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Other than location of the primary colorectal cancer (CRC), a few factors are known to influence the intrahepatic distribution of colorectal cancer liver metastases (CRLM). We aimed to assess whether the anatomy of the portal vein (PV) could influence the intrahepatic distribution of CRLM.

Renin-angiotensin-aldosterone system abnormalities are the most prevalent cause of renal hemodynamic abnormalities, and candidate genes in this system are involved in the etiology of diabetic nephropathy (DN). A polymorphism in the angiotensin converting enzyme (ACE) gene I(insertion)\D(deletion) has been correlated to plasma ACE levels. Furthermore, the Angiotensin II Type 1 Receptor AGT1R (A1166C) expression pattern is highly related to nephropathy. The objectives of this study involved evaluating the frequency of the ACE (I/D) and AGT1R (A1166C) gene polymorphisms and investigating the association of these polymorphism with the development of DN in Iraqi patients with Type 2 diabetes mellitus (T2DM) and evaluating the levels of several urinary and serum markers in relation to studied polymorphisms. This is a cross-sectional study that included 161 T2DM patients whom were divided into two groups: T2DM with DN(included 98 patients) and normalbuminuric T2DM (included 63 patients). ACE gene polymorphism analysis revealed that the D allele was far more prevalent in DN patients compared to normalbuminuric patients (60.2% vs. 50.8%), while the I allele frequency was 39.8% in DN and 49.2% in normoalbuminuric patients. In addition, DN patients carrying the DD genotype had higher serum kidney injury molecule 1 (KIM1), serum cystatin C (CysC), and HbA1C and lower glomerular filtration rate (GFR) compared to ID+II genotypes. For AGT1R (A1166C), both DN and normalbuminuric patients had a comparable high prevalence of the AA genotype, followed by the AC genotype, while the CC genotype had been seen only in 3 patients. In conclusion, among the studied T2DM patients, individuals with DD genotype had higher frequency of DN and had 2-fold risk for DN compared to II genotype which had the lowest risk for DN. Also the current study shows that the A1166C polymorphisms of AGT1R distribution frequency were similar for both study groups with higher frequency for A allele compared to C allele and not associated with risk of DN in Iraqi T2DM Keywords: Angiotensin Converting Enzyme (I\D) gene polymorphism, Angiotensin II Type 1 Receptor (A166C) gene polymorphisms, Cystatin C, Diabetic nephropathy, Kidney injury molecule1.

Background:Obesity is a chronic disease characterized by excessive fat accumulation that can lead to different complications.Objectives:However, identifying the prevalence of nutritional status and obesity in adolescents in Babylon governorate and searching for the relationship with different factors constitute the main objectives of this study.Materials and Methods:This study was cross-sectional study curried on 500 high school students aged between 16 and 19 years. Among them, half of them were female students. Study period was between February and June 2022; weight and height were measured to each participant to calculate body mass index (BMI) and they were requested to fill a questionnaire to identify any risk factor relation-ship.Results:Out of all, 14.2% were underweight, 55.4% were normal weight, 20.4% were overweight and 10% obese adolescents. There was a significant relationship between BMI from one hand and male gender, living in rural areas, high family income and soft drink (beverage consumption per week) on the other hand.Conclusion:The prevalence of overweight and obesity was around than one third (20.4% + 10% = 30.4% collectively, whereas 14.2% were underweight out of all participants in this study).

Background Cisplatin (CIS) is a broad-spectrum anticancer drug, with cytotoxic effects on either malignant or normal cells. We aimed to evaluate the hepatotoxicity in rats caused by CIS and its amelioration by the co-administration of either curcumin or resveratrol. Materials and Methods Forty adult male rats divided into four equal groups: (control group): rats were given a saline solution (0.9%) once intraperitoneally, daily for the next 28 days; (cisplatin group): rats were given a daily oral dose of saline solution (0.9%) for 28 days after receiving a single dose of cisplatin (3.3 mg/kg) intraperitoneally for three successive days; (CIS plus curcumin/resveratrol groups): rats received the same previous dose of cisplatin (3.3 mg/kg) daily for three successive days followed by oral administration of either curcumin/resveratrol solution at a dose of (20 mg/kg) or (10 mg/kg) consequently daily for 28 days. Different laboratory tests (ALT, AST, ALP, bilirubin, oxidative stress markers) and light microscopic investigations were done. Results Administration of CIS resulted in hepatotoxicity in the form of increased liver enzymes, oxidative stress markers; degenerative and apoptotic changes, the co-administration of CIS with either curcumin or resveratrol improved hepatotoxicity through improved microscopic structural changes, reduction in liver enzymes activity, decreased oxidative stress markers, improved degenerative, and apoptotic changes in liver tissues. Conclusion Co-administration of either curcumin or resveratrol with cisplatin treatment could ameliorate hepatotoxicity caused by cisplatin in rats via anti-inflammatory and oxidative stress-apoptotic pathways.

