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Improving the energy efficiency of the building sector has become an increasing concern in the world, given the alarming reports of greenhouse gas emissions. The management of building energy systems is considered an essential means for achieving this goal. Predicting indoor temperature constitutes a critical task for the management strategies of these systems. Several approaches have been developed for predicting indoor temperature. Determining the most effective has thus become a necessity. This paper contributes to this objective by comparing the ability of seven machine learning algorithms (ML) and the thermal gray box model to predict the indoor temperature of a closed room. The comparison was conducted on a set of data recorded in a room of the Laboratory of Civil Engineering and geo-Environment (LGCgE) at Lille University. The results showed that the best prediction was obtained with the artificial neural network (ANN) and extra trees regressor (ET) methods, which outperformed the thermal gray box model.

Nowadays, the increasing number of patients accompanied with the emergence of new symptoms and diseases makes heath monitoring and assessment a complicated task for medical staff and hospitals. Indeed, the processing of big and heterogeneous data collected by biomedical sensors along with the need of patients’ classification and disease diagnosis become major challenges for several health-based sensing applications. Thus, the combination between remote sensing devices and the big data technologies have been proven as an efficient and low cost solution for healthcare applications. In this paper, we propose a robust big data analytics platform for real time patient monitoring and decision making to help both hospital and medical staff. The proposed platform relies on big data technologies and data analysis techniques and consists of four layers: real time patient monitoring, real time decision and data storage, patient classification and disease diagnosis, and data retrieval and visualization. To evaluate the performance of our platform, we implemented our platform based on the Hadoop ecosystem and we applied the proposed algorithms over real health data. The obtained results show the effectiveness of our platform in terms of efficiently performing patient classification and disease diagnosis in healthcare applications.

The use of grey-box models for short-time forecasting of buildings’ thermal behavior requires the determination of the models’ order since this order could influence the grey-box models’ performance. This paper presents an analysis of the optimal order of these models for different thermal conditions. The novelty of this work consists of considering the influence of the heating conditions on the determination of the performances of grey-box models. The analysis is based on experimental tests that were conducted in a room with different thermal conditions, related to the variation of the heating power. Experimental results were used for the determination of the optimal grey-box models’ order that minimizes the gap between the experimental results and the grey-box forecasting. Results show that the optimal grey-box models’ order depends on the buildings’ thermal conditions, but generally lies between two and three with an error less than 0.2 °C and a fit percent greater than 90%.

During the next 15 years, around 200 km of tunnels and 68 new metro stations will be built around Paris to increase the capacity of the existing metro and the transport efficiency. The Société du Grand Paris—the public entity in charge of the design and the execution of this new network—is also highly concerned by the development and the use of renewable energy within this project, especially the integration of thermoactive metro stations in a smart energy system. This paper discusses some issues related to this strategy within the “Grand Paris Project„. The first part presents how smart technology could help to the integration of thermoactive metro stations into the urban energy system, while the second part addresses the following issues: assessment of the geothermal potential, estimate of the energy demand, ground investigations, thermal design, and finally system monitoring. The mechanical design is not considered in this paper. The paper shows the pertinence of the smart energy system for the integration of the thermoactive metro stations energy and the procedure for its implementation.

Aim: To explore secondary school students' perspectives about nursing careers and their motivations to become future nurses., Design: Qualitative descriptive design., Methods: A qualitative study was conducted among secondary school students in Central Tanzania. Secondary school students who study science subjects and are eligible for nursing studies were selected from two schools. Two focus-group discussions, comprising seven and eight students per group, one in each school, were conducted. The data were transcribed verbatim and analysed using qualitative thematic analysis., Results: Two themes with seven sub-themes emerged representing students' perspectives about nursing and the factors that motivate them to choose nursing as their future career. These themes are as follows: (1) Perspectives about a nurse and nursing, with five sub-themes: (i) nurses' roles; (ii) qualities of nurses; (iii) workplace for nurses; (iv) nature of the job; and (v) position of a nurse or nursing; and (2) Motivations to become future nurses, with two sub-themes: (i) extrinsic factors, and (ii) intrinsic factors., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Language is a method by which individuals express their thoughts. Each language has its own alphabet and numbers. Oral and written communication are both effective means of human interaction. However, each language has a sign language equivalent. Hearing-impaired and/or nonverbal individuals communicate through sign language. BDSL is the abbreviation for the Bangla sign language. The dataset contains images of hand signs in Bangla. The collection comprises 49 individual sign language images of the Bengali alphabet. BDSL49 is a set of 29,490 images with 49 labels. During data collection, images of fourteen distinct adults, each with a unique appearance and context, were captured. During data preparation, numerous strategies have been utilized to reduce noise. This dataset is available for free to researchers. Using techniques such as machine learning, computer vision, and deep learning, they are able to develop automated systems. Moreover, two models were applied to this dataset. The first is for detection, and the second is for identification., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

The telocytes (TCs) are novel interstitial cells that have been overlooked for a long time due to their histologic similarity to other stromal cells. TCs can be separated from the stromal cells based on their distinct immunohistochemical, ultrastructural, and molecular features. Functionally, TCs are involved in the tissue renewal, mechanical support, and immune modulation. These cells are also involved in the signal transduction either through their direct interactions with the neighboring cells or through the paracrine signaling via extracellular vesicles. TCs are damaged in several inflammatory and fibrotic conditions such as ulcerative colitis, Crohn's disease, hepatic fibrosis, psoriasis, and systemic sclerosis. The transplantation of TCs in the damaged tissue can promote tissue regeneration. Therefore, enhancing tissue TCs either by their transplantation or by promoting their survival and growth using novel medications represents novel therapeutic strategy in the future. In this review, we addressed several aspects of TCs including their origin, distribution, morphologic features, and functions. We also discussed their involvement of the cutaneous TCs in the development various pathologic conditions., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Background: Basal cell carcinoma (BCC) is common cutaneous malignancy., Aims: To examine the expression patterns of CD10, p63, BCL-2, and epithelial membrane antigen (EMA) proteins in BCC., Materials and Methods: We used immunohistochemistry to evaluate the expression pattern of these proteins in 45 BCC specimens and their adjacent normal skin., Results: We found variations in the expression pattern of these proteins among normal skins and BCC. In normal skins, we found strong EMA cytoplasmic expression (adnexal structures). A strong nuclear p63 protein expression was found in basal and some suprabasal keratinocytes, external root sheath cells of the hair follicles, basal cells of the sebaceous glands, and in sweat glands.CD10 protein expression was seen in peri-adnexal mesenchymal spindle cells and myoepithelial cells of sweat glands.BCL-2 protein expression was confined to the basal cell keratinocytes, epidermal melanocytes, outer root sheath, and infundibulum of the hair follicle. In BCC, we found p63 (diffuse, strong nuclear staining), CD10 (focal, moderate cytoplasmic reactivity), and BCL-2 (focal, moderate cytoplasmic reactivity) protein expression in the neoplastic cells. BCC was consistently negative for EMA (except in areas of squamous differentiation)., Conclusions: There is an altered expression of these proteins in BCC. The underlying molecular mechanisms are open to further investigations., (Copyright © 2022 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Striae distensae (SD) are common skin conditions., Objectives: This study was done to test the hypothesis that 'the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.', Patients and Methods: Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes., Results: As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis., Conclusions: This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.

