The document provides information about routine histopathology techniques and staining. It discusses fixation of histology samples, ideal fixatives, changes after fixation, types of fixatives, and the mechanisms of fixation. It also covers tissue processing techniques including dehydration, clearing, infiltration, embedding, and sectioning of tissue blocks using a microtome. Key steps in processing like fixation, dehydration, clearing and infiltration are described in detail. Common fixatives, dehydrating agents, and clearing agents used are also listed.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This is a presentation covering all techniques in histopathology. Comprehensive coverage of all related aspects.. Useful for postgraduate Pathology students and practitioners.
This is a presentation covering all techniques in histopathology. Comprehensive coverage of all related aspects.. Useful for postgraduate Pathology students and practitioners.
A STEP IN CASTING OF CAST PARTIAL DENTURE, a precious duplication process and proper wax up of refractory cast results in accurate fitting of the framework of the prosthesis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. FIXATION OF HISTOLOGY SAMPLES
• APPROPRIATE FIXATION IS CENTRAL TO ALL HISTOLOGY TESTS
AIMS OF FIXATION-
1. TO PRESERVE THE TISSUE NEAREST TO ITS LIVING STATE
2. TO PREVENT ANY CHANGE IN SHAPE AND SIZE OF THE TISSUE AT THE TIME OF
PROCESSING
3. TO PREVENT ANY AUTOLYSIS
4. TO MAKE THE TISSUE FIRM TO HARD
5. TO PREVENT ANY BACTERIAL GROWTH IN THE TISSUE
6. TO MAKE IT POSSIBLE TO HAVE CLEAR STAIN
7. TO HAVE BETTER OPTICAL QUALITY OF THE CELLS
3. IDEAL FIXATIVE -
AN IDEAL FIXATIVE SHOULD HAVE THE FOLLOWING QUALITIES-
1. PREVENTION OF AUTOLYSIS OF THE CELLS OR TISSUE
2. PREVENTION OF DECOMPOSITION OF THE TISSUE BY BACTERIA
3. MAINTAINING THE VOLUME AND SHAPE OF THE CELL AS FAR AS
POSSIBLE
4. CONSISTENTLY HIGH-QUALITY STAINING PARTICULARLY ROUTINE STAIN
5. RAPID ACTION
6. CHEAP
7. NON-TOXIC
4. CHANGE IN TISSUE AFTER FIXATION –
• VOLUME CHANGES – SHRINKAGE OF THE VOLUME BY FORMALIN (33%).
• HARDENING OF TISSUE – MILD DEGREE HARDENING MAY OCCUR.
• INTERFERENCE OF STAINING – INHIBITS ROUTINE STAIN: OSMIUM TETROXIDE
INHIBITS HAEMATOXYLIN AND EOSIN STAINING.
• CHANGES OF OPTICAL DENSITY BY FIXATION – NUCLEI MAY LOOK LIKE
HYPERCHROMATIC.
6. ESSENTIAL PRECAUTIONS FOR FIXATION –
• THE TISSUE SHOULD BE FREE FROM EXCESSIVE BLOOD BEFORE PUTTING IT INTO
FIXATIVE.
• TISSUE SHOULD BE THINLY CUT IN 3–5 MM THICKNESS.
• THE AMOUNT OF FIXATIVE FLUID SHOULD BE 20 TIMES MORE THAN THE
VOLUME OF THE
TISSUE.
• THE TISSUE WITH FIXATIVE SHOULD BE IN A TIGHTLY SCREW-CAPPED BOTTLE.
7. MECHANISM OF FIXATION
• DEHYDRATION AND COAGULATION OF PROTEIN –
• ALCOHOLS REMOVE WATER FROM THE TISSUE, DESTABILIZE THE HYDROGEN
BONDS & DISRUPT THE TERTIARY STRUCTURE OF PROTEIN.
• THE SECONDARY STRUCTURE OF THE PROTEIN IS MAINTAINED.
• ETHANOL IS RELATIVELY STRONGER DEHYDRATING AGENT THAN METHANOL.
• THE ETHANOL AND METHANOL START WORK FROM 60–80% CONCENTRATION,
RESPECTIVELY.
