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Plasma Cell Neoplasms, Clinicopathological Characteristics and Immunophenotype of 21 Patients

Open Journal of Pathology 2012年第4期2卷 127-132页

作者： mónica belinda romero-guadarrama Cinthia Adriana meza medina Elvira Aguilar martínez Facultad de medicina Universidad Autónoma de Nayarit Tepic Mexico Unidad de Hematología del Hospital General de méxico Mexico City Mexico Unidad de Patología del Hospital General de méxico Mexico City Mexico

Introduction: Plasma cell neoplasms are monoclonal proliferations characterized by the secretion of an immunoglobulin product known as component "m" or monoclonal. The World Health Organization (WHO 2008) defines as plasma cell neoplasms the following: plasma cell myeloma, plasmacytoma and those syndromes defined by immunoglobulin deposits and primary amyloidosis, The objective of the present work was to correlate their clinical, morphological and phenotype characteristics in 21 patients. material and methods: A 2-year retrospective review was performed of the files of the surgical pathology laboratory and of the hematology service of the General Hospital of mexico, searching for patients with a diagnosis of plasma cell neoplasm. We analyzed the following variables: age, gender, clinical symptoms, evolution, localization, laboratory tests, morphology, and expression of immunohistochemical markers. Of the 21 patients, 12 (57.1%) corresponded to plasma cell myelomas and 9 (42.8%) were plasmacytomas (seven extraosseous and two solitary bone plasmacytoma);women predominated with 61.4% and age ranged between 22 and 84 years. mass and epistaxis were observed in the patients with plasmacytomas, and symptoms of medullary compression and anemia were observed in those patients with plasma cell myeloma. The time of symptomatology varied from 3 to 12 months. Laboratory tests revealed that lactate dehydrogenase (LDH), beta 2 microglobulin, C-reactive protein were altered and that hypercalcemia and anemia were present more in the systemic form of the disease. Treatment depended on the clinical staging and laboratory data. mature forms predominated morphologically. Immunohistochemical stain revealed a constant expression for CD 138, six patients expressed CD 56, and expression of the Kappa and Lambda light chains was while.

关键词： Plasma Cell Neoplasms

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Diffuse Large B-Cell Lymphoma with Anaplastic Clear Cells: A Rare Variant

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Open Journal of Pathology 2012年第4期2卷 150-154页

作者： mónica belinda romero-guadarrama Leslie Elizmara Aguilar-Ayala German Ott Jorge Pérez-Espinosa Department of Clinical Pathology Robert-Bosch-Hospital Stuttgart Germany Unit Pathology Hospital General de México OD and Medicine School Autonomous National University of Mexico Mexico City Mexico

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous group conformed by morphological and clinical varieties of neoplasms;it originates from peripheral B-cells and is distinguished into three groups: germinal center (GC), activated B lymphocyte (ABL), and the third type. The existence of DLBCL with anaplastic morphology and expression of CD30 without t (2;5) translocation is rare. The aim of the present article is to describe this morphologic variant in a 54-year-old woman and a 74-year-old man, respectively. materials and methods: Patients diagnosed with DLBCL with anaplastic variant were identified from the surgical pathology records. Results: Out of 357 biopsies with this diagnosis, 11 (3%) corresponded to the anaplastic variant, 2 presented morphological clear cells;they became visible because of an increase in volume in the cervical area of 4 months of evolution, usually associated to diaphoresis and weight loss with clinical fulminating progression. An autopsy study was performed to one patient and it showed infiltration in supraclavicular lymph nodes, thyroid, and lung. The neoplastic cells presented abundant clear cytoplasm and pleomorphic nuclei that expressed CD20, CD30 and CD45. Conclusion: This variation is rare. The clinical presentation and prognosis are controversial;we present the morphological and immunophenotype changes of this variant. The differential diagnosis from other clear cell neoplasms should be made.

关键词： B-Cell Anaplastic Lymphoma with Clear Cells

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Diffuse Large B-Cell Lymphoma of the Central Nervous System. Immunophenotype, Clinicopathological Features and Differential Diagnosis

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Open Journal of Pathology 2012年第4期2卷 133-139页

作者： mónica belinda romero-guadarrama maría Esther Gutiérrez Díaz-Ceballos Fiacro Jiménez-Ponce Samantha Thingen-Velarde Hemathology Service Hospital General de México Mexico City Mexico mónica belinda romero-guadarrama Neurosurgery Unit Hospital General de méxico Mexico City Mexico Unit Pathology Hospital General de méxico Medicine School Autonomous University of Mexico Mexico City Mexico

Background: Diffuse large B-cell lymphomas of the central nervous system (DLBCL CNS) represent less than 1% of all lymphomas and between 2% and 3% of all cerebral tumors. They occur in adults of 60 years of age or more. The objective of this work is to describe the clinical-pathological characteristics, the immunophenotype and the differential diagnosis. Clinical Case: From the files of the surgical pathology unit we found four cases of primary diffuse large B cell lymphoma of the central nervous system in a 6-year period. Three corresponded to women over 47 years of age and the other to a 42-year-old man. The time of evolution was between 2 and 4 months. The symptoms were headache, blurred vision, hemiparesis, and seizures. Localization was in the pineal region, the frontal, parietal regions, and the right thalamus. morphologically, large lymphoid cells with a diffuse growth pattern and necrosis were observed. Immunohistochemical markers, such as CD 20 and bcl2 were positive, one was positive to CD3. Expression of bcl6 and CD 10 was positive in one case, and mUm-1 was positive in three cases. All the cases were negative for Epstein-Barr virus. Conclusions: The diffuse large-B cell lymphoma of the central nervous system is rare. Its average age of presentation is at 60 years or older. The localization is in the pineal, frontal, parietal and thalamic regions. Three cases were originated by activated B lymphocyte (mUm-1 expression) and other from the Germinal Center (GC) (CD 10 expression). The clinical course was bad. The four patients died shortly after the diagnosis.

关键词： Primary Lymphoma Central Nervous System

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Association of morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone marrow Infiltration in a Sample mexican Population

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Open Journal of Pathology 2012年第2期2卷 29-37页

作者： mónica-belinda romero-guadarrama Fiacro Jiménez Ponce Armando medina Cruz Elsa Lorena Durán Ramírez Icela Palma Lara molecular and Celular morphology Laboratory Escuela Superior de Medicina Instituto Politécnico Nacional and Morphology Department Facultad de Medicina Veterinaria y Zootecnia (UNAM) México City México Unidad de Patología del Hospital General de méxico Facultad de Medicina Universidad Nacional Autónoma de México (UNAM) México City México

Introduction: Diffuse large B-cell lymphoma (DLBCL), not otherwise specified, is a large B-cell lymphoma with a diffuse growth pattern and aggressive clinical course. It is divided in subgroups according to its morphology, immunophenotype, and primary site. Dissemination to bone marrow occurs in 11% to 35% of cases and can be of concordant or discordant morphology. Objective: To examine the association, the type of bone marrow involvement in relation to the primary site, morphology, immunohistochemistry of DLBCLs and to determine the cases of Epstein-Barr virus positive DLBCLs. materials and methods: We reviewed lymph node and extranodal biopsies as well as the respective bone marrow biopsies in all cases of DLBCL diagnosed in the Hospital General de méxico during the period from 2002 to 2010. We used immunohystochemistry for immunophenotype identification (Hans’s algorithm) and an in-situ hybridization technique to detect presence of Epstein Barr encoded RNA (EBER). Results: We included 108 patients with a mean age of 51.9 years, 59 (55%) were men. DLBCL involved lymph nodes in 60% of cases and palatine tonsils in 13%. The centroblastic variant predominated (80%) and 58% originated from activated B-cells. Infiltration of bone marrow was present in 30% of cases and was discordant in 55% of these cases. Correlation between morphology and bone marrow infiltration was statistically significant (P = 0.0003). Presence of Epstein-Barr virus was demonstrated in 15% of patients older than 50 years. Conclusions: Dissemination to bone marrow occurred in 30% of cases and discordant involvement was most common. DLBCL originating from activated B-lymphocytes predominated and the most common extranodal sites were palatine tonsils, suggesting that our population has a clinical behavior similar to Asiatic populations.

关键词： Dissemination to Bone marrow Diffuse Large B-Cell Lymphoma Immunophenotype

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Kikuchi-Fujimoto Disease Associated to the Epstein-Barr Virus. A Type of Rare Necrotizing Lymphadenitis and Its Differential Diagnosis

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Open Journal of Pathology 2013年第4期3卷 186-192页

作者： mónica belinda romero guadarrama Oscar Daniel Guzmán-Aguilar Adriana Carolina López-Ugalde José Samuel Almeida Navarro Humberto Cruz-Ortíz Unidad de Patología Hospital General de México “Dr. Eduardo Liceaga” México D.F. México

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a specific and self-limited disease;its etiology is unknown. Some causal microorganisms have been proposed. The objective of the present article is to emphasize the clinicopathological characteristics of this disease that has been associated to the Epstein-Barr virus and to compare the histological changes with other types of necrotizing lymphadenopathies. material and methods: We studied 32 patients of the Surgical Pathology Service with necrotizing lymphadenitis, diagnosed in the years from 2004 to 2012 to found more cases of this rare disease in our Institution. Patients were 18 women and 14 men with an average age of 37 years. Results: The lymph nodes were cervical and axillary ones, some were associated to autoimmune diseases and no cause was identified in others. One of the cases, was diagnosed as KFD, presented morphological changes characteristic of this disease, such as subcapsular lymphoid follicles, zones with cell debris, epithelioid macrophages, clear-cytoplasm histiocytes, and immunoblast-reactive lymphocytes. Immunohistochemical markers were determined, such as CD20, CD2, CD4, CD8, CD68, lysozyme, CD56, granzyme B and EBER, which demonstrated the presence of B, T lymphocytes, histiocytes and cells positive to EBER. Histological changes in KFD occurred in three stages: proliferative stage, necrotizing, and xanthomatous. It is important to identify the histological stages of the disease because a differential diagnosis must be performed in regard to lymphadenopathies with necrosis and diverse types of lymphomas. Conclusion: We present a case of necrotizing lymphadenitis (KFD) associated to the Epstein-Barr virus and in some cases it is not possible to render a specific diagnosis based on morphologic findings, alone, and a diagnosis of necrotizing lymphadenitis may be used.

关键词： Kikuchi-Fujimoto Disease Epstein Barr Virus

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Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 255-258页

作者： belinda Sánchez-Pérez Josém Ramia Department of General Digestive and Transplantation SurgeryUniversity Regional HospitalMálaga 29010MálagaSpain Department of Surgery Hospital General Universitario Dr.BalmisAlicante 03010Spain

Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in *** surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly *** advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving ***,ERAS could be another way to improve our oncological *** will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.

关键词： Enhanced recovery after surgery programs Liver surgery Key components Long-term oncological outcomes Enhanced recovery after surgery compliance

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Physical activity and amyloid beta in middle-aged and older adults:A systematic review and meta-analysis

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Journal of Sport and Health Science 2024年第2期13卷 133-144页

作者： maría Rodriguez-Ayllon Patricio Solis-Urra Cristina Arroyo-ávila miriam álvarez-Ortega Pablo molina-García Cristina molina-Hidalgo manuel Gómez-Río belinda Brown Kirk I.Erickson Irene Esteban-Cornejo Department of Epidemiology Erasmus University Medical Center RotterdamRotterdamGD 3015the Netherlands Department of Physical Education and Sports Faculty of Sport SciencesSport and Health University Research Institute(iMUDS)University of GranadaGranada 18071Spain Faculty of Education and Social Sciences Universidad Andres BelloVina del Mar 2531015Chile Department of Nuclear medicine Virgen de las Nieves University HospitalInstitute of Biosanitary Research of Granada(IBS)Granada 18014Spain Physical medicine and Rehabilitation Service Virgen de las Nieves University HospitalInstitute of Biosanitary Research of Granada(IBS)Granada 18014Spain Department of Psychology University of PittsburghPittsburghPA 15260USA Centre for Healthy Ageing Health Futures InstituteMurdoch UniversityMurdochWA 6150Australia School of medical and Health Sciences Edith Cowan UniversityJoondalupWA 6027Australia Advent Health Research Institute Neuroscience Institute OrlandoOrlandoFL 32803USA Physiopathology of Obesity and Nutrition Research Center(CIBERobn) Institute of Health Carlos Ⅲ(ISCⅢ)Madrid 28029Spain

Background:One of the pathological hallmarks distinguishing Alzheimer’s disease from other dementias is the accumulation of amyloid beta(Aβ).Higher physical activity is associated with decreased dementia risk,and one potential path could be through Aβlevels *** aimed to explore the relationship between physical activity and Aβin middle-aged and older ***:A systematic search of Pubmed,Web of Science,PsycINFO,Cochrane Central Register of Controlled Trials,and SPORTDiscus was performed from inception to April 28,*** were eligible if they included physical activity and Aβdata in adults aged 45 years or ***-level metaanalyses of intervention and observational studies were performed to examine the role of physical activity in modulating Aβ***:In total,37 articles were included(8 randomized controlled trials,3 non-randomized controlled trials,4 prospective longitudinal studies,and 22 cross-sectional studies).The overall effect size of physical activity interventions on changes in blood Aβwas medium(pooled standardized mean difference=-0.69,95%confidence interval(95%CI):-1.41 to 0.03;I^(2)=74.6%).However,these results were not statistically significant,and there were not enough studies to explore the effects of physical activity on cerebrospinal fluid(CSF)and brain Aβ.Data from observational studies were examined based on measurements of Aβin the brain using positron emission tomography scans,CSF,and *** physical activity was positively associated with Aβonly in the CSF(Estimate r=0.12;95%CI:0.05-0.18;I^(2)=38.00%).Conclusion:Physical activity might moderately reduce blood Aβin middle-aged and older ***,results were only near statistical significance and might be interpreted with caution given the methodological limitations observed in some of the included *** observational studies,higher levels of physical activity were positively associated with Aβonly in ***,further research is needed t

关键词： Aging Cognitive impairment Dementia Exercise PET

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New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report

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World Journal of Transplantation 2024年第1期14卷 210-214页

作者： belinda Sánchez Pérez maría Pérez Reyes Jose Aranda Narvaez Julio Santoyo Villalba Jose Antonio Perez Daga Claudia Sanchez-Gonzalez Julio Santoyo-Santoyo Hepatobiliary and Trasplantation Unit General and Digestive Surgery DepartmentUniversity Regional HospitalMalaga 29010Spain Department of General and Digestive Surgery Regional University Hospital of MalagaMalaga 29010Spain

BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive *** is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic *** can reverse the physiopathology of this process and restore normal ***,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECmO)can be used as a rescue therapy with good *** SUmmARY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for *** had good liver function(model for End-Stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>*** demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide *** was needed after 72 *** to the non-response to supportive therapies,installation of ECmO was decided with progressive recovery after 9 *** was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 *** was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen *** recycling was needed twice for acute *** patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen *** Due to the favorable results observed,ECmO could bec

关键词： Liver transplantation Hepatopulmonary syndrome Refractory hypoxemia Treatment Extracorporeal membrane oxygenation Case report

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Evaluation of Clinician Training in Autism Screening, Care management, and Patient Education

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Open Journal of Pediatrics 2024年第3期14卷 488-513页

作者： belinda O’Hagan Julie White Ilana Hardesty Rachel Amgott Candice Bangham Xinyang Liu Alyson Codner Amy Ursitti Alana Chandler Sarah Foster marilyn Augustyn Jacey Greece Division of Developmental and Behavioral Pediatrics Department of Pediatrics Boston Medical Center Boston United States of America Boston University Chobanian & Avedisian School of medicine Boston United States of America Department of Community Health Sciences Boston University School of Public Health Boston United States of America

Objective: The demand for pediatric developmental evaluations has far exceeded the workforce available to perform them, which creates long significant wait times for services. A year-long clinician training using the Extension for Community Healthcare Outcomes (ECHO®) model with monthly meetings was conducted and evaluated for its impact on primary care clinicians’ self-reported self-efficacy, ability to administer autism screening and counsel families, professional fulfillment, and burnout. methods: Participants represented six community health centers and a hospital-based practice. Data collection was informed by participant feedback and the Normalization Process Theory via online surveys and focus groups/interviews. Twelve virtual monthly trainings were delivered between November 2020 and October 2021. Results: 30 clinicians participated in data collection. matched analyses (n = 9) indicated statistically significant increase in self-rated ability to counsel families about autism (Pre-test mean = 3.00, Post-test mean = 3.89, p = 0.0313), manage autistic patients’ care (Pre-test mean = 2.56, Post-test mean = 4.11, p = 0.0078), empathy toward patients (Pre-test mean = 2.11, Post-test mean = 1.22, p = 0.0156) and colleagues (Pre-test mean = 2.33, Post-test mean = 1.22, respectively, p = 0.0391). Unmatched analysis revealed increases in participants confident about educating patients about autism (70.59%, post-test n = 12 vs. 3.33%, pre-test n = 1, p = 0.0019). Focus groups found increased confidence in using the term “autism”. Conclusion: Participants reported increases in ability and confidence to care for autistic patients, as well as empathy toward patients and colleagues. Future research should explore long-term outcomes in participants’ knowledge retention, confidence in practice, and improvements to autism evaluations and care.

关键词： Autism Spectrum Disorder Program Evaluation Case-Based Training Provider Burnout Continuing medical Education

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从干针崛起看古典针灸传承与创新的必要性

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World Journal of Acupuncture-moxibustion 2024年第1期34卷 1-8页

作者：金观源金雷何洁金霞美国国际系统医学研究所威斯康辛州53214美国美国威斯康星州密尔沃基市顶级针灸诊所威斯康辛州53214美国美国德克萨斯州伍德兰市针灸诊所得克萨斯州77381美国美国威斯康星州大学-麦迪逊分校威斯康辛州53706美国

By reviewing the historical background and the current state of dry needling(DN),including the"AntiDN Independence"movement by the acupuncture profession in the west,this paper emphasizes that DN is acupuncture,or more precisely,a"de-meridian"style of *** applications of DN and its modern studies have seen a tremendous growth spurt during the past two decades,which suggests that the meridian theory of traditional Chinese medicine(TCm)may not be the exclusive theory to guide *** certain high-quality DN trials may serve as good examples for acupuncture research,such as refining the stimulation targets in acupoints,recognizing the reflex properties of acupoints known as acu-reflex points(ARPs),or establishing standardized indicators of stimulus amount while objectively assessing the needling *** any other therapies,DN has its shares of drawbacks or limitations,which reminds that while innovating classical acupuncture,it is still necessary to inherit the valuable experience of classic acupuncture and the rational core of meridian *** is crucial for enhancing the efficacy of clinical acupuncture intervention including DN to broaden the treatment scope and indications of acupuncture.

关键词： Dry needling(DN) De-meridian Classical acupuncture modern acupuncture Inheritance Innovation Acu-reflex points(ARPs)

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