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At least 883 records · Page 49Linked to original sources
PubMed2002

Unimpaired activation of c-Jun NH2-terminal kinase (JNK) 1 upon CD40 stimulation in B cells of patients with X-linked agammaglobulinemia.

X-linked agammaglobulinemia (XLA) is caused by mutations in the gene encoding the cytoplasmic Bruton's tyrosine kinase (Btk). Btk has been shown to play an essential role in the development of B1 (CD5+) and conventional circulating mature B cells (B2) in mouse and man. It has been shown in earlier studies that Btk is involved in both the BCR- and CD40-mediated signaling pathways. In this study, we analyzed the responsiveness of Epstein-Barr virus (EBV) transformed B cells from nine XLA patients to CD40 stimulation, particularly the CD40 induced activation of c-Jun N-terminal kinase (JNK). In eight XLA patients the JNK activation was unimpaired and in one case INK could not be activated by anti-CD40 stimulation. Btk protein expression was detectable by Western blotting in six cases, in one case Btk expression was drastically reduced, and in three cases no Btk expression could be observed. Btk kinase activity was found in three cases and it was reduced in one and not detectable in five cases. Furthermore, in one female patient with an agammaglobulinemia, Btk expression and function as well as JNK activation by CD40 stimulation was unimpaired. Our findings demonstrate that INK activation via the CD40 signaling pathway is intact in EBV-transformed B cells of most if not all XLA patients, independent of the mutation and its effect on Btk expression and kinase activity. We suggest that Btk is not necessary for the activation of INK upon CD40 stimulation, at least in the B cell subpopulation we had studied. We cannot exclude that these B cells belong to a "leaky" B-cell subpopulation in which the CD40 signaling pathway has become independent of Btk function.

Agammaglobulinaemia Tyrosine Kinase↗
PubMed2003

Sequential image analysis and measurement of pigmented lesions: false variations due to patient positioning.

Clinical researchers are evaluating the utility of obtaining sequential images of pigmented lesions taken over time for purposes of comparison with the aim of detecting subtle changes suggestive of melanoma. Therefore, the image acquisition process is critical and will need to be strictly standardized before any firm conclusions can be drawn from analysis of sequential images. The influence of patient positioning on the accuracy of sequential image analysis has not been considered in most studies evaluating sequential images. In this experimental study, the influence of patient positioning on the size and shape of an inked circle placed on the skin was determined and measured. Inked circular marks (15 mm in diameter, area 176.71 mm2) were placed on the skin of the lumbar and suprascapular areas of 60 consecutive patients. The diameter and area of the 'circle' was measured with the patient in the prone position with head centred, prone position with head turned to the right, prone position with head turned left, and in the seated position. Statistical analysis was performed with Student's t-tests (paired data). We observed statistically significant differences in the shape, mean maximal diameter and area of the inked circular marks on both the suprascapular area and in the lumbar area after changes of patient positioning (P<0.001). To conclude, the position of the patient must be fixed and standardized during acquisition of sequential images, at least for lesions 15 mm in diameter or larger. Furthermore, it is our opinion that the methods used to control for patient positioning should be reported in the methodology section of studies that report on comparison of sequential images. Only then can we accurately compare sequential images and avoid 'false positive lesion enlargement' being categorized as a true change.

Adolescent↗
PubMed2001

A new method of margin evaluation in breast conservation surgery using an adjustable mould during fixation.

AIMS: We have developed a new method of breast resection margin assessment in quadrantectomy using an adjustable mould to prevent the three-dimensional specimen from distorting during fixation. METHODS AND RESULTS: The new method has been applied to 10 consecutive quadrantectomies (six invasive duct carcinomas, four duct carcinoma in situ with or without microinvasion). The precise configuration of the fixed specimen enabled pathologists to examine the side slices, the 5 mm thick slices cut parallel to the flat lateral margins of the specimen, permitting the separation of margin evaluation from tumour characterization. Eight cases with negative margins by our method would also be negative by assessment of inked margins since the margin widths were estimated to be from 5 to 30 mm (average 16.3 mm); two cases with positive margins would also be positive by inked margins. CONCLUSIONS: Our new method was as reliable as the inked margins employing sequential slicing of the entire tissue, although it reduced the number of blocks by more than half in invasive carcinomas. A further advantage of this method is that the accuracy in margin evaluation is not influenced by the extent of tumour sampling. In addition, our system can pinpoint the positive margins facilitating re-excision to obtain tumour-free margins.

Adult↗
PubMed1998

In vitro dentinal penetration by tracers used in microleakage studies.

Many microleakage studies, in their methodology, employ different tracers which may penetrate around restorative materials to varying extents due to their physical or chemical characteristics. The present series of in vitro studies were designed to compare the ability of freshly obtained microleakage tracers to enter cut dentinal tubules. Tracers selected were 5% eosin, 2% methylene blue, 50% silver nitrate and Indian ink all buffered, where necessary, to a range of pH 6.9-7.2. The solution of Indian ink was further investigated by particle size analysis to determine the range of particle sizes within the solution. Particles ranged from < 1 micron to 600 microns. Buffered and unbuffered solutions of the tracers were applied for 1 h to open cavities, devoid of a smear layer, prepared in 42 premolars. Specimens were sectioned longitudinally through the cavities either with or without water coolant. Penetration into dentinal tubules by the tracer resulted in an area of stained dentine and this area was subsequently measured using image analysis. The results demonstrated that there were few statistically significant differences between the areas of dentinal penetration associated with each tracer. Neither the tracer used, its pH nor sectioning technique had a predictably significant effect on dentinal penetration. Indian ink was observed to be capable of entering dentinal tubules.

Analysis of Variance↗
PubMed2002

Multiple color changes following laser therapy of cosmetic tattoos.

OBJECTIVE: To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems. METHODS: A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. RESULTS: Significant but incomplete resolution of the tattoo ink was achieved. CONCLUSION: Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.

Eyebrows↗
PubMed2001

A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique.

BACKGROUND AND STUDY AIMS: Knowledge of the exact location of colorectal lesions is necessary but difficult to establish during surgery. Thus, endoscopic tattooing has been used as an important preoperative marker for identification. Using the conventional technique, we injected tattooing agents directly into the colonic wall. However, to make sure that the tattooing agents were adequately injected into the submucosal layer, and to prevent spillage into the peritoneal cavity, we modified the conventional method and developed a new tattooing technique: using India ink with prior and subsequent injection of saline into the submucosa. The aim of this study was to retrospectively assess the clinical utility and potential complications of the above two techniques of endoscopic tattooing using India ink. PATIENTS AND METHODS: A total of 153 patients underwent laparoscopically assisted colectomy at the National Cancer Center Hospital East, Kashiwa, Chiba, Japan, between June 1994 and December 1999, and 91 patients underwent preoperative endoscopic tattooing by either the conventional or the new technique. The conventional and new techniques were used from June 1994 to December 1997 (n = 36) and from January 1998 to December 1999 (n = 55), respectively. Informed consent was obtained from all the patients. RESULTS: Using the conventional technique, the exact location of the lesion was identified in 31 of 36 cases (86.1 %) during surgery. The complications of this procedure were silent local peritonitis in two patients and reactive lymph node swelling in one patient (3/36, 8.3 %). Using the new technique, in 54 of 55 cases lesions (98 %) were easily identified (p = 0.034),and in only one there was a small leakage of India ink into the peritoneal cavity (1/55; 1.8 %), no other serious complications were observed. CONCLUSIONS: The results demonstrate that our new technique for endoscopic tattooing is probably better than the conventional technique for clinical use, in terms of diagnostic accuracy and safety, but this would have to be proven in a randomized comparison.

Carbon↗
PubMed2006

A novel endoscopic marker: safety experiments in the rat stomach.

BACKGROUND AND STUDY AIMS: The study aimed to assess a newly developed endoscopic marker designed to cause only minor inflammatory reactions. MATERIALS AND METHODS: Chitosan and carbon powder were used in the marker substance. The product was a viscoelastic solution, which was injected into the submucosa in rat stomach walls. The tissue reactions were then examined histopathologically. The structure of the injected marker substance was examined with electron microscopy into rat stomach walls. India ink, which is currently used as an endoscopic marker, served as the control. RESULTS: Histopathological examination showed that inflammatory reactions with the novel agent were remarkably mild in the rat organs, while submucosally applied india ink caused severe inflammation in situ. The electron-microscopic findings showed that the carbon particles used were completely spherical in shape and that the carbon in the marker substance was entrapped in the chitosan networks. The india ink was shown to consist of a mixture of fine carbon particles and adhesive additives. CONCLUSIONS: The chitosan-carbon solution appears to be a promising endoscopic marker substance, causing significantly reduced inflammation.

Animals↗
PubMed2005

Accelerated chemically induced tumor development mediated by CD4+CD25+ regulatory T cells in wild-type hosts.

We examined the role of CD4+CD25+ regulatory T cells in the development of 3-methylcholanthrene (MCA)-induced tumors. Immunization of wild-type BALB/c mice with a series of SEREX (serological identification of antigens by recombinant expression cloning)-defined broadly expressed self-antigens results in the development of highly active CD4+CD25+ regulatory T cells. Accelerated tumor development was observed in mice immunized with self-antigens and was abolished by antibody-mediated depletion of CD4+ T cells or CD25+ T cells. A similar acceleration of tumorigenesis was also observed in mice adoptively transferred 2 or 4 weeks after MCA injection with CD4+CD25+ T cells derived from mice immunized with DnaJ-like 2, one of these self-antigens. Experiments with Jalpha281-/- mice lacking invariant natural killer (iNK) T cells indicated that iNK T cells, known for their protective role in the development of MCA-induced tumors, were suppressed in immunized hosts. NK cells, also known to play a protective role in MCA induced-tumorigenesis, were also suppressed in mice immunized with serologically defined self-antigens in a CD4+CD25+ T cell-dependent manner. We propose that CD4+CD25+ regulatory T cells generated by immunization with these self-antigens enhance susceptibility to MCA induced-tumorigenesis by down-regulating iNK T and NK reactivity, and suggest that these observations provide direct evidence for the existence of cancer immunosurveillance in this system of chemical carcinogenesis.

Animals↗
PubMed1960

Electron microscopic study of the phagocytosis process in lung.

Diluted India ink was instilled into the nasal cavity of mice and the lungs of some animals were fixed with osmium tetroxide at various intervals after one instillation. The lungs of other animals were fixed after 4, 7, 9, 16, or 18 daily instillations. The India ink was found to be phagocytized almost exclusively by the free alveolar macrophages. A few particles are occasionally seen within thin portions of alveolar epithelium, within the "small" alveolar epithelial cells, or within occasional leukocytes in the lumina of alveoli. The particles are ingested by an invagination process of the plasma membrane resulting in the formation of intracellular vesicles and vacuoles. Ultimately large amounts of India ink accumulate in the cell, occupying substantial portions of the cytoplasm. The surfaces of phagocytizing macrophages show signs of intense motility. Their cytoplasm contains numerous particles, resembling Palade particles, and a large amount of rough surfaced endoplasmic reticulum. These structures are interpreted as indicative of protein synthesis. At the level of resolution achieved in this study the membranes of this reticulum appear as single dense "lines." On the other hand, the plasma membrane and the limiting membranes of vesicles and of vacuoles often exhibit the double-line structure typical of unit membranes (Robertson, 37). The inclusion bodies appear to be the product of phagocytosis. It is believed that some of them derive from the vacuoles mentioned above, and that they correspond to similar structures seen in phase contrast cinemicrographs of culture cells. Their matrix represents phagocytized material. Certain structures within this matrix are considered as secondary and some of these structures possess an ordered form probably indicative of the presence of lipid. The possible origin and the fate of alveolar macrophages are briefly discussed.

Animals↗
PubMed2004

A novel method for producing x-ray test objects and phantoms.

A novel method for producing customized x-ray test objects and clinically realistic phantoms has been developed. Test objects can be created with a drawing software package and the digital images can be printed on a standard inkjet printer but using potassium iodide solution in place of the cartridge's ink. The reproducibility and the consistency, the limiting spatial resolution, the uniformity as well as the potassium iodide thickness per print have been evaluated. The relationship between the number of prints, grey levels and the radiation contrast was investigated and quantified. A copy of the Leeds TO10 contrast detail test object was printed and the x-ray images of the Leeds TO10 and of the printed Leeds TO10 were compared. In addition, the potential use of this method was demonstrated by reproducing a percutaneous transluminal coronary angioplasty clinical digital image. The reproducibility and consistency of this method was found to be better than 0.1%. The limiting spatial resolution of the printer using ink was found to be 3.55 1p mm(-1) but it deteriorated when the ink was replaced with potassium iodide and as the print density increases. The uniformity across the printed area was found to be satisfactory although an artefact due to the printer was present in the x-ray images. The comparison between the Leeds TO10 and the printed Leeds TO10 gave differences less than 10%. A good agreement between the clinical image and the printed clinical image was found. In conclusion, the method is a reliable, cost-effective, flexible and alternative way for producing x-ray test objects and clinically related phantoms.

Air↗
PubMed2004

Reliability of the Prognos electrodermal device for measurements of electrical skin resistance at acupuncture points.

OBJECTIVES: (1) To characterize and calibrate an electrodermal screening device, Prognos. (2) To replicate a previous test-retest reliability study of this device with measurements of electrical skin resistance (ESR) at 24 Jing-well acupuncture points (APs). (3) To determine measurement precision in three successively more exacting trial protocols on the same set of subjects. SETTINGS: Oregon College of Oriental Medicine and Portland State University, Portland, OR. INSTRUMENTS: The Prognos device was electrically characterized by a team of research engineers at the Biomedical Signal Processing Laboratory of Portland State University. They determined that Prognos measures the average direct-current (DC) resistance between a metallic wrist strap and an electrode probe tip. The probe tip is connected to a linear spring set to trigger with an optically generated signal at a deflection of 2.62 mm, which corresponds to an average applied force of 2.68 +/- 0.04 N (mean +/- standard deviation [SD], n = 6). They also determined that the device quantifies resistance by applying a 1.1 microA current for an average of 223 +/- 3 ms (n = 7). When calibrated against a series of known resistors, Prognos measures accurately in the range of 150 kOmega to 14.3 MOmega with an error of less than 0.4%. SUBJECTS: Thirty-one (31) healthy volunteers, 17 females and 14 males, 23-63 years of age. RESULTS OF RELIABILITY TEST-RETEST: The mean reliability of a single measurement was; 0.758 for a standard measurement protocol of four sequential sweeps of 24 Jing-well (Ting) APs; 0.851 for four sequential sweeps after ink-marking the APs; and 0.961 for four rapid repeat measurements at each inked AP. Mean absolute values of ESR decreased between the standard and marked protocols, but not between the marked and rapid repeat protocols. CONCLUSIONS: Prognos performs accurately, against known resistors over the reported range of ESR. The reliability in the standard protocol (r = 0.758) is comparable to the reliability of 0.721 demonstrated under similar conditions by other investigators. Marking APs, and performing measurements in a rapid sequence, increases reliability of ESR measurements. Increased reliability in the second and third protocols is associated with decreased mean ESR values which may be related to increased accuracy of Prognos probe placement and/or inking the APs.

Acupuncture Points↗
PubMed1999

Treatment of cervical dentin hypersensitivity by various methods using pulsed Nd:YAG laser.

OBJECTIVE: The purpose of this study was to evaluate the results of two irradiated regions, the cervical and apical, for cervical dentin hypersensitivity treatment using pulsed a Nd:YAG laser with or without black ink. SUMMARY BACKGROUND DATA: There has been no reports on the irradiated area(s) except the cervical region for dentin hypersensitivity treatment using pulsed Nd:YAG laser. METHODS: A total of 180 teeth diagnosed with cervical dentin hypersensitivity in 54 (39 females, 15 males, aged 21 to 73) healthy adult patients were included in this study, and teeth were randomly divided into four groups of 45 each. Sensitivity was rated using a blast from a fully depressed air syringe on a four-grade scale both before and up to 2 months after laser treatment. The effectiveness was evaluated on the change in the degree of hypersensitivity after laser treatment. The tooth surfaces in groups 1 and 2 were observed by the replica model method using scanning electron microscopy (SEM). RESULTS: The methods of irradiation at the cervical regions were better than those at the apical regions except for the period 2 months later. The laser effect was enhanced by black ink at both areas. The effective (excellent and good) rate was decreased depending on the time in every group. SEM observation at the tooth surfaces from group 2 showed that dentinal tubules were occluded or narrowed after laser irradiation. CONCLUSIONS: These results show that the method of irradiation by a pulsed Nd:YAG laser at cervical regions with black ink is the most effective for cervical dentin treatment of hypersensitivity and recurrence by this method is less than in other methods.

Adult↗
PubMedDate not supplied

Biocompatible inkjet printing technique for designed seeding of individual living cells.

Inkjet printers are capable of printing at high resolution by ejecting extremely small ink drops. Established printing technology will be able to seed living cells, at micrometer resolution, in arrangements similar to biological tissues. We describe the use of a biocompatible inkjet head and our investigation of the feasibility of microseeding with living cells. Living cells are easily damaged by heat; therefore, we used an electrostatically driven inkjet system that was able to eject ink without generating significant heat. Bovine vascular endothelial cells were prepared and suspended in culture medium, and the cell suspension was used as "ink" and ejected onto culture disks. Microscopic observation showed that the endothelial cells were situated in the ejected dots in the medium, and that the number of cells in each dot was dependent on the concentration of the cell suspension and ejection frequency chosen. After the ejected cells were incubated for a few hours, they adhered to the culture disks. Using our non-heat-generating, electrostatically driven inkjet system, living cells were safely ejected onto culture disks. This microseeding technique with living cells has the potential to advance the field of tissue engineering.

Animals↗
PubMed1984

Continuous intercostal nerve blockade. An anatomical study to elucidate its mode of action.

India ink was injected through extradural catheters placed in the posterior intercostal space in 12 cadavers undergoing autopsy and the subsequent spread of the India ink was assessed under direct vision. The ink spread subpleurally to reach a number of intercostal spaces and medially to reach the paravertebral space. It is concluded that analgesia extending over a number of dermatomes is achieved by subpleural tracking of local anaesthetic to reach intercostal nerves above and below the one injected.

Anesthetics, Local↗
PubMed1996

Interpleural local anaesthesia: anatomical basis for mechanism of action.

India ink was injected through an extradural catheter placed in the right interpleural space in cadavers at autopsy. The lung was removed and the spread of the ink noted and photographed. In six cadavers, block sections were cut at the anterior axillary line through three ribs, intercostal muscles and parietal pleura. The blocks were fixed in formalin and then decalcified, sectioned, stained and mounted on slides. In all cases the ink covered the chest wall, lung and diaphragm, and was seen to pool in the paravertebral area. Examination of the histological slides revealed black pigment on the pleural surface and in the subpleural space. The mechanism of transport across the parietal pleura is discussed.

Adult↗
PubMed2003

Posthemorrhagic ventricular dilation in the neonate: development and characterization of a rat model.

Intraventricular hemorrhage is a common complication of prematurity. Posthemorrhagic ventricular dilation (PHVD) has a high rate of disability and no safe and effective treatment. Its pathogenesis is poorly understood, largely because of the lack of a satisfactory animal model. We have developed a model of neonatal PHVD in the rat. Seven-day-old (P7) Wistar rat pups were given 80-microl injections of citrated rat blood or artificial cerebrospinal fluid (CSF) into alternate lateral ventricles on P7 and P8. Intracranial pressure was monitored and increased briefly by over 8-fold. Some rats received further 10-microl intraventricular injections of India ink on P21. Animals were weighed daily and simple neurologic tests performed. On P21 (or P22 if India ink had been injected), the rats were perfusion-fixed and blocks processed for paraffin histology. Sixty-five percent of pups injected with blood and 50% injected with artificial CSF developed dilated lateral ventricles, with patchy loss of ependyma, marked astrocytic gliosis, and rarefaction of periventricular white matter. India ink injection revealed slow transit of CSF from the dilated lateral ventricles but eventual passage into the subarachnoid space. Pups that had received intraventricular injections but did not develop ventricular dilation nonetheless had lighter brains than littermate controls (p < 0.001). Body weights were not significantly different from controls. Hydrocephalic animals had reduced motor performance as assessed by a grip traction test (p = 0.0002). This model is well suited to studying the pathogenesis of PHVD.

Animals↗
PubMed1990

Evaluation of radical prostatectomy capsular margins of resection. The significance of margins designated as negative, closely approaching, and positive.

Capsular margins of resection in radical prostatectomy specimens performed for carcinoma of the prostate are difficult to assess because of the scant soft tissue removed with the prostate. There is little objective information as to the validity of what are designated as positive or negative capsular margins of resection. From January 1, 1984 through June 30, 1989 there were 40 radical prostatectomies performed in which the prostate was initially removed leaving the neurovascular bundle within the patient in order to preserve potency. However, based on the surgeons' gross examination of the prostate at the time of radical prostatectomy, the neurovascular bundle was then subsequently removed during the same operation and submitted to pathology as a separate specimen. In these 40 cases the capsular margin in the region of the neurovascular bundle was assessed blindly without knowledge of tumor presence or absence in the subsequently resected neurovascular bundle, and then compared to whether the neurovascular bundle contained tumor. Of the 10 cases called positive based on review of the radical prostatectomy, only six neurovascular bundles (60%) contained tumor. Eight cases had equivocal margins with tumor extending just to the inked margin, and only one (12.5%) had tumor in the neurovascular bundle. All 20 cases with negative assigned margins had complete removal of tumor from this area with none of the neurovascular bundles containing tumor. This study demonstrated that negative capsular margins in radical prostatectomy specimens often contain only a scant amount of soft tissue. Of the 33 cases with true negative margins, the amount of soft tissue between the inked margin and tumor was only greater than 1 mm in two cases and less than or equal to 1 m in 20 cases (less than 0.5 mm in 13 cases with less than 0.25 mm in eight of these cases). Furthermore, 11 cases with tumor extending to the inked margin of resection showed no residual tumor in additional tissue removed from these regions.

Blood Vessels↗
PubMed1999

Pathologic features of initial biopsy specimens associated with residual intraductal carcinoma on reexcision in patients with ductal carcinoma in situ of the breast referred for breast-conserving therapy.

The histologic criteria for determining which patients require a reexcision after an initial excisional biopsy for ductal carcinoma in situ (DCIS) of the breast are poorly defined. The authors examined the initial biopsy specimens of 98 patients with inked margins and determined the amount of DCIS on reexcision to help clarify which histologic criteria are useful in judging the need for reexcision. Features in initial biopsy specimens that were associated with an increasing number of slides with DCIS on reexcision were an increasing number of slides with DCIS, an increasing number of DCIS ducts or terminal duct lobular units (TDLUs) with "cancerization" of lobules (COL) within 0.42 cm of the inked margin, and multifocal positive margins. In patients with negative (>0.2 cm) initial biopsy specimen margins, an increasing number of DCIS ducts or TDLUs with COL near the initial biopsy specimen margin were also associated significantly with an increasing number of slides with DCIS on reexcision. Six or more slides with DCIS or 11 or more DCIS ducts or TDLUs with COL within 0.42 cm of the inked margin in the initial biopsy specimens were associated with 6 or more slides with DCIS on reexcision. These results suggest that the amount of DCIS in initial biopsy specimens and the amount of DCIS near the margin are associated with the quantity of DCIS remaining in the breast after an initial excisional biopsy. Pathologists can use these factors when assisting clinicians in evaluating the need for a reexcision.

Adult↗