Samia Q Alghamdi,1 NF Alotaibi,2 Sameera N Al-Ghamdi,3 Laila S Alqarni,4 Touseef Amna,1 Shaima MN Moustafa,5 Ibrahim Hotan Alsohaimi,2 IA Alruwaili,2 AM Nassar2 1Department of Biology, Faculty of Science, Al-Baha University, Al-Baha, 65799 Saudi Arabia; 2Chemistry Department, College of Science, Jouf University, Sakaka, Saudi Arabia; 3Chemistry Department, Faculty of Science, Al-Baha University, Al-Baha, Saudi Arabia; 4Chemistry Department, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623 Saudi Arabia; 5Biology Department, College of Science, Jouf University, Sakaka, Saudi ArabiaCorrespondence: AM Nassar, Jouf University, Sakaka, Aljouf, 2014, Saudi Arabia, Tel +966555978016, Email amnassar@ju.edu.saBackground: Nowadays, recycling agricultural waste is of the utmost importance in the world for the production of valuable bioactive compounds and environmental protection. Olive leaf bioactive compounds have a significant potential impact on the pharmaceutical industry. These compounds possess remarkable biological characteristics, including antimicrobial, antiviral, anti-inflammatory, hypoglycemic, and antioxidant properties.Methods: The present study demonstrates a green synthetic approach for the fabrication of nickel oxide nanoparticles (NiO-olive) using aqueous wasted olive leaf extract. Calcination of NiO-olive at 500°C led to the fabrication of pure NiO nanoparticles (NiO-pure). Different techniques, such as thermal gravimetric analysis (TGA), Fourier-transform infrared spectra (FTIR), ultraviolet-visible spectra (UV-Vis), X-ray diffraction (XRD), scanning electron microscopy (SEM) fitted with energy-dispersive X-ray analysis (EDX), and transmission electron microscopy (TEM), were used to characterize both NiO-olive and NiO-pure. The extract and nanoparticles were assessed for antiparasitic activity against adult ticks (Hyalomma dromedarii) and antimicrobial activity against Bacillus cereus, Pseudomonas aeruginosa, Aspergillus niger, and Candida albicans.Results: From XRD, the crystal sizes of NiO-olive and NiO-pure were 32.94 nm and 13.85 nm, respectively. TGA, FTIR, and EDX showed the presence of olive organic residues in NiO-olive and their absence in NiO-pure. SEM and TEM showed an asymmetrical structure of NiO-olive and a regular, semi-spherical structure of NiO-pure. UV–Vis spectra showed surface plasmon resonance of NPs. Antiparasitic activity showed the highest mortality rate of 95% observed at a concentration of 0.06 mg/mL after four days of incubation. The antimicrobial activity showed the largest inhibition zone diameter of 33 ± 0.2 mm against the Candida albicans strain.Conclusion: Nanoparticles of NiO-olive outperformed nanoparticles of NiO-pure and olive leaf extract in both antiparasitic and antimicrobial tests. These findings imply that NiO-olive may be widely used as an eco-friendly and effective antiparasitic and disinfection of sewage.Keywords: biosynthesis, olive, NiO-NP, antiparasitic, antimicrobial]

