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The aim of this study was to further investigate the immunocytochemical expression of p53, PTEN, Fas, p16, and HPV L1 capsid proteins in cervical smears with low and high grade squamous intraepithelial lesions (LSIL and HSIL, respectively). A total of 92 ThinPrep cervical samples, comprising 11 cases of HSIL, 61 cases of LSIL, and 20 negative cases were studied by immunocytochemical methods. The results obtained in LSIL cases were correlated with the available follow up data. Abnormal p53, PTEN, or Fas expression was found in a subset of HSIL cases, while positive expression for p16 was significantly associated with the diagnosis of HSIL (P < 0.0001, P = 0.001, P < 0.0001, and P < 0.0001, respectively). Among cases positive for p16 expression, the staining pattern was weak in 88.9% of LSIL cases and strong in 80% of HSIL cases (P < 0.0001). The p16 negative/L1 positive and p16 positive/L1 negative staining patterns were significantly associated with the presence of LSIL and HSIL, respectively (P < 0.0001). None of these markers had a significant prognostic value in LSIL cases (P > 0.05). Our results suggest that loss of PTEN or Fas expression and p53 overexpression may be involved in the process of neoplastic transformation of the cervical epithelium. Furthermore, negative or weak immunocytochemical staining for p16 in a Pap smear may strongly argue against the presence of a high grade lesion, while the combined p16/L1 staining pattern may be useful as a diagnostic adjunct for differentiating between LSIL and HSIL. Diagn. Cytopathol. 2014;42:465-475. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.

Introduction: The aim of the present study was to evaluate the effect of triiodothyronine (T3) administration in a porcine model of hemorrhagic shock due to liver surgery, in terms of hemodynamic stability, acid-base status, and hepatic injury markers. Materials and Methods: Hemorrhagic shock was induced in swine by left lobe liver resection and allowed bleeding to a mean arterial pressure of 35-40 mmHg for 40 min. Animals were randomly assigned into a sham group (n = 5), a fluid-resuscitated group (n = 7), and a fluid plus T3-resuscitated group (n = 7). T3 was given by continuous intravenous infusion from the beginning of the experiment. After the 40 min of shock animals were resuscitated with the aim of restoring mean arterial pressure (±10% from baseline). Resuscitation lasted for 1 hr and then swine were followed for another 460 min (total 6 hr). Blood loss, hamodynamic parameters, fluids administered, acid-base status, and liver enzymes were measured. Results: Blood loss was similar in both groups. Animals treated with T3 required less fluids than swine resuscitated with crystalloids and colloids only (N/S 0.9%: 1071 ± 189 ml vs. 2429 ± 535 ml, Voluven 6%: 550 ± 96 ml vs. 1000 ± 289 ml, p < .05), plus they were less acidotic at the end of the observing period (7.38 ± 0.08 vs. 7.26 ± 0.12, p < .05). Tachycardia was not associated with T3 administration. Hepatic enzymes did not exhibit differences between groups. Conclusion: Our study demonstrates the beneficial impact of T3 administration during controlled hemorrhagic shock and resuscitation. Animals resuscitated with T3 necessitate less amounts of fluids to maintain hemodynamic stability and acid-base status. Moreover, T3 administration does not seem to aggravate blood loss or harm the hepatic tissue. Copyright © 2013 Informa Healthcare USA, Inc.

Context: Experimental studies linked gestational diabetes mellitus (GDM) and intrauterine growth restriction (IUGR) with altered expression of the offspring's hypothalamic galanin mRNA, possibly contributing to the development of obesity and metabolic syndrome in later life. We hypothesized that plasma galanin levels at birth would reflect presumably altered hypothalamic galanin expression and production that cannot be assessed in the human offspring. Objective: Our objective was to investigate whether neonates born to GDM mothers or being IUGR differ from healthy ones in circulating galanin at birth. Design, Patients, and Methods: Twenty-five neonates born to GDM mothers, 25 with IUGR, and 15 healthy neonates (controls) were prospectively studied. Neonatal plasma galanin levels were assayed immediately after birth by using enzyme immunoassay. Results: Neonatal plasma galanin showed a high variability within each group and did not differ significantly among the three groups of neonates. No correlation between plasma galanin and anthropometric maternal and neonatal data was found. Multiple linear regression confirmed that the neonatal group (infants of diabetic mothers, IUGR, and controls) was not an independent predictor for galanin levels at birth after controlling for possible confounders, i.e. maternal body mass index and weight gain during pregnancy and neonatal body mass index. Conclusions: Circulating galanin levels at birth are not affected by GDM and IUGR, providing no evidence for alternations in hypothalamic galanin expression and secretion in humans, as they were previously documented in experimental models. This fact precludes the use of plasma galanin as an early indicator for the development of obesity and metabolic syndrome in this high-risk population. Copyright © 2012 by The Endocrine Society.