Background: Self-directed learning is important in nursing as it is associated with improved clinical and moral competencies in providing quality and cost-effective care among people. However, unethical professional conduct demonstrated by some graduate nurses is linked with the way they are developed in schools alongside the content and pedagogies prescribed in nursing curricula. Pedagogical transformations appear to be inevitable to develop enthusiastic nursing students who can work independently in delivering quality and cost-effective nursing services to people. This study intended to examine the impact of facilitation in a problem-based pedagogy on self-directed learning readiness among undergraduate nursing students in Tanzania., Methods: A controlled quasi-experimental design was conducted in Tanzanian higher training institutions from January to April 2019. A 40-item Self-directed learning Readiness scale for nursing education adopted from previous studies measured self-directed learning and the Student A descriptive analysis via a Statistical Package for Social Sciences software program (version 23) was performed to establish nursing students' socio-demographic characteristics profiles. Independent samples t-test determined mean scores difference of self-directed learning readiness among nursing students between groups while regression analysis was performed to discriminate the effect of an intervention controlled with other co-related factors., Results: The post-test results of self-directed learning readiness showed that nursing students scored significantly higher [(M = 33.01 ± 13.17; t (399) = 2.335; 95%CI: 0.486,5.668)] in the intervention group than their counterparts in the control. Findings of SDL readiness subscales were significantly higher among students in the intervention including self-management [(M = 10.11 ± 4.09; t (399) = 1.354; 95%CI: 0.173,4.026)], interest learning [(M = 9.21 ± 2.39; t (399) = 1.189; 95%CI: 0.166,4.323)] and self-control [(M = 13.63 ± 5.05; t (399) = 2.335; 95%CI: 0.486,5.668)]. The probability of nursing students to demonstrate self-directed learning readiness was 1.291 more times higher when exposed to the intervention (AOR = 1.291, p < 0.05, 95%CI: 0.767, 2.173) than in the control., Conclusion: Facilitation in a problem-based pedagogy promises to change the spectrum of nursing learning habits potentially to their academic and professional achievements. Nurse tutors need to be empowered with it to prepare nursing students to meet their academic and professional potentials., (© 2021. The Author(s).)

Objectives: In 2018, a nationwide mandatory switch from originator to biosimilar adalimumab was conducted in Denmark. The available biosimilar was GP2017 (Hyrimoz) in Eastern regions and SB5 (Imraldi) in Western regions. We aimed to assess the comparative effectiveness of GP2017 versus SB5 in patients with rheumatoid arthritis (RA)/psoriatic arthritis (PsA)/axial spondyloarthritis (AxSpA)., Methods: Observational cohort study based on the DANBIO registry with geographical cluster pseudo-randomisation, analysed by emulating a randomised clinical trial. Main outcome was adjusted 1-year treatment retention (Cox regression). Furthermore, 6 months' remission rates (logistic regression), reasons for withdrawal and back-switching to originator were investigated (overall and stratified by indication)., Results: Overall, of 1570 eligible patients, 1318 switched and were included (467 RA/321 PsA/530 AxSpA); 623 (47%) switched to GP2017, 695 (53%) to SB5. Baseline characteristics of the two clusters were largely similar, but some differences in registration practice were observed. The combined 1-year retention rate for the two biosimilars was 89.5%. Compared with SB5, estimated risk of withdrawal for GP2017 was lower (HR 0.60; 95% CI 0.42 to 0.86) and 6 months' remission rate was higher (OR 1.72; 95% CI 1.25 to 2.37). Stratified analyses gave similar results (statistically significant for RA). During 1 year, 8.5% and 12.9% withdrew GP2017 and SB5, respectively (primarily lack of effect and adverse events), of whom 48 patients (3.6%) back-switched., Conclusion: This head-to-head comparison of GP2017 versus SB5 following a mandatory switch from the originator indicated differences in effectiveness in routine care. This may reflect a true difference, but other explanations, for example, differences in excipients, differences between clusters and residual confounding cannot be ruled out., Competing Interests: Competing interests: AGL: AbbVie, Eli Lilly Denmark A/S, Janssen-Cilag A/S, MSD, Novartis, Pfizer, UCB teaching or consultancy fees. OH: AbbVie, Pfizer, Novartis. MLH: AbbVie, Biogen, BMS, Celtrion, Eli Lilly Denmark A/S, Janssen Biologics BV, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Bioepis, Sandoz. Furthermore, chair of the steering committee of the Danish Rheumatology Quality Registry (DANBIO), which receives public funding from the hospital owners and funding from pharmaceutical companies. Co-chair EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondyloarthritis based on secondary data and is partly funded by Novartis. BG: BMS, Pfizer, Sandoz (research grants)., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Renal transplantation is the ideal therapeutic implement for end-stage renal disease patients. However, late kidney graft defeat remains a main challenge. Torque teno virus (TTV) is a small DNA virus whose replication is strictly related to person immune status besides TTV Antigens could prevent organ rejection by regulating both adaptive and innate immunity through interfering with NF-κB pathway which decrease interleukin-6 (IL-6) levels in renal transplanted patients. This cross-sectional study was conducted eighty serum samples were collected renal transplant recipients, DNA was extracted and the viral DNA was detected and quantified by quantitative polymerase chain reaction (PCR) for human cytomegalovirus (CMV) and real-time PCR for TTV. In addition, enzyme-linked immunosorbent assays (ELISA) were used for the detection of TTV antigen and IL-6 levels were also done. Result of PCR showed that 25% and 56.25% of renal transplantation patients had positive for CMV and TTV viremia. CMV viremia was positive in 20% of patients who have positive result to TTV-DNA, which was statistically nonsignificant. Results of ELISA presented that TTV-Ag was positive in 10% of renal transplantation patients, while IL-6 level was very low in patients who have positive results to present of TTV-Ag which was significantly lower in those patients (P = 0.008). In conclusion, TTV could have not an association with reactivation of CMV in renal transplant patients and the presence of TTV-Ag reduce renal rejection by decreasing of IL-6 levels which might be an indicator of allograft status.

