). Medication history was available in 9 of 11 patients, all of whom were taking iron sulfate pills. Two patients reported possible aspiration episodes; 4 had risk factors for aspiration. The diagnosis of iron pill aspiration was suspected prior to biopsy in only 1 case. Histologically, iron pill particles were yellow, golden brown, or gray, were elongated and crystal or fiber like, and stained strongly with an iron stain. Common histologic findings included mucosal ulceration, acute and/or chronic inflammation, fibrosis, and squamous metaplasia. Iron pill particles were also identified in 11 cytology specimens from 6 patients. On Papanicolaou staining, iron pill particles were yellow to golden, fiber like, refractile, and crystalline. Reactive epithelial cells, squamous metaplasia, and acute inflammation were common. The combination of iron pill intake and discolored mucosa on bronchoscopy is a potential clue to the diagnosis of iron pill aspiration. Pathologists should familiarize themselves with the appearance of iron pill particles in endobronchial biopsies and cytology specimens from the respiratory tract as this diagnosis is seldom suspected on clinical grounds, and most patients lack a history of aspiration.
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Affiliation(s)
- Juan Xing
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Ruchi Yadav
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel P Raymond
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Tasnim S, Raja S, Mukhopadhyay S, Blackstone EH, Toth AJ, Barron JO, Raymond DP, Bribriesco AC, Schraufnagel DP, Murthy SC, Sudarshan M. Preoperative predictors of spread through air spaces in lung cancer. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01106-6. [PMID: 38006997 DOI: 10.1016/j.jtcvs.2023.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE Spread through air spaces (STAS) is a new histologic feature of invasion of non-small cell lung cancer that lacks sensitivity and specificity on frozen sections and is associated with higher recurrence and worse survival with sublobar resections. Our objective is to identify preoperative characteristics that are predictive of STAS to guide operative decisions. METHODS From January 2018 through December 2021, 439 cT1-3N0 M0 patients with non-small cell lung cancer and a median age of 68 years, 255 (58%) women, who underwent primary surgery at our institution were included. Patients who received neoadjuvant therapy and whose STAS status was not documented were excluded. Age, sex, smoking status, tumor size, ground-glass opacities, maximum standardized uptake values, and molecular markers on preoperative biopsy were evaluated as preoperative markers. Comparisons between groups were conducted using standardized mean differences and random forest classification was used for prediction modeling. RESULTS Of the 439 patients, 177 had at least 1 STAS-positive tumor, and 262 had no STAS-positive tumors. Overall, 179 STAS tumors and 293 non-STAS tumors were evaluated. Younger age (50 years or younger), solid tumor, size ≥2 cm, and maximum standardized uptake value ≥2.5 were independently predictive of STAS with prediction probabilities of 50%, 40%, 38%, and 40%, respectively. STAS tumors were more likely to harbor KRAS mutations and be PD-L1 negative. CONCLUSIONS Young age (50 years or younger), larger (≥2 cm) solid tumors, high maximum standardized uptake values, and presence of KRAS mutation, are risk factors for STAS and can be considered for lobectomy. Smoking status and gender are still controversial risk factors for STAS.
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Affiliation(s)
- Sadia Tasnim
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Andrew J Toth
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John O Barron
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel P Raymond
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alejandro C Bribriesco
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dean P Schraufnagel
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Monisha Sudarshan
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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Berglund F, Ali A, Sankar P, Karmali R, Majid M, Kumar A, Mudra S, Mukhopadhyay S, Klein AL. Pericardial mesothelioma presenting as constrictive pericarditis. Echocardiography 2023; 40:1147-1150. [PMID: 37694436 DOI: 10.1111/echo.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
A 46-year-old woman underwent pericardiocentesis and pericardial window for recurrent pericardial effusion. She presented 17 months later with signs and symptoms consistent with constrictive pericarditis. Cardiac magnetic resonance imaging revealed an infiltrative mass surrounding the pericardium. A transcutaneous core needle biopsy of the pericardium confirmed the diagnosis of pericardial mesothelioma.
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Affiliation(s)
- Felix Berglund
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ambreen Ali
- Centre for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Parvathy Sankar
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rehan Karmali
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad Majid
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Centre for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Centre for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Sarah Mudra
- Centre for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | | | - Allan L Klein
- Centre for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Mukhopadhyay S, Senior J, Saez-Mollejo J, Puglia D, Zemlicka M, Fink JM, Higginbotham AP. Superconductivity from a melted insulator in Josephson junction arrays. Nat Phys 2023; 19:1630-1635. [PMID: 37970534 PMCID: PMC10635826 DOI: 10.1038/s41567-023-02161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/03/2023] [Indexed: 11/17/2023]
Abstract
Arrays of Josephson junctions are governed by a competition between superconductivity and repulsive Coulomb interactions, and are expected to exhibit diverging low-temperature resistance when interactions exceed a critical level. Here we report a study of the transport and microwave response of Josephson arrays with interactions exceeding this level. Contrary to expectations, we observe that the array resistance drops dramatically as the temperature is decreased-reminiscent of superconducting behaviour-and then saturates at low temperature. Applying a magnetic field, we eventually observe a transition to a highly resistive regime. These observations can be understood within a theoretical picture that accounts for the effect of thermal fluctuations on the insulating phase. On the basis of the agreement between experiment and theory, we suggest that apparent superconductivity in our Josephson arrays arises from melting the zero-temperature insulator.
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Affiliation(s)
| | - J. Senior
- IST Austria, Klosterneuburg, Austria
| | | | - D. Puglia
- IST Austria, Klosterneuburg, Austria
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10
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Persaud P, Morillas J, Budev M, Mukhopadhyay S, Sethi S, Almeida F, Lum J. Acrophialophora Anastomotic Site Infection in a Re-Do Lung Transplant Recipient with Cystic Fibrosis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Sarkar T, Mukherjee A, Nag B, Ghosh A, Mondal S, Bhattacharyya R, Mukhopadhyay S. 95P Anticancer activity of Inula recemosa root extract in human liver cancer cell line by attenuation of OCT4/Sox2 axis. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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12
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Vehar SJ, Yadav R, Mukhopadhyay S, Nathani A, Tolle LB. Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease. Am J Clin Pathol 2022; 159:146-157. [PMID: 36495281 PMCID: PMC9891418 DOI: 10.1093/ajcp/aqac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To describe the clinical, radiologic, and pathologic findings in cases where smoking-related interstitial fibrosis (SRIF) was diagnosed in surgical lung biopsy specimens from patients with clinical and imaging features of diffuse parenchymal lung disease (DPLD). METHODS Cases were included in this study if patients had clinical and imaging evidence of DPLD and surgical lung biopsy specimens revealed SRIF. A dedicated multidisciplinary conference was held to correlate clinical, radiologic, and pathologic findings. RESULTS Six cases met inclusion criteria; all six (five women/one man, aged 42-57 years, mean age 47 years) were either current smokers (five of six) or ex-smokers (one of six) and were evaluated for respiratory symptoms and abnormal pulmonary function tests, most commonly reduced forced vital capacity (n = 3) and diffusing capacity for carbon monoxide (n = 6). The most common imaging abnormalities were bilateral ground-glass opacities, which correlated with histopathologic SRIF. Follow-up of up to 10 years showed stable or improved clinical symptoms, pulmonary function tests, and radiologic findings with smoking cessation (three patients) or a decrease in smoking (three patients). No specific treatments were given, and those treated with empiric corticosteroid tapers did not show discernible responses. CONCLUSIONS SRIF can present as clinically meaningful diffuse parenchymal lung disease in relatively young heavy smokers, characterized by bilateral ground-glass opacities and a stable clinical course.
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Affiliation(s)
- Susan J Vehar
- Pulmonary Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Leslie B Tolle
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Jebastin Thangaiah J, Booth CN, Brainard JA, Elsheikh TM, Reynolds JP, Ondrejka SL, Thilagar BP, Mukhopadhyay S, Doxtader EE. Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury. Am J Clin Pathol 2022; 158:723-729. [DOI: 10.1093/ajcp/aqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI.
Methods
Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case.
Results
We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218).
Conclusions
ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non–vaping-related cases.
