E-learning module for cytopathology education based on virtual microscopy

INTRODUCTION

In cytopathology education, Virtual Microscopy e-learning modules (VM-eLM) have achieved remarkable results in the improvement and personalization of learning. However, it remains to be determined whether these modules can significantly contribute to improving the accuracy of cytological diagnosis. The aim of this work was to create a VM-eLM for gynecologic cytopathology education designed to improve screening and interpretation skills in two groups of cytologists: experienced and nonexperienced.

MATERIALS AND METHODS

The module was designed in Moodle with both Whole Slide Images and Static Images taken from Papanicolaou smears that were diagnosed as: negative for intraepithelial lesion, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, squamous cell carcinoma, or adenocarcinoma. We assessed the effectiveness of the module using 1) clinical quality indicators to measure skill development and 2) a user survey.

RESULTS

After training, participants significantly improved their cytological screening skills, decreasing their false negative diagnosis by 78% in the non-experienced group and eliminating them entirely in the experienced group. Nonexperienced participants also significantly increased their recognition of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion by 31% and 50%, respectively. Participants positively evaluated the module, highlighting its novelty, the possibility to train remotely, the immediate feedback and the quality of the Whole Slide Images.

CONCLUSIONS

We designed, implemented and tested a VM-eLM for Gynecologic Cytopathology Education that improved cytological screening skills for both non-experienced and experienced cytologists, also increasing the diagnostic accuracy of preinvasive lesions by less experienced cytologists. The module was positively evaluated by participants, who perceived an improvement in their interpretive skills.

SNAIL expression correlates with the translocation of syndecan‑1 intracellular domain into the nucleus in prostate cancer cell lines

Zinc finger protein SNAI1 (SNAIL) and zinc finger protein SNAI2 (SLUG) transcription factors promote epithelial-mesenchymal transition, a process through which epithelial cells acquire a mesenchymal phenotype, increasing their migratory and invasive properties. In prostate cancer (PCa) progression, increased expression levels of SNAIL and SLUG have been described. In advanced PCa, a decrease in the cell surface proteoglycan syndecan-1 (SDC-1), which has a role in cell-to-extracellular matrix adhesion, has been observed. Notably, SDC-1 nuclear location has been observed in mesenchymal cancers. The present study aimed to determine if SNAIL and SLUG may be associated with the nuclear location of SDC-1 in PCa. To determine the location of SDC-1, antibodies against its intracellular domain (ID) or extracellular domain (ED) were used in benign prostatic hyperplasia (BPH) and PCa samples with high Gleason scores. Only ID-SDC-1 was located in the cell nuclei in advanced PCa samples, but not in the BPH samples. ED-SDC-1 was located in the cell membrane and cytoplasm, exhibiting decreased levels in PCa in comparison with those in BPH. Furthermore, LNCaP and PC3 PCa cell lines with ectopic SNAIL expression exhibited nuclear ID-SDC-1. No change was observed in the ED-SDC-1 levels, and maintained its location in the cell membrane and cytoplasm. SLUG induced no change in ID-SDC-1 location. At the protein level, an association between SNAIL and nuclear ID-SDC-1 was observed. In conclusion, the results of the present study demonstrated that nuclear ID-SDC-1 localization was associated with SNAIL expression in PCa cell lines.

Prevalence of developmental enamel defects in mentally retarded children

Developmental defects of enamel (DDE) are commonly observed in children with neurological disorders. However, information related to these patients is very scarce. The purpose of this study was to determine the prevalence of DDE in mentally retarded children and to correlate it with specific perinatal factors and childhood diseases. A total of 170 retarded children between 4 and 17 years from a nonfluoridated area were examined. Teeth with defective enamel were seen in 37% of the patients. Permanent central incisors were the most affected teeth (68.38%). White/single opacities were present in 48.38% and white/diffuse patchy opacities in 28.38% of the patients. There was a significantly higher prevalence of DDE in patients with history of bacterial diseases. No statistically significant relation was found between presence of DDE and sex, nutritional status of the mother, use of alcohol and tobacco during pregnancy, presence of syndromes, neonatal disturbances and viral diseases.

Phenytoin improves hemodynamic tolerance and survival after severe hypoxia

Three groups of 12 rabbits each, anesthetized with ketamine (30 mg/kg, intramuscularly) and spontaneously breathing N2O-O2, were given intravenous injections of either placebo (group 1), thiopental (TP) (40 mg/kg, intravenously; group 2), or phenytoin (PNT) (15 mg/kg, intravenously; group 3). Four minutes later, succinylcholine was given and, while ventilation was controlled with N2O alone, changes in systolic blood pressure (SBP) and heart rate (HR) were measured. Tachycardia (greater than 210 beats/min) occurred in groups 1, 2, and 3-111, 107, and 151 sec later, respectively. SBP decreased below 100 torr at 189, 192, and 362 sec, respectively, and below 30 torr 245, 216, and 433 sec after the onset of hypoxia (P less than 0.05), respectively. Bradycardia (less than 30 beats/min) appeared 248, 219, and 439 sec (P less than 0.05), respectively. The onset of severe bradycardia and hypotension was significantly (P less than 0.05) delayed by PNT but not by TP. All rabbits in the placebo group died, while 3 and 8 of the animals given TP and PNT, respectively, survived; survival rate was significantly (P less than 0.05) increased by PNT but not by TP. Phenytoin appears to sustain cardiovascular function during hypoxia better than thiopental does, but phenytoin may not be more effective than thiopental in increasing survival.

Humidity and temperature changes during low flow and closed system anaesthesia

Water humidity and temperature were measured in the proximal end of the inspiratory limb in anaesthetic circuits used to anaesthetize three groups of adult patietnts using various fresh gas flows (FGF). Humidity increased as FGF's were lowered, with 98% water humidification achieved when FGF's of less than 0.51/min were administered. Temperature at the same site changed about 1-2.5 degrees C in inverse proportion to the volume of FGF. This advantage of closed system and low flow anaesthesia is a further reason for their wide-spread utilization.