Misinformation such as on coronavirus disease 2019 (COVID-19) drugs, vaccination or presentation of its treatment from untrusted sources have shown dramatic consequences on public health. Authorities have deployed several surveillance tools to detect and slow down the rapid misinformation spread online. Large quantities of unverified information are available online and at present there is no real-time tool available to alert a user about false information during online health inquiries over a web search engine. To bridge this gap, we propose a web search engine misinformation notifier extension (SEMiNExt). Natural language processing (NLP) and machine learning algorithm have been successfully integrated into the extension. This enables SEMiNExt to read the user query from the search bar, classify the veracity of the query and notify the authenticity of the query to the user, all in real-time to prevent the spread of misinformation. Our results show that SEMiNExt under artificial neural network (ANN) works best with an accuracy of 93%, F 1-score of 92%, precision of 92% and a recall of 93% when 80% of the data is trained. Moreover, ANN is able to predict with a very high accuracy even for a small training data size. This is very important for an early detection of new misinformation from a small data sample available online that can significantly reduce the spread of misinformation and maximize public health safety. The SEMiNExt approach has introduced the possibility to improve online health management system by showing misinformation notifications in real-time, enabling safer web-based searching on health-related issues.

Background: We investigated if initiating preventive care against HIV vertical transmission by antenatal HIV screening is independent of the patients' source of financial reimbursement for the care received in sub-Saharan Africa (SSA)., Methods: Using information from the WHO's Global Health Expenditure Database and the Demographic Health Surveys Database for 27 sub-Saharan countries, we used Spearman's correlation and adjusted survey logistic regression to determine the potential relationship between enrollment in health insurance and the likelihood that expectant mothers would be offered antenatal HIV screening., Results: We found that expectant mothers covered by health insurance were more than twice as likely to be offered antenatal screening for HIV compared to the uninsured. The likelihood differed by the type of insurance plan the expectant mother carried., Discussion: Health insurance is more of a financial tool that this study finds to be necessary to boost the uptake of preventive and therapeutic HIV care in SSA., Conclusion: The ensuing disparity in receiving proper care could hinder the goals of 90-90-90 and the forthcoming 95-95-95 plan in SSA., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The spinel ferrite nanoparticles, such as zinc, nickel, and cobalt ferrites have exceptional electronic and magnetic properties. Cobalt ferrite nanomaterial (CoFe2O4) is a hard material that reveals high magnetic, mechanical, and chemical stability., Aim and Objective: The objective of this research is to predict the corrosion behavior of cobalt ferrite (CoFe2O4) thin films deposited on different substrates (platinum Pt, stainless steel S.S, and copper Cu) in acidic, neutral, and alkaline medium., Materials and Methods: Cobalt ferrite thin films were deposited on platinum, stainless steel, and copper via electrodeposition-anodization process. After that, corrosion resistance of the prepared nanocrystalline cobalt ferrite on different substrates was investigated in acidic, neutral, and alkaline medium using open circuit potential and potentiodynamic polarization measurements. The crystal structure, crystallite size, microstructure, and magnetic properties of the ferrite films were investigated using a combination of XRD, SEM and VSM., Results: The results of XRD revealed a cubic spinel for the prepared cobalt ferrite CoFe2O4. The average size of crystallites was found to be about 43, 77, and 102 nm precipitated on platinum, stainless steel, and copper respectively. The magnetic properties of which were enhanced by rising the temperature. The sample annealed at 800oC is suitable for practical application as it showed high magnetization saturation and low coercivity. The corrosion resistance of these films depends on the pH of the medium as well as the presence of oxidizing agent., Conclusion: Depending on the obtained corrosion rate, we can recommend that, CoFe2O4 thin film can be used safely in aqueous media in neutral and alkaline atmospheres for Pt and Cu substrates, but it can be used in all pH values for S.S. substrate., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Non-Hodgkin lymphomas of the oral and maxillofacial regions are uncommon malignancies. They usually have progressive course and dismal outcome. Areas covered: This review provides an update about the clinicopathologic, immunophenotypic, and molecular features of these lymphomas. Some relevant case reports are presented. Expert commentary: The lymphomas of the oral and maxillofacial regions involve the tongue, gingiva, hard palate, maxilla, mandible, Waldeyer's ring, palatine, and lingual tonsils. They include diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma, Burkitt lymphoma (BL), natural killer/T-cell lymphoma (NKTCL), marginal zone lymphoma, plasmablastic lymphoma (PBL), mantle cell lymphoma, and lymphoblastic lymphoma. They are more common in males than in females. They commonly present as mass lesions covered by an intact or ulcerated mucosa. Some lymphomas are associated with viral infections (Epstein-Barr virus or HIV) and specific genetic alterations. Each subtype has its specific clinicopathologic features and the most common subtypes include DLBCL, BL, NKTCL, and PBL. DLBCL is the most common oral lymphoma. BL is a rapidly proliferating mature B cell neoplasm almost always presenting in extranodal sites. Nasal-type NKTCL presents as a locally destructive, midfacial necrotizing lesion. PBL is a rare, highly aggressive disease that is commonly associated with immunodeficiency conditions.

Background: Microdermabrasion and chemical peeling are popular, inexpensive, and safe methods for treatment of some skin disorders and to rejuvenate skin., Objectives: To study the alterations of the dermal connective tissue following salicylic acid peeling and microdermabrasion., Methods: Twenty patients were participated in our study. All participants underwent facial salicylic acid 30% peel or microdermabrasion (10 cases in each group) weekly for 6 weeks. Punch biopsies were obtained from the clinically normal skin of the right postauricular region 1 week before treatment (control group). Other punch skin biopsies were obtained 1 week after the end of the treatments from the left postauricular area. This region was treated in a similar way to the adjacent lesional skin (treated group). We used routine histological techniques (H&E stain), special stains (Masson trichrome and orcein stains), and image analyzer to study the alterations of the dermal connective tissues., Results: Our study demonstrates variations in the morphological changes between the control and the treated groups, and between chemical peels and microdermabrasion. Both salicylic acid 30% and microdermabrasion were associated with thickened epidermal layer, shallow dermal papillae, dense collagen, and elastic fibers. There was a significant increase among those treated sites vs control regarding epidermal thickness and collagen thickness. Also, there was a highly statistically significant increase among those treated with salicylic acid vs microdermabrasion regarding the epidermal, collagen, and elastin thickness., Conclusions: Both methods stimulate the repair process. The mechanisms underlying these variations are open for further investigations., (© 2017 Wiley Periodicals, Inc.)

