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Quarterly published in print and online "Inventi Impact: Pathology (Formerly Inventi Impact: Medical Devices)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. The journal focuses on medical devices that improve diagnostic, interventional and therapeutic treatments. It provides special coverage to novel devices that allow new surgical strategies, new methods of drug delivery, or possible reductions in the complexity, cost, or adverse effects of healthcare.
For patients receiving chemotherapy, drugs represent the largest cost. Clinical
chemotherapy Pathways have become a critical strategy to identify unnecessary
drug costs and to implement mechanisms to deliver lower cost alternatives
without sacrificing outcomes or quality of care. This paper describes the
steps of development of a functioning pathways program beginning in an environment
of full-risk capitation, including drugs. The next steps involved
quantitating the potential impact of such a program and then collaborating
with a payer to test the concept. When these studies showed promise, the
practices adopting pathways used them as a backbone for drug management
in the Oncology Care Model. These experiences very likely represent steps in
a continuum towards placing more of the drug delivery costs at risk. The potential
for again considering capitated payments is discussed....
Retinitis pigmentosa (RP) represents a clinically and genetically heterogeneous disease characterized by progressive photoreceptor\nloss. In recent years, research has been rarely made in blood flow affected in RP. The specific mechanism of blood flow affected in\nRP is not completely clear. A number of studies indicated that the decreased blood flow was related to RP. According to clinical\nobservation and treatment experience, Chinese medicine considered that blood stasis runs throughout the RP disease\nprogression, and the blood stasis corresponding to Chinese herbal medicine has a positive effect on the clinical treatment of RP.\nTherefore, we proposed that the decreased blood flow may participate in the lesion. In this article, we will review the findings on\nthe decreased blood flow affected in RP from the perspective of modern medicine and Chinese medicine...
The oncocytic variant of chromophobe renal cell carcinoma (oChRCC) and low-grade oncocytic tumor (LOT) is introduced as new
renal disease entity. Both of these tumors are low-grade malignancies consisting of cells with eosinophilic cytoplasm. Distinguishing
between eosinophilic variant of chromophobe renal cell carcinoma (eCRCC) and oncocytoma is often a diagnostic challenge in
routine surgical pathology. However, oChRCC and LOT might be independent disease entities that might not fit completely into
any of these categories. Histologically, these tumors have greater morphological similarity with oncocytoma than with ChRCC.
However, immunohistochemically, they exhibit diffuse and dense positivity for CK7 and are negative for CD117. In the present
case, we initially had difficulty distinguishing among oncocytoma, eCRCC, and type 2 papillary renal cell carcinoma (2-pRCC).
However, after learning about new disease entities such as oChRCC and LOT, we were able to diagnose this tumor....
Background: Sudden unexpected death of epilepsy (SUDEP) is a severe outcome of epilepsy. This study aimed to\nreport the clinical and pathological findings in patients with SUDEP.\nMethods: The record of patients with sudden death was screened. When the reason of death matched with the\ndefinition of SUDEP, the clinical and pathological data were analyzed. Eleven patients with SUDEP were included in\nthe study.\nResults: Eight patients died after a generalized tonic-clonic seizure, seizures were induced by emotional changes in\nfive patients, four cases were found dead in bed. Carbamazepine was prescribed in six patients. The autopsy\nshowed brain edema and pulmonary edema in all eleven patients. Loss of neurons and gliosis were presented in\nsome brains of SUDEP subjects. The main pathological changes in SUDEP include brain edema, pulmonary edema,\nloss of neurons and gliosis.\nConclusions: Risk factors for SUDEP in the study are generalized tonic-clonic seizure, emotional disturbance and\ncarbamazepine treatment....