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Affiliation(s)
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Tarik M Elsheikh
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | | | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Bright P Thilagar
- Division of General Internal Medicine , Mayo Clinic, Rochester, MN , USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
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14
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Dinnon KH, Leist SR, Okuda K, Dang H, Fritch EJ, Gully KL, De la Cruz G, Evangelista MD, Asakura T, Gilmore RC, Hawkins P, Nakano S, West A, Schäfer A, Gralinski LE, Everman JL, Sajuthi SP, Zweigart MR, Dong S, McBride J, Cooley MR, Hines JB, Love MK, Groshong SD, VanSchoiack A, Phelan SJ, Liang Y, Hether T, Leon M, Zumwalt RE, Barton LM, Duval EJ, Mukhopadhyay S, Stroberg E, Borczuk A, Thorne LB, Sakthivel MK, Lee YZ, Hagood JS, Mock JR, Seibold MA, O’Neal WK, Montgomery SA, Boucher RC, Baric RS. SARS-CoV-2 infection produces chronic pulmonary epithelial and immune cell dysfunction with fibrosis in mice. Sci Transl Med 2022; 14:eabo5070. [PMID: 35857635 PMCID: PMC9273046 DOI: 10.1126/scitranslmed.abo5070] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/17/2022] [Indexed: 01/27/2023]
Abstract
A subset of individuals who recover from coronavirus disease 2019 (COVID-19) develop post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC), but the mechanistic basis of PASC-associated lung abnormalities suffers from a lack of longitudinal tissue samples. The mouse-adapted SARS-CoV-2 strain MA10 produces an acute respiratory distress syndrome in mice similar to humans. To investigate PASC pathogenesis, studies of MA10-infected mice were extended from acute to clinical recovery phases. At 15 to 120 days after virus clearance, pulmonary histologic findings included subpleural lesions composed of collagen, proliferative fibroblasts, and chronic inflammation, including tertiary lymphoid structures. Longitudinal spatial transcriptional profiling identified global reparative and fibrotic pathways dysregulated in diseased regions, similar to human COVID-19. Populations of alveolar intermediate cells, coupled with focal up-regulation of profibrotic markers, were identified in persistently diseased regions. Early intervention with antiviral EIDD-2801 reduced chronic disease, and early antifibrotic agent (nintedanib) intervention modified early disease severity. This murine model provides opportunities to identify pathways associated with persistent SARS-CoV-2 pulmonary disease and test countermeasures to ameliorate PASC.
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Affiliation(s)
- Kenneth H. Dinnon
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Sarah R. Leist
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Kenichi Okuda
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Ethan J. Fritch
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Kendra L. Gully
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Gabriela De la Cruz
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Mia D. Evangelista
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Takanori Asakura
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Rodney C. Gilmore
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Padraig Hawkins
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Satoko Nakano
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Ande West
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Alexandra Schäfer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Lisa E. Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Jamie L. Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado 80206, USA
| | - Satria P. Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado 80206, USA
| | - Mark R. Zweigart
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Stephanie Dong
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Jennifer McBride
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Michelle R. Cooley
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Jesse B. Hines
- Golden Point Scientific Laboratories, Hoover, Alabama 35216, USA
| | - Miriya K. Love
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Steve D. Groshong
- Division of Pathology, Department of Medicine, National Jewish Health, Denver, Colorado 80206, USA
| | | | | | - Yan Liang
- NanoString Technologies, Seattle, Washington 98109, USA
| | - Tyler Hether
- NanoString Technologies, Seattle, Washington 98109, USA
| | - Michael Leon
- NanoString Technologies, Seattle, Washington 98109, USA
| | - Ross E. Zumwalt
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Lisa M. Barton
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma 73105, USA
| | - Eric J. Duval
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma 73105, USA
| | | | - Edana Stroberg
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma 73105, USA
| | - Alain Borczuk
- Weill Cornell Medicine, New York, New York 10065, USA
| | - Leigh B. Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Muthu K. Sakthivel
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina 27599, USA
| | - Yueh Z. Lee
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina 27599, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - James S. Hagood
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Pediatrics, Pulmonology Division and Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Jason R. Mock
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Max A. Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado 80206, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Stephanie A. Montgomery
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Ralph S. Baric
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Rapidly Emerging Antiviral Drug Discovery Initiative, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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15
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Mukhopadhyay S, Taylor L, Rasheed A. 385 Service Evaluation of the Management of Acute Cholecystitis in the Royal Gwent Hospital Pre and During the COVID-19 Pandemic. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
NICE guidelines set out the criteria for the treatment of patients with acute cholecystitis and the operative timescales for cholecystectomy. These targets were greatly affected during the Covid-19 pandemic. Therefore, we aimed to assess the impact that COVID-19 had on patients presenting with acute cholecystitis at a busy district general hospital. June 2020, compared with patients who presented with the same in June 2019.
Method
Patient cohorts were identified for matching seasons pre- and post-covid-19 (June 2019 and June 2020). Data of all patients who presented with acute cholecystitis was obtained using an electronic patient management system. Statistical analyses were performed using a Wilcoxon test.
Results
The results of the study indicate that waiting times post-covid are going down (p<0.05). Thus, days until cholecystectomy have decreased but the number of patients being operated on too has decreased thus further worsening waiting times for elective patients. The median and IQR's of days to surgery post-covid are 198 (121.5–278) and pre-covid are 251 (89.5–586.5). Presentations of gallstone complications almost doubled post-covid and the percentage of patients operated on decreased by over 20%.
Conclusions
It is clear from the data that the NICE guidance on the management of acute cholecystitis has been difficult to adhere to during the pandemic. While the time from diagnosis to operation has reduced post-covid the total number of operations has decreased drastically, putting further strain on elective waiting lists. This, inevitably, will result in further presentations of complications from gallstones and adverse patient outcomes.
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Affiliation(s)
| | - L Taylor
- Aneurin Bevan University Health Board , Newport , United Kingdom
| | - A Rasheed
- Aneurin Bevan University Health Board , Newport , United Kingdom
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16
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Lahiri SK, Malhotra S, Mukhopadhyay S, Srivastava GP. Intelligent inspection technology for cross-country buried petroleum pipelines. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v123/i3/396-405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Sen N, Tat D, Singh K, Goswami A, Mukhopadhyay S, Shenoy K. Single-phase flow distribution and mixing in a novel microfluidic header: Experimental and CFD studies. Chem Eng Res Des 2022. [DOI: 10.1016/j.cherd.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Viswanathan VS, Toro P, Corredor G, Mukhopadhyay S, Madabhushi A. The state of the art for artificial intelligence in lung digital pathology. J Pathol 2022; 257:413-429. [PMID: 35579955 PMCID: PMC9254900 DOI: 10.1002/path.5966] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 05/15/2022] [Indexed: 12/03/2022]
Abstract
Lung diseases carry a significant burden of morbidity and mortality worldwide. The advent of digital pathology (DP) and an increase in computational power have led to the development of artificial intelligence (AI)-based tools that can assist pathologists and pulmonologists in improving clinical workflow and patient management. While previous works have explored the advances in computational approaches for breast, prostate, and head and neck cancers, there has been a growing interest in applying these technologies to lung diseases as well. The application of AI tools on radiology images for better characterization of indeterminate lung nodules, fibrotic lung disease, and lung cancer risk stratification has been well documented. In this article, we discuss methodologies used to build AI tools in lung DP, describing the various hand-crafted and deep learning-based unsupervised feature approaches. Next, we review AI tools across a wide spectrum of lung diseases including cancer, tuberculosis, idiopathic pulmonary fibrosis, and COVID-19. We discuss the utility of novel imaging biomarkers for different types of clinical problems including quantification of biomarkers like PD-L1, lung disease diagnosis, risk stratification, and prediction of response to treatments such as immune checkpoint inhibitors. We also look briefly at some emerging applications of AI tools in lung DP such as multimodal data analysis, 3D pathology, and transplant rejection. Lastly, we discuss the future of DP-based AI tools, describing the challenges with regulatory approval, developing reimbursement models, planning clinical deployment, and addressing AI biases. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
| | - Paula Toro
- Department of PathologyCleveland ClinicClevelandOHUSA
| | - Germán Corredor
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOHUSA
- Louis Stokes Cleveland VA Medical CenterClevelandOHUSA
| | | | - Anant Madabhushi
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOHUSA
- Louis Stokes Cleveland VA Medical CenterClevelandOHUSA
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19
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Ribeiro Neto ML, Arrossi AV, Yadav R, Culver DA, Mukhopadhyay S, Parambil JG, Southern BD, Tolle L, Pande A, Almeida FA, Sahoo D, Glennie J, Ahmad U, Mehta AC, Gildea TR. Prospective cohort of cryobiopsy in interstitial lung diseases: a single center experience. BMC Pulm Med 2022; 22:215. [PMID: 35655191 PMCID: PMC9161499 DOI: 10.1186/s12890-022-01990-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Rationale Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy.