Glial cell line-derived neurotrophic factor (GDNF) and its cognate receptor (GFRα-1) are expressed in normal human skin. They are involved in murine hair follicle morphogenesis and cycling control. We hypothesize that 'GDNF and GFRα-1 protein expression in human skin undergoes age-associated alterations. To test our hypothesis, the expression of these proteins was examined in human skin specimens obtained from 30 healthy individuals representing three age groups: children (5-18 years), adults (19-60 years) and the elderly (61-81 years). Immunofluorescent and light microscopic immunohistologic analyses were performed using tyramide signal amplification and avidin-biotin complex staining methods respectively. GDNF mRNA expression was examined by RT-PCR analysis. GDNF mRNA and protein as well as GFRα-1 protein expressions were detected in normal human skin. We found significantly reduced epidermal expression of these proteins with ageing. In the epidermis, the expression was strong in the skin of children and declined gradually with ageing, being moderate in adults and weak in the elderly. In children and adults, the expression of both GDNF and GFRα-1 proteins was strongest in the stratum basale and decreased gradually towards the surface layers where it was completely absent in the stratum corneum. In the elderly, GDNF and GFRα-1 protein expression was confined to the stratum basale. In the dermis, both GDNF and GFRα-1 proteins had strong expressions in the fibroblasts, sweat glands, sebaceous glands, hair follicles and blood vessels regardless of the age. Thus there is a decrease in epidermal GDNF and GFRα-1 protein expression in normal human skin with ageing. Our findings suggest that the consequences of this is that GFRα-1-mediated signalling is altered during the ageing process. The clinical and therapeutic ramifications of these observations mandate further investigations., (© 2016 The Authors. International Journal of Experimental Pathology © 2016 International Journal of Experimental Pathology.)

Background: mTOR signaling pathway is commonly activated in cancer. PTEN, a tumor suppressor gene, is a potent inhibitor of this pathway. To date the expression pattern of mTOR and PTEN in schistosomal bladder squamous cell carcinoma and urothelial carcinoma was not investigated. Also, whether alterations of these proteins are associated with pathological parameters was not established., Hypothesis: We hypothesize that "expression of mTOR and/or PTEN will be altered in schistosomal-related urothelial and squamous cell carcinomas"., Patients and Methods: To test our hypothesis we examined the expression pattern of mTOR and PTEN in normal and hyperplastic urothelium, squamous metaplasia, schistosomal urothelial carcinomas (70 cases) and squamous cell carcinomas (47 cases) using immunohistochemical methods., Results: mTOR protein expression was absent in the normal, hyperplastic urothelium and metaplastic squamous epithelium. mTOR was over-expressed in muscle invasive urothelial and high grade squamous cell carcinomas. In contrast, PTEN protein expression was seen in the normal and hyperplastic urothelium. The expression was reduced (metaplastic squamous epithelium) or lost in muscle invasive urothelial and high grade squamous carcinomas. Alterations of these proteins were associated with some clinicopathological features. mTOR expression was negatively correlated with PTEN expression in urothelial carcinoma only., Conclusions: We report, for the first time, altered expression of mTOR and PTEN proteins in schistosomal urothelial and squamous cell carcinomas. Alterations of these proteins may contribute to the progression and aggressive behavior of schistosomal bladder carcinoma. Targeting mTOR, may be a promising therapeutic strategy in these tumors., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Cutaneous drug reactions are common adverse effects that occur in about 2-3% of the hospitalized patients. They have both immunologic and non-immunologic underlying mechanisms. These reactions are clinically and histologically similar to dermatoses. Their significant clinical indicators include: history of drug intake, atypical clinical features and improvement after cessation of the offending drugs. Their diagnostic histological clues include the presence of mixed histological patterns, apoptotic keratinocytes, eosinophils (dermis and epidermis), papillary dermal edema and extravasations of erythrocytes. However, no single clinical or histological feature is specific of drug eruptions. This work attempts to classify the histomorphologic reactions to various drugs in defined categories for assistance in morphologic diagnosis.

Background: Vitiligo is an idiopathic skin disease, characterized by circumscribed white macules or patches on the skin due to loss of the functional melanocytes. Glial cell line-derived neurotrophic factor (GDNF) and its cognate receptor (GFRα-1) are distal members of the transforming growth factor-β superfamily. GDNF, produced by the basal cell keratinocytes, is involved in the migration and differentiation of the melanocytes from the neural crest to the epidermis. This study examines the hypothesis that expression of GDNF protein and its cognate receptor GFRα-1 protein is altered in vitiliginous skin., Patients and Methods: To test our hypothesis, we examined the expression patterns of these proteins in vitiliginous and corresponding healthy (control) skin biopsies (20 specimens each) using immunoperoxidase staining techniques., Results: We found variations between the vitiliginous skin and healthy skin. In healthy skin, the expression of GDNF and GFRα-1 proteins was strong (basal cell keratinocytes and melanocytes), moderate (spinous layer), and weak (granular cell layer). In contrast, weak expression of GDNF protein was observed in all epidermal layers of vitiliginous skin. GFRα-1 protein expression was strong (basal cell keratinocytes and melanocytes), moderate (spinous layer), and weak (granular cell layer). In both healthy skin and vitiliginous skin, the expression of GDNF and GFRα-1 proteins was strong in the adnexal structures., Conclusions: We report, for the first time, decreased expression of GDNF proteins in the epidermal keratinocytes of vitiliginous skin. Our findings suggest possible pathogenetic roles for these proteins in the development of vitiligo. The clinical ramifications of these observations mandate further investigations., (© The Author(s) 2015.)

Background: Vitiligo is an idiopathic skin disease characterized by white areas on the skin due to loss of the functional melanocytes, with possible involvement of oxidative stress. Glutathione peroxidase (GPx) is an antioxidant enzyme that protects cells against oxidative damage., Aim: To examine serum GPx levels in patients with vitiligo and to relate the findings to the clinical features., Patients and Methods: The study group included 60 patients with vitiligo and 30 matching healthy controls. GPx activity was evaluated using enzyme-linked immunosorbent assay., Results: We found a significant decrease in serum GPx activity level in the patients with vitiligo compared to the healthy controls (0.29 ± 0.14 versus 0.47 ± 0.13, p < .001). The levels were significantly low in skin phenotypes III and IV (p < .001). Higher levels were also observed with increasing age (≥ 14 years), prolonged disease duration (≥ 3 years), and generalized and extensive vitiligo (< 50%). However, these variations were statistically insignificant., Conclusions: Low levels of serum GPx activity, indicative of a disturbed oxidant-antioxidant system, may contribute to the development of vitiligo., (© 2014 Canadian Dermatology Association.)