• THE DEHYDRATING FIXATIVE HAS TWO DISADVANTAGES: –
- SHRINKAGE OF THE CELLS
- REMOVAL OF THE SOLUBLE SUBSTANCES FROM THE TISSUE
8. • CROSS-LINKING FIXATIVES:
FORMALDEHYDE-
• IN AQUEOUS SOLUTION IT COMBINES WITH WATER TO FORM METHYLENE
HYDRATE, A METHYLENE GLYCOL
• ON LONG-STANDING, THIS METHYLENE GLYCOL FURTHER REACT WITH WATER &
FORM A POLYMER KNOWN AS POLYOXYMETHYLENE GLYCOL.
• THIS AGAIN DEPOLYMERIZED IN METHYLENE GLYCOL IN A NEUTRAL BUFFER
SYSTEM.
• FORMALDEHYDE REACTS WITH VARIOUS SIDE CHAIN OF THE PROTEIN AND
FORMS HYDROXYMETHYL SIDE GROUP.
• THESE COMPOUNDS ARE HIGHLY REACTIVE AND SUBSEQUENTLY CROSS-LINKING
OCCURS BY FORMING A METHYLENE BRIDGE (PRIMARY REACTION)
9. CONT….
• SUBSEQUENT INTERMOLECULAR AND INTRAMOLECULAR CROSS-LINKING OF THE
MOLECULES OCCURS AS A SLOW-GROWING PROCESS.
• THIS ULTIMATELY PRODUCES AN INSOLUBLE PRODUCT.
• THE FORMALIN CAN BE REMOVED FROM TISSUE BY
PROLONGED WASHING.
• ONCE METHYLENE BRIDGE IS FORMED IN THE TISSUE,
THE REACTION IS STABLE, AND IT IS DIFFICULT TO
REMOVE FORMALIN FROM THE TISSUE.
• FORMALDEHYDE ALSO REACTS WITH THE NUCLEIC ACID
BY REACTING WITH THE AMINO GROUP OF NUCLEOTIDES
10. GLUTARALDEHYDE-
• THE ALDEHYDE GROUP OF GLUTARALDEHYDE REACTS WITH AMINO GROUP OF THE
PROTEIN PREDOMINANTLY LYSINE.
• GLUTARALDEHYDE RAPIDLY AND IRREVERSIBLY CROSS-LINKS THE PROTEIN.
• THE PENETRATION OF GLUTARALDEHYDE IS SLOWER THAN FORMALDEHYDE.
OSMIUM TETROXIDE
• IT CAUSES OXIDATION OF UNSATURATED BONDS IN LIPID.
• IT CONVERTS THE UNSATURATED FATTY ACID INTO A STABLE PRODUCT KNOWN AS
GLYCOL OSMATE.
• THE TETRAVALENT OS BECOMES HEXAVALENT IN THIS REACTION. OSMIC ACID
MONOESTER FORMED IN THIS REACTION IS EASILY HYDROLYSED TO A DIOL AND
OSMIC ACID.
• OSMIUM TETROXIDE MAY REACT WITH TWO UNSATURATED CARBON ATOM OF THE
LIPIDS AND MAY CROSS-LINK
19. PROCESSING OF TISSUE
• AIMS OF TISSUE PROCESSING: TO PROVIDE SUFFICIENT RIGIDITY TO THE TISSUE
SO THAT IT CAN BE CUT INTO THIN SECTION FOR MICROSCOPIC EXAMINATION.
• PRINCIPLE OF PROCESSING: WATER WITHIN THE TISSUE IS REMOVED, AND
ANOTHER MEDIUM (USUALLY PARAFFIN WAX) IS IMPREGNATED IN THE TISSUE
THAT PROVIDES THE ADEQUATE SUPPORT TO THE TISSUE.
• THE ESSENTIAL STEPS IN TISSUE PROCESSING:
20. INFLUENCING FACTORS OF TISSUE PROCESSING
• SIZE OF THE TISSUE: – THE SMALLER THE SIZE, THE BETTER THE PROCESSING.
• AGITATION: – AGITATION FACILITATES THE CONTACT OF TISSUE WITH FRESH
SOLUTION.
• HEAT: – INCREASES THE BETTER PENETRATION OF FLUID.
• VISCOSITY: – THE HIGHER THE VISCOSITY OF THE MEDIUM, LOWER THE
PENETRATION.
• NEGATIVE PRESSURE: – NEGATIVE PRESSURE REMOVES TRAPPED AIR IN THE
TISSUE.
– REMOVAL OF CLEARING AGENT BY INCREASING
VOLATILITY.
