The prostate biopsy is an essential tool for diagnosing prostate cancer (PCa). While transrectal biopsy (TR-Bx) continues to be considered the gold standard in Germany, the European Association of Urology (EAU) guidelines increasingly recommend transperineal biopsy (TP-Bx) due to lower infection rates and higher tumor detection rates. This article provides an overview of the history and development of the perineal biopsy, compares TR-Bx and TP-Bx and discusses the need for antibiotic prophylaxis before TP-Bx. Current studies have shown that TP-Bx can be performed without antibiotic prophylaxis and new techniques such as robotic-assisted and vector biopsy show very precise results. The establishment of TP-Bx is being promoted by extrabudgetary funding and technological advancements, with the choice of biopsy method remaining an individual decision jointly made in dialogue with the patient.
UNASSIGNED: Die Prostatabiopsie ist ein essenzielles Werkzeug zur Diagnose eines Prostatakarzinoms (PCa). Während die transrektale Biopsie (TR-Bx) in Deutschland weiterhin als Goldstandard gilt, empfehlen die EAU(European Association of Urology)-Leitlinien zunehmend die transperineale Biopsie (TP-Bx) aufgrund niedrigerer Infektionsraten und höherer Tumordetektionsraten. Dieser Artikel gibt einen Überblick über die Geschichte und Entwicklung der perinealen Biopsie, vergleicht TR- und TP-Bx und diskutiert die Notwendigkeit einer antibiotischen Prophylaxe vor TP-Bx. Aktuelle Studien zeigen, dass TP-Bx ohne antibiotische Prophylaxe durchführbar ist, und neue Techniken wie robotisch assistierte und Vektorbiopsie zeigen sehr präzise Ergebnisse. Die Etablierung der TP-Bx wird durch Extrabudgetierung und technologische Fortschritte vorangetrieben, wobei die Wahl der Biopsiemethode eine individuelle Entscheidung im Dialog mit dem Patienten bleibt.

Organochlorine pesticides (OCPs) are persistent organic pollutants (POPs), characterized by their high mobility and environmental persistence, bioaccumulation, and trophic transfer. Considering the highly migratory nature and longevity of the whale shark, this species can be considered as an early warning bioindicator of regional contamination from the marine environment. This work investigated the concentration of twenty OCPs in thirty whale shark skin biopsies, collected between 2014 and 2015 in Bahía La Paz (Gulf of California, Mexico). Mean detected OCP levels were 33.99 ± 105.23 ng/g dw (dry weight), and ΣChlordane, ΣDrin, and ΣHCH showed the highest concentrations. Statistically differences in mean OCP concentration were not found by sex and size. PC1 and PC2 accounted for 68.1 % and 16.1 % of the total variance, respectively. The presence of higher levels of some pesticides than their corresponding metabolites suggests recent applications related to agricultural activity in the surrounding areas of Baja California peninsula.

UNASSIGNED: Diagnosing tuberculosis (TB) can be particularly challenging in the absence of sputum for pulmonary tuberculosis cases and extrapulmonary TB (EPTB). This study evaluated the utility of nanopore-based targeted next-generation sequencing (tNGS) for diagnosing TB in tissue samples, and compared its efficacy with other established diagnostic methods.
UNASSIGNED: A total of 110 tissue samples from clinical cases were examined. The sensitivity and specificity of tNGS were benchmarked against a range of existing diagnostic approaches including hematoxylin and eosin (HE) staining in conjunction with acid-fast bacilli (AFB) detection, HE staining combined with PCR, HE staining paired with immunohistochemistry (IHC) using anti-MPT64, and the Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay.
UNASSIGNED: The sensitivity and specificity of tNGS were 88.2 and 94.1%, respectively. The respective sensitivities for HE staining combined with AFB, HE staining combined with PCR, HE staining combined with IHC using anti-MPT64, and Xpert MTB/RIF were 30.1, 49.5, 47.3, and 59.1%. The specificities for these methods were 82.4, 88.2, 94.1, and 94.1%, respectively. Analysis of drug resistance based on tNGS results indicated that 10 of 93 TB patients (10.75%) had potential drug resistance.
UNASSIGNED: Targeted next-generation sequencing achieved higher accuracy than other established diagnostic methods, and can play a crucial role in the rapid and accurate diagnosis of TB, including drug-resistant TB.

