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Background Exogenous materials may be encountered in skin biopsies as contamination. Contamination may occur during the biopsy procedure in the clinic or during tissue processing in the laboratory. Although the experienced pathologist may often instinctively ignore clear examples of contamination, such tissue may be a source of confusion for young pathologists and those in training. Foreign materials can typically be recognized as exogenous by morphology, polarizability, and the presence or absence of a tissue reaction, but we have rarely encountered situations in which exogenous materials could be misinterpreted as organisms, either by their morphologic appearance or staining properties. Methods Exogenous materials used during skin biopsy and grossing were embedded in a nonhuman tissue scaffold and prepared into histologic slides. Hematoxylin and eosin (H&E), periodic acid-Schiff with diastase, and Grocott methenamine silver stains were performed, and each material was evaluated under polarized microscopy. Results Exogenous materials were divided into the following 3 categories with shared morphologic appearances and staining properties: suture materials, plant-based materials, and synthetic materials. Conclusion We present a comprehensive characterization of the morphologic and cytochemical staining properties of multiple exogenous materials that may contaminate a skin biopsy. This characterization will aid the pathologist by providing a mechanism to identify potential contaminants in skin biopsies.

Made available in DSpace on 2020-12-10T20:03:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-03-15 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Study Design. Cross-sectional study. Objective. To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP). Summary of Background Data. Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear. Methods. Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used. Results. The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions. Conclusion. Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP. Univ Estadual Paulista, Dept Fisioterapia, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Fed Minas Gerais UFMG, Dept Phys Therapy, Belo Horizonte, MG, Brazil Univ Estadual Paulista, Dept Educ Fis, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Estadual Paulista, Dept Fisioterapia, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Estadual Paulista, Dept Educ Fis, Fac Ciencias & Tecnol, Presidente Prudente, Brazil FAPESP: 2017/21336-8 FAPESP: 2016/03826-5 FAPESP: 2017/12246-5

Objective: The aim of this study was to investigate the association between occupational exposure and chronic rhinosinusitis. Methods: A random population from the region of Telemark, aged 16 to 50 years, answered a respiratory questionnaire including questions on chronic rhinosinusitis and exposure in the occupational environment. Results: A total of 16,099/48,142 subjects responded. The prevalence of chronic rhinosinusitis was 9%. Exposure associated with chronic rhinosinusitis comprised paper dust [odds ratio (OR) 1.3, 95% confidence interval (95% CI) 1.1 to 1.5], cleaning agents (OR 1.2, 95% CI 1.0 to 1.3), metal dust (OR 1.3, 95% CI 1.1 to 1.6), animals (OR 1.2, 95% CI 1.0 to 1.5), moisture/mould/mildew (OR 1.3, 95% CI 1.1 to 1.5), and physically strenuous work (OR 1.4, 95% CI 1.2 to 1.7). Conclusion: Occupational exposure to paper dust, cleaning agents, metal dust, animals, moisture/mould/mildew, and physically strenuous work was independently related to having chronic rhinosinusitis. An occupational history should be reviewed when assessing patients with chronic rhinosinusitis.

OBJECTIVE To explore differences in baseline King-Devick Test (KD) completion time between 2 testing modalities: (1) spiral-bound paper cards (cards) and (2) iPad application (iPad). DESIGN Cross-sectional cohort analysis. SETTING National Collegiate Athlete Association (NCAA) institutions. PARTICIPANTS Student athletes from 13 women's and 11 men's collegiate sports who completed KD baseline testing as part of their first year in the Concussion Assessment, Research and Education (CARE) Consortium from 2014 to 2016 (n = 2003, 52.2% male). INDEPENDENT VARIABLES King-Devick Test modalities; cards or iPad. MAIN OUTCOME MEASURE Baseline KD completion time (seconds). RESULTS Mean baseline KD completion time of the iPad modality group [42.8 seconds, 95% confidence interval (CI), 42.1-43.3] was 2.8 seconds (95% CI, 2.1-3.4) greater than the cards group (40.0 seconds, 95% CI, 39.7-40.3) (t(1, 1010.7) = -8.0, P < 0.001, Cohen's d = 0.41). CONCLUSIONS Baseline KD performance is slower when tested on an iPad than when tested on spiral-bound paper cards. The 2 KD modalities should not be used interchangeably in concussion assessments because differences in the modalities can lead to time differences similar in magnitude to those used to indicate concussion. From a research perspective, modality may influence interpretation and/or synthesis of findings across studies.

