Mediastinal epithelioid hemangioendothelioma with abundant spindle cells and osteoclast-like giant cells mimicking malignant fibrous histiocytoma

Abstract

Epithelioid hemangioendothelioma is a relatively uncommon lesion usually presenting in soft tissues. The occurrence in the mediastinum is exceptional rare. Histologically, this tumor is characterized by epithelioid cells with intracytoplasmic vacuoles in a hyalinized or mucinous stroma. Occasionally, spindle cells or osteoclast-like giant cells can be observed. Herein, we present a case of epithelioid hemangioendothelioma in a 38 year-old Chinese male. The tumor was predominantly composed of abundant spindle cells with marked atypia and scattered osteoclast-like giant cells reminiscent of malignant fibrous histiocytoma. The unusual histological appearance can pose a great diagnostic challenge. It may be easily misdiagnosed, especially if the specimen is limited or from fine-needle aspiration.

Virtual slides

http://www.diagnosticpathology.diagnomx.eu/vs/5804918529726307

The Application of Tannic Acid in Orthopedics

Tannic acid (TA) is a naturally occurring polyphenol compound commonly found in tea, wine, and fruits. Because of the excellent structural and functional properties afforded by TA, materials based on the structure of polyhydroxyphenols have great value, particularly for orthopedic transplantation. This compound, for example, can form a strong interaction with metals and can form a stable coating on their surfaces, thus, improving the physical and chemical properties of bone–implant surfaces and boosting implantation success rates. TA can also inhibit the activity of osteoclasts, thus, playing a potential role in the treatment of osteoporosis. Furthermore, if the body becomes polluted with heavy metals, TA can chelate the ions to protect bone morphology and structure. It also has a significant antibacterial effect and can reduce infections caused by surgical implantation and inhibit a variety of tumor cells, thereby promoting its potential application in spinal metastasis surgery. Furthermore, it can also slow the corrosion caused by magnesium alloys, thereby greatly improving the development of degradable orthopedic metal fixatives. Importantly, TA is cheap and easy to obtain, making it extremely valuable for use in orthopedics. This review focuses on the research status and practical applications of TA, and prospects for its future application for orthopedics (Figure 1).

Embedding patient and public involvement in dementia research: Reflections from experiences during the 'Journeying through Dementia' randomised controlled trial

BACKGROUND

The involvement of people with a diagnosis of dementia in patient and public involvement and engagement (PPIE) in research is an emerging field in the delivery of studies. Researchers need to understand and use the learning derived from various projects so that this growing body of knowledge can be applied in future research.

OBJECTIVE

To embed PPIE throughout a randomised controlled trial of a psychosocial intervention called Journeying through Dementia. We identify and discuss the approaches to involvement that worked well and those where improvements were indicated.

DESIGN

The Guidance for Reporting Involvement of Patients and the Public Short Form (GRIPP2-SF) is used to describe and critically appraise the approaches taken and the impact of PPIE involvement upon study processes, the study team and those people with dementia and their supporters who acted as advisors.

FINDINGS

The involvement of people with a diagnosis of dementia and supporters as study advisors improved the accessibility and relevance of the research for people living with dementia. It also highlighted issues that researchers may have otherwise overlooked. Successful engagement of people with dementia and their supporters in the study was associated with staff skills and particularly use of techniques to scaffold meaningful involvement, as well as participants' memory and cognitive capacity. However, embedding robust and meaningful involvement processes required significant time and resources.

DISCUSSION

We propose that certain research processes need to be adapted to be accessible and appropriate for people living with dementia. Recruitment of PPIE advisors needs to reflect population diversity. There also needs to be greater parity of voice between people with lived experience of dementia and researchers. These steps will increase the impact of PPIE in research and improve the experience for those who volunteer to be PPIE advisors.

Hydrogel and nanoparticle carriers for kidney disease therapy: trends and recent advancements

Achieving local therapeutic agent concentration in the kidneys through traditional systemic administration routes have associated concerns with off-target drug effects and toxicity. Additionally, kidney diseases are often accompanied by co-morbidities in other major organs, which negatively impacts drug metabolism and clearance. To circumvent these issues, kidney-specific targeting of therapeutics aims to achieve the delivery of controlled doses of therapeutic agents, such as drugs, nucleic acids, peptides, or proteins, to kidney tissues in a safe and efficient manner. Current carrier material approaches implement macromolecular and polyplex hydrogel constructs, prodrug strategies, and nanoparticle (NP)-based delivery technologies. In the context of multidisciplinary and cross-discipline innovations, the medical and bioengineering research fields have facilitated the rapid development of kidney-targeted therapies and carrier materials. In this review, we summarize the current trends and recent advancements made in the development of carrier materials for kidney disease targeted therapies, specifically hydrogel and NP-based strategies for acute kidney disease, chronic kidney disease, and renal cell carcinoma. Additionally, we discuss the current limitations in carrier materials and their delivery mechanisms.