In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.

Atypical fibroxanthoma (AFX) is an ultraviolet radiation-associated dermal neoplasm. To address the clinicopathologic and molecular features of this particular neoplasm. The author conducted a literature review using PubMed searching for articles relating to AFX. AFX usually appears as a rapidly growing nodular or nodulo-ulcerative lesion. It occurs on sun-exposed skin of elderly peoples. AFX may be composed predominantly of pleomorphic, spindle, epithelioid cells, or admixture of these cells. The differential diagnosis of AFX includes pleomorphic dermal sarcoma, squamous cell carcinoma, malignant melanoma and leiomyosarcoma. Several observations favor a mesenchymal origin for AFX. These reviews address the clinicopathologic features, molecular pathology, prognosis and treatment of this neoplasm.

Purpose: To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing., Methods: The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES)., Results: A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II., Conclusion: Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.

Melanocytes arise from the neural crest and migrate to the epidermis, meninges, uveal tract and ectodermal mucosa. Normal gastric mucosa lacks melanocytes. A 64-year-old woman presented to us with nausea and vomiting. She had a past history of invasive primary mucosal epithelioid malignant melanoma of the hard palate 21 months ago, treated by a wide surgical excision. Gastroscopy revealed multiple punched out ulcers involving the stomach and the first part of duodenum. Immunohistology and clinicopathologic correlation established the diagnosis of metastatic gastric malignant melanoma. To our knowledge, this is the first report in the English literature about gastric metastases arising from primary palatal mucosal melanoma.

Skin is an organ of the immune and lymphoid systems. Lymphoid tissue analogous to gut mucosa-associated lymphoid tissue proliferates in the skin in response to antigenic stimulation. This putative skin-associated tissue is called skin-associated lymphoid tissues (SALT). In the opinion of this author, cutaneous pseudolymphomas represent inflammatory, reactive proliferations of SALT following antigenic stimulation of the cutaneous immune cells. Cutaneous pseudolymphomas commonly involve the exposed areas such as head and neck region and upper extremities. They appear as localized nodules, plaques or noduloplaques. They include B- and T-cell pseudolymphomas. Their histologic patterns include nodular, diffuse, band-like and folliculitis-like morphology. Most pseudolymphomas are idiopathic, but some are secondary to known etiologies (drug intake, arthropod assaults, infectious agents and traumas). Cutaneous pseudolymphomas are usually polyclonal proliferations that regress spontaneously or after treating the underlying etiology. Rare cases harbor clonal lymphoid populations and can progress to low-grade lymphomas. Herein, the author reviews the etiology, clinicopathologic features and diagnosis of the cutaneous pseudolymphomas.

Lymphoid proliferations are traditionally thought to be either benign conditions (reactive hyperplasia and lymphadenitis) or malignant lymphomas. However, not all lymphoid lesions at present can be precisely placed into one of these categories. Therefore, in addition to these two extremes, there also exist a third group of lymphoid proliferations - the atypical lymphoid proliferations (AtLP). AtLP is a descriptive term used when it is not possible for the pathologist to differentiate between the benign and the malignant nature of a given lymphoid infiltrate. AtLP represent biologically indeterminate lesions that have some worrisome clinicopathologic features but cannot be interpreted as malignant lymphomas using all criteria currently available. They have some likelihood for subsequent transformation into lymphomas, and therefore AtLP occupy a middle ground between benign and malignant lymphoid proliferations. Nevertheless, sometimes AtLP are not necessarily premalignant and may very well represent a fully benign situation mimicking malignancy. In the author's opinion, when confronted with a challenging lymphoproliferative lesion, the pathologist should marshall all resources available to interpret it as precisely as possible and therefore place it into one of the two categories: unequivocally benign condition or malignant lymphomas. The resources should include immunohistochemical and molecular studies, obtaining expert opinion and rebiopsy. However, if clinical, morphologic and molecular findings are not sufficient for diagnosis of a benign condition versus lymphoma, the descriptive term AtLP can be used. In the author's opinion, the use of this descriptive term AtLP may obviate the need to force some lymphoid proliferations (equivocal lesions or mimickers of lymphomas) into either the benign or malignant categories.

Background: Sensory stimuli are conducted by several cutaneous sensory nerves and tactile corpuscles. The latter are specialized sensory organs that represent the starting point of many afferent sensory pathways. To date, our knowledge about the distribution of the sensory innervation in the umbilical skin of females is incomplete., Aim of the Study: To elucidate the morphology of the cutaneous innervation of the normal female umbilical skin., Materials and Methods: Biopsies of normal umbilical skin were obtained from female patients undergoing umbilical hernial repair. The specimens were processed for both immunohistological (antibodies against PGP9.5, pan-neuronal marker, and S-100 protein, marker of Schwann cells) and ultrastructural (transmission electron microscopy) examinations., Results: The authors found abundant genital end-bulb-like structures, numerous epidermal and dermal Merkel cells, Meissner and Ruffini corpuscles, intraepidermal nerve terminals, and multiple free nerve endings surrounding the ducts and acini of the sweat glands., Conclusions: The umbilical skin of females has abundant sensory innervation similar to that of the glans penis.

Leprosy is a devastating disease caused by Mycobacterium leprae. It includes a spectrum of clinicopathological lesions. Neuritic leprosy with caseation necrosis (abscess) manifesting as a soft tissue mass is a relatively rare presentation of leprosy. Here, the authors report their experience with three patients with neuritic leprosy. The patients presented with swellings in the right ulnar nerve, the right great auricular nerve, and the temporal branch of the right sixth cranial nerve. The clinical impression was that of tumorous masses. Gross examination of the biopsy specimens revealed caseous necrotic materials. Further histological evaluation disclosed tuberculoid granulomas with extensive caseation necrosis. Stains for acid-fast bacilli were positive in the third case. A comparison between the caseation encountered in the tuberculoid neurotic leprosy and the neurolysis of lepromatous neurotic leprosy has been also discussed. The findings here emphasize "mass lesion with necrosis" as a possible clinical presentation of the neuritic leprosies. The clinicopathologic features were addressed and the relevant literature was reviewed.

Background: Thermal tissue injury is partly mediated by reactive oxygen metabolites. Oxygen free radicals are contributory to local tissue damage following thermal injury and accordingly an interventional therapy using antioxidants may be beneficial. Copper nicotinate complex can scavenge reactive oxygen species (i.e., has antioxidant activity)., Objectives: To examine time-related morphological and biochemical changes following skin thermal injury and their modulation by copper nicotinate complex., Materials and Methods: An animal model composed of 80 albino rats was established. Ten rats (nonburn group) served as a control group. Seventy rats (burn group) were anesthetized, given a 10% total body surface area, full-thickness burn. Ten rats (from the postburn group) were sacrificed after 24 h (without treatment, i.e., untreated-burn group). The remaining rats were divided into three subgroups (20 rats, each) and were treated topically either with soft paraffin, moist exposed burn ointment (MEBO, a standard therapeutic treatment for burns), or copper nicotinate complex. Five animals from each subgroup were sacrificed every week over a period of 4 weeks. The morphological and biochemical changes were evaluated and compared among the different groups., Results: High levels of the plasma and skin nitiric oxide (marker of oxidative stress) were observed in the untreated-burn group. These levels were significantly low following the application of copper nicotinate complex. Low levels of plasma and skin superoxide dismutase (marker of oxidative stress) and plasma ceruloplasmin were observed in the untreated-burn group. These levels were significantly high following copper nicotinate complex treatment. The total and differential leukocyte counts were low following the onset of the thermal injury. They gradually returned to normal levels over a 4-week period following the application of MEBO or copper nicotinate complex. Compared to untreated-burn group, postburn-healing changes (resolution of the inflammatory reaction, reepithelization of the epidermis, angiogenesis, deposition of collagen fibers, and recovery of the subcellualr organelles) were significantly accelerated following the application of either MEBO or copper nicotinate complex., Conclusions: Application of copper nicotinate complex was associated with improved healing of the thermal burns of the skin. The underlying molecular changes underlying these effects await further investigations.

Background: Iron supplementation is recommended during pregnancy to meet the needs of the rapidly growing fetus. However, its intake is associated with the generation of destructive free radicals, i.e., oxidative damage to the fetal brain. Folic acid supplementation is needed during pregnancy to reduce the risk of neural tube defects., Hypothesis: Intake of folic acid can ameliorate the morphological features of cell damage in the striatal tissue (brain of neonatal rats) associated with the intake of iron., Objectives and Methods: To test this hypothesis, an animal model (pregnant Albino rats) was established. The animals were divided into three groups: group A, control animals treated with saline only; group B, animals treated with iron gluconate; and group C, animals treated concomitantly with iron gluconate and folic acid. The striatal brain tissues of the neonates were examined for features of cellular damage, using immunohistological and ultrastructural methods., Results: The authors found significant variations among the three groups. The intake of iron (group B) and its deposition in the striatal tissue (neurons and glial cells) was associated with changes indicative of both cellular injury and regeneration. The former includes neuronal apoptosis and necrosis, and destruction of the organelles, including the mitochondria, endoplasmic reticulum, Golgi apparatus, and lysosomes of the neurons and glial cells. The latter includes microgliosis, astrogliosis, upregulation of glial fibrillary acidic protein, and inducible nitric oxide synthase. These changes were absent in the striatal tissue of the control group (group A) and in animals treated concomitantly with both iron gluconate and folic acid (group C)., Conclusion: Intake of folic acid can protect the neonatal striatal tissue against iron-induced oxidative stress damage.

Objective: To determine the rates of malignancy of thyroid nodules in each standard cytologic diagnostic category of the Bethesda system., Methods: In a retrospective cohort study from October 1998 to April 2007 at the Department of Pathology, Aseer Central Hospital, Southwestern region of Saudi Arabia, all cases of thyroid nodules that underwent preoperative cytologic examination by fine-needle aspiration (FNA) and concurrent postoperative histopathologic examination were included. All FNA diagnoses were reclassified using the thyroid FNA Bethesda reporting system, including non-diagnostic (insufficient), benign, atypical follicular lesion of undetermined significance (AFLUS), neoplasm, suspicious of malignancy, and malignant groups. The rate of malignancy based on final histopathologic evaluation was analyzed for each of these cytologic groups., Results: A total of 323 thyroid fine needle aspiration cytology (FNAC) diagnoses were reclassified into non-diagnostic 6.2%, benign 57.3%, AFLUS 13.6%, follicular and Hurthle cell neoplasms 16.1%, suspicious of malignancy 1.5%, and malignant 5.3% groups. The corresponding rate of malignancy on histopathologic examination was as follows: 35% in the non-diagnostic group, 10.3% in the benign group, 15.9% in AFLUS group, 32.7% in follicular and Hurthle cell neoplasms, 60% in the suspicious of malignancy group, and 94% in the malignant group., Conclusion: Applying a standard terminology reporting system for thyroid FNA may enhance the communication between pathologists and clinicians, assists them to find out the rate of malignancy in each cytologic group, and facilitating a more consistent approach for patients' management.

Introduction: The α-chain variant Hb Q-India (c.193G>C) is caused by a point mutation GAC→CAC at codon 64 of the α1 globin gene and is clinically silent. Point mutations can be diagnosed easily by many simple polymerase chain reaction (PCR) techniques including PCR-restriction digest, but for Hb Q-India the restriction digest has never been described. In this work we aimed to develop a restriction enzyme digestion assay for DNA diagnosis of Hb Q-India, in order to increase the panel of restriction enzymes used in DNA diagnosis of haemoglobinopathies and also as a simple cheap alternative to the ARMS-PCR method., Methods: A restriction enzyme digestion assay was designed for diagnosis of Hb Q-India using the restriction enzyme EaeI enzyme as the Hb Q-India mutation abolishes the recognition site of this enzyme. Patients were screened for an abnormal haemoglobin by high performance liquid chromatography (HPLC) and those had an abnormal peak with a retention time between 4.7 and 4.8 minutes were selected for diagnosis at the molecular level. The α1 globin gene was amplified in 12 cases with a presumed diagnosis of Hb Q-India by HPLC and isoelectric focusing (IEF), and the amplified products were subjected to the EaeI digestion., Results: All the 12 cases were diagnosed positive (100%) for Hb Q-India by the EaeI restriction enzyme digest. They were heterozygotes for the mutation., Conclusion: EaeI restriction enzyme digestion can be used as a simple and robust alternative method to ARMS-PCR for DNA diagnosis of Hb Q-India. The EaeI restriction enzyme can be added to the panel of restriction enzymes used in the DNA diagnosis of the abnormal Hb variants. Concomitant use of HPLC and IEF can be used efficiently for presumed diagnosis of this rare variant., (© 2011 Blackwell Publishing Ltd.)