BACKGROUND: Fine-needle aspiration cytology (FNAC) specimens are widely utilized for the diagnosis and molecular testing of various cancers. We performed a comparative proteomic analysis of three different sample types, including breast FNAC, core needle biopsy (CNB), and surgical resection tissues. Our goal was to evaluate the suitability of FNAC for in-depth proteomic analysis and for identifying potential therapeutic biomarkers in breast cancer.
METHODS: High-throughput proteomic analysis was conducted on matched FNAC, CNB, and surgical resection tissue samples obtained from breast cancer patients. The protein identification, including currently established or promising therapeutic targets, was compared among the three different sample types. Gene Ontology (GO) enrichment analysis was also performed on all matched samples.
RESULTS: Compared to tissue samples, FNAC testing revealed a comparable number of proteins (7,179 in FNAC; 7,196 in CNB; and 7,190 in resection samples). Around 85% of proteins were mutually identified in all sample types. FNAC, along with CNB, showed a positive correlation between the number of enrolled tumor cells and identified proteins. In the GO analysis, the FNAC samples demonstrated a higher number of genes for each pathway and GO terms than tissue samples. CCND1, CDK6, HER2, and IGF1R were found in higher quantities in the FNAC compared to tissue samples, while TUBB2A was only detected in the former.
CONCLUSIONS: FNAC is suitable for high-throughput proteomic analysis, in addition to an emerging source that could be used to identify and quantify novel cancer biomarkers.

Diagnostic assessment of chronic wounds is essential for the initiation of causal therapeutic treatment. For diagnostic classification of the wound genesis, it may be necessary to take a tissue sample for histological and/or microbiological processing. If there is clinical suspicion of a specific cause of the wound such as a neoplasm, an inflammatory dermatosis or a pathogen-induced wound, a tissue sample for further diagnosis is required immediately. If the ulceration does not respond sufficiently to adequate causal therapy, a tissue sample for further evaluation is recommended after 12 weeks. The choice of the correct sampling technique, further storage, transport and processing are just as decisive for a reliable result as the specific question for the diagnostic laboratory.
UNASSIGNED: Die Abklärung chronischer Wunden ist essenziell für die Einleitung einer kausaltherapeutischen Behandlung. Zur diagnostischen Einordnung der Wundgenese kann es erforderlich sein, eine Biopsie zur histologischen und/oder mikrobiologischen Aufarbeitung zu entnehmen. Besteht klinisch Verdacht auf eine spezifische Ursache der Wunde wie eine Neoplasie, eine entzündliche Dermatose oder eine erregerbedingte Wunde, so ist unverzüglich eine Biopsie zur weiteren Diagnostik erforderlich. Zeigt sich unter einer adäquat erscheinenden Kausaltherapie kein zufriedenstellendes Therapieansprechen der Ulzeration, so ist spätestens nach 12 Wochen eine Biopsie zur weiteren Evaluation empfohlen. Die Wahl der richtigen Entnahmetechnik, die weitere Lagerung, der Transport und die Aufarbeitung sind dabei ebenso entscheidend für ein verwertbares Ergebnis wie die möglichst spezifische Fragestellung an das diagnostische Labor.

Adult spinal deformity (ASD) surgery is still associated with high surgical risks. Machine learning algorithms applied to multicenter databases have been created to predict outcomes and complications, optimize patient selection, and improve overall results. However, the multiple data points currently used to create these models allow for 70% of accuracy in prediction. We need to find new variables that can capture the spectrum of probability that is escaping from our control. These proposed variables are based on patients\' biological dimensions, such as frailty, sarcopenia, muscle and bone (tissue) sampling, serological assessment of cellular senescence, and circulating biomarkers that can measure epigenetics, inflammaging, and -omics. Many of these variables are proven to be modifiable and could be improved with proper nutrition, toxin avoidance, endurance exercise, and even surgery. The purpose of this manuscript is to describe the different future data points that can be implemented in ASD assessment to improve modeling prediction, allow monitoring their response to prerehabilitation programs, and improve patient counseling.

BACKGROUND: Septic nonunion is one of the major complications in fracture healing. The challenge is to identify the infection as the cause of nonunion first and then to achieve healing of the infection and the bone.
OBJECTIVE: Because of the more heterogeneous appearance of an infected nonunion, the prevalence of germ detection in surgical nonunion revision is often underestimated.
METHODS: In a retrospective study between 2010 and 2017, 86 patients with radiologically confirmed femoral shaft nonunion without clinical evidence and unremarkable medical history of a florid infection as the cause of nonunion, who had undergone primary single-stage surgical nonunion revision were analyzed. At least four intraoperatively obtained samples were evaluated for microbiological diagnosis. A distinction was made between tissue samples with subsequent 48‑h short-term incubation and tissue samples with 14-day long-term cultivation. The finding \"germ detection\" was made if at least two of the samples demonstrated bacterial growth.
RESULTS: In 18 of 86 patients with a nonunion preoperatively judged to be aseptic, positive bacterial evidence was obtained after short-term incubation. After long-term cultivation, positive bacterial detection was possible in 38 of 86 patients with a femoral shaft nonunion initially classified as aseptic. Regarding potential risk factors, the two groups demonstrated no relevant differences. In 29 patients, 1 pathogen was isolated from the obtained samples, whereas in the remaining 9 patients, a mixed culture with an average of 2.9 ± 0.5 different bacteria was detected. Identification revealed mainly low-virulence bacteria, most commonly Staphylococcus epidermidis.
CONCLUSIONS: If the preoperative diagnostics including clinical, laboratory and radiological examination as well as a careful anamnesis reveal indications of a possible infectious event, the surgical nonunion revision should be performed in two stages with specimen collection before definitive nonunion revision. For microbiological diagnosis, several representative tissue samples should independently be obtained from the nonunion site and incubated for 14 days. Only in the absence of evidence of septic nonunion is a single-stage procedure suggested.
UNASSIGNED: HINTERGRUND: Die infizierte Pseudarthrose stellt eine der schwerwiegendsten Komplikationen bei der Frakturheilung dar. Die Herausforderung besteht darin, die Infektion zuerst als Ursache einer Pseudarthrose zu erkennen und dann die Heilung der Infektion und des Knochens zu erreichen.
UNASSIGNED: Aufgrund des heterogeneren Erscheinungsbildes infizierter Pseudarthrosen wird die Prävalenz eines Keimnachweises bei der operativen Pseudarthrosenrevision häufig unterschätzt.
UNASSIGNED: In einer retrospektiven Untersuchung zwischen 2010 und 2017 wurden 86 Patienten, die aufgrund einer radiologisch gesicherten Femurschaftpseudarthrose primär revidiert wurden und die ohne klinische Hinweise auf einen floriden Infekt als Ursache der Pseudarthrose waren, analysiert. Es wurden mindestens 4 intraoperativ gewonnene Proben mikrobiologisch ausgewertet. Dabei wurde zwischen Gewebeproben mit anschließender 48-stündiger Kurzzeitbebrütung und Gewebeproben mit 14-tägiger Langzeitkultivierung unterschieden. Der Befund „Keimnachweis“ wurde gestellt, wenn mindestens 2 der Proben ein Keimwachstum zeigten.
UNASSIGNED: Bei 18 der 86 präoperativ als aseptisch eingeschätzten Pseudarthrosen konnte nach Kurzzeitbebrütung ein positiver Keimnachweis erhoben werden. Nach Langzeitbebrütung war bei 38 von 86 Patienten ein positiver Keimnachweis möglich. Hinsichtlich potenzieller Risikofaktoren zeigten die beiden Gruppen keine relevanten Unterschiede. Bei 29 Patienten wurde ein einzelner Erregertyp aus den gewonnenen Proben isoliert, während bei den übrigen 9 Patienten eine Mischkultur mit durchschnittlich 2,9 ± 0,5 verschiedenen Bakterien nachgewiesen wurde. Bei der Keimidentifizierung fanden sich mit Staphylococcus epidermidis am häufigsten niedrigvirulente Bakterien.
UNASSIGNED: Ergibt die präoperative Diagnostik unter Einbeziehung der klinischen, laborchemischen und radiologischen Untersuchung sowie der Anamnese Hinweise auf ein mögliches Infektgeschehen, sollte die operative Revision zweizeitig mit Probengewinnung vor der definitiven Pseudarthrosenrevision erfolgen. Zur mikrobiologischen Diagnostik sollten mehrere repräsentative Gewebeproben unabhängig voneinander aus der Pseudarthrosenzone gewonnen und für 14 Tage bebrütet werden. Nur bei fehlenden Hinweisen auf eine infizierte Pseudarthrose wird das einzeitige Vorgehen vorgeschlagen.

The diagnosis and initiation of appropriate treatment against invasive fungal infections depend upon accurate identification of pathogens by pathologists and clinical microbiologists. Histopathology is often critical in providing diagnostic insight in patients with suspected fungal infections, and such findings are incorporated into the definitions of proven or probable disease caused by certain pathogens. Such examinations can offer provisional identifications of fungal organisms, which can help guide initial therapy while laboratory results are pending. Common etiologic agents of invasive mycoses may be recognized based on morphologic characteristics observed in tissue and biologic fluids, such as those obtained from bronchoalveolar lavage and bronchial washings. However, care should be taken in the interpretation of these findings, as there may be a false sense of the ability to correctly categorize fungal organisms to the genus or species level by morphologic features alone. Studies have demonstrated discordant results between histopathology and laboratory results due to overlapping morphologic features, morphologic mimics, and sampling errors. Thus, histopathology plays an integral role in providing a differential of potential fungal pathogens but must be combined with results from laboratory studies, including cultures, antigen tests, serology, and molecular assays, in order to improve accuracy in the identification of etiologic agents of fungal infections. Inaccurate identification of the infecting organism can lead to inappropriate antifungal therapy and possibly poor clinical outcomes.

BACKGROUND: To explore the differential expression of apolipoproteinA1 (APOA1) in urologic neoplasm patient compared with controls, as well as investigates whether APOA1 correlated with infiltration of urologic neoplasm.
METHODS: A total of 59 tissue sections of surgically-resected urologic neoplasm and 6 cases of normal tissue sections were collected. Fourteen cases of urine samples from transitional cell carcinoma patients and 6 cases urine samples from controls were also applied in this experiment. We also selected 6 cases of fresh bladder transitional cell carcinoma tissues. The urologic neoplasm tissue sections were classified into infiltration and non-infiltration urologic neoplasm groups. The expressions of APOA1 between urologic neoplasm and normal control were detected by Western blot, Immunohistochemistry and qRT-PCR. The method of Immunohistochemistry was applied to examine the differences of APOA1 expression between infiltration and non-infiltration urologic neoplasm tissue section groups.
RESULTS: Compared with none expression in normal controls, APOA1 was exhibited higher level in urologic neoplasm patient\'s urine and fresh bladder transitional cell carcinoma tissues (P<0.05). There were statistical differences of APOA1 between infiltration and non-infiltration urologic neoplasm tissue section groups. APOA1 expressions were found to be up-regulated in the infiltration neoplasm tissue sections compared to non-infiltration group (P<0.001).
CONCLUSIONS: APOA1 could act as a valuable biomarker for predicting the occurrence and development of urologic neoplasm.

When examining infectious samples, rapid identification of the pathogenic agent is required for diagnosis and treatment or for investigating the cause of death. In our previous study, we applied exhaustive amplification using non-specific primers (the rapid determination system of viral genome sequences, the RDV method) to identify the causative virus via swab samples from a cat with a suspected viral infection. The purpose of the current study is to investigate suitable methods for the rapid identification of causative pathogens from infected tissue samples. First, the influenza virus was inoculated into mice to prepare infected tissue samples. RNA extracted from the mouse lung homogenates was transcribed into cDNA and then analyzed using the RDV method and next-generation sequencing, using MiSeq and MinION sequencers. The RDV method was unable to detect the influenza virus in the infected tissue samples. However, influenza virus reads were detected using next-generation sequencing. Comparing MiSeq and MinION, the time required for library and sequence preparation was shorter for MinION sequencing than for MiSeq sequencing. We conclude that when a causative virus needs to be rapidly identified from an infectious sample, MinION sequencing is currently the method of choice.