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Coronavirus disease 2019 (COVID-19) is a novel disease resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has quickly risen since the beginning of 2020 to become a global pandemic. As a result of the rapid growth of COVID-19, hospitals are tasked with managing an increasing volume of these cases with neither a known effective therapy, an existing vaccine, nor well-established guidelines for clinical management. The need for actionable knowledge amidst the COVID-19 pandemic is dire and yet, given the urgency of this illness and the speed with which the healthcare workforce must devise useful policies for its management, there is insufficient time to await the conclusions of detailed, controlled, prospective clinical research. Thus, we present a retrospective study evaluating laboratory data and mortality from patients with positive RT-PCR assay results for SARS-CoV-2. The objective of this study is to identify prognostic serum biomarkers in patients at greatest risk of mortality. To this end, we develop a machine learning model using five serum chemistry laboratory parameters (c-reactive protein, blood urea nitrogen, serum calcium, serum albumin, and lactic acid) from 398 patients (43 expired and 355 non-expired) for the prediction of death up to 48 h prior to patient expiration. The resulting support vector machine model achieved 91% sensitivity and 91% specificity (AUC 0.93) for predicting patient expiration status on held-out testing data. Finally, we examine the impact of each feature and feature combination in light of different model predictions, highlighting important patterns of laboratory values that impact outcomes in SARS-CoV-2 infection.

The COVID-19 pandemic put most in-person pathology electives on-hold as departments adapted to changes in education and patient care. To address the subsequent void in pathology education, we created a free, virtual, modular, and high-quality pathology elective website. Website traffic from June 1, 2020, to October 1, 2020, was monitored using the built-in analyses on Squarespace. Twitter engagement was analyzed using Twitter analytics and the Symplur Social Graph Score. A voluntary satisfaction survey was sent to all PathElective users and results were analyzed. During this time, the site saw 25 467 unique visitors, over 34 988 visits, 181 302 page views, and 4449 subscriptions from 99 countries. Countries with the highest traffic are the United States (14 682), India (5210), and the Philippines (2195). PathElective’s Twitter social graph score increased from 63.59 to 89.3 with the addition of 1637 followers. Data from surveyed users (n = 177) show most to be pathology residents (41%). Most subscribers (89%) are committed to a career in pathology. The majority heard of the website via Twitter (55%). Almost half of those surveyed engaged with the PathTwitter community on Twitter and of those who participated, 99% found that interaction useful. In all survey questions surrounding satisfaction and usefulness, a large majority of the users were either satisfied or very satisfied. PathElective is a novel pathology elective that offers a unique opportunity to educate medical students and residents from around the globe and demonstrates high effectiveness and satisfaction among users.

Intrahepatic macrophages influence the composition of the microenvironment, host immune response to liver injury, and development of fibrosis. Compared with stellate cells, the role of macrophages in the development of fibrosis remains unclear. Multispectral imaging allows detection of multiple markers in situ in human formalin‐fixed, paraffin‐embedded tissue. This cutting‐edge technology is ideal for analyzing human liver tissues, as it allows spectral unmixing of fluorophore signals, subtraction of auto‐fluorescence, and preservation of hepatic architecture. We analyzed five different antibodies commonly observed on macrophage populations (CD68, MAC387, CD163, CD14, and CD16). After optimization of the monoplex stains and development of a Spectral Library, we combined all of the antibodies into a multiplex protocol and used them to stain biopsies collected from representative patients with chronic liver diseases, including chronic hepatitis C, nonalcoholic steatohepatitis, and autoimmune hepatitis. Various imaging modalities were tested, including cell phenotyping, tissue segmentation, t‐distributed stochastic neighbor embedding plots, and phenotype matrices that facilitated comparison and visualization of the identified macrophage and other cellular profiles. We then tested the feasibility of this platform to analyze numerous regions of interest from liver biopsies with multiple patients per group, using batch analysis algorithms. Five populations showed significant differences between patients positive for hepatitis C virus with advanced fibrosis when compared with controls. Three of these were significantly increased in patients with advanced fibrosis when compared to controls, and these included CD163+CD16+, CD68+, and CD68+MAC387+. Conclusion: Spectral imaging microscopy is a powerful tool that enables in situ analysis of macrophages and other cells in human liver biopsies and may lead to more personalized therapeutic approaches in the future. We optimized a spectral imaging microscopy platform to evaluate intrahepatic macrophages in liver biopsies from patients with chronic liver diseases (HCV, NASH, and AIH). We then compared differences in macrophage populations in patients with chronic viral hepatitis C and different stages of fibrosis (minimal and advanced), using batch analysis algorithms. Several macrophage phenotypes were significantly increased in patients with advanced fibrosis when compared to controls. Spectral imaging microscopy is a powerful tool that enables phenotypic characterization and quantification of intrahepatic macrophages, key players in hepatic fibrosis development that may be targets for future therapeutic intervention.