Background: CK10 is a heterotetramer of type I and two type II keratins., Aim: This study examines the expression pattern of cytokeratin 10 (CK10) in human testis., Materials and Methods: CK10 protein expression was examined using immunofluorescense staining methods in 30 human testicular biopsy specimens (normal spermatogenesis, maturation arrest and Sertoli cell only syndrome, 10 cases each) obtained from patients undergoing investigations for infertility., Results: In the testis showing normal spermatogenesis, CK10 was expressed in the interstitium and in the seminiferous tubules. A strong cytoplasmic expression was seen in the Leydig cells, Sertoli cells, and spermatocytes. In testes showing spermatogenic arrest, weak CK10 protein expression was observed both in the interstitium and seminiferous tubules (some primary spermatocytes). In the testes showing Sertoli cell only syndrome, negligible CK10 staining was seen both in the seminiferous tubules and in the interstitial cells of Leydig., Conclusions: To the authors' knowledge, this is the first study indicating CK10 expression in the human testis during normal and abnormal spermatogenesis. The varied expression of CK10 in testes showing abnormal spermatogenesis suggests its possible involvement in this process.

Introduction: Haemoglobin (Hb) G-Philadelphia mutation is a common alpha-globin chain variant [α68(E17)Asn > Lys]. Combined high performance liquid chromatography (HPLC) and isoelectric focusing (IEF) can be used in a presumptive diagnosis of Hb G-Philadelphia, but there are other α-chain variants with a similar phenotype that cannot be excluded. Our aim was to develop a novel StyI restriction enzyme assay to diagnose the common Hb G-Philadelphia mutation and to identify any other variants with a similar phenotype by DNA sequencing., Methods: Thirty-one cases given a presumptive diagnosis as Hb G-Philadelphia by HPLC and IEF were subjected to DNA analysis by restriction enzyme digestion using StyI. Negative cases were then subjected to DNA sequencing., Results: Twenty-two cases (78.6%) of 28 cases amplified were tested positive for Hb G-Philadelphia by StyI restriction digestion. Sequencing of the six negative cases revealed two cases of Hb G-Philadelphia with C→A mutation in codon 68 in α2 globin gene, plus one case each of Hb G-Norfolk Hb Stanleyville-II, Hb Matsue-Oki and Hb Mizushi., Conclusion: A novel StyI restriction enzyme can be used to confirm the commonest type of Hb G-Philadelphia. DNA sequencing identified four other α-chain variants with a similar HPLC and IEF phenotype., (© 2011 Blackwell Publishing Ltd.)

CD1d is a member of CD1 family of transmembrane glycoproteins, which represent antigen-presenting molecules. Immunofluorescent staining methods were utilized to examine expression pattern of CD1d in human testicular specimens. In testis showing normal spermatogenesis, a strong CD1d cytoplasmic expression was seen the Sertoli cells, spermatogonia, and Leydig cells. A moderate expression was observed in the spermatocytes. In testes showing maturation arrest, CD1d expression was strong in the Sertoli cells and weak in spermatogonia and spermatocytes compared to testis with normal spermatogenesis. In Sertoli cell only syndrome, CD1d expression was strong in the Sertoli and Leydig cells. This preliminary study displayed testicular infertility-related changes in CD1d expression. The ultrastructural changes associated with with normal and abnormal spermatogenesis are open for further investigations.

Background: Genetic alterations in renal cell carcinoma (RCC) involve tumor suppressor genes such as Von Hippel-Lindau (VHL); proto-oncogenes such as MET and transcription factors such as TFE3 oncoprotein., Aim: To examine the clinicopathologic features and the expression of some oncogenic molecules in various RCCs in patients from Upper Egypt., Materials and Methods: The authors examined the expression pattern of pVHL; MET; and TFE3 proteins in 59 RCC using immunoperoxidase staining methods. The study group consisted of clear cell RCCs (CRCC); papillary RCCs type 1 (PRCC1); papillary RCCs type 2 (PRCC2); Xp11-2 translocation RCCs (XP11.2RCC); chromophobe RCCs (ChRCC); and sarcomatoid RCCs (SRCC)., Results: Variations were found in the expression of these molecules in the different types of RCCs. The mean age of RCCs among Egyptians was 52.70 ± 1.73 years; with male sex predominance. Mass lesion; pain; and hematuria were the main presenting features. Metastatic disease was more frequent with CRCC variant. pVHL expression was strong in PCRCC2; Xp11.2RCC; and ChRCC; moderate in CRCC; and weak in both PRCC1 and sarcomatoid RCC. MET protein expression was moderate in Xp11.2RCC; PRCC1; PRCC2; and sarcomatoid RCC. TFE3 protein expression was strong in Xp11.2RCC and PRCC2 variants. The expression was moderate in PRCC1; CRCC; ChRCC; and sarcomatoid RCC. Positive correlation was found in the expression of the different proteins (pVHL; MET; and TFE3) and some histological features (tumor grade; inflammation; necrosis and metastasis) and the presence of metastasis and some histological features (inflammation and/or necrosis)., Conclusions: This study provides the first indication about the clinicopathologic features of RCCs in Upper Egypt. The variable expression of these molecules in the different variants of RCC suggests that several oncogenic pathways are operational in their development.