Objective: To re-evaluate the reproducibility of additional slides prepared from residual cervical ThinPrep (TP) samples. Study Design: Sixty paired specimens (conventional smears and direct-to-vial TP) were studied. Up to 10 additional slides were prepared from each TP vial. All slides were reviewed for adequacy of material, presence of abnormal cells and presence of normal flora or other pathogens. The additional TP slides were further evaluated for the presence of diagnostic elements which were not found on the conventional smear and primary TP slide. Results: Abnormal cells found on the primary TP slide were also identified on all additional slides in 48/50 cases (96%) with squamous cell lesions. The distribution of material on TP slides was evaluated as homogenous in 51 cases (85%) and as non-homogenous in 9 (15%). Using the primary slides (conventional smear and TP) as a reference, additional diagnostic cells upgrading the cytologic diagnosis were found on the repeat slides in 7 cases (11.7%) and fungi consistent with Candida in 3 (5%). Conclusion: Repeat processing of residual cervical TP samples may not be an invariably reproducible procedure and the first slide may not be necessarily representative of the specimen as a whole. Nevertheless, both primary and repeat TP slides seem to be extremely effective in detecting a lesion (regardless of grade) in abnormal cases. The exact impact of non-homogeneous sampling of the vial on the diagnostic accuracy of the TP method should be further investigated. Copyright © 2011 S. Karger AG, Basel.

Strongyloidiasis is an opportunistic infection which may result in a fatal hyperinfection syndrome in immunocompromised patients. We report the case of a pulmonary infection with Strongyloides stercoralis in a 61-year-old male with a history of a long-term administration of corticosteroids. Cytologic examination of a bronchial washing specimen, processed both as conventional and as Thin-Prep smears, revealed an abundance of the typical larvae of Strongyloides stercoralis, amidst a cellular population comprising several acute inflammatory cells as well as bronchial epithelial cells with features of basal cell hyperplasia or regenerative atypia. To the best of our knowledge there is only one previous report describing Strongyloides stercoralis in thin-layer smears, and there are no previous studies comparing its morphology in conventional and thin-layer preparations. © 2009 Wiley-Liss, Inc.

BACKGROUND: Primary effusion lymphoma (PEL) is a rare type of lymphoma that presents as an effusion, seldom with evidence of a solid neoplasm elsewhere; thus, cytology is the basic diagnostic method. It usually occurs in HIV-positive males with a history of Kaposi's sarcoma (KS), and DNA sequences of human herpesvirus 8 (HHV-8) are detected by molecular analysis. The distinct morphologic, immunophenotypic, molecular and clinical characteristics render this neoplasm a new pathologic entity. CASE: A 57-year-old, HIV-positive man presented to the hospital with ascites and absence of neoplasm on radiologic investigation. Cytologic evaluation of the ascitic fluid revealed the presence of highly atypical, pleomorphic lymphoid cells. Immunocytochemistry of the lymphoma cells was positive for CD45 (leukocyte common antigen), CD30 and epithelial membrane antigen antigens and negative for panB, panT and cytokeratin antigens. DNA sequences of HHV-8 were identified by polymerase chain reaction (PCR), and DNA ploidy analysis showed aneuploidy. The patient died 5 months after the diagnosis. CONCLUSION: Conventional and ThinPrep (Cytyc Corp., Boxborough, Massachusetts, U.S.A.) cytology, in combination with immunocytochemistry and PCR for HHV-8 DNA sequences, can lead to an accurate diagnosis of PEL. DNA ploidy analysis confirms the aggressive nature of this neoplasm.