The ongoing global pandemic of coronavirus disease 2019 (COVID-19) has rapidly disrupted traditional modes of operation in health care and education. In March 2020, institutions in the United States began to implement a range of policies to discourage direct contact and encourage social distancing. These measures have placed us in an unprecedented position where education can no longer occur at close quarters—most notably, around a multiheaded microscope—but must instead continue at a distance. This guide is intended to be a resource for pathologists and pathologists-in-training who wish to leverage technology to continue collaboration, teaching, and education in this era. The article is focused mainly on anatomic pathology; however, the technologies easily lend themselves to clinical pathology education as well. Our aim is to provide curated lists of various online resources that can be used for virtual learning in pathology, provide tips and tricks, and share our personal experience with these technologies. The lists include videoconferencing platforms; pathology Web sites; free online educational resources, including social media; and whole slide imaging collections. We are currently living through a unique situation without a precedent or guidebook, and we hope that this guide will enable the community of pathology educators worldwide to embrace the opportunities that 21st century technology provides.

AimsEvaluate the rate and significance of Helicobacter pylori (H. pylori) involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).MethodsWe identified 100 biopsy cases of CPD with synchronous stomach biopsies. All 200 were reviewed for histological changes (eg, chronic gastritis, acute inflammation) and underwent immunohistochemical staining for H. pylori. Results were correlated with patient age, sex, endoscopy indication and findings on stomach biopsy.ResultsCases included 49 men and 51 women, with a median age of 56 years. Reflux or dysphagia was the most common symptom. Chronic gastritis was present in 46 stomach biopsies, with 54 within normal limits. Twelve stomach biopsies showed H. pylori, all of which showed gastritis. Two duodenal biopsies (2%) demonstrated H. pylori organisms on immunohistochemistry, both from patients with H. pylori gastritis.ConclusionsRoutine examination of CPD samples for H. pylori appears unnecessary if a stomach biopsy is available for review.

The range of lesions with a serrated appearance within the large intestine has expanded and become more complex over the last 30 years. The majority of these were previously known as metaplastic polyps but are today called hyperplastic polyps (HPs). HPs show two main growth patterns: microvesicular and goblet cell-rich. The former type shows morphological and molecular similarities (eg, BRAF mutations) to the more recently described sessile serrated lesion (SSL). In this review, we debate whether these lesions represent a biological spectrum or separate entities. Whichever view is held, microvesicular HPs and SSLs are distinct from the goblet cell-rich HP and the traditional serrated adenoma (TSA), which may themselves share molecular changes (eg, KRAS mutations), with the goblet cell-rich HP representing a precursor to the TSA. Both SSLs and the goblet cell-rich HP-TSA pathway are routes to colorectal cancer within the serrated pathway and overlaps between them can occur, for example, a (BRAF-mutated) TSA may arise from an SSL.

During the past 3 decades, numerous articles in the literature have offered terminology, diagnostic criteria, and consensus recommendations regarding the entity currently referred to by the World Health Organization as sessile serrated lesion. Given the many names and various, variably reproducible diagnostic criteria ascribed to sessile serrated lesion, confusion persists for many pathologists and gastroenterologists regarding the diagnosis. This distinction is important, as sessile serrated lesion can progress to malignancy, unlike its main differential diagnosis, hyperplastic polyp. Research studies have shed light on the characteristic architecture and morphology, immunohistochemical patterns, and molecular alterations of sessile serrated lesion, and multiple consensus meetings around the globe have developed their criteria and nomenclature, often clashing or mixing terms. To provide a narrative review from the entity's early description to our current understanding. The existing scientific and clinical literature, published texts, medical society recommendations, and specialty consensus guidelines. The current World Health Organization criteria are a distillation of this scientific process, but terminology is still a point of contention worldwide.

The goal of the academy is to better prepare pathologists to lead the field forward through engaging and communicating with their peers and colleagues, as well as nonpathologists, in the ever-evolving health care atmosphere.1-3 Current issues that have a significant impact in the field of pathology include the opioid epidemic, digital pathology, the advent of advanced molecular testing and immunotherapy, and new techniques for obtaining patient samples. Since becoming an ELA graduate, I have encouraged anyone who will listen to apply for the academy. In my professional life in academic medicine, these skills are necessary tools that I can use as I engage with residents and fellows, communicate with peers and colleagues, interact with my patients, promote health care research, provide education to improve the health of individuals and the community, and advocate for the field of pathology.