Background: Hydatidiform mole is a gestational trophoblastic disease with two different types: complete (CHM) and partial hydatidiform moles (PHM). The villous stroma of CHM is avascular or contains primitive endothelial-lined vascular elements. CD99 is a leukocyte antigen expressed in both normal and neoplastic tissue., Objectives: To examine the expression of CD99 and vascular profile in PHM and CHM compared to first trimester pregnancy termination (TOP)., Materials and Methods: Fifty trophoblastic tissue specimens were immunostained using monoclonal antibodies decorating CD99 and CD34 antigens (vasculogenesis). CD99 expression and the vascular parameters were scored., Results: In CHM and PHM, the number of blood vessels with distinct lumens in the villous stroma (centrally and peripherally located) was significantly reduced (p<0.05), compared to TOM. In CHM, the number of the centrally located hemangiogenetic cords was higher compared to TOP. No statistically significant differences were found between CHM and PHM. In chorionic villi of TOP, a strong CD99 reactivity was seen in the endothelial, decidual, fibroblastic and in trophoblastic cells (syncytiotrophoblasts and cytotrophoblasts). Weak to virtually absent CD99 reactivity was seen in the trophoblastic cells of chorionic villi with molar changes., Conclusions: Vasculogenesis can be initiated in the molar pregnancies despite the absence of embryos or maternal derived chromosomes. CD99 may have a possible role in the development of molar changes., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Leukocyte adhesion molecules are important for migration of the inflammatory cells into sites of inflammation. Intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) are members of the immunoglobulin superfamily that are expressed in normal kidney. Their expression is up-regulated in the renal tissue of patients with lupus nephritis (LN)., Objectives: We evaluated whether changes in urinary levels of ICAM-1 and VCAM-1 reflect renal tissue damage in LN. We related the levels of these molecules to other laboratory findings, especially complement C3/C4 levels. We also tested the hypothesis that changes in urinary levels of ICAM-1 and VCAM-1 reflect the severity of renal tissue damage in LN., Patients and Methods: This study included 30 systemic lupus erythematosus (SLE) patients with LN (16 with mild histological changes, i.e., with World Health Organization (WHO) class I and II LN, and 14 with advanced histological changes, i.e., class III, IV, and V LN) and 20 with SLE without nephritis. In addition, 20 healthy individuals of comparable age were included as a control group. The levels of urinary ICAM-1 and VCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA) and related to the clinical, laboratory [rheumatoid factor(RF), antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), complements C3 and C4] and histological findings., Results: Levels of urinary ICAM-1 and VCAM-l in LN patients with advanced histological changes (renal damage) were statistically significantly higher than those in other groups (LN patients with mild histological changes or SLE patients without nephritis and control group; p < 0.01). In contrast, serum levels of C3 and C4 in LN patients with advanced histological changes were significantly lower than those in other groups (p < 0.01). There was a significant negative correlation between the levels of urinary adhesion molecules and serum complement levels (p < 0.01)., Conclusions: The significantly high urinary levels of the adhesion molecules in the LN group with advanced histological changes may reflect their renal tissue expression and therefore the severity of the nephritis. Renal tissue damage in these cases may be the result of transmigration of activated inflammatory cells, inducing serious tissue damage. The hypocomplementemia combined with increased urinary levels of adhesion molecules seems to be a useful biomarker of disease severity in LN.

Background: Microvillous inclusion disease (MVID) is a rare congenital disease producing intractable secretory diarrhea in early infancy. It is characterized by diffuse intestinal villous atrophy with no inflammatory reaction. Ultrastructural identification of apical microvillous inclusions in the surface enterocytes is diagnostic. However, there is difficulty in the diagnosis of MVID due to the existence of variants (e.g., microvillous dystrophy), possible disease resolution, and tissue orientation for electron microscopy (EM). The authors analyzed materials from 4 patients with MVID from a single institution. The morphologic features, distribution of lesions, biomarkers, and complementary ultrastructural characteristics were studied., Design: Materials of MVID cases were collected from 6 different hospitals in the United Kingdom between 1990 and 2008. Epidemiological data, including age range, median, mode, sex ratios, and follow-up, were retrieved. All intestinal biopsy specimens were analyzed histologically, histochemically (for PAS, n = 17), immunohistochemically (for CD10, n = 2 and polyclonal CEA, n = 4), and ultrastructurally (n = 9)., Results: Ultrastructurally, apical microvillous inclusions in surface enterocytes in duodenal biopsies were identified in all cases, while 1 case had variant morphology (microvillous dystrophy and very occasionally atypical microvillous inclusions). Tissue orientation for EM was supportive for identification of inclusions in apical enterocytes. Morphologically, a bubbly vacuolated appearance of the apical cytoplasm with extensive or patchy absence of the brush border with occasional cytoplasm inclusions was observed in the enterocytes. Some of these changes vaguely resembled gastric mucin cell metaplasia. Architecturally, villous blunting with either crypt hypoplasia or hyperplasia and absence of inflammation were common findings. The epithelial changes were also found in colon biopsies. PAS, CD10, and p-CEA showed a bright apical cytoplasmic blush/staining, which correlated ultrastructurally with apical granules with inclusions of variable electron density in all cases. These stains also highlighted the targetoid inclusions., Conclusion: Besides electron microscopy identification of inclusions, the light microscopic morphological features together with the biomarker studies highlighting the apical cytoplasmic blush are quite unique and diagnostic of MVID. Furthermore, it is the opinion of the authors that a diagnosis of MVID can be made without electron microscopy.

Background: Thyroid Hurthle cell neoplasm (THCN) is relatively rare., Objective: To describe the presentation, diagnostic approach and management of THCN in our institution., Methods: This was a retrospective chart review of all thyroid Hurthle cell neoplasms diagnosed at Aseer Central Hospital (ACH), Saudi Arabia during the period from October 1998 to April 2007. Data including clinical, cytopathologic, radiologic, histopathologic and surgical treatment were extracted for analysis., Results: Nine patients were diagnosed as THCN (eight females and one male). Their ages ranged from 24-49 years. Three cases were Hurthle cell carcinomas and six cases were Hurthle cell adenomas. Carcinomas presented as solitary nodules (two cases) and as multinodular goiter (one case). Adenomas presented as solitary nodules (two cases), as multinodular goiter (three cases) and as diffuse swelling (one case). Fine needle aspiration cytology (FNAC) was diagnostic for THCN in two cases of carcinoma that presented as solitary nodules and hence total thyroidectomy was performed. Total thyroidectomy was also done in one case of adenoma. Hemithyroidectomy was performed in two cases of adenoma in which FNAC showed benign lesion and in one case of carcinoma based on clinical and ultrasonographic impression of benign MNG in the involved lobe and inconclusive FNAC result. Subtotal thyroidectomy was performed in one case of adenoma., Conclusion: Preoperative diagnosis and management of THCN is still a dilemma. Neither clinical nor FNAC findings can exclude carcinoma. Therefore a combination of clinical, radiological, FNAC and histopathological results should be used for a more definitive subtyping and proper management.

Background: Varicocele consists of dilatation of the pampiniform venous plexus and the internal spermatic veins. It is present in 15% of male population and is a common cause of male infertility., Objective: To describe the normal structure of the internal spermatic vein and the morphological changes in grade 3 varicocele., Methods: The authors dissected and analyzed a 2- to 3-cm tract of the pampiniform venous plexus of 20 patients undergoing varicocelectomy for left varicocele and of 10 consecutive patients undergoing surgery for left inguinal hernia. The histological examination was performed with hematoxylin–eosin and Masson trichrome stains. The ultrastructural evaluation was done using both scanning and transmission electron microscopy., Results: Compared with normal internal spermatic veins, varicocele veins showed narrowing and/or obliteration of the lumens, destruction of the endothelial cells, invagination of the intima, and deposition of collagen bundles in the media (light microscopy). The ultrastructural changes in varicocele veins included elongation of the endothelial cells with features of cellular damage, loss of the internal elastic lamina, and the appearance of ghost bodies and degenerative vacuoles in the subendothelial layer., Conclusions: The authors believe this is the first report analyzing ultrastructual changes in normal human internal spermatic vein samples and in varicocele. The underlying molecular mechanisms of these changes await further studies.