Hypertrophic gastropathy is a rare idiopathic hyperproliferative disorder which may present as Menetrier’s disease (MD)
characterized by foveolar hyperplasia in the gastric fundus and body. It is often accompanied by a severe loss of plasma proteins
(including albumin) from the altered gastric mucosa. The disease occurs in two forms, a childhood form due to cytomegalovirus
infection and an adult form attributed to overexpression of transforming growth factor-alpha (TGF-α). The most common
symptoms include epigastric pain with fullness and vomiting and generalized peripheral edema with hypoalbuminemia. We
present a case of 75-year-old female presenting with epigastric pain and vomiting. Upper gastrointestinal endoscopy and
computed tomography scan revealed an irregular mucosal fold at the body and antrum and thickening of the stomach wall,
respectively. Though the endoscopic gastric mucosal biopsy was nonspecific, the patient underwent partial gastrectomy due to
clinicoradiological suspicion of carcinoma. On histopathology, the case was reported as hypertrophic gastropathy, consistent
with MD. Though there is a strong clinical and radiological suspicion of malignancy in the hypertrophied gastric mucosa, MD
should be one of the important differential diagnoses....
Introduction: We evaluate an innovative device consisting of an enteral feeding tube equipped with a\nphotoplethysmography (PPG) sensor in contact with the duodenal mucosa. This study aims to determine if the\nPPG signal, composed of a continuous (PDC) and a pulsatile part (PAC), is a reliable method to assess gut\nperfusion in a porcine model of septic shock.\nMethod: Fourteen piglets were anesthetized and mechanically ventilated. They were randomly assigned to two\ngroups: the nonseptic (NS) group received an infusion of RingerÃ¢â?¬â?¢s lactate solution (RL) alone, the septic (S) group\nreceived in addition a suspension of live Pseudomonas aeruginosa. Heart rate (HR), pulse oximetry (SpO2), mean\narterial pressure (MAP), cardiac index (CI) and serum lactates were recorded and gut microcirculation (GM) was\nmonitored with a laser Doppler probe applied on the duodenal serosa. PDC and PAC were given by the PPG\nprobe inserted in the duodenum. Data was collected every 15 minutes (t0, t15Ã¢â?¬Â¦) during 150 minutes (t150).\nAfter administration of the bacteria suspension (t0), resuscitation maneuvers were performed following a defined\nalgorithm. GM PAC, and PDC were expressed as variation from baseline (GMvar, PACvar, PDCvar). Analysis of variance\n(ANOVA) with repeated measures was performed to compare hemodynamic variables, with Bonferroni correction\nas post hoc analysis on t0, t60 and t150.\nResults: One piglet was withdrawn from analysis due to a defective probe. S group (six piglets) received\nresuscitation therapy while NS group (seven piglets) did not. A significant group effect was found for the all\nparameters except HR. Post hoc analysis found a significant decrease for GM and PAC at t60. The correlation between\nPAC, PDC and microcirculatory parameters were as follows: rPACvar-GMvar = 0.496, P <0.001, rPDCvar-GMvar = 0.244; P = 0.002.\nIn the septic group, correlations were as follows: rPAC-lactate = ?0.772, P <0.001; rPDC-lactate = ?0.681, P <0.01). At the\nonset of shock, a decrease of PAC, PDC and GM occurred before the alteration of MAP.\nConclusions: PAC and PDC decreased at the onset of shock and were correlated with GM and lactate. These results\nconfirm that PPG signal reliably reflects the early perfusion alteration of the gut. Further studies should assess the\nclinical use of this device....
Purpose: Urinary pH is an important factor linked to renal stone disease and a useful marker in the treatment of\nurolithiasis. Although the gold standard for measuring urinary pH utilizes a glass electrode and a pH meter, at\npresent dipstick testing is largely used to estimate urinary pH. However, the accuracy and precision of this method\nmay be insufficient for making clinical decisions in patients with lithiasis. The aim of this study is to describe a new\ndevice for urinary pH testing.\nMethods: The device includes a pH sensor based on differential measurement of an ISFET-REFET pair. The drawbacks\nassociated with this type of configuration, namely short lifetime and manual fabrication, have been overcome in\nthe prototype. An automatic one point calibration is performed when turning on the system. Two buffer solutions\nwere utilized to determine the intra- and inter-day precision of the device. The pH of 30 fresh human urine\nsamples was measured using a pH-meter, a dipstick and the new electronic device.\nResults: In some cases, dipstick measurements differed from those of the pH meter by more than 0.40 units, a\nclinically relevant discrepancy, whereas none of the measurements made with the new electronic device differed\nfrom the results of the pH-meter by more than 0.1 pH units.\nConclusions: This new electronic device has the possibility to be used by stone-formers to control their urinary\npH at home, increasing the tools available for stone prevention and prophylaxis...