Natural polysaccharide-based hydrogel bioprinting for articular cartilage repair

Tissue engineering represents a promising approach for impaired articular cartilage tissue regeneration. 3D printed hydrogels have become an emerging tissue engineering strategy because they closely mimic the physical and biochemical characteristics of the extracellular matrix. The formulation of hydrogel ink holds significant importance in attaining a precisely defined scaffold, which could exhibit excellent shape fidelity post-printing. Natural polysaccharide-based hydrogels are a highly promising class of scaffold biomaterials for articular cartilage regeneration in the field of material science and tissue engineering. These hydrogels are particularly advantageous due to their exceptional water absorption capacity, biodegradability, adjustable porosity, and biocompatibility, which closely resemble those of the natural extracellular matrix. This review aims to provide a comprehensive overview of the key characteristics, functions, and research progress in 3D printing technology for natural polysaccharide-based hydrogels. Specifically, this review categorizes the commonly used natural polysaccharide-based hydrogel materials in cartilage tissue engineering, and summarizes the classic literature in this area. In the end, we provide a comprehensive analysis of the challenges and potential applications of natural polysaccharide-based hydrogels in cartilage tissue engineering.

2694. Infectious Complications in CAR-T Cell Therapy Recipients: A Systematic Review and Meta-Analysis

Background

Chimeric antigen receptor (CAR) T-cell therapy is a rapidly evolving immunotherapy for hematological malignancies. With increasing access to this modality, there is an urgent need for a comprehensive understanding of infectious complications to optimize prophylaxis and improve clinical outcomes. We conducted a meta-analysis to assess the incidence and types of infectious complications in adult patients receiving CAR T-cell therapy.

Methods

The study was registered on PROSPERO and we searched 5 electronic databases from inception to 2022. Each author independently screened titles, reviewed full texts to identify eligible studies and extracted data from included studies using Covidence, a data extraction tool for conduction of standard systematic reviews. A random effects model was used, and proportions were used as a measure of outcome. We assessed heterogeneity using I^2 statistic. Risk of bias assessments were conducted using the RoB 2.0 for RCTs and ROBINS I tool for non-RCTs.

Results

Our search identified 12,441 studies of which 363 underwent full-text review. 33 studies were eligible for inclusion in the analysis and enrolled a total of 2866 patients. The pooled incidence of an infectious event in adult patients after CAR T-cell therapy was 38% (95%CI 0.31, 0.46; p< 0.01; I2 = 98%]. No significant difference was noted in the incidence among studies with a longer follow up duration compared to studies with follow up of ≤ 30 days [40% (95% CI 0.30-0.50) vs 32% (95% CI 0.24-0.40), p=0.20 respectively]. BCMA-directed CAR T-cell therapies used for management of multiple myeloma had a significantly higher incidence of infectious complications compared to CD19 targeted agents, 64% (95% CI 0.53-0.74, I2 = 65%) versus 39% (95% CI 0.30-0.49; I2 = 98%; p < 0.01) respectively, Figure 1. Clostridium difficile and Escherichia coli were the most common pathogens causing bacterial infections, while cytomegalovirus was the most commonly identified viral pathogen.

Figure 1.

Subgroup analysis of the pooled incidence of infectious events after CAR T-cell therapy among adult patients with hematologic malignancies

Conclusion

In this study, BCMA-directed CAR T-cell therapies were associated with a significantly higher risk of infectious complications. The results of this study can guide the development of strategies to prevent and manage infectious complications in this patient population.