This study explores the feasibility of employing (U, Th)-based accident tolerant fuels (ATFs), specifically (0.8UO2, 0.2ThO2), (0.8UN, 0.2ThN), and (0.8UC, 0.2ThC). The investigation assesses the overall performance of these proposed fuel materials in comparison to the conventional UO2, focusing on deep neutronic and thermal-hydraulic (Th) analyses. Neutronic analysis utilized the MCNPX code, while COMSOL Multiphysics was employed for thermal-hydraulic analysis. The primary objective of this research is to overcome the limitations associated with traditional UO2 fuel by exploring alternative fuel materials that offer advantages in terms of abundance and potential improvements in performance and safety. Given the limited abundance of UO2, long-term sustainable nuclear energy production faces challenges. From a neutronic standpoint, the U–Th based fuels demonstrated remarkable fuel cycle lengths, except (0.8UN, 0.2ThN), which exhibited the minimum fuel cycle length and, consequently, the lowest fuel burn-up. Regarding thermal-hydraulic performance, (0.8UN, 0.2ThN) exhibited outstanding performance with significant margins against fuel melting compared to the other materials. Overall, when considering the integrated performance, the most favourable results were obtained with the use of the (0.8UC, 0.2ThC) fuel configurations. This study contributes valuable insights into the potential benefits of (U, Th)-based ATFs as a promising avenue for enhanced nuclear fuel performance.

Diabetic kidney disease (DKD) is caused by a variety of processes. As a result, one biomarker is insufficient to represent the complete process. This study Evaluate the diagnostic value of serum kidney injury molecule-1(KIM-1) and cystatin C (CysC) as early biochemical markers of DKD and predictive their sensitivities and specificities as biomarkers of nephropathy in Iraqi type 2 diabetic (T2DM) patients. This cross-sectional study include 161 T2DM patients from Diabetes and Endocrinology Center at Merjan medical city in Babylon. Patients divided according to urinary albumin creatinine ratio(ACR) (Group1:ACR≤30mg/g,Group2:ACR>30mg/g). Random spot urine and fasting blood samples were taken from each patient and urinary ACR, blood glycated hemoglobin(HbA1c), and serum glucose, creatinine(SCr), lipid profile, CysC, KIM-1 were assayed, and the estimated glomerular filtration rat (eGFR) was calculated. When compared to the normoalbuminuric group, the DKD group had significantly greater prevalence of retinopathy, and significantly elevated HbA1c and total cholesterol values. Also had significantly greater serum levels of KIM-1 and CysC, and there is a significant (P-value< 0.01) positive correlation between them. In contrast, GFR was significantly higher in normoalbuminuric group and was significantly negatively correlated with both CysC and KIM-1. Multiple linear regression analysis, found that there were a significant positive association between CysC, KIM-1 and ACR. ROC analysis reveal that eGFR had the highest area under the curve(AUC=0.717), while SCr had the lowest AUC(0.556). In conclusion, Serum KIM-1 and CysC levels consider as early biomarker for DKD along with eGFR that consider the best diagnostic indicator of DKD, Additionally, there is a strong correlation between serum CysC and KIM-1 as well as other renal measures that indicate deteriorating kidney function. [ J Adv Biotechnol Exp Ther 2023; 6(3.000): 673-685]

Abstract The motivation of the present paper is to introduce and establish some new fixed point results for monotone multivalued functions in partially ordered complete D ∗ $D^{*}$ -metric spaces, where the partial ordered set ( X , ≤ ) $(X,\leq )$ is obtained via a pair of functions ( ϒ , Ω ) $( \Upsilon,\Omega )$ . Moreover, several existence and uniqueness coupled fixed point theorems of mappings satisfying contractive conditions have been investigated and verified in the setting of partially ordered complete D ∗ $D^{*}$ -metric spaces by using the concept of integral type contractions with respect to partially ordered D ∗ $D^{*}$ -metric space. Furthermore, we present appropriate examples as an application for our main results. Our results generalize the work of Ghasab, Majani, and Rad on the study of integral type contraction and coupled fixed point theorems in the ordered G-metric spaces.