21. DEHYDRATION
• REMOVES FREE OR UNBOUND WATER MOLECULE OF THE TISSUE AS THE
SUPPORTING
MEDIUM (PARAFFIN) IS NOT MISCIBLE WITH WATER.
• SHARP DIFFERENCE OF CONCENTRATION GRADIENT OF THE DEHYDRATING
FLUID MAY
DAMAGE THE DELICATE TISSUE.
• GRADUAL DEHYDRATION IS NECESSARY.
• TOO MUCH TIME IN THE DEHYDRATING FLUID: THE TISSUE BECOMES HARD AND
BRITTLE.
• ROUTINE LABORATORY: 70, 90 AND 100% ALCOHOL FOR 2 H EACH.
• COMMON DEHYDRATING AGENTS: – ETHYL ALCOHOL, METHYLATED SPIRIT,
METHANOL,
BUTYL ALCOHOL, ISOPROPYL ALCOHOL
22. COMPARISON OF DIFFERENT DEHYDRATING AGENTS
Dehydrating
agents
Advantages Disadvantage
Ethyl alcohol • Rapid and efficient
dehydrating agent
• Needs licence from the government
• Inflammable
• Hard and brittle tissue if kept for
long time
Methanol Equally effective as ethanol • Volatile • High cost
Isopropyl
alcohol
• Relatively rapid action
• Non-toxic
• Minimal tissue shrinkage
Not possible to use in celloidin
technique
Dioxane • Rapid action
• No shrinkage of tissue
Highly toxic gas is generated
Ethylene glycol • Rapid
• No graded solution is needed
• Tissue can be kept in it for
long time
• Very expensive
• Clearing agent is needed
Acetone • Rapid action
• Cheaper than ethanol
• Good for fatty tissue
• Quickly evaporates
• Inflammable
• Prolonged use may cause shrinkage
25. INFILTRATION AND EMBEDDING
• AIMS: TO PROVIDE SUPPORT TO THE TISSUE.
• PRINCIPLE: CLEARING AGENT IS REMOVED BY THE PROCESS OF DIFFUSION, AND THE
TISSUE
SPACE IS NOW INFILTRATED WITH THE EMBEDDING MEDIA.
• IDEAL IMPREGNATING MEDIUM:
• MISCIBLE WITH CLEARING AGENT
• LIQUID IN HIGHER TEMPERATURE AND SOLID IN ROOM TEMPERATURE
• HOMOGENOUS AND STABLE • NON-TOXIC AND CHEAP
• TRANSPARENT
• FIT FOR SECTIONING
• THE TISSUE TIME DURATION AND THE NUMBER OF CHANGES OF EMBEDDING
MEDIUM:
• SIZE OF TISSUE: LARGE VERSUS SMALL.
• TYPE OF TISSUE: HARD VERSUS SOFT.
• THE TYPE OF CLEARING AGENT: CEDARWOOD OIL TAKES LONGER TIME.
• TYPE OF PROCESSING: VACUUM PROCESSING ACCELERATES.
26. • PARAFFIN WAX- HYDROCARBON, BY-PRODUCT OF CRUDE PETROLEUM.
• MOST POPULAR EMBEDDING MEDIUM FOR TISSUE PROCESSING.
• THE MELTING POINT VARIES FROM 39 °C TO 70 °C.
• IN INDIAN SUBCONTINENT, THE PARAFFIN WAX WITH MELTING POINT AROUND
60 °C IS THE MOST SUITABLE FOR LABORATORY USE.
• TOTAL 3–4 HR. TIME IN PARAFFIN WAX IS SUFFICIENT FOR IMPREGNATION OF
TISSUE BY WAX.
• ADVANTAGES OF PARAFFIN WAX:
• TISSUE BLOCK CAN BE STORED FOR LONG DURATION.
• NON-TOXIC • CHEAP
• SAFE
• DISADVANTAGES OF PARAFFIN WAX:
• MAY CAUSE TISSUE SHRINKAGE AND HARDENING IN CASE OF PROLONGED
IMPREGNATION.
• PARAFFIN WAX TAKES LONG DURATION FOR THE IMPREGNATION OF THE BONE
27. TISSUE PROCESSING METHODS
• MANUALLY OR BY AUTOMATED PROCESSOR.
• AUTOMATED TISSUE PROCESSOR: THE BASIC PRINCIPLE OF IS TO TRANSFER THE
TISSUE IN DIFFERENT FLUID FOR A SPECIFIED TIME IN A DESIRED ENVIRONMENT.