Disclosures

Jon Arnason, MD , BMS: Advisor/Consultant|Regeneron: Advisor/Consultant Carolyn D. Alonso, MD , Academy for Continued Healthcare Learning: Honoraria|AiCuris: Advisor/Consultant|American Society of Healthcare Pharmacists: Honoraria|Cidara Therapeutics: Advisor/Consultant|Clinical Care Options: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support

Maternal Cardiovascular Outcomes of Pregnancy in Childhood, Adolescent, and Young Adult Cancer Survivors

This review focuses on the maternal cardiovascular risk and outcomes of pregnancy in childhood, adolescent, and young adult cancer survivors who are achieving survival to their prime reproductive years. Childhood, adolescent, and young adult cancer survivors are a growing population and have increasing needs for reproductive care over decades of life. Female cancer survivors have an overall higher risk of maternal cardiovascular events compared to those without a history of cancer. In female cancer survivors with normal cardiac function before pregnancy, the incidence of new heart failure during pregnancy is low. In survivors with cardiotoxicity prior to pregnancy, the risk of heart failure during and immediately after pregnancy is much higher. We recommend cardiomyopathy surveillance with echocardiography before pregnancy for all female survivors treated with anthracyclines and chest radiation. Survivors with cardiotoxicity prior to pregnancy should be cared for by an expert multidisciplinary team, including obstetrics, cardiology, anesthesia, and specialized nursing, among others.

MICROGLIAL RESPONSE TO UNILATERAL SPINAL CORD COMPRESSION IN RABBITS

There have been several pathologic descriptions of the spinal cord compressed chronically. Microglial changes, however, have been described scarcely. In the present study, microglial responses to the anterior unilateral compression were investigated by immunohistochemistry in the rabbit model. The cervical spinal cord was unilaterally compressed with a small screw at C5. The microglial response in the compressed and the contralateral halves of the spinal cord were investigated after 48 hours with the lectin RCA-1 immunostaining. Microglia were classified morphologically into resting and reactive microglia. Under mild compression, the mild proliferation of reactive microglia was observed in the anterior horn of the compressed half. A few reactive microglia were observed in the anterior horn of the contralateral half. The total number of resting and reactive microglia in each area of the gray and white matters did not differ between the sham and mild compression groups. Under severe compression, marked proliferation of reactive microglia was observed around the cavity in the gray matter of the compressed half. Moderate proliferation of reactive microglia was observed in gray matter of the contralateral half. These findings suggested that the resting microglia transformed into the reactive microglia, but not proliferated in the early stage of compression myelopathy.

Physician Turnover Increased In Private Equity-Acquired Physician Practices

Consolidation of physician practices by private equity (PE) firms has accelerated, raising concerns that PE's emphasis on short-term profitability may exacerbate physician turnover, with implications for care continuity. Despite their significance, evidence on how PE acquisitions affect physician turnover is limited. Using clinician-level data linked to practice acquisition data from the period 2014-21, we used a difference-in-differences design to examine changes to physician employment and turnover after PE acquisition of 200 ophthalmology practices with 1,980 clinicians. Relative to matched controls, PE-acquired practices increased the total number of clinicians by 46.8 percent through three years after acquisition. This growth was driven by increases in the numbers of both ophthalmologists and optometrists (30.7 percent and 36.2 percent, respectively). PE acquisitions also increased physician turnover, with the share of physicians leaving PE-acquired practices from one year to another increasing by 13 percentage points, or 265 percent, after acquisition, relative to non-PE-acquired practices. Findings highlight how PE acquisitions of physician practices are reshaping physician employment and workforce stability. As PE expands its footprint, policy makers should monitor the long-term implications of PE ownership on physician employment and turnover to mitigate potential undesirable effects on patient health.

PSVI-16 The Essential oil of Arnica Montana Positively Modulates the Fatty Acid Profile of Lamb Meat

Essential oils can modulate ruminal biohydrogenation. Dorper x Santa Inês lambs (n=40; initial BW of 30.3 ± 5.76 kg and 92 ± 9 d old) were assigned to a randomized complete block to evaluate the effect of different levels of arnica montana essential oil (AM) as a feed additive on the fatty acid (FA) profile of the meat. The treatments were: 25 mg of monensin/kg DM (M25); and four monensin-free diets containing 0 (AM0), 450 (AM450), 900 (AM900) and 1350 (AM1350) mg of AM/kg DM. All diets contained 90% concentrate and 10% forage (Coastcross hay). The experiment lasted 90 d, then the lambs were slaughtered and the meat samples were taken to evaluate the fatty acid profile by gas chromatography. The increase in AM promoted a linear reduction (P< 0.05) in the proportion of C17:0, C18:0, C18:1 t11, C22:6 n-3 and the sum of saturated FA (ΣSFA). A linear increase (P< 0.05) in the proportion of C18:2 c9,12, C18:3 n-3, in the sum of polyunsaturated (ΣPUFA) and the sum of the FA of the omega-6 series (Σn-6) when AM was included in the diet. The M25 diet increased (P< 0.05) the proportion of C16:0, C17:0, C18:0 and decreased (P< 0.05) the proportion of C18:2 c9,12, ΣSFA, Σn-6 and the relationship n-6/n-3 compared with AM diets. There was a reduction (P< 0.05) in the proportion of C16:0; C18:3 n-3 and an increase to C18:1 t11 and C22:6 n-3 when AM0 was compared with the M25. The proportions of C12:0; C14:0; C14:1 c9; C16:1 c9; C18:1 c9; C18:1 t9; C18:2 c9, t11; C18:2 t10, c12; C18:3 n-6 e C20:5 n-3 were similar between treatments (P >0.05). The AM positively modulates the FA profile of lamb meat, and the content of 1350 mg/kg DM of AM was the most efficient.

Continuous Eligibility Policies And CHIP Structure Affected Children's Coverage Loss During Medicaid Unwinding

In April 2023, with the "unwinding" of the Families First Coronavirus Response Act (FFCRA) continuous enrollment provisions in Medicaid, states were permitted to commence redetermination and disenrollment procedures for Medicaid beneficiaries. Using Centers for Medicare and Medicaid Services monthly state enrollment data for forty-nine states and Washington, D.C., from the period January 2021-December 2023, we examined changes in children's Medicaid and Children's Health Insurance Program (CHIP) coverage during the Medicaid unwinding, both overall and by whether states had previous twelve-month continuous eligibility policies for children and by the structure of states' programs for CHIP. We found substantially lower Medicaid and CHIP enrollment among children during the unwinding than during the FFCRA period, with lower levels of coverage declines among children in states that had previous twelve-month continuous eligibility policies and states with a program structure of separate CHIP or Medicaid expansion CHIP, rather than combination CHIP. These findings highlight the consequences of the FFCRA unwinding for children's Medicaid and CHIP enrollment, as well as potential state health policies that can promote coverage continuity and prevent further coverage loss for children moving forward.

301 Effects of housing system on performance and behavior of dairy calves before and after weaning

The aim of this study was to evaluate the effects of housing system on performance and behavior of dairy calves during pre-weaning (d 1–42), weaning (d 43–56), post-weaning (d 57–63) and mixing (d 64–70) period. Thirty-seven newborn Holstein dairy calves were allocated to individual (n = 17) or pair housing (n = 10 pairs). After that, calves remained in their pens until d 63 ± 1, and then PH group and IH group were mixed and moved to 6 group pens randomly. Starter intake, fecal consistency scores and body weight were collected. Instantaneous scan-sampling with 5-min intervals was used to collect the behavioral observations (lying, ruminating, standing, eating, drinking, walking, self-grooming, manipulating object) for 48 h beginning on d 43, 50, 57 and the second day after mixing. Data were analyzed by mixed effect model with treatment, time, and the interaction between them as fixed effects, and animal within treatment as a random effect. During post-weaning period, PH group had higher starter intake (P = 0.02) and average daily gain (P = 0.02) than IH group. PH group weighed more on d 63 (P = 0.002) and d 70 (P = 0.002). PH group had higher diarrhea frequency than IH group in week 3 (P = 0.03). PH increased lying time in week 8 (P = 0.03) and walking time during post-weaning period (P = 0.05), yet IH group spent more time standing in week 8 (P = 0.008), eating during post-weaning period (P = 0.008), self-grooming during weaning period (week 7, P = 0.007; week 8, P = 0.03). Furthermore, previous housing system had no effect on calves’ behavior after mixing. In conclusion, Pair housing during post-weaning period improved performance of calves and housing system had on effect on behavior after mixing.

Figure 1.ADG (mean±SEM) for calves housed individually (n = 17 calves) or in pairs (n = 10 pairs). PH = calves housed in pairs; IH = calves housed individually. * P ≤ 0.05, † P < 0.10. Figure 2.BW (mean±SEM) for calves housed individually (n = 17 calves) or in pairs (n = 10 pairs). PH = calves housed in pairs; IH = calves housed individually. * P ≤ 0.05, † P < 0.10. Figure 3.Diarrhea frequency for calves housed individually (n = 17 calves) or in pairs (n = 10 pairs) before 63d. PH = calves housed in pairs; IH = calves housed individually. * P ≤ 0.05. Figure 4.Time (mean±SEM) for calves (n = 6) performing each behavior as affected by different housing system during weaning, post-weaning and mixing period.* P ≤ 0.05.

Variation in opioid-free discharge after metabolic surgery from 2018 to 2023: a state-wide analysis from the Michigan Bariatric Surgery Collaborative

BACKGROUND

Efforts have been made to reduce opioid prescribing after metabolic-bariatric surgery (MBS) given the increased risk for misuse. Variation in prevalence of opioid-free discharge following MBS and its impact on outcomes remains unclear.

OBJECTIVES

To evaluate variation in opioid prescribing practices after MBS and the impact of opioid-free discharge on outcomes.

SETTING

MBS programs participating in a state-wide quality improvement collaborative.

METHODS

Using a state-wide bariatric-specific data registry, all patients who underwent MBS between 2018 and 2023 and had opioid prescribing data were identified (n = 54,276). Patient characteristics and 30-day risk-adjusted outcomes were compared between patients who were and were not prescribed opioids at discharge. Surgeon and practice characteristics were also compared between the top and bottom quartiles of opioid-free discharge.

RESULTS

The prevalence of opioid-free discharge increased from 7.7% to 32.1% over the study period. Only .4% of patients, who were opioid-free at discharge, obtained an opioid prescription within 30 days of discharge. Opioid-free discharge was associated with lower rates of emergency department (ED) visits (7.7% vs 8.2%, P = .0008), despite similar complication rates (7.6% vs 7.3%, P = .7261). There were no significant differences in age, case volume, or practice types between surgeons in the top quartile and bottom quartile for opioid-free discharge.

CONCLUSIONS

Opioid-free discharge after MBS has increased in prevalence with extremely low failure rates without negatively impacting ED visit rates. Variation in opioid prescribing persists and may be due to patient-specific factors as well as surgeon-specific preference.

[Research advances in pediatric nonalcoholic fatty liver disease]

In recent years, nonalcoholic fatty liver disease (NAFLD) has increased because of the growing prevalence of obesity and overweight in the pediatric population. It has become the most common form of chronic liver diseases in children and the related research on NAFLD is expanded. The "two-hit" and "multiple hit" hypothesis have been widely accepted, and some research has shown that genetic, diet structure and environmental factors appear to play a crucial role in the development of pediatric NAFLD. Though it is expected by researchers, there is not an available satisfactory noninvasive marker for the diagnosis of this disease. Fortunately, some new non-invasive prediction scores for pediatric NAFLD have been developed. There is currently no established special therapy, and lifestyle intervention should be adequate for most cases of NAFLD in children. This article reviews the advances in the current knowledge and ideas concerning pediatric NAFLD, and discusses the diagnosis, perspective therapies and scoring methods for this disease.

Label-free hyperspectral multiphoton microscopy

Label-free multiphoton microscopy is a powerful tool for investigating pristine biological specimens. This imaging modality leverages optical signals originating from the nonlinear response of native biomolecules to intense optical radiation, nonlinear signals that allow localizing and quantifying the constituents of specimens, driving applications in biology and medicine. However, since its inception over three decades ago, this approach has operated with a narrowband detection scheme, relying on narrow bandwidths from the entire spectra to derive imaging contrast. This detection scheme hinders the analytical power of the nonlinear microscope, preventing the rigorous unmixing of co-localized constituents with spectral overlap. In this Letter, we shift from the narrowband paradigm to the broadband, demonstrating label-free hyperspectral multiphoton imaging of biological specimens. We validate this configuration by disentangling the constituents of fresh murine tissues by virtue of nonlinear spectra.

Male Sexual Health Implications of the 2022 Global Monkeypox Outbreak

The 2022 global monkeypox (MPX) outbreak is the largest in history to occur outside of endemic African regions. Disease spread during this outbreak has been primarily through human-to-human transmission, with sexual contact being of particular concern. Clinical presentations have commonly featured genital, perianal, and oral lesions associated with sexual activity among men who have sex with men (MSM), who compose the vast majority of MPX cases. This review discusses the epidemiology, clinical features, and evaluation of MPX with regards to men's sexual health. Comparisons were made between MPX and its relative from the Orthopoxvirus genus, smallpox, in order to make informed inferences on the potential effects of MPX on men's sexual health. This review also discusses the role of men's health specialists and urologists in addressing the current outbreak.