Background: Marine bacteria, a relatively untapped resource, have shown potential for synthesizing nanoparticles with distinct properties. Methods: The AgNPs were synthesized by using the marine bacteria Planococcus maritimus MBP-2 as a reducing and capping agent. The nanoparticles produced were characterized by UV–Vis spectroscopy, TEM and FTIR. The Planococcus maritimus MBP-2 synthesized AgNPs adhered antibacterial activity against selected both gram-negative and gram-positive bacteria such as Staphylococcus aureus, Bacillus cereus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, and antifungal such Aspergillus niger, Aspergillus flavus, Penicillium commune and Penicillium digitatum. and the cytotoxic effect of Dalton’s Lymphoma Ascites (DLA) cell lines. Results: The formation of AgNPs by bacteria was confirmed visually by a shift in color of the solution and the presence of UV-absorption maxima at 440 nm. The TEM images revealed spherical and cubic structures, with an average size of 24.9 nm. FTIR analysis confirmed the presence of some functional groups by showing peaks at 3330 and 1636 cm−1. The AgNPs exhibited minimal antibacterial activity except P. aeruginosa. (11 mm). Whereas, inhibiting the growth of the fungi belonging to genus Aspergillus than to Penicillium. Also, in vitro cytotoxicity of AgNPs was evaluated using Dalton’s Lymphoma Ascites (DLA) cell lines. The percentage of cell death was maximum (95.4 ± 2.16) at 20 µg/mL, indicating an excellent cytotoxic efficiency of AgNPs against DLA cells from the peritoneal cavity of the tumor-bearing mouse. Conclusion: This study suggests that Planococcus maritimus MBP-2 bacteria-mediated AgNPs can effectively be used as a potential biomedical agent.

The first objective of the present manuscript is to introduce the notion of complex-valued Dc∗-metric spaces as generalizing and improving the idea of D∗-metric spaces by using the context of complex-valued metric space and D∗-metric spaces. The principle of contraction mappings has recently been established. Furthermore, the second objective is devoted to establishing various new fixed-point theorems in complete complex-valued Dc∗-metric spaces that are improved and generalized by Azam et al. Banach’s contraction principle and various distinguished outcomes are also presented in the literatures. Additionally, some implementations of common fixed-point theory on complete complex-valued Dc∗-metric spaces have been offered by applying open and closed balls. Additionally, we provide some illustrative examples as an implementation for our main results.

Experiments have assessed various polymer composites for radiation shielding in diverse applications. These composites are lighter and non-toxic when compared to lead (Pb), making them particularly effective in diagnostic imaging for shielding against low-energy photons. This study demonstrates the fabrication of four composites by combining a base material, specifically a high-density polyethylene (HDPE) polymer, with 10% and 20% silicon (Si) and silicon carbide (SiC), respectively. Additionally, 5% molybdenum (Mo) was incorporated into the composites as a heavy metal element. The composites obtained were fabricated into 20 disks with a uniform thickness of 2 mm each. Discs were exposed to radiation from a low-energy X-ray source (32.5–64.5 keV). The chemical and physical properties of composites were assessed. The shielding ability of samples was evaluated by determining the linear and mass attenuation coefficients (μ and μm), radiation protection efficiency (RPE), half-value layer (HVL), and mean free path (MFP). According to our findings, supplementing HDPE with additives improved the attenuation of beams. The μm values showed that composite X-ray shielding characteristics were enhanced with filler concentration for both Si and SiC. Polymer composites with micro-molecule fillers shelter X-rays better than polymers, especially at low energy. The HVL and MFB values of the filler are lower than those of the pure HDPE sample, indicating that less thickness is needed to shield at the appropriate energy. HC-20 blocked 92% of the incident beam at 32.5 keV. This study found that increasing the composite sample thickness or polymer filler percentage could shield against low-energy radiation.

Cadmium is an extremely dangerous heavy metal that can lead to disastrous consequences in all organisms. Several natural remedies reduce the toxicities of experimentally generated metals in animals. Strawberry Fragaria ananassa contains several bioactive compounds that may mitigate heavy-metal toxicity. The study aim was to evaluate the ability of a strawberry fruit methanol extract (SE) to reduce Cd toxicity and to identify and quantify the active constituents of SE. Forty Wistar rats were classified into four groups: the control group– 1 ml saline IP; SE group– 100 mg of SE/kg rats orally; cadmium (Cd) group–2 mg CdCl2/kg body weight/IP daily; and treated group– SE given 1 hour before Cd administration. Administration of Cd induced several histopathological and immunohistochemical alterations in lung sections. Biochemical analysis of lung homogenates and mRNA levels of antioxidants and inflammatory cytokines indicated significant changes to the risk profile. SE administration significantly decreased the oxidative stress, inflammation, tissue damage, the mean area percentage of collagen fibers, and positive immuno-expressions of TNF-α and NF-κB induced by CdCl2. Moreover, the MDA, TNF-α, GM-CSF, and IL-1β levels in Cd-exposed rat lung tissue were significantly lower in the SE-treated group than in the Cd-group. SE significantly augmented lung GSH, SOD, HO‐1, GPx-2, and Nrf2 levels in Cd-exposed rats. SE mitigated Cd-caused oxidative stress and lung inflammation. Therefore, regularly consuming a strawberry-rich diet could benefit general health and help prevent and treat diseases.