The paper demonstrates the feasibility of the gel-clot method for the analysis of bacterial endotoxins in water extracts of ultrapure\nparaffin oil which is a water insoluble oily medical device. Because ultrapure paraffin oil is water insoluble oily liquid, the ultrapure\nparaffin oil (10 mL) was shaken with 10mL water for 15 minutes at 2000 rpm, the endotoxin present was extracted to the aqueous\nphase without interference inhibition/enhancement of the product, the recovery of the endotoxin added to the ultrapure paraffin\noil was determined. A validation study confirmed that endotoxins present in ultrapure paraffin oil which is water insoluble liquid\nmedical device pass over into the aqueous phase at concentrations of 20, 10, and 5 EU/mL with recoveries of 94.2% to 111%. So the\nconclusion is that the gel-clot test is suitable for detecting bacterial endotoxins in ultrapure paraffin oil which is a water insoluble\noily medical device....
Background Extracellular vesicles (EVs), including small EVs (sEVs) such as exosomes, exhibit great potential for the
diagnosis and treatment of brain disorders, representing a valuable tool for precision medicine. The latter demands
high-quality human biospecimens, especially in complex disorders in which pathological and specimen heterogeneity,
as well as diverse individual clinical profile, often complicate the development of precision therapeutic schemes
and patient-tailored treatments. Thus, the collection and characterization of physiologically relevant sEVs are of the
utmost importance. However, standard brain EV isolation approaches rely on tissue dissociation, which can contaminate
EV fractions with intracellular vesicles.
Methods Based on multiscale analytical platforms such as cryo-EM, label-free proteomics, advanced flow cytometry,
and ExoView analyses, we compared and characterized the EV fraction isolated with this novel method with a classical
digestion-based EV isolation procedure. Moreover, EV biogenesis was pharmacologically manipulated with either
GW4869 or picrotoxin to assess the validity of the spontaneous-release method, while the injection of labelled-EVs
into the mouse brain further supported the integrity of the isolated vesicles.
Results We hereby present an efficient purification method that captures a sEV-enriched population spontaneously
released by mouse and human brain tissue. In addition, we tested the significance of the release method under conditions
where biogenesis/secretion of sEVs was pharmacologically manipulated, as well as under animals’ exposure to
chronic stress, a clinically relevant precipitant of brain pathologies, such as depression and Alzheimer’s disease. Our
findings show that the released method monitors the drug-evoked inhibition or enhancement of sEVs secretion while
chronic stress induces the secretion of brain exosomes accompanied by memory loss and mood deficits suggesting a
potential role of sEVs in the brain response to stress and related stress-driven brain pathology.
Conclusions Overall, the spontaneous release method of sEV yield may contribute to the characterization and biomarker
profile of physiologically relevant brain-derived sEVs in brain function and pathology....
Digital pathology analysis using deep learning has been the subject of several studies. As
with other medical data, pathological data are not easily obtained. Because deep learning-based
image analysis requires large amounts of data, augmentation techniques are used to increase the
size of pathological datasets. This study proposes a novel method for synthesizing brain tumor
pathology data using a generative model. For image synthesis, we used embedding features extracted
from a segmentation module in a general generative model. We also introduce a simple solution for
training a segmentation model in an environment in which the masked label of the training dataset is
not supplied. As a result of this experiment, the proposed method did not make great progress in
quantitative metrics but showed improved results in the confusion rate of more than 70 subjects and
the quality of the visual output....
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