PURPOSE To introduce a novel interferometer and provide clinical data based on its use. METHODS Twenty-two normal subjects, 27 patients with dry eye syndrome, 1 patient with obstructive meibomian gland dysfunction, and 2 patients with ocular graft-versus-host disease were included in the study. We cut a piece of copy paper to create an interferometer comprising a handle, a window, and an illumination area. The patient sits in front of a biomicroscope with his or her head fixed on the headrest. The examiner holds the handle of the interferometer 10 mm from the front of the patient's eye. The examiner positions the illumination beam of the biomicroscope at the "illumination area." The examiner then observes a lipid layer interference pattern on the cornea through the window. RESULTS For the normal subjects, wave or amorphous patterns with white or grey color were observed in interferometry. The mean estimated lipid layer thickness in the dry eye group (43 ± 9 nm) was significantly thinner than that of the normal group (59 ± 29 nm) (P = 0.021). For the patient with obstructive meibomian gland dysfunction, interferometry revealed a white interference pattern (30 nm). For ocular graft-versus-host disease, the lipid pattern was brown and blue (165 nm). Patients felt no discomfort, and no complications occurred during examination. CONCLUSIONS We could successfully obtain photographs of the lipid layer pattern with this novel interferometer without additional equipment or cost. This interferometer may be useful for research regarding the pathophysiology, diagnosis, and treatment of dry eye.

BACKGROUND: A bridging study was performed to compare the safety, dose delivery, and acceptability of a prefilled plastic and user-filled paper applicator to assess whether a low-cost, user-filled, paper applicator could serve as a delivery option for tenofovir (TFV) 1% vaginal microbicide gel. METHODS: The study used a randomized crossover design with 25 healthy women randomized to begin with the prefilled or user-filled applicator. Within each study arm, participants delivered two 4.0-mL doses of TFV 1% gel vaginally for 7 days, with one dose delivered at the clinic each morning and a second dose delivered at home each evening. To assess the primary objective, applicator safety, colposcopy examinations were performed at 2 time points in each study arm. RESULTS: There were no colposcopic findings or adverse events attributable to either applicator. One case of vulvovaginal candidiasis was considered possibly related to gel use. On average, the user-filled applicator delivered 96% of the target dose, with 85% of doses falling within ± 10% of the average dose volume. Participants found both applicators comparable for ease of use, insertion, and dispensing gel, with 60% of participants preferring the user-filled applicator. CONCLUSIONS: This study suggests that both applicators are safe, and most women delivered TFV with the user-filled applicator as directed. Participants found both applicators acceptable, with a slight majority preferring the user-filled applicator. Incorporating a low-cost, user-filled, paper applicator to deliver TFV could help reduce costs and improve access to TFV 1% gel, especially in resource-limited settings heavily impacted by HIV.

Background: Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery. The purpose of the present study was to determine whether the introduction of a handheld computer could improve both the quantitative and qualitative aspects of medical records. Methods: A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were randomized to daily documentation of their clinical charts on a handheld computer or on conventional paper forms. The electronic documentation consisted of a specially designed software package on a handheld computer for bedside use with structured decision trees for examination, obtaining a history, and coding. In the control arm, chart notes were compiled on standard paper forms and were subsequently entered into the hospital's information system. The number of documented ICD (International Classification of Diseases) diagnoses was the primary end point for sample size calculations. All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager. These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes. Results: Eighty patients were randomized to one of the two documentation arms, and seventy-eight (forty-seven men and thirty-one women) of them were eligible for final analysis. Documentation with the handheld computer increased the median number of diagnoses per patients from four to nine (p < 0.0001), but it produced some overcoding for false or redundant items. Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. Various learning curve effects were observed with different operators. Study physicians assigned slightly better practicability ratings to the handheld device. Conclusions: The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery. Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