Afnan A Nassar,1 Mona T Rajeh2 1Department of Preventive Dentistry, Faculty of Dentistry, Umm Al Qura University, Makkah, Saudi Arabia; 2Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Afnan A Nassar, Department of Preventive Dentistry, Faculty of Dentistry, Umm Al Qura University, Makkah, Saudi Arabia, Tel +966 506378234, Email aanassar@uqu.edu.saIntroduction: E-learning systems play a vital role in education during the COVID-19 pandemic. These systems allow educators to plan, deliver, and follow up on the education process during the closure of universities and schools. This study aims to report the experiences of dental faculty members using the Blackboard system.Methods: The study used a descriptive qualitative design. Data were collected from staff members at the Dental Faculty of Umm Al Qura University through semi-structured focus group discussions that were audio-recorded and transcribed verbatim for thematic content analysis.Results: The analysis revealed three barriers: (1) pedagogical, (2) technical, and (3) individual. For the advantages, three themes emerged: (1) ease of use, (2) ongoing support, and (3) usefulness. Most participants were satisfied with using Blackboard and believed it to be a valuable and complementary educational tool in dentistry.Conclusion: The reported experiences and recommendations are helpful for university leaders, policymakers, and program designers in improving the quality of e-learning in the future.Keywords: Blackboard, dentistry, e-learning, faculty members, qualitative study

Hamdy N El-Tallawy,1 Sawsan Abuhamdah,2,3 Ahmed Y Nassar,4 Wafaa MA Farghaly,1 Tahia H Saleem,4 Sara A Atta,4 Ayat A Sayed,4 Amal M Tohamy,1 Mohammed H Hassan5 1Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates; 3Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan; 4Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt; 5Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, EgyptCorrespondence: Mohammed H Hassan Email mohammedhosnyhassaan@med.svu.edu.egPurpose: Gephyrin (GPHN) is an essential protein in the regulation of inhibitory postsynaptic density and polymorphism in the corresponding gene may have a role in the development of pharmacoresistant epilepsy (PRE). For the first time, we aimed to evaluate the association of rs928553T/C variants with PRE susceptibility. Moreover, we have analyzed the genetic polymorphism affecting CYP2C9 “rs12782374G/A” in the same population to detect the effect of SNP on the drug-metabolizing ability of patients with PRE.Patients and Methods: This case-control study enrolled 100 patients (group A) and 100 healthy, age and sex-matched controls, unrelated to patients (group B). TaqMan™ assays using real-time PCR were run for genotyping of rs928553T/C and rs12782374G/A in all participants.Results: GPHN T>C polymorphism revealed significant risk association with occurrence of PRE using dominant, recessive and codominant models as follows: TT vs (TC+CC): OR 0.23, 95%CI: 0.13– 0.43, P< 0.001. In addition, (TT+TC vs CC): OR 0.38, 95%CI: 0.18– 0.77, P< 0.001. Also, T vs C (OR 0.34, 95%CI: 0.22– 0.51, P=< 0.001). Similarly, CYP2C9 G>A polymorphism showed a significant increased risk of PRE (GG vs (GA+AA): OR 0.11, 95%CI: 0.05– 0.23, P< 0.001). Furthermore, (GG+GA vs AA): OR 0.18, 95%CI: 0.084– 0.39, P< 0.001. Also, G vs A (OR 0.24, 95%CI: 0.15– 0.366, P=< 0.001).Conclusion: Mutation of both GPHN (rs928553) and CYP2C9 (rs1278237) genes may be implicated as a genetic mediators of resistance in patients with PRE.Keywords: pharmacoresistant epilepsy, rs928553T/C, rs12782374G/A, real time-PCR