Objectives To evaluate the diagnostic yield and complications of cryobiopsy in patients selected by multidisciplinary discussion.
Methods This was a prospective cohort from 2017 to 2019. We included consecutive patients with suspected interstitial lung diseases being considered for lung biopsy presented at our multidisciplinary meeting. Measurements and main results Of 112 patients, we recommended no biopsy in 31, transbronchial forceps biopsy in 16, cryobiopsy in 54 and surgical biopsy in 11. By the end of the study, 34 patients had had cryobiopsy and 24 patients, surgical biopsy. Overall pathologic and multidisciplinary diagnostic yield of cryobiopsy was 47.1% and 61.8%, respectively. The yield increased over time for both pathologic (year 1: 28.6%, year 2: 54.5%, year 3: 66.7%, p = 0.161) and multidisciplinary (year 1: 50%, year 2: 63.6%, year 3: 77.8%, p = 0.412) diagnosis. Overall rate of grade 4 bleeding after cryobiopsy was 11.8%. Cryobiopsy required less chest tube placement (11.8% vs 100%, p < 0.001) and less hospitalizations compared to surgical biopsy (26.5% vs 95.7%, p < 0.001), but hospitalized patients had a longer median hospital stay (2 days vs 1 day, p = 0.004). Conclusions Diagnostic yield of cryobiopsy increased over time but the overall grade 4 bleeding rate was 11.8%. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01990-4.
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20
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Rama Esendagli D, Ntiamoah P, Kupeli E, Bhardwaj A, Ghosh S, Mukhopadhyay S, Mehta AC. Recurrence of primary disease following lung transplantation. ERJ Open Res 2022; 8:00038-2022. [PMID: 35651363 PMCID: PMC9149385 DOI: 10.1183/23120541.00038-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Lung transplant has become definitive treatment for patients with several end-stage lung diseases. Since the first attempted lung transplantation in 1963, survival has significantly improved due to advancement in immunosuppression, organ procurement, ex vivo lung perfusion, surgical techniques, prevention of chronic lung allograft dysfunction and bridging to transplant using extracorporeal membrane oxygenation. Despite a steady increase in number of lung transplantations each year, there is still a huge gap between demand and supply of organs available, and work continues to select recipients with potential for best outcomes. According to review of the literature, there are some rare primary diseases that may recur following transplantation. As the number of lung transplants increase, we continue to identify disease processes at highest risk for recurrence, thus shaping our future approaches. While the aim of lung transplantation is improving survival and quality of life, choosing the best recipients is crucial due to a shortage of donated organs. Here we discuss the common disease processes that recur and highlight its impact on overall outcome following lung transplantation. This article reviews the underlying conditions leading to lung transplant with potential for recurrence and the impact of such recurrences on the overall outcome following transplanthttps://bit.ly/3v3gSvJ
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21
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Verma N, Mukhopadhyay S, Barnable P, Plagianos MG, Teleshova N. Estradiol inhibits HIV-1 BaL infection and induces CFL1 expression in peripheral blood mononuclear cells and endocervical mucosa. Sci Rep 2022; 12:6165. [PMID: 35418661 PMCID: PMC9008051 DOI: 10.1038/s41598-022-10163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
An inhibitory effect of estradiol (E2) on HIV-1 infection was suggested by several reports. We previously identified increased gene expression of actin-binding protein cofilin 1 (CFL1) in endocervix in the E2-dominated proliferative phase of the menstrual cycle. Actin cytoskeleton has an integral role in establishing and spreading HIV-1 infection. Herein, we studied in vitro effects of E2 on HIV-1 infection and on CFL1 expression to gain insight into the mechanism of HIV-1 inhibition by E2. E2 dose-dependently inhibited HIV-1BaL infection in peripheral blood mononuclear cells (PBMCs) and endocervix. In PBMCs and endocervix, E2 increased protein expression of total CFL1 and phosphorylated CFL1 (pCFL1) and pCFL1/CFL1 ratios. LIMKi3, a LIM kinase 1 and 2 inhibitor, abrogated the phenotype and restored infection in both PBMCs and endocervix; inhibited E2-induced expression of total CFL1, pCFL1; and decreased pCFL1/CFL1 ratios. Knockdown of CFL1 in PBMCs also abrogated the phenotype and partially restored infection. Additional analysis of soluble mediators revealed decreased concentrations of pro-inflammatory chemokines CXCL10 and CCL5 in infected tissues incubated with E2. Our results suggest a link between E2-mediated anti-HIV-1 activity and expression of CFL1 in PBMCs and endocervical mucosa. The data support exploration of cytoskeletal signaling pathway targets for the development of prevention strategies against HIV-1.
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Affiliation(s)
- N Verma
- Center for Biomedical Research, Population Council, 1230 York Ave., New York, NY, 10065, USA
| | - S Mukhopadhyay
- Center for Biomedical Research, Population Council, 1230 York Ave., New York, NY, 10065, USA
| | - P Barnable
- Center for Biomedical Research, Population Council, 1230 York Ave., New York, NY, 10065, USA
| | - M G Plagianos
- Center for Biomedical Research, Population Council, 1230 York Ave., New York, NY, 10065, USA
| | - N Teleshova
- Center for Biomedical Research, Population Council, 1230 York Ave., New York, NY, 10065, USA.
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22
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Ntiamoah P, Mukhopadhyay S, Marshall T, You JY, Mehta AC. Giant Cell Interstitial Pneumonia In Native, Transplanted And Re-Transplanted Lungs 8 Years Apart Without Known Hard Metal Exposure. Int J Surg Pathol 2022; 30:926-930. [PMID: 35382615 DOI: 10.1177/10668969221092113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pneumoconioses are a group of non-neoplastic pulmonary disorders caused by inhaled inorganic particles. Well-described pneumoconioses include asbestosis, silicosis, coal worker's pneumoconiosis, chronic beryllium disease, and hard metal lung disease. Giant cell interstitial pneumonia (GIP) is a distinctive and rare pneumoconiosis most frequently found in workers exposed to hard metals, primarily cobalt and tungsten carbide. The pathologic picture is considered virtually pathognomonic for hard metal lung disease, although this dogma has been questioned by a few reports of giant cell interstitial pneumonia in patients without apparent hard metal exposure. Giant cell interstitial pneumonia is even rarer in lung transplant recipients. Here, we present a patient without known hard metal exposure who was found to have persistent giant cell interstitial pneumonia in native, transplanted and re-transplanted lungs 8 years apart.
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Affiliation(s)
- Prince Ntiamoah
- Department of Pulmonary and Critical Care Medicine, 2569Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tanya Marshall
- Department of Internal Medicine, 2569Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Jee Young You
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Atul C Mehta
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Pellegrinelli V, Rodriguez-Cuenca S, Rouault C, Figueroa-Juarez E, Schilbert H, Virtue S, Moreno-Navarrete JM, Bidault G, Vázquez-Borrego MC, Dias AR, Pucker B, Dale M, Campbell M, Carobbio S, Lin YH, Vacca M, Aron-Wisnewsky J, Mora S, Masiero MM, Emmanouilidou A, Mukhopadhyay S, Dougan G, den Hoed M, Loos RJF, Fernández-Real JM, Chiarugi D, Clément K, Vidal-Puig A. Dysregulation of macrophage PEPD in obesity determines adipose tissue fibro-inflammation and insulin resistance. Nat Metab 2022; 4:476-494. [PMID: 35478031 DOI: 10.1038/s42255-022-00561-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
Resulting from impaired collagen turnover, fibrosis is a hallmark of adipose tissue (AT) dysfunction and obesity-associated insulin resistance (IR). Prolidase, also known as peptidase D (PEPD), plays a vital role in collagen turnover by degrading proline-containing dipeptides but its specific functional relevance in AT is unknown. Here we show that in human and mouse obesity, PEPD expression and activity decrease in AT, and PEPD is released into the systemic circulation, which promotes fibrosis and AT IR. Loss of the enzymatic function of PEPD by genetic ablation or pharmacological inhibition causes AT fibrosis in mice. In addition to its intracellular enzymatic role, secreted extracellular PEPD protein enhances macrophage and adipocyte fibro-inflammatory responses via EGFR signalling, thereby promoting AT fibrosis and IR. We further show that decreased prolidase activity is coupled with increased systemic levels of PEPD that act as a pathogenic trigger of AT fibrosis and IR. Thus, PEPD produced by macrophages might serve as a biomarker of AT fibro-inflammation and could represent a therapeutic target for AT fibrosis and obesity-associated IR and type 2 diabetes.