Objectives. This prospective study was undertaken to evaluate the diagnostic efficacy of the BTAstat test and nuclear matrix protein (NMP22) compared with voided urine cytology (VUC) in the detection of primary and recurrent bladder cancer. Methods. A total of 147 patients provided a single voided urine sample for the BTAstat test, NMP22, and cytology prior to cystoscopy. Eighty-five of them had no bladder cancer history, whereas the remaining 62 were monitored for superficial bladder cancer. A group of 21 healthy age-matched volunteers were also enrolled in the study. Results. Bladder cancer was confirmed histologically in 99 patients, of which 62 had primary tumors and 37 had recurrent ones. The overall sensitivity and specificity were 71.7% and 56.5% for the BTAstat test, 62.6% and 73.9% for NMP22, and 38.4% and 94.2% for VUC. The optimal threshold value for NMP22 calculated with receiver operating characteristics curve, was 8 U/mL. BTAstat test was significantly more sensitive than VUC in detecting bladder cancer in all stage and grade subgroups, except GIII. On the contrary, NMP22 was significantly more sensitive than VUC only in stage Ta, grade I and II patients. BTAstat test had higher but not significantly different sensitivity than NMP22. Conclusions. Our data indicate a superiority of both BTAstat test and NMP22 over VUC in the detection of bladder cancer. Comparing BTAstat test with NMP22, the former proved to be more sensitive, whereas the latter was more specific. Ruling out diseases with potential interference can increase the overall specificity of both tests. False-positive results of either test in patients followed up for bladder cancer seem to correspond to future recurrences. UROLOGY 55: 871-875, 2000. (C) 2000, Elsevier Science Inc.

Purpose: We investigated the potential value of morphometry and artificial intelligence tools to discriminate between benign and malignant lower urinary tract lesions. Materials and Methods: The lesions included lithiasis in 50 cases, inflammation in 61, benign prostatic hyperplasia in 99, carcinoma in situ in 5, and grade I and grades II and III transitional cell carcinoma of the bladder in 71 and 184, respectively. Images of routine processed voided urine smears stained by the Giemsa technique were analyzed using a custom image analysis system, providing a data set of 45,452 cells. A neural net model of the back propagation type was used to discriminate benign from malignant cells based on the extracted morphometric and textural features. Data from 13,636 randomly selected cells (30% of the total data) were used as a training set and the data from the remaining 31,816 cells comprised the test set. In a similar attempt to discriminate at the patient level data on 30% of those randomly selected were used to train a back propagation neural net and data on the remaining 329 were used for testing. Results: Application of the back propagation neural net enabled the correct classification of 95.34% of benign and 86.71% of malignant cells with overall 90.57% accuracy. At the patient level the back propagation neural net enabled the correct classification of 100% of those with benign and 94.51% of those with malignant disease with overall 96.96% accuracy. Conclusions: The use of neural nets and image morphometry may increase the speed of cytological diagnosis and the diagnostic accuracy of voided urine cytology.

To investigate the potential of the learning vector quantization (LVQ) neural network for the discrimination of benign from malignant breast lesions.Using a custom image analysis system on Giemsa-stained smears, 25 parameters describing the size, shape and texture of the cell nucleus were measured. Three thousand nuclei from a total of 9,356 were selected as a training set for the neural network, and the whole data set was used for testing. An additional 238 cells from 16 cases without final cytologic diagnoses were evaluated by the system. The total number of cells (9,594) was collected from 100 patients (68 carcinomas and 32 benign lesions).Cytologic examination of the cases gave two false positive and two false negative results. However, in eight cases of ductal breast carcinoma and in eight cases of benign lesions, histologic confirmation was necessary in order to confirm the cytologic diagnosis. Application of the LVQ permitted correct classification of 87.41% of the cells. Classification at the patient level by using a hypothesis test for proportion with a hypothesis value equal to 50% permitted the correct diagnosis in 98% of patients.These results indicate that the use of neural networks combined with image morphometry and statistical techniques may offer useful information about the potential for malignancy, improving the diagnostic accuracy of fine needle aspiration of breast lesions.