Evaluation of staining techniques on the results of micronucleus in exfoliated oral mucosa cells

Micronuclei (MN) in exfoliated epithelial cells are widely used as biomarkers of cancer risk in humans. MN are classified as biomarkers of the break age and loss of chromosomes. They are small, extra nuclear bodies that arise in dividing cells from centric chromosome/chromatid fragments or whole chromosomes/chromatids that lag behind in anaphase and are not included in the daughter nuclei in telophase. Buccal mucosa cells have been used in biomonitoring exposed populations because these cells are in the direct route of exposure to ingested pollutant, are capable of metabolizing proximate carcinogens to reactive chemicals, and are easily and rapidly collected by brushing the buccal mucosa. The objective of the present study was to further investigate if, and to what extent, different stains have an effect on the results of micronuclei studies in exfoliated cells. These techniques are: Papanicolaou (PAP), Modified Papanicolaou, May-Grünwald Giemsa (MGG), Giemsa, Harris’s Hematoxylin, Feulgen with Fast Green counterstain and Feulgen without counterstain.

Determination of chitin content in fungal cell wall: an alternative flow cytometric method

The conventional methods used to evaluate chitin content in fungi, such as biochemical assessment of glucosamine release after acid hydrolysis or epifluorescence microscopy, are low throughput, laborious, time-consuming, and cannot evaluate a large number of cells. We developed a flow cytometric assay, efficient, and fast, based on Calcofluor White staining to measure chitin content in yeast cells. A staining index was defined, its value was directly related to chitin amount and taking into consideration the different levels of autofluorecence. Twenty-two Candida spp. and four Cryptococcus neoformans clinical isolates with distinct susceptibility profiles to caspofungin were evaluated. Candida albicans clinical isolate SC5314, and isogenic strains with deletions in chitin synthase 3 (chs3Δ/chs3Δ) and genes encoding predicted Glycosyl Phosphatidyl Inositol (GPI)-anchored proteins (pga31Δ/Δ and pga62Δ/Δ), were used as controls. As expected, the wild-type strain displayed a significant higher chitin content (P < 0.001) than chs3Δ/chs3Δ and pga31Δ/Δ especially in the presence of caspofungin. Ca. parapsilosis, Ca. tropicalis, and Ca. albicans showed higher cell wall chitin content. Although no relationship between chitin content and antifungal drug susceptibility phenotype was found, an association was established between the paradoxical growth effect in the presence of high caspofungin concentrations and the chitin content. This novel flow cytometry protocol revealed to be a simple and reliable assay to estimate cell wall chitin content of fungi.

Re-evaluation of a reported increased micronucleus frequency in lymphocytes of workers occupationally exposed to formaldehyde

A replicate evaluation of increased micronucleus (MN) frequencies in peripheral lymphocytes of workers occupationally exposed to formaldehyde (FA) was undertaken to verify the observed effect and to determine scoring variability. May–Grünwald–Giemsa-stained slides were obtained from a previously performed cytokinesis-block micronucleus test (CBMNT) with 56 workers in anatomy and pathology laboratories and 85 controls. The first evaluation by one scorer (scorer 1) had led to a highly significant difference between workers and controls (3.96 vs 0.81 MN per 1000 cells). The slides were coded before re-evaluation and the code was broken after the complete re-evaluation of the study. A total of 1000 binucleated cells (BNC) were analysed per subject and the frequency of MN (in ‰) was determined. Slides were distributed equally and randomly between two scorers, so that the scorers had no knowledge of the exposure status. Scorer 2 (32 exposed, 36 controls) measured increased MN frequencies in exposed workers (9.88 vs 6.81). Statistical analysis with the two-sample Wilcoxon test indicated that this difference was not significant (p = 0.17). Scorer 3 (20 exposed, 46 controls) obtained a similar result, but slightly higher values for the comparison of exposed and controls (19.0 vs 12.89; p = 0.089). Combining the results of the two scorers (13.38 vs 10.22), a significant difference between exposed and controls (p = 0.028) was obtained when the stratified Wilcoxon test with the scorers as strata was applied. Interestingly, the re-evaluation of the slides led to clearly higher MN frequencies for exposed and controls compared with the first evaluation. Bland–Altman plots indicated that the agreement between the measurements of the different scorers was very poor, as shown by mean differences of 5.9 between scorer 1 and scorer 2 and 13.0 between scorer 1 and scorer 3. Calculation of the intra-class correlation coefficient (ICC) revealed that all scorer comparisons in this study were far from acceptable for the reliability of this assay. Possible implications for the use of the CBMNT in human biomonitoring studies are discussed.

Imunohistoquímica no diagnóstico da glomerulonefrite membranosa: estudo comparativo de binómios cromogênio + coloração de contraste

A glomerulonefrite membranosa faz parte das doenças glomerulares que provocam glomerulonefrite crônica, apresentando-se como uma das causas da doença renal terminal. As técnicas de imunofluorescência são o gold standard no estudo imunológico desta patologia em biópsia renal, através da deteção de imunocomplexos (e.g. IgG e C3) e do seu padrão de distribuição granular característico. No entanto, a imunofluorescência não permite uma contextualização histológica e os fluorocromos utilizados possuem um reduzido tempo de atividade, ao contrário das técnicas imunoenzimáticas que utilizam cromogénios coloridos precipitados que permitem a obtenção de uma marcação permanente e a sua contextualização histológica por via da utilização de eficientes colorações de contraste. Com a finalidade de contribuir para a qualidade do diagnóstico da glomerulonefrite membranosa, em biópsias renais, procurou-se, com esta pesquisa, identificar uma técnica imunoenzimática, através da conjugação entre diferentes cromogênios e colorações de contraste, que permita a deteção de depósitos de IgG e C3, com padrão granular. Foram constituídos diferentes binômios cromogênio + coloração, com os cromogênios 3,3›- Diaminobenzidine Tetrahydrochloride e 3-Amino-9-ethylcarbazole e as colorações Periodic Acid Schiff, Periodic Acid Methenamine Silver e Hematoxilina. Foram utilizadas 72 secções de tecido provenientes de seis de casos de biópsias renais com diagnóstico de glomerulonefrite membranosa, fixados em formalina a 10% e incluídos em parafina. A recolha de dados foi realizada por observação microscópica com preenchimento de uma grelha de classificação dos parâmetros: preservação da morfologia, intensidade da marcação específica, quantidade relativa de estruturas marcadas, marcação inespecífica/fundo, contraste e padrão da marcação, que permitiu a classificação dos binómios estudados num score quantitativo de 0-100 pontos. O binômio que apresentou melhores resultados foi 3-Amino-9-ethylcarbazole + Hematoxilina (score 71,81) e o binômio 3,3›- Diaminobenzidine Tetrahydrochloride+Periodic Acid Methenamine Silver (score 7,81), apresentou os piores resultados. O resultado do teste Kruskal-Wallis indica-nos a presença de diferenças estatísticas entre os binómios em estudo (p=0,000). A Hematoxilina pode ser considerada a coloração mais eficaz, pois cumpriu a sua função de auxiliar e facilitar a observação do tipo de padrão com os dois cromogênios utilizados. O cromogênio 3-Amino-9-ethylcarbazole apresentou resultados semelhantes aos produzidos pelo 3,3›-Diaminobenzidine Tetrahydrochloride, no entanto, permitiu identificar em todos os casos o padrão granular de imunomarcação, ao contrário do que aconteceu com este último.

Immunohistochemistry in formalin-gel fixed tissues

There are several hazards in histopathology laboratories and its staff must ensure that their professional activity is set to the highest standards while complying with the best safety procedures. Formalin is one of the chemical hazards to which such professionals are routinely exposed. To decrease this contact, it is suggested that 10% neutral buffered liquid formalin (FL) is replaced by 10% formalin-gel (FG), given the later reduces the likelihood of spills and splashes, and decreased fume levels are released during its handling, proving itself less harmful. However, it is mandatory to assess the effectiveness of FG as a fixative and ensure that the subsequent complementary techniques, such as immunohistochemistry (IHC), are not compromised. Two groups of 30 samples from human placenta have been fixed with FG and FL fixatives during different periods of time (12, 24, and 48 hours) and, thereafter, processed, embedded, and sectioned. IHC for six different antibodies was performed and the results were scored (0–100) using an algorithm that took into account immunostaining intensity, percentage of staining structures, non-specific immunostaining, contrast, and morphological preservation. Parametric and non-parametric statistical tests were used (alpha = 0•05). All results were similar for both fixatives, with global score means of 95•36±6•65 for FL and 96•06±5•80 for FG, and without any statistical difference (P>0•05). The duration of the fixation had no statistical relevance also (P>0•05). So it is proved here FG could be an effective alternative to FL.

Optimization of immunocytochemistry in cytology: comparison of two protocols for fixation and preservation on cytospin and smear preparations

Objective: A new protocol for fixation and slide preservation was evaluated in order to improve the quality of immunocytochemical reactions on cytology slides. Methods: The quality of immunoreactions was evaluated retrospectively on 186 cytology slides (130 direct smears, 56 cytospins) prepared from different cytology samples. Ninety-three of the slides were air dried, stored at -20 °C and fixed in acetone for 10 minutes (Protocol 1), whereas the other 93 were immediately fixed in methanol at -20 °C for at least 30 minutes, subsequently protected with polyethylene glycol (PEG) and stored at room temperature (Protocol 2). Immunocytochemical staining, with eight primary antibodies, was performed on a Ventana BenchMark Ultra instrument using an UltraView Universal DAB Detection Kit. The following parameters were evaluated for each immunoreaction: morphology preservation, intensity of specific staining, background and counterstain. The slides were blinded and independently scored by four observers with marks from 0 to 20. Results: The quality of immunoreactions was better on methanol-fixed slides protected with PEG than on air-dried slides stored in the freezer: X¯ = 14.44 ± 3.58 versus X¯ = 11.02 ± 3.86, respectively (P < 0.001). Conclusion: Immediate fixation of cytology slides in cold methanol with subsequent application of PEG is an easy and straightforward procedure that improves the quality of immunocytochemical reactions and allows the storage of the slides at room temperature.

Amplificação em imunohistoquímica: estudo comparativo de sistemas de polímeros

Desde o início da utilização da imunohistoquímica em anatomia patológica, um dos objetivos tem sido detetar as quantidades mais ínfimas de antigénio, tornando-o visível ao microscópio ótico. Vários sistemas de amplificação têm sido aplicados de forma a concretizar este objetivo, tendo surgido um grupo genérico de métodos simples e que apresentam uma amplificação superior: são os denominados métodos do polímero indireto. Tendo em conta a variedade de métodos disponíveis, o autor propõe-se a comparar a qualidade de quatro sistemas de amplificação, que recorrem ao método do polímero indireto com horseradish peroxidase (HRP). Foram utilizadas lâminas de diferentes tecidos, fixados em formol e incluídos em parafina, nos quais se procedeu à identificação de 15 antigénios distintos. Na amplificação recorreu-se a quatro sistemas de polímero indireto (Dako EnVision+ System – K4006; LabVision UltraVision LP Detection System – TL-004-HD; Leica NovoLink – RE7140-k; Vector ImmPRESS Reagent Kit – MP-7402). A observação microscópica e classificação da imunomarcação obtida foram feitas com base num algoritmo que enquadra intensidade, marcação específica, marcação inespecífica e contraste, num score global que pode tomar valores entre 0 e 25. No tratamento dos dados, para além da estatística descritiva, foi utilizado o teste one-way ANOVA com posthoc de tukey (alfa=0.05). O melhor resultado obtido, em termos de par média/desvio-padrão, dos scores globais foi o do NovoLink (22,4/2,37) e o pior foi o do EnVision+ (17,43/3,86). Verificou-se ainda que existe diferença estatística entre os resultados obtidos pelo sistema NovoLink e os sistemas UltraVision (p=.004), ImmPRESS (p=.000) e EnVision+ (p=.000). Concluiu-se que o sistema que permitiu a obtenção de melhores resultados, neste estudo, foi o Leica NovoLink.

Impact of a training course on the quality of malaria diagnosis by microscopy in Angola

Background: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. Discussion: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.

Color and Luminescence stability of selected dental materials in vitro

To study luminescence, reflectance, and color stability of dental composites and ceramics. Materials and Methods: IPS e.max, IPS Classic, Gradia, and Sinfony materials were tested, both unpolished (as-cast) and polished specimens. Coffee, tea, red wine, and distilled water (control) were used as staining drinks. Disk-shaped specimens were soaked in the staining drinks for up to 5 days. Color was measured by a colorimeter. Fluorescence was recorded using a spectrofluorometer, in the front-face geometry. Time-resolved fluorescence spectra were recorded using a laser nanosecond spectrofluorometer. Results: The exposure of the examined dental materials to staining drinks caused changes in color of the composites and ceramics, with the polished specimens exhibiting significantly lower color changes as compared to unpolished specimens. Composites exhibited lower color stability as compared to ceramic materials. Water also caused perceptible color changes in most materials. The materials tested demonstrated significantly different initial luminescence intensities. Upon exposure to staining drinks, luminescence became weaker by up to 40%, dependent on the drink and the material. Time-resolved luminescence spectra exhibited some red shift of the emission band at longer times, with the lifetimes in the range of tens of nanoseconds. Conclusions: Unpolished specimens with a more developed surface have lower color stability. Specimens stored in water develop some changes in their visual appearance. The presently proposed methods are effective in evaluating the luminescence of dental materials. Luminescence needs to be tested in addition to color, as the two characteristics are uncorrelated. It is important to further improve the color and luminescence stability of dental materials.

The contribution of cellblock – histogel – in bronchial washing samples

Introduction: The cellblock is a technique that enables the pathologist to study the morphological detail of residual samples and can be used when it is necessary to perform additional diagnostic techniques. Objective: Demonstrate the processing of bronchial washings in liquid based cytology to cellblock using HistoGel in residual samples, evaluating the morphology and preservation of cytological material. Methods: There were used 40 residual samples from bronchial washings in liquid based cytology, after determination of the clinical diagnosis, being made subsequently 40 cellblocks using HistoGel. For each cellblock there was made one histological section for analysis of cell morphology, which was subsequently stained with the routine histological staining. After microscope observation, the morphology was evaluated by 3 experts in the field of pathology, based on the parameters: Cellularity, Preservation and Background. Results: The average final score of 3 evaluators, on a scale of 0 to 100, in assessing the morphology of the 40 samples was 55.6. From the 40 histological sections, 5 of them were considered not viable for evaluation. Conclusions: The results obtained indicate median quality maintenance of morphology. However, it is noted that in only 5 cases it was not possible to determine an evaluation, knowing from the outset that these are residual samples with a very scant cellularity. Thus, it is possible to say that the processing of bronchial washings to cellblock using HistoGel contributes to a concentration of the cytological material, allowing its evaluation and subsequent diagnosis. Additional diagnostic techniques are shown equally viable in these cellblocks.