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Affiliation(s)
- V Pellegrinelli
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK.
| | - S Rodriguez-Cuenca
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Cambridge University Nanjing Centre of Technology and Innovation, Nanjing, P. R. China
| | - C Rouault
- Sorbonne University, INSERM, NutriOmique Research Unit, Paris, France
| | - E Figueroa-Juarez
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - H Schilbert
- Genetics and Genomics of Plants, Centre for Biotechnology (CeBiTec) & Faculty of Biology, Bielefeld University, Bielefeld, Germany
| | - S Virtue
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - J M Moreno-Navarrete
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), University Hospital of Girona Dr Josep Trueta, Girona, Spain
- Department of Medicine, University of Girona, Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Institut of Salud Carlos III, Madrid, Spain
| | - G Bidault
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - M C Vázquez-Borrego
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
| | - A R Dias
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - B Pucker
- Genetics and Genomics of Plants, Centre for Biotechnology (CeBiTec) & Faculty of Biology, Bielefeld University, Bielefeld, Germany
- Evolution and Diversity, Department of Plant Sciences, University of Cambridge, Cambridge, UK
| | - M Dale
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - M Campbell
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Cambridge University Nanjing Centre of Technology and Innovation, Nanjing, P. R. China
| | - S Carobbio
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Centro de Investigacion Principe Felipe, Valencia, Spain
| | - Y H Lin
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - M Vacca
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
- Insterdisciplinary Department of Medicine, Università degli Studi di Bari 'Aldo Moro', Bari, Italy
| | - J Aron-Wisnewsky
- Sorbonne University, INSERM, NutriOmique Research Unit, Paris, France
- Assistance-Publique Hôpitaux de Paris, Nutrition department, Pitié-Salpêtrière hospital, Paris, France
| | - S Mora
- Dept Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Institute of Biomedicine, University of Barcelona (IBUB), Barcelona, Spain
| | - M M Masiero
- The Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - A Emmanouilidou
- The Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - S Mukhopadhyay
- MRC Centre for Transplantation Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King's College, London, UK
| | - G Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
- Division of Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, UK
| | - M den Hoed
- The Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - R J F Loos
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - J M Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), University Hospital of Girona Dr Josep Trueta, Girona, Spain
- Department of Medicine, University of Girona, Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Institut of Salud Carlos III, Madrid, Spain
| | - D Chiarugi
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK
| | - K Clément
- Sorbonne University, INSERM, NutriOmique Research Unit, Paris, France
- Assistance-Publique Hôpitaux de Paris, Nutrition department, Pitié-Salpêtrière hospital, Paris, France
| | - A Vidal-Puig
- Wellcome-MRC Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge, Cambridge, UK.
- Cambridge University Nanjing Centre of Technology and Innovation, Nanjing, P. R. China.
- Centro de Investigacion Principe Felipe, Valencia, Spain.
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Topcu G, Mukhopadhyay S, Ayres-de-Campos D, Ventura C, Messinis I, Mahmood T, Horala A. 467 Access to antenatal care in europe. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Dinnon KH, Leist SR, Okuda K, Dang H, Fritch EJ, Gully KL, De la Cruz G, Evangelista MD, Asakura T, Gilmore RC, Hawkins P, Nakano S, West A, Schäfer A, Gralinski LE, Everman JL, Sajuthi SP, Zweigart MR, Dong S, McBride J, Cooley MR, Hines JB, Love MK, Groshong SD, VanSchoiack A, Phelan SJ, Liang Y, Hether T, Leon M, Zumwalt RE, Barton LM, Duval EJ, Mukhopadhyay S, Stroberg E, Borczuk A, Thorne LB, Sakthivel MK, Lee YZ, Hagood JS, Mock JR, Seibold MA, O’Neal WK, Montgomery SA, Boucher RC, Baric RS. A model of persistent post SARS-CoV-2 induced lung disease for target identification and testing of therapeutic strategies. bioRxiv 2022:2022.02.15.480515. [PMID: 35194605 PMCID: PMC8863140 DOI: 10.1101/2022.02.15.480515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
COVID-19 survivors develop post-acute sequelae of SARS-CoV-2 (PASC), but the mechanistic basis of PASC-associated lung abnormalities suffers from a lack of longitudinal samples. Mouse-adapted SARS-CoV-2 MA10 produces an acute respiratory distress syndrome (ARDS) in mice similar to humans. To investigate PASC pathogenesis, studies of MA10-infected mice were extended from acute disease through clinical recovery. At 15-120 days post-virus clearance, histologic evaluation identified subpleural lesions containing collagen, proliferative fibroblasts, and chronic inflammation with tertiary lymphoid structures. Longitudinal spatial transcriptional profiling identified global reparative and fibrotic pathways dysregulated in diseased regions, similar to human COVID-19. Populations of alveolar intermediate cells, coupled with focal upregulation of pro-fibrotic markers, were identified in persistently diseased regions. Early intervention with antiviral EIDD-2801 reduced chronic disease, and early anti-fibrotic agent (nintedanib) intervention modified early disease severity. This murine model provides opportunities to identify pathways associated with persistent SARS-CoV-2 pulmonary disease and test countermeasures to ameliorate PASC.
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Affiliation(s)
- Kenneth H. Dinnon
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah R. Leist
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenichi Okuda
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ethan J. Fritch
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kendra L. Gully
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gabriela De la Cruz
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mia D. Evangelista
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Takanori Asakura
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rodney C. Gilmore
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Padraig Hawkins
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Satoko Nakano
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ande West
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra Schäfer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa E. Gralinski
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie L. Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado, USA
| | - Satria P. Sajuthi
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado, USA
| | - Mark R. Zweigart
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie Dong
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer McBride
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle R. Cooley
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jesse B. Hines
- Golden Point Scientific Laboratories, Hoover, Alabama, USA
| | - Miriya K. Love
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve D. Groshong
- Division of Pathology, Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | | | | | - Yan Liang
- NanoString Technologies, Seattle, Washington, USA
| | - Tyler Hether
- NanoString Technologies, Seattle, Washington, USA
| | - Michael Leon
- NanoString Technologies, Seattle, Washington, USA
| | - Ross E. Zumwalt
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa M. Barton
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, USA
| | - Eric J. Duval
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, USA
| | | | - Edana Stroberg
- Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, USA
| | | | - Leigh B. Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Muthu K. Sakthivel
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Yueh Z. Lee
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James S. Hagood
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, Pulmonology Division and Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason R. Mock
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Max A. Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado-Denver, Denver, Colorado, USA
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie A. Montgomery
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ralph S. Baric
- Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Rapidly Emerging Antiviral Drug Discovery Initiative, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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26
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Kunal S, Gupta M, Shah B, Palleda G, Bansal A, Batra V, Yusuf J, Mukhopadhyay S, Tyagi S. Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography. Eur Heart J Cardiovasc Imaging 2022. [PMCID: PMC9383410 DOI: 10.1093/ehjci/jeab289.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear. Purpose We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters. Methods Of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%; moderate: -15.3 ± 3.4%; severe: -10.7 ± 5.1%; P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%; moderate: -16.8 ± 4.8%; severe: -9.7 ± 4.6%; P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%; moderate: -18.1 ± 5.5%; severe: -9.3 ± 4.4%; P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission. Conclusions Subclinical LV and RV dysfunction was seen in majority of COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.
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Affiliation(s)
- S Kunal
- G B PANT HOSPITAL, Delhi, India
| | - M Gupta
- G B PANT HOSPITAL, Delhi, India
| | - B Shah
- G B PANT HOSPITAL, Delhi, India
| | | | | | - V Batra
- G B PANT HOSPITAL, Delhi, India
| | - J Yusuf
- G B PANT HOSPITAL, Delhi, India
| | | | - S Tyagi
- G B PANT HOSPITAL, Delhi, India
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27
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Mukhopadhyay S, Sudarshan M. Spread through airspaces (STAS) on frozens: too much, too soon. Mod Pathol 2022; 35:140-141. [PMID: 34702995 DOI: 10.1038/s41379-021-00957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Monisha Sudarshan
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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28
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Ashour S, Reynolds JP, Mukhopadhyay S, McKenney JK. SMARCA4-Deficient Undifferentiated Tumor Diagnosed on Adrenal Sampling. Am J Clin Pathol 2022; 157:140-145. [PMID: 34463317 DOI: 10.1093/ajcp/aqab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES SMARCA4-deficient undifferentiated tumor has distinct clinicopathologic features. We describe our experience with primary diagnosis on adrenal sampling. METHODS We collected six SMARCA4-deficient undifferentiated tumors diagnosed on adrenal sampling. Immunostains for SMARCA4, SF-1, inhibin, calretinin, S-100 protein, EMA, and TTF-1 were performed. A control group of 63 primary adrenocortical tumors was also immunostained. RESULTS Patients included four men and two women (aged 52-77 years). Five had unilateral adrenal masses and one bilateral (range, 2.4-9.6 cm). Five had pulmonary masses, and one had a midline mediastinal mass. All cases had a monotonous epithelioid appearance and variable rhabdoid morphology. Immunophenotypically, all six cases had loss of nuclear SMARCA4 expression and no staining for SF-1, inhibin, calretinin, or S-100 protein. Variable EMA immunoreactivity was present in four of six cases and focal nuclear TTF-1 expression in one of six. All 63 adrenocortical neoplasms had retained nuclear SMARCA4 expression. CONCLUSIONS SMARCA4-deficient undifferentiated tumor may present in the adrenal gland, and this series likely represents metastases from thoracic primaries. Because of the frequent absence of lineage marker expression, knowledge of the characteristic clinical presentation, the rhabdoid morphology, and the typical immunophenotype (loss of SMARCA4/BRG1) allow for appropriate distinction from adrenocortical carcinoma.
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Affiliation(s)
- Salam Ashour
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Jordan P Reynolds
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Mukhopadhyay
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse K McKenney
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
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29
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Sen N, Singh K, Mukhopadhyay S, Shenoy K. Microfluidic extraction of uranium from dilute streams using TiAP in ionic liquid as the solvent. Chem Eng Res Des 2022. [DOI: 10.1016/j.cherd.2021.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rakheja D, Treat K, Timmons CF, Carrillo D, Miller SE, Stroberg E, Barton LM, Duval EJ, Mukhopadhyay S. SARS-CoV-2 Immunohistochemistry In Placenta. Int J Surg Pathol 2021; 30:393-396. [PMID: 34939436 PMCID: PMC9111943 DOI: 10.1177/10668969211067754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Compared to the parental SARS-CoV-2 virus, infections by the now dominant Delta
variant of SARS-CoV-2 appear to be more common and more severe in pregnant
women. The need for a robust, cheap, and quick method for diagnosing placental
infection by SARS-CoV-2 has thus become more acute. Here, we describe a highly
sensitive and specific immunohistochemical assay for SARS-CoV-2 nucleocapsid
protein for routine use in placental pathology practice.
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Affiliation(s)
- Dinesh Rakheja
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | | | - Charles F. Timmons
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | | | | | - Edana Stroberg
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
| | - Lisa M. Barton
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
| | - Eric J. Duval
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
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31
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Sawal N, Mukhopadhyay S, Rayancha S, Moore A, Garcha P, Kumar A, Kaul V. A narrative review of interstitial lung disease in anti-synthetase syndrome: a clinical approach. J Thorac Dis 2021; 13:5556-5571. [PMID: 34659821 PMCID: PMC8482343 DOI: 10.21037/jtd-20-3328] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
Anti-synthetase syndrome (AS) is a rare autoimmune disorder characterized by the presence of aminoacyl-transfer RNA synthetase antibodies in conjunction with clinical features such as interstitial lung disease (ILD), Raynaud's phenomenon, nonerosive arthritis, and myopathy. AS distinguishes itself from other inflammatory myopathies by its significant lung involvement and rapidly progressive interstitial lung disease (AS-ILD), therefore the management of AS-ILD requires careful clinical, serologic and radiologic assessment. Glucocorticoids are considered the mainstay of therapy; however, additional immunosuppressive agents are often required to achieve disease control. Patient prognosis is highly dependent on early diagnosis and symptom recognition as the antibody profile is thought to influence therapy response. Since progressive ILD is the leading cause of morbidity and mortality, this review will discuss the clinical approach to patient with suspected AS, with particular emphasis on diagnosis and management of AS-ILD.
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Affiliation(s)
- Naina Sawal
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Sheetal Rayancha
- Department of Rheumatology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alastair Moore
- Department of Radiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Puneet Garcha
- Department of Pulmonary Critical-Care, Baylor College of Medicine, Houston, TX, USA
| | - Anupam Kumar
- Department of Pulmonary Critical-Care, Baylor College of Medicine, Houston, TX, USA
| | - Viren Kaul
- Department of Pulmonary Critical-Care, Crouse Health/SUNY Upstate Medical University, Syracuse, NY, USA
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32
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Akhtar M, Shafi A, Khanna V, Mukhopadhyay S, Patel K, Ozkor M, Baumbach A, Mathur A, Kennon S, Awad W, Mullen MM. The management of severe aortic stenosis during the COVID-19 pandemic: an observational study comparing TAVI and SAVR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Outcomes and characteristics of patients with severe aortic stenosis (AS) treated during the COVID-19 pandemic is unknown.
Methods
This was a single-centre observational study of patients undergoing AS treatment with transcatheter (TAVI) or surgical (SAVR) therapy during the first-wave of the UK COVID-19 pandemic compared to a control cohort undergoing treatment in 2019.
Demographics, baseline echocardiogram, CT, procedural characteristics and outcome data were collated. The primary outcome was 30-day all-cause mortality. The secondary endpoint was duration of post-procedural hospitalisation.
Results
319 patients were recruited - 122 underwent intervention during the pandemic [73 TAVI; 49 SAVR] and 197 in 2019 [127 TAVI; 70 SAVR].
In 2020, TAVI patients had a higher Euroscore II (p<0.001) but there were no differences in procedural complications or mortality [p=0.16] compared to TAVI 2019 cases. Duration from TAVI to discharge was shorter in 2020 (p<0.001).
SAVR 2020 patients had similar baseline profile [p=0.48], surgical characteristics, mortality (p=0.68) and duration from SAVR to discharge compared to those in 2019.
During the pandemic, TAVI patients were older (p<0.001) and had a higher Euroscore II (p<0.001) than SAVR counterparts. TAVI patients had reduced 30-day mortality [0 (0%) vs 3 (6%); p=0.06] and were discharged more rapidly post-intervention than SAVR patients [median 1 [1] vs 7 [4] days; p<0.001) translating into shorter hospitalization (p<0.001).
Conclusions
TAVI and SAVR can be safely delivered with predictable resource utilisation during a pandemic. Despite the TAVI cohort incorporating higher risk, older patients, outcomes were at least as good as SAVR with a shorter length of post-procedural hospitalisation.
Funding Acknowledgement
Type of funding sources: None. Procedural Complications TAVI/SAVRDuration to discharge post TAVI/SAVR
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Affiliation(s)
- M Akhtar
- Barts Heart Centre, London, United Kingdom
| | - A Shafi
- Barts Heart Centre, London, United Kingdom
| | - V Khanna
- Barts Heart Centre, London, United Kingdom
| | | | - K Patel
- Barts Heart Centre, London, United Kingdom
| | - M Ozkor
- Barts Heart Centre, London, United Kingdom
| | - A Baumbach
- Barts Heart Centre, London, United Kingdom
| | - A Mathur
- Barts Heart Centre, London, United Kingdom
| | - S Kennon
- Barts Heart Centre, London, United Kingdom
| | - W Awad
- Barts Heart Centre, London, United Kingdom
| | - M M Mullen
- Barts Heart Centre, London, United Kingdom
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Ntiamoah P, Mukhopadhyay S, Ghosh S, Mehta AC. Recycling plastic: diagnosis and management of plastic bronchitis among adults. Eur Respir Rev 2021; 30:30/161/210096. [PMID: 34407979 DOI: 10.1183/16000617.0096-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even life-threatening airway obstruction. Plastic bronchitis in adulthood should not be overlooked, particularly in patients with chronic inflammatory lung diseases. This review presents current understanding of the presentation, aetiology, pathogenesis, pathology and management of plastic bronchitis in adults.
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Affiliation(s)
- Prince Ntiamoah
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Subha Ghosh
- Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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Bahuguna S, Mukhopadhyay S, Tiwari A. Sensor position optimization for flux mapping in a nuclear reactor using compressed sensing. ANN NUCL ENERGY 2021. [DOI: 10.1016/j.anucene.2021.108298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robinson SD, Towler JD, Kitson R, Saleh D, Younan HC, Mukhopadhyay S, Weir J, Gujral DM. Survival Outcomes for p16-positive Oropharyngeal Squamous Cell Carcinoma Based on Human Papillomavirus Status. Clin Oncol (R Coll Radiol) 2021; 33:e614. [PMID: 34412969 DOI: 10.1016/j.clon.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Affiliation(s)
- S D Robinson
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - J D Towler
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - R Kitson
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - D Saleh
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - H-C Younan
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - S Mukhopadhyay
- Histopathology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - J Weir
- Histopathology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK
| | - D M Gujral
- Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
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Robinson S, Towler J, Kitson R, Saleh D, Younan H, Mukhopadhyay S, Weir J, Gujral D. PO-1024 Survival outcomes for p16+ oropharyngeal squamous cell carcinoma based on HPV status. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corredor G, Toro P, Bera K, Rasmussen D, Viswanathan VS, Buzzy C, Fu P, Barton LM, Stroberg E, Duval E, Gilmore H, Mukhopadhyay S, Madabhushi A. Computational pathology reveals unique spatial patterns of immune response in H&E images from COVID-19 autopsies: preliminary findings. J Med Imaging (Bellingham) 2021; 8:017501. [PMID: 34268443 DOI: 10.1117/1.jmi.8.s1.017501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/28/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose: We used computerized image analysis and machine learning approaches to characterize spatial arrangement features of the immune response from digitized autopsied H&E tissue images of the lung in coronavirus disease 2019 (COVID-19) patients. Additionally, we applied our approach to tease out potential morphometric differences from autopsies of patients who succumbed to COVID-19 versus H1N1. Approach: H&E lung whole slide images from autopsy specimens of nine COVID-19 and two H1N1 patients were computationally interrogated. 606 image patches ( ∼ 55 per patient) of 1024 × 882 pixels were extracted from the 11 autopsied patient studies. A watershed-based segmentation approach in conjunction with a machine learning classifier was employed to identify two types of nuclei families: lymphocytes and non-lymphocytes (i.e., other nucleated cells such as pneumocytes, macrophages, and neutrophils). Based off the proximity of the individual nuclei, clusters for each nuclei family were constructed. For each of the resulting clusters, a series of quantitative measurements relating to architecture and density of nuclei clusters were calculated. A receiver operating characteristics-based feature selection method, violin plots, and the t-distributed stochastic neighbor embedding algorithm were employed to study differences in immune patterns. Results: In COVID-19, the immune response consistently showed multiple small-size lymphocyte clusters, suggesting that lymphocyte response is rather modest, possibly due to lymphocytopenia. In H1N1, we found larger lymphocyte clusters that were proximal to large clusters of non-lymphocytes, a possible reflection of increased prevalence of macrophages and other immune cells. Conclusion: Our study shows the potential of computational pathology to uncover immune response features that may not be obvious by routine histopathology visual inspection.
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Affiliation(s)
- Germán Corredor
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States
| | - Paula Toro
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States
| | - Kaustav Bera
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States
| | - Dylan Rasmussen
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States
| | - Vidya Sankar Viswanathan
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States
| | - Christina Buzzy
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States
| | - Pingfu Fu
- Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, Ohio, United States
| | - Lisa M Barton
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, United States
| | - Edana Stroberg
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, United States
| | - Eric Duval
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, United States
| | - Hannah Gilmore
- University Hospitals, Department of Pathology, Cleveland, Ohio, United States
| | | | - Anant Madabhushi
- Case Western Reserve University, Center for Computational Imaging and Personalized Diagnostics, Cleveland, Ohio, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States
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Sen N, Ekhande S, Singh K, Mukhopadhyay S, Sirsam R, Shenoy K. Large-scale synthesis of ionic liquid [BMIM]Br in a microbore tube. Chem Eng Res Des 2021. [DOI: 10.1016/j.cherd.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lepe M, Oltulu P, Canepa M, Wu RI, Deeken A, Alex D, Dinares C, Doxtader EE, Fitzhugh VA, Gibier JB, Jain D, Janaki N, Jelinek A, Labiano T, L'Imperio V, Michael C, Mukhopadhyay S, Pagni F, Panizo A, Pijuan L, Quintana LM, Roy-Chowdhuri S, Sanchez-Font A, Sansano I, Sauter J, Skipper D, Spruill LS, Torous V, Gardner JM, Jiang XS. #EBUSTwitter: Novel Use of Social Media for Conception, Coordination, and Completion of an International, Multicenter Pathology Study. Arch Pathol Lab Med 2021; 144:878-882. [PMID: 31846366 DOI: 10.5858/arpa.2019-0297-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Social media sites are increasingly used for education, networking, and rapid dissemination of medical information, but their utility for facilitating research has remained largely untapped. OBJECTIVE.— To describe in detail our experience using a social media platform (Twitter) for the successful initiation, coordination, and completion of an international, multi-institution pathology research study. DESIGN.— Following a tweet describing a hitherto-unreported biopsy-related histologic finding in a mediastinal lymph node following endobronchial ultrasound-guided transbronchial needle aspiration, a tweet was posted to invite pathologists to participate in a validation study. Twitter's direct messaging feature was used to create a group to facilitate communication among participating pathologists. Contributing pathologists reviewed consecutive cases of mediastinal lymph node resection following endobronchial ultrasound-guided transbronchial needle aspiration and examined them specifically for biopsy site changes. Data spreadsheets containing deidentified data and digital photomicrographs of suspected biopsy site changes were submitted via an online file hosting service for central review by 5 pathologists from different institutions. RESULTS.— A total of 24 pathologists from 14 institutions in 5 countries participated in the study within 143 days of study conception, and a total of 297 cases were collected and analyzed. The time interval between study conception and acceptance of the manuscript for publication was 346 days. CONCLUSIONS.— To our knowledge, this is the first time that a social media platform has been used to generate a research idea based on a tweet, recruit coinvestigators publicly, communicate with collaborating pathologists, and successfully complete a pathology study.
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Affiliation(s)
- Marcos Lepe
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Pembe Oltulu
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Mariana Canepa
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Roseann I Wu
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Amy Deeken
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Deepu Alex
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Carme Dinares
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Erika E Doxtader
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Valerie A Fitzhugh
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Jean-Baptiste Gibier
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Deepali Jain
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Nafiseh Janaki
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Alexis Jelinek
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Tania Labiano
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Vincenzo L'Imperio
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Claire Michael
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Sanjay Mukhopadhyay
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Fabio Pagni
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Angel Panizo
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Lara Pijuan
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Liza M Quintana
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Sinchita Roy-Chowdhuri
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Albert Sanchez-Font
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Irene Sansano
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Jennifer Sauter
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Daniel Skipper
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Laura S Spruill
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Vanda Torous
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Jerad Michael Gardner
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
| | - Xiaoyin Sara Jiang
- From the Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia (Dr Lepe); the Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey (Dr Oltulu); the Department of Pathology, Rhode Island Hospital, Providence (Dr Canepa); the Department of Clinical Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (Dr Wu); the Department of Pathology, Summa Health Systems, Akron, Ohio (Drs Deeken and Jelinek); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Alex and Sauter); Patologia, Vall d'Hebron Hospital, Barcelona, Spain (Drs Dinares and Sansano); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Drs Doxtader and Mukhopadhyay); the Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Fitzhugh); Centre de Biologie, University of Lille, Lille, France (Dr Gibier); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, Case Western Reserve University, Cleveland, Ohio (Drs Janaki and Michael); Patologia, Complejo Hospitalario de Navarra, Navarra, Spain (Drs Labiano and Panizo); the Department of Pathology, University of Milano Biocca, Monza, Italy (Dr L'Imperio and Pagni); Patologia, Hospital del Mar, Barcelona, Spain (Drs Pijuan and Sanchez-Font); the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Quintana); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston (Drs Skipper and Spruill); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Torous); the Department of Pathology, Dermatopathology, Bone & Soft Tissue, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Jiang)
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Baratchian M, McManus JM, Berk MP, Nakamura F, Mukhopadhyay S, Xu W, Erzurum S, Drazba J, Peterson J, Klein EA, Gaston B, Sharifi N. Androgen regulation of pulmonary AR, TMPRSS2 and ACE2 with implications for sex-discordant COVID-19 outcomes. Sci Rep 2021; 11:11130. [PMID: 34045511 PMCID: PMC8159988 DOI: 10.1038/s41598-021-90491-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
The sex discordance in COVID-19 outcomes has been widely recognized, with males generally faring worse than females and a potential link to sex steroids. A plausible mechanism is androgen-induced expression of TMPRSS2 and/or ACE2 in pulmonary tissues that may increase susceptibility or severity in males. This hypothesis is the subject of several clinical trials of anti-androgen therapies around the world. Here, we investigated the sex-associated TMPRSS2 and ACE2 expression in human and mouse lungs and interrogated the possibility of pharmacologic modification of their expression with anti-androgens. We found no evidence for increased TMPRSS2 expression in the lungs of males compared to females in humans or mice. Furthermore, in male mice, treatment with the androgen receptor antagonist enzalutamide did not decrease pulmonary TMPRSS2. On the other hand, ACE2 and AR expression was sexually dimorphic and higher in males than females. ACE2 was moderately suppressible with enzalutamide administration. Our work suggests that sex differences in COVID-19 outcomes attributable to viral entry are independent of TMPRSS2. Modest changes in ACE2 could account for some of the sex discordance.
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Affiliation(s)
- Mehdi Baratchian
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Jeffrey M McManus
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Mike P Berk
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Fumihiko Nakamura
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - Weiling Xu
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Serpil Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, USA.,Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Judy Drazba
- Imaging Core, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - John Peterson
- Imaging Core, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Eric A Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Benjamin Gaston
- Herman Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, USA
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA. .,Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA. .,Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA.
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41
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MacMurdo M, Lin C, Saeedan MB, Doxtader EE, Mukhopadhyay S, Arrossi V, Reynolds J, Ghosh S, Choi H. e-Cigarette or Vaping Product Use-Associated Lung Injury: Clinical, Radiologic, and Pathologic Findings of 15 Cases. Chest 2021; 157:e181-e187. [PMID: 32505323 DOI: 10.1016/j.chest.2020.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Since mid-2019, > 2,000 cases of e-cigarette or vaping product use-associated lung injury (EVALI) have been reported. Although initial reports suggested that this entity may be a form of inhalation-related lipoid pneumonia, subsequent studies indicate that EVALI represents various patterns of acute lung injury. Cases of EVALI continue to be reported, and public awareness of the epidemic is increasingly high. However, evidence surrounding optimal management of EVALI remains limited. In this case series, we report 15 cases of EVALI across a spectrum of severity, highlighting key radiologic, pathologic, and cytologic findings, and discuss management implications. In line with national findings, most patients with EVALI in the series vaped liquids containing tetrahydrocannabinol. Our imaging and pathologic findings support the notion that EVALI is a form of acute lung injury.
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Affiliation(s)
| | - Charlie Lin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Mnahi Bin Saeedan
- Section of Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Valeria Arrossi
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Jordan Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Subha Ghosh
- Section of Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Humberto Choi
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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42
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Ghosh A, Ray S, Garg MK, Chowdhury S, Mukhopadhyay S. The role of infrared dermal thermometry in the management of neuropathic diabetic foot ulcers. Diabet Med 2021; 38:e14368. [PMID: 32743838 DOI: 10.1111/dme.14368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
AIM This prospective observational study evaluated the role of infrared (IR) dermal thermometry in the management of diabetic foot ulcers. METHODS Thirty participants with unilateral neuropathic diabetic foot ulcers of University of Texas grade 1 or 2 (stage A) were followed up monthly for 1 year. At each visit, skin temperatures were measured with an IR dermal thermometer at corresponding sites on both feet, using the contralateral feet without ulcers as controls. RESULTS Average temperature and ulcer temperature in affected feet were significantly higher than in unaffected feet, with a mean difference of 1.2 °C [95% confidence interval (CI) 0.7 to 1.7] and 3.1 °C (95% CI 2.3 to 3.9), respectively. Although the gradient between average temperature of affected foot and that of unaffected foot normalized (mean difference 0.2 °C, 95% CI -0.2 to 0.7) at healing, the temperature gradient between the ulcer and a corresponding site on the unaffected foot decreased but did not normalize (mean difference 2.1 °C, 95% CI 1.2 to 3.1) even at healing, as documented by skin closure, and persisted for up to 1 month after skin closure. A gradient of ≥1 °C between average temperature of affected foot and that of unaffected foot at initial presentation or at any time during ulcer healing was found to predict impaired healing and should alert clinicians to ulcers requiring more attention. An incremental trend in temperature gradient (median difference 2.2 °C; range 0.1-6.3 °C) at a site on the foot was predictive of a recurrent ulcer involving the same site. CONCLUSIONS IR dermal thermometry may have a role in predicting diabetic foot ulcer healing, in determining the completeness of healing and in guiding the duration of offloading. Serial monitoring of the temperature gradient may predict the development of recurrent diabetic foot ulcers.
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Affiliation(s)
- A Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - S Ray
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - M K Garg
- Department of General Medicine and Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, India
| | - S Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - S Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
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43
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Dutta S, Bhaskarwar AN, Mukhopadhyay S, Shenoy K. Kinetics of solvent extraction of zirconium from acidic raffinate using tributyl phosphate. SEP SCI TECHNOL 2021. [DOI: 10.1080/01496395.2020.1744651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Snehasis Dutta
- Chemical Engineering Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Ashok N Bhaskarwar
- Department of Chemical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - S. Mukhopadhyay
- Chemical Engineering Division, Bhabha Atomic Research Centre, Mumbai, India
| | - K.T. Shenoy
- Chemical Engineering Division, Bhabha Atomic Research Centre, Mumbai, India
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Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, Mehta AC, Mukhopadhyay S. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol 2021; 155:506-514. [PMID: 33316056 PMCID: PMC7799292 DOI: 10.1093/ajcp/aqaa264] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. METHODS We conducted a retrospective case series. RESULTS The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. CONCLUSIONS This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.
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Affiliation(s)
| | | | - Ruchi Yadav
- Imaging Institute, and Cleveland Clinic, Cleveland, OH
| | - Summer L Nugent
- Department of Pathology Critical Care, WellSpan York Hospital, York, PA
| | - Dmitriy Zubkus
- Department of Pulmonary and Critical Care, WellSpan York Hospital, York, PA
| | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Abstract
This review describes how Twitter is currently used by laboratory professionals for education, research, and networking. This platform has a global audience. It enables users to post information publicly, easily, rapidly, and free of charge. The absence of hierarchies enables interactions that may not be feasible offline. Laboratory professionals teach thousands of people using text, images, polls, and videos. Academic discussion flourishes without paywalls. Published research is shared faster than ever before, articles are discussed in online journal clubs, and research collaborations are facilitated. Pathologists network globally and make new friends within and beyond their specialty. Pathology departments and residency programs showcase trainees and faculty and celebrate graduations. As users in one time zone go to bed, others who are just waking up begin to read and tweet, creating a 24/7/365 live global online conference. We encourage others to plug into the power of Twitter, the network that never sleeps.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Constantine Kanakis
- Department of Pathology and Laboratory Medicine, Loyola University Health System, Maywood, Illinois
| | - Kathryn Golab
- Wisconsin Diagnostic Laboratories, Milwaukee, Wisconsin
| | - Daniela Hermelin
- Department of Pathology, St. Louis University Hospital, St. Louis, Missouri
| | - Genevieve M Crane
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University Health System, Maywood, Illinois
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Bruehl FK, Doxtader EE, Cheng YW, Farkas DH, Farver C, Mukhopadhyay S. Does histological assessment accurately distinguish separate primary lung adenocarcinomas from intrapulmonary metastases? A study of paired resected lung nodules in 32 patients using a routine next-generation sequencing panel for driver mutations. J Clin Pathol 2021; 75:390-396. [PMID: 33649140 DOI: 10.1136/jclinpath-2021-207421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022]
Abstract
AIM Various approaches have been reported for distinguishing separate primary lung adenocarcinomas from intrapulmonary metastases in patients with two lung nodules. The aim of this study was to determine whether histological assessment is reliable and accurate in distinguishing separate primary lung adenocarcinomas from intrapulmonary metastases using routine molecular findings as an adjunct. METHODS We studied resected tumour pairs from 32 patients with lung adenocarcinomas in different lobes. In 15 of 32 tumour pairs, next-generation sequencing (NGS) for common driver mutations was performed on both nodules. The remainder of tumour pairs underwent limited NGS, or EGFR genotyping. Tumour pairs with different drivers (or one driver/one wild-type) were classified as molecularly unrelated, while those with identical low-frequency drivers were classified as related. Three pathologists independently and blinded to the molecular results categorised tumour pairs as related or unrelated based on histological assessment. RESULTS Of 32 pairs, 15 were classified as related by histological assessment, and 17 as unrelated. Of 15 classified as related by histology, 6 were classified as related by molecular analysis, 4 were unrelated and 5 were indeterminate. Of 17 classified as unrelated by histology, 14 were classified as unrelated by molecular analysis, none was related and 3 were indeterminate. Histological assessment of relatedness was inaccurate in 4/32 (12.5%) tumour pairs. CONCLUSIONS A small but significant subset of two-nodule adenocarcinoma pairs is inaccurately judged as related by histological assessment, and can be proven to be unrelated by molecular analysis (driver gene mutations), leading to significant downstaging.
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Affiliation(s)
- Frido K Bruehl
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erika E Doxtader
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yu-Wei Cheng
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel H Farkas
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol Farver
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Cecchini MJ, Mukhopadhyay S, Arrossi AV, Beasley MB, Butt YM, Jones KD, Pambuccian S, Mehrad M, Monaco SE, Saqi A, Smith ML, Tazelaar HD, Larsen BT. E-Cigarette or Vaping Product Use-Associated Lung Injury: A Review for Pathologists. Arch Pathol Lab Med 2021; 144:1490-1500. [PMID: 32401055 DOI: 10.5858/arpa.2020-0024-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2010] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Vaping is the inhalation of heated aerosol from a small battery-powered device as a method to deliver nicotine or other substances. A recent outbreak of severe respiratory illness primarily in the United States has put a spotlight on vaping and its potential risks. OBJECTIVE.— To familiarize pathologists with vaping, the cytologic and histopathologic features of vaping-associated acute lung injury, and the role of pathology in this diagnosis. DATA SOURCES.— A targeted literature review was performed. CONCLUSIONS.— Most cases of vaping-associated lung injury have been linked to vaping products containing tetrahydrocannabinol or other cannabinoids. Lung biopsies show a spectrum of nonspecific acute lung injury patterns (organizing pneumonia, diffuse alveolar damage, acute fibrinous, and organizing pneumonia, or combinations of the above), accompanied by prominent, foamy macrophage accumulation. Injury is usually accentuated around small airways. Lipid-laden macrophages can be identified in bronchioloalveolar lavage fluid in most patients and these can be highlighted using lipid stains, such as oil red O, but the clinical utility of this finding remains unclear, as lipid-laden macrophages can be seen in a wide variety of processes and should not be relied upon to make the diagnosis. Classic histologic features of exogenous lipoid pneumonia have not been identified in tissue samples. Lightly pigmented macrophages, similar to those seen with traditional cigarette smoking, are present in some cases but are usually a minor feature. To date, no specific pathologic features for vaping-related injury have been identified, and it remains a diagnosis of exclusion that requires clinicopathologic correlation.
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Affiliation(s)
- Matthew J Cecchini
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Cecchini)
| | - Sanjay Mukhopadhyay
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Mukhopadhyay, Arrossi)
| | - Andrea V Arrossi
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Mukhopadhyay, Arrossi)
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Beasley)
| | - Yasmeen M Butt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Butt, Smith, Tazelaar, Larsen)
| | - Kirk D Jones
- Department of Pathology, University of California San Francisco, San Francisco (Jones)
| | - Stefan Pambuccian
- Department of Pathology, Loyola University Medical Center and Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois (Pambuccian)
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Mehrad)
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Monaco)
| | - Anjali Saqi
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York (Saqi)
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Butt, Smith, Tazelaar, Larsen)
| | - Henry D Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Butt, Smith, Tazelaar, Larsen)
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Butt, Smith, Tazelaar, Larsen)
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Wiles S, Mireles-Cabodevila E, Neuhofs S, Mukhopadhyay S, Reynolds JP, Hatipoğlu U. Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series. J Intensive Care Med 2020; 36:604-611. [PMID: 33375893 DOI: 10.1177/0885066620981891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing endotracheal tube (ETT) obstruction that has not been previously described in patients with ARDS due to other causes. The purpose of this report is to describe a case series of patients with COVID-19 and ARDS in which ETT occlusion resulted in significant clinical consequences and to define the pathology of the obstructing material. METHODS Incidents of ETT occlusion during mechanical ventilation of COVID-19 patients were reported by clinicians and retrospective chart review was conducted. Statistical analysis was performed comparing event rates between COVID-19 and non-COVID 19 patients on mechanical ventilation over the predefined period. Specimens were collected and submitted for pathological examination. FINDINGS Eleven COVID-19 patients experienced endotracheal tube occlusion over a period of 2 months. Average age was 69 (14.3, range 33-85) years. Mean APACHE III score was 73.6 (17.3). All patients had AKI and cytokine storm. Nine exhibited biomarkers for hypercoagulability. Average days on mechanical ventilation before intervention for ETT occlusion was 14 (5.18) days (range of 9 to 23 days). Five patients were discharged from the ICU, and 4 expired. Average documented airway resistance on admission was 14.2 (3.0) cm H2O/L/sec. Airway resistance before tube exchange was 28.1 (8.0) cm H2O /L/sec. No similar events of endotracheal tube occlusion were identified in non-COVID patients on mechanical ventilation during the same time period. Microscopically, the material consisted of mucin admixed with necrotic cell debris, variable numbers of degenerated inflammatory cells, oral contaminants and red blood cells. INTERPRETATION Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing ETT obstruction due to deposition of a thick, tenacious material within the tube that consists primarily of mucin and cellular debris. Clinicians should be aware of this dangerous but treatable complication.
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Affiliation(s)
- Samuel Wiles
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
| | | | - Scott Neuhofs
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology, Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic Foundation, OH, USA
| | - Jordan P Reynolds
- Department of Pathology, Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic Foundation, OH, USA
| | - Umur Hatipoğlu
- Department of Pulmonary/Critical Care, Respiratory Institute, 2569Cleveland Clinic, OH, USA
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Aldera AP, Govender D, Locketz ML, Mukhopadhyay S, McHugh K, Allende D. Combined Use of INSM1 and Synaptophysin Is the Most Sensitive and Specific Panel to Detect Neuroendocrine Neoplasms in the Digestive Tract. Am J Clin Pathol 2020; 154:870-871. [PMID: 33118595 DOI: 10.1093/ajcp/aqaa164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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50
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Best Rocha A, Stroberg E, Barton LM, Duval EJ, Mukhopadhyay S, Yarid N, Caza T, Wilson JD, Kenan DJ, Kuperman M, Sharma SG, Larsen CP. Detection of SARS-CoV-2 in formalin-fixed paraffin-embedded tissue sections using commercially available reagents. J Transl Med 2020; 100:1485-1489. [PMID: 32647285 PMCID: PMC7344352 DOI: 10.1038/s41374-020-0464-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/25/2023] Open
Abstract
Coronavirus Disease-19 (COVID-19), caused by the coronavirus SARS-CoV-2, was initially recognized in Wuhan, China and subsequently spread to all continents. The disease primarily affects the lower respiratory system, but may involve other organs and systems. Histopathologic evaluation of tissue from affected patients is crucial for diagnostic purposes, but also for advancing our understanding of the disease. For that reason, we developed immunohistochemical (IHC) and in situ hybridization (ISH) assays for detection of the. virus. A total of eight autopsy lungs, one placenta, and ten kidney biopsies from COVID-19 patients were stained with a panel of commercially available antibodies for IHC and commercially available RNA probes for ISH. Similarly, autopsy lungs, placentas and renal biopsies from non-COVID-19 patients were stained with the same antibodies and probes. All eight lungs and the placenta from COVID-19 patients stained positive by IHC and ISH, while the kidney biopsies stained negative by both methodologies. As expected, all specimens from non-COVID-19 patients were IHC and ISH negative. These two assays represent a sensitive and specific method for detecting the virus in tissue samples. We provide the protocols and the list of commercially available antibodies and probes for these assays, so they can be readily implemented in pathology laboratories and medical examiner offices for diagnostic and research purposes.
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Affiliation(s)
| | - Edana Stroberg
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, OK, US
| | - Lisa M. Barton
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, OK, US
| | - Eric J. Duval
- Oklahoma Office of the Chief Medical Examiner, Oklahoma City, OK, US
| | | | - Nicole Yarid
- King County Medical Examiner's Office, Seattle, WA, US
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