• TWO TYPES OF PROCESSOR:
1. TISSUE TRANSFER PROCESSOR 2. FLUID TRANSFER
PROCESSOR
28. Overall Precautions of Tissue Processing-
1. The bulk of the tissue should be
optimum for adequate penetration of
fluid.
2. The amount of fluid should be adequate,
fluid level should be always higher than
the tissue level.
3. The tissue basket and cassettes should
be clean and any spillage of wax should
be cleaned.
4. The temperature of the infiltrating
medium should be optimum, and it is
preferable to keep the temperature 3–
4 °C above the melting point.
5. There should be a proper record of the
change of fluid, number of tissues
30. EMBEDDING OF TISSUE
• THE TISSUE IS SURROUNDED IN A MOLTEN MEDIUM BY USING A MOULD.
• SUBSEQUENTLY THIS MEDIUM IS SOLIDIFIED TO MAKE A BLOCK FOR CUTTING THIN SECTION
OF TISSUE.
• AIMS OF EMBEDDING:
1. TO GIVE SUPPORT OF THE TISSUE
2. TO PREVENT DISTORTION OF THE TISSUE DURING CUTTING
3. TO PRESERVE THE TISSUE FOR ARCHIVAL USE
• THE CHOICE OF THE EMBEDDING MEDIUM:
• PARAFFIN WAX, EPOXY RESIN, METHACRYLATE, CARBOWAX, ETC. ARE USED.
• PARAFFIN WAX IS THE MOST COMMONLY USED EMBEDDING MEDIUM.
• THE CHOICE OF THE EMBEDDING MEDIUM DEPENDS ON :
1. TYPE OF TISSUE: THE DENSITY OF THE TISSUE AND THE EMBEDDING MEDIUM SHOULD BE
CLOSE OTHERWISE TISSUE MAY NOT BE SECTIONED PROPERLY, AND TISSUE WILL BE
DEFORMED.
2. TYPE OF MICROTOME
3. TYPE OF MICROSCOPE
31. DIFFERENT TYPES OF MOULD USED FOR BLOCK
• LEUCKHARD EMBEDDING MOULDS
• STAINLESS STILL MOULD
• PLASTIC MOULD
34. TISSUE MARKING
NEEDED FOR-
1. TO IDENTIFY THE RESECTION PLANE OR OUTER MARGIN OF THE TISSUE
2. TO HELP IN EMBEDDING THE TISSUE
3. ANY AREA OF INTEREST TO IDENTIFY SUCH AS THE AREA OF TRANSITIONAL
ZONE IN CONE BIOPSY OF CERVIX
THE TISSUE MARKERS SHOULD HAVE THE FOLLOWING CHARACTERISTICS
FEATURES:
• THE MARKER SUBSTANCE SHOULD NOT BE DISSOLVED IN FIXATIVE AND TISSUE
PROCESSING
AGENTS.
• THE MARKER SHOULD NOT PENETRATE THE DEEPER TISSUE.
• IT SHOULD BE RECOGNIZABLE IN THE STAINED SECTION BOTH
MICROSCOPICALLY AND
MACROSCOPICALLY.
38. TISSUE MICROTOMY
• MICROTOMES- INSTRUMENT BY WHICH WE CUT THE EMBEDDED TISSUE IN THE
PARAFFIN BLOCK AS THIN SECTION.
• THE DIFFERENT TYPES OF MICROTOMES-
• ROTARY MICROTOME
• ROCKING MICROTOME
• BASE SLEDGE MICROTOME
• SLIDING MICROTOME
• CRYOMICROTOME
• ULTRAMICROTOME
• LASER MICROTOME
39. • ROTARY MICROTOME- MOST COMMONLY USED
• THE CUTTING BLADE IS KEPT IN HORIZONTAL POSITION, AND THE BLOCK CONTAINING TISSUE
MOVES UP AND DOWN WITH THE HELP OF ROTATORY HANDLE ATTACHED WITH THE
MICROTOME.
• IN EACH 360° ROTATION OF THE WHEEL HANDLE, THE BLOCK MOVES DOWN FOLLOWED BY UP,
AND THE TISSUE IS CUT AS THIN RIBBON.
• THIS MICROTOME HAS THE OPTION TO BE SEMIAUTOMATED OR AUTOMATED
• ADVANTAGES:
1. GOOD-QUALITY 2–3-ΜM-THIN SECTION IS POSSIBLE.
2. HEAVY AND STABLE AUTOMATED ROTARY MICROTOME REDUCES HEALTH HAZARD AND
GIVES THE BEST-QUALITY SECTION.