In this study, silver nanoparticles were synthesized using Cucumis melo L. leaf extract via a green synthesis approach and their potential against diabetes and coccidiosis was tested under in vitro conditions. The phytochemical components in the leaf extract reacted with silver nitrate in solution and yielded C. melo-silver nanoparticles (Cm-AgNPs). The synthesis of AgNPs was confirmed via UV–visible spectroscopy by obtaining a peak at 440 nm. The nanoparticles were characterized by their morphology, crystallinity, and the presence of functional groups. In vitro α-amylase and α-glucosidase inhibition assays were carried out at different concentrations in the range of 20 to 100 μg/mL of Cm-AgNPs. The Cm-AgNPs exhibited enzyme inhibitory activity in a concentration-dependent manner. As the concentration of Cm-AgNPs increased the inhibitory activities were also increased linearly and the highest inhibition was observed at 100 μg/mL. The effectiveness of Cm-AgNPs against Eimeria tenalla was assessed by an in vitro 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay using Madin–Darby bovine kidney (MDBK) cell lines. The results revealed that the viability of the oocysts and further sporulation were decreased with the increased concentration of Cm-AgNPs. The AgNPs synthesized from the C. melo leaf extract have shown promising potential against diabetes and coccidiosis, and they could be used in biomedical applications.

Introduction: Multiple-drug resistant tuberculosis (MDR-Tb) has become a global issue especially in many African countries. Regular studies are needed to ascertain its early detection and elimination in the endemic regions in order to reduce the morbidity and mortality rates Objective: To assess the frequency of MDR-Tb among HIV sero-positive and sero-negative populations in Ilorin, North-Central Nigeria. Method: Sputum samples were collected from 1,601 subjects provisionally diagnosed with pulmonary tuberculosis (TB) at Sobi Specialist Hospital, Ilorin-Nigeria. Inclusion criteria were based on cough for at least three weeks with no response to antibiotics treatment or when the chest Xray indicated TB infection. From each patient, three specimens were obtained for Ziehl Neelsen staining and 4ml of blood were collected for HIV antibody testing. Results: The frequency of Acid Fast Bacilli (AFB) positive cases was 10.86% while 0.72% MDR-Tb and 3.2% concurrent infection with Mycobacterium tuberculosis and HIV were documented. Statistically, no significant association between age and MDR-Tb (X2=0.6731, P>0.05) was found. Conclusion: The study revealed 10.86% of AFB positive cases, 0.74% MDR-Tb cases, and 3.2% concurrent infection between Mycobacterium tuberculosis and HIV. We, therefore, recommend aggressive and effective control measures to prevent further transmission of MDR-Tb between patients and health care workers while increased access to ART for HIV infected MDR-TB patients is also suggested.

Context.-The Nottingham Grading System (NGS) developed by Elston and Ellis is used to grade invasive breast cancer (IBC). Glandular (acinar)/tubule formation is a component of NGS. Objective.-To investigate the ability of pathologists to identify individual structures that should be classified as glandular (acinar)/tubule formation. Design.-A total of 58 hematoxylin-eosin photographic images of IBC with 1 structure circled were classified as tubules (41 cases) or nontubules (17 cases) by Professor Ellis. Images were sent as a PowerPoint (Microsoft) file to breast pathologists, who were provided with the World Health Organization definition of a tubule and asked to determine if a circled structure represented a tubule. Results.-Among 35 pathologists, the [kappa] statistic for assessing agreement in evaluating the 58 images was 0.324 (95% CI, 0.314-0.335). The median concordance rate between a participating pathologist and Professor Ellis was 94.1% for evaluating 17 nontubule cases and 53.7% for 41 tubule cases. A total of 41% of the tubule cases were classified correctly by less than 50% of pathologists. Structures classified as tubules by Professor Ellis but often not recognized as tubules by pathologists included glands with complex architecture, mucinous carcinoma, and the "inverted tubule" pattern of micropapillary carcinoma. A total of 80% of participants reported that they did not have clarity on what represented a tubule. Conclusions.-We identified structures that should be included as tubules but that were not readily identified by pathologists. Greater concordance for identification of tubules might be obtained by providing more detailed images and descriptions of the types of structures included as tubules. (Arch Pathol Lab Med. 2024;148:1119-1125; doi: 10.5858/arpa.2023-0163-OA), Histologic grading of invasive breast carcinoma (IBC) represents a morphologic assessment of the degree of tumor differentiation and is routinely reported in the pathologic assessment of IBC. Histologic grade is [...]

BackgroundThe COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner.ObjectiveWe aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital.MethodsA retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic.ResultsThe study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001).ConclusionsTeleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the 'hybrid care' which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient's needs.