The visual analogue scale (VAS) is an established, validated, self-report measure usually consisting of a 10 cm line on paper with verbal anchors labeling the ends. Palmtop computers (PTCs also known as personal digital appliances) have incorporated VAS entry by use of a touch screen. However, the validity and psychophysical properties of the electronic VAS have never been formally compared with the conventional paper VAS. The aim of this study is to determine the agreement between the electronic (eVAS) and paper (pVAS) modes. Twenty-four healthy volunteers were recruited for this study. Each study participant provided input using both measurement methods by marking the eVAS and pVAS in response to two kinds of stimuli, cognitive and sensory. A verbal rating scale of seven descriptors of intensity represented the cognitive stimuli. Participants were asked to mark the location that best corresponded to the pain intensity described by each word on scales from 'no pain' to 'worst possible pain'. The sensory stimuli used were a set of test weights consisting of plastic containers ranging from 7 to 129 g. The VAS for sensory stimuli ranged from 0 (no weight) to 'reference weight' (the heaviest weight outside the range of test weights). There were two types of input stimuli and two modes for recording responses for a total of four experimental conditions. Two evaluators independently measured and recorded all the pVAS forms to the nearest millimeter. A total of 2016 stimuli were rated. The overall correlation for ratings of both sensory and cognitive stimuli on eVAS and pVAS was r = 0.91. For paired verbal stimuli the correlation was r = 0.97. For paired sensory stimuli the correlation was r = 0.86. The correlation between group eVAS and pVAS ratings to common verbal stimuli was r = 0.99. For common sensory stimuli the group correlation was r = 0.99. The median of correlations comparing eVAS and pVAS ratings was 0.99 for verbal stimuli and 0.98 for sensory stimuli. Multivariate analyses showed equivalent stimuli to be rated much the same whether entered on paper VAS or PTC touch screen VAS (P < 0.0001). Support was found for the validity of the computer version of the VAS scale.

Electronic data collection for monitoring pain has become increasingly popular in clinical research. However, no direct comparison has been made between electronic diaries and self-report paper diaries or phone interviews. We asked 36 patients with chronic low back pain to monitor their pain for 1 year; 20 of them used both a palmtop computer and paper diaries, and 16 used paper diaries alone. All patients were called once a week and asked to rate their pain. Regression analyses with a measurement error model were run on hourly pain scores recorded by both palmtop computer and paper diaries. Ratings of pain intensity were highly reliable between data recorded with a palmtop computer and with data from paper diaries. Patients who monitored their pain with the palmtop computer entered data on average 6.75 times a week and were 89.9% compliant with daily monitoring throughout the year. Two-way messaging available through the palmtop computer seemed to encourage continued use of the device. Internal consistency of reporting and correlations with phone reports and standardized measures were highly significant, suggesting that data from electronic diaries are both reliable and valid. Patients using electronic diaries preferred them to paper diaries and showed much higher rates of compliance and satisfaction over the 1-year trial.

This pilot study compared a prototype electronic menstrual calendar on a handheld computer with a paper calendar for data quality and participants' perceptions.Twenty-three women completed identical information about menstrual bleeding and symptoms using paper and electronic calendars for 1 month each.Use of the paper calendar resulted in more missing data than the electronic calendar for bleeding characteristics (13% vs. 4%) and symptoms (35% vs. 4%). The electronic calendar's ability to log data entries revealed retrospective entry for 61% of the data. Total data entry and cleaning time was reduced by 81% with the electronic calendar. Overall, participants preferred the electronic (70%) to the paper (22%) calendar.Data quality with conventional paper calendars may be poorer than recognized. The data-logging feature, unique to the electronic calendar, is critical for assessing data quality. Electronic menstrual calendars can be useful data collection tools for research in women's health.

OBJECTIVE To evaluate the clinical utility of measuring gastric pH with a pH meter vs. pH paper in critical care patients. DESIGN Prospective comparison of gastric pH measurements, using both pH meter and pH paper. SETTING Surgical intensive care unit (ICU) at a rural Midwestern university medical center. PATIENTS Fifty-one patients who received therapy for prophylaxis of stress ulcers in the surgical ICU. INTERVENTIONS Therapy for stress ulcer prophylaxis was monitored. MEASUREMENTS AND MAIN RESULTS The pH of 985 gastric samples, taken from 51 patients, was measured with both pH meter and pH paper. The pH meter and pH paper measures demonstrated a concordance correlation coefficient of .896. The mean difference between the two measures (pH paper - pH meter) was estimated to be between -0.4 and 1.4, suggesting a positive bias for the paper. The prevalence of events representing clinically relevant differences between the pH meter and pH paper in the measurement of the same gastric sample was calculated. The frequency with which each of the events occurred consecutively (or, in one case, two nearly consecutive events on the same day) was also calculated. Bias in a clinically relevant range was estimated. A set of "probability profiles" was constructed. CONCLUSIONS A hand-held pH meter and pH paper are not interchangeable measures of gastric pH. The pH paper exhibits an appreciable positive bias compared with a hand-held pH meter in the clinically relevant range of 2 to 6. More research is needed to determine if that bias affects treatment outcomes. We recommend the use of a pH meter for patients who demonstrate pH readings of < or = 4, consecutive with readings of < or = 5.

Karelia air-pollution. Malodorous sulfur-compounds. Lung-function. Pulmonary-function. Mill workers. Occupational asthma. New-hampshire. Pulp-mills. Dust. Mortality. The respiratory function and Immunological status of workers employed in the paper recycling industry were studied. The mean age of the 101 studied workers was 41 years, and the mean duration of their exposure was 17 years. A group of 87 unexposed workers of similar age, duration of employment, and smoking history was studied for the prevalence of chronic respiratory symptoms. Lung function in the paper workers was measured by recording maximum expiratory flow volume (MEFV) curves and recording forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum expiratory flow rates at 50% and the last 25 % of the FVC (FEF50, FEF25). Immunological studies were performed in all 101 paper workers and in 37 control workers (volunteers). These included skin-prick tests with paper-dust extracts and other nonoccupational allergens, as well as the measurement of total serum immunoglobulin E. Significantly higher prevalences of all chronic respiratory symptoms were found in paper compared with control workers (P < 0.01). The highest prevalences were found for chronic cough (36.6%), chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnea (18.8%). Occupational asthma was diagnosed in four(4.0%) of the paper workers. A logistic regression analysis performed on chronic respiratory symptoms of paper workers indicated significant effects of smoking and exposure, with the smoking effect bring the most important. Multivariate analysis of lung-function parameters indicate significant effects of exposure. For paper workers, the measured FEF50 and FEF25 were significantly decreased, compared with predicted values, suggesting obstructive changes located primarily in smaller airways. Among 101 tested paper workers, 16 (15.8%) had positive shin-prick tests to at least one of the paper extracts ; none of the control workers reacted to these extracts. increased serum IgE levels were found in 21% of the paper workers and in 5 % of control workers (P < 0.05). Paper workers with positive skin-prick tests to any of the paper and/or other tested extracts had higher prevalences of chronic respiratory symptoms and lower measured lung-function tests compared with predicted than did those with negative skin-prick tests, but the differences were not statistically significant. The measured concentrations of total and respirable dust in this industry were higher than those recommended by Croatian standards. Our study suggests that work in the paper-recycling industry is associated with respiratory impairment and that sensitive workers employed in this industry may be at particular risk of developing chronic respiratory abnormalities

To compare the accuracy of litmus paper-determined gastric pH to a nasogastric graphite antimony pH probe.A prospective clinical trial of gastric pH determination in patients enrolled in a study of histamine-2-receptor (H2) antagonists.The medical intensive care unit (ICU) of a 450-bed county hospital.Critically ill ICU patients requiring stress ulcer prophylaxis.Using a crossover design, the patients were randomized to initially receive an H2 antagonist by continuous infusion or intravenous bolus, and subsequently were crossed over to the other limb of the study.Gastric pH was determined using pH-sensitive litmus paper at the initiation of each limb of the study and at 1, 2, 4, and 8 hrs after the initiation of H2 receptor antagonist therapy. In addition, gastric pH was continuously determined over the same time period utilizing a graphite antimony pH probe. Gastric pH measurements determined with litmus paper and intragastric pH probes demonstrated an excellent correlation (r2 = .93, p.001). McNemar's test of correlated proportions could not demonstrate a significant difference between the two monitoring methods (chi-square = 0.5, p.47), and the kappa statistic (0.95, p.001) demonstrated excellent concordance. Bias measurement was 0.01 (95% confidence interval = -0.155 to 0.176).Measurement of intragastric pH, using pH-sensitive litmus paper, is both sensitive and specific when utilizing a graphite antimony nasogastric pH probe as a reference standard. Litmus paper-determined gastric pH testing is both easy to perform and inexpensive. Therefore, based on the current data, we believe this technique (i.e., litmus paper determined gastric pH testing) to be the method of choice for determination of intragastric pH in patients at risk for stress gastric ulcers in the medical ICU.

A physician's alert prompted us to investigate workers' cancer risk at a paperboard printing manufacturer. We conducted a retrospective cohort mortality study of all 2,050 persons who had worked at the facility for more than 1 day, calculated standardized incidence ratios (SIRs) for bladder and renal cell cancer, and conducted a nested case-control study for renal cell cancer. Standardized mortality ratios (SMRs) from all causes [SMR = 1.0, 95% confidence interval (CI) = 0.9-1.2] and all cancers (SMR = 0.6, 95% CI = 0.3-1.0) were not greater than expected. One bladder cancer and one renal cell cancer were included in the mortality analysis. Six incident renal cell cancers were observed, however, compared with less than two renal cell cancers expected (SIR = 3.7, 95% CI = 1.4-8.1). Based on a nested case-control analysis, the risk of renal cell cancer was associated with overall length of employment but was not limited to any single department or work process. Although pigments containing congeners of dichlorobenzidine and o-toluidine had been used at the plant, environmental sampling could not confirm any current exposure. Several limitations and a potential selection bias limit the inferences that can be drawn.

We have devised a paper model of the auricle that is simple to design and easily fabricated. An oval-shaped sheet of paper is folded so that the prominent and hollow parts center around a helical crus and concha. Most parts of the human auricle can be created by using this model. Studies of the model show that a large skin area is required for the helical crus. The model is considered to be useful in simulating total or partial auricular reconstruction. It also reveals new possibilities in reconstructive methods using tissues composed of cartilage and skin, which are flat and large. Furthermore, it is interesting that the formation of our paper model by forward rotation and folding is compatible with the process of auricle embryonic development.

We report a case of Alternaria infection of the nail and cornea in an immunocompromised patient working in the paper-manufacturing industry. This unusual clinical presentation could represent an occupational disorder. The importance of histologic examination of the altered nails is emphasized. The proof of a real nondermatophytic onychomycosis is established only when hyphae of culture-proven molds are shown inside the nail plate.

A proportionate mortality ratio (PMR) analysis utilizing death certificates and work histories was performed on 201 white male decedents who had been employed in pulp and paper production plants and had died between 1970 and 1984. PMRs for all malignant neoplasms (PMR = 131) and lung cancer (PMR = 151) were significantly elevated, whereas PMRs for lymphopoietic system cancer (PMR = 190) and cancer of the large intestine (PMR = 147) showed nonsignificant excesses. Most of the excess cancers of the lung and large intestine were limited to those with greater than 30 years between initial employment in a pulp and paper plant and death. Excess lung and lymphopoietic system cancers have been found in other studies of paperworker mortality, although this study failed to support previous findings of excess stomach cancer. These results continue to raise concerns that paperworkers are at elevated risk for some occupational cancers.

This study investigated whether occupational exposure in pulp and paper mills or geographic proximity to mills was associated with an increase in risk for respiratory disease hospitalizations. Three years (1980 to 1982) of 100% age- and sex-adjusted hospital admission rates for selected respiratory diagnoses were calculated for 66 Maine towns located between 0 and 15 miles for seven Kraft mills and four groundwood pulp and paper mills. Additional data collected for each town included the number of production workers at each mill, mill proximity, insurance coverage, hospital distance, bed size, full-time equivalent physicians, unemployment and income rates. Regression results provide evidence that occupational exposure may be a significant factor in hospitalizations for respiratory infections, bronchitis and asthma, and respiratory signs and symptoms, although potential confounders (smoking, commercial health insurance) need to be examined.

Hyperthermia, hypoxia, and other conditions induce the appearance of heat shock or stress proteins in cells. We have previously shown that in the ischemic dog myocardium the level of a messenger RNA (mRNA) coding for a protein with migration characteristics similar to heat shock/stress protein 71 increases. Using a human heat-shock protein (hHSP) 70 genomic clone and anti-HSP70 antibodies as probes, we demonstrate in this report that heart stress protein (SP) 71 mRNA and its translational products (71 kDa polypeptides) are members of the stress protein family. In rabbit hearts, the ischemia-induced mRNAs translate into three isoforms with different isoelectric points (6.0, 6.1, and 6.15), in contrast to dog heart mRNA that translates into a protein with a pI of 5.8. The levels of SP71 mRNA in the dog and rabbit ischemic myocardium increased by sixfold and 18-fold, respectively. In the same samples, the levels of creatine kinase M mRNA decreased by about 40%, whereas those of myosin heavy chain mRNA remain unaltered. Our comparative analysis of three different mRNAs indicates that ischemia manifests its effects by differentially changing the levels of specific mRNAs coding for proteins with separate and distinct roles in the cell.

SUMMARY The survival of rabbit skin allografts was significantly prolonged for up to 22 days following treatment of the skin grafts with electrophoresis prior to transplantation. No relationship between one combination of current and time and a maximum survival time could be established. A new method of window electrophoresis is presented, and its possible advantages over regular paper electrophoresis are discussed.