3. GOOD TISSUE RIBBON PRODUCTION.
4. EASY-TO-CUT VARIOUS TYPES OF TISSUE: FIRM, FRAGILE, SMALL BIOPSY, ETC.
• DISADVANTAGES:
1. EXPENSIVE.
2. UNSUITABLE TO CUT LARGE BLOCK.
3. KNIFE FACES UP AND SO MAY BE DANGEROUS TO THE TECHNICAL STAFF.
41. • SECTIONING THE PARAFFIN BLOCK
• THE FOLLOWING INSTRUMENTS ARE ESSENTIAL –
1. MICROTOME WITH BLADE
2. WATER BATH
3. PARAFFIN BLOCK WITH EMBEDDED TISSUE TO CUT
4. ICE TRAY
5. A BLUNT FORCEPS OR CAMEL BRUSH
6. SLIDE RACK WITH SLIDES WATER BATH (FLOATATION CHAMBER)
7. ADHESIVE- USED FOR BRAIN SECTIONS, DECALCIFIED TISSUE, USING STRONG ALKALI AT THE
TIME OF STAINING
THE MOST COMMONLY USED ADHESIVES INCLUDE:
• MAYER’S EGG ALBUMIN AND GLYCEROL
• POLY-L-LYSINE
• 3-AMINOPROPYLTRIETHOXYSILANE (ACEP)
46. FROZEN SECTION
• INDICATIONS-
• RAPID DIAGNOSIS OF THE LESION FOR INTRAOPERATIVE MANAGEMENT
• TO KNOW THE EXTENT OF THE LESION
• TO DO ENZYME IMMUNOCYTOCHEMISTRY
• TO DO IMMUNOFLUORESCENCE STUDY
• TO STAIN LIPID AND CERTAIN CARBOHYDRATE IN THE TISSUE
• PRINCIPLE-
• RAPID FREEZING OF THE TISSUE SAMPLE CONVERTS THE WATER INTO ICE. THE
FIRM ICE WITHIN THE TISSUE ACTS AS EMBEDDING MEDIA TO CUT THE TISSUE.
• THE CRYOSTAT IS THE INSTRUMENT THAT HAS THE ARRANGEMENT TO FREEZE
THE TISSUE AND ALSO TO CUT THE FROZEN TISSUE FOR MICROSCOPIC SECTION.
50. • STAINING- HAEMATOXYLIN AND EOSIN (H&E) STAINING-
• RINSE THE SLIDE IN TAP WATER.
• PUT IN HAEMATOXYLIN FOR 1 MIN.
• RINSE IN TAP WATER FOR 5 S.
• RINSE IN SCOTT’S TAP WATER FOR 5 S FOR BLUING.
• DIP IN EOSIN FOR 20 S.
• RAPIDLY RINSE IN TAP WATER.
• 95% ETHANOL FOR 10 S.
• 100% ETHANOL FOR 10 S.
• 100% ETHANOL FOR 10 S.
• DIP IN XYLENE FOR 20 S.
• MOUNT BY DPX.
54. DYE-MORDANT COMPLE –
• HAEMATEIN IS A WEAK ANION AND CANNOT COMBINE WITH NUCLEIC ACID IN THE NUCLEUS.
• WHEN A METALLIC SALT (MORDANT) IS COMBINED WITH HAEMATEIN, THEN A CATIONIC
DYEMETAL COMPLEX IS FORMED THAT BEHAVES AS A STRONG BASIC DYE AND COMBINES
WITH NUCLEIC ACID.
• THE TYPE OF MORDANT DETERMINES THE TYPE OF TISSUE AFFINITY OF THE DYE AND THE
COLOUR OF THE STAIN.
• COMMONLY ALUMINIUM (AL3+), IRON (FE3+), MOLYBDENUM, TUNGSTEN AND LEAD SALTS
ARE USED AS MORDANT.
• TYPES OF HAEMATOXYLIN ON THE BASIS OF MORDANT:
1. IRON HAEMATOXYLIN 2. ALUM HAEMATOXYLIN
3. TUNGSTEN HAEMATOXYLIN 4. LEAD HAEMATOXYLIN
5. MOLYBDENUM HAEMATOXYLIN
6. ONLY HAEMATOXYLIN (NO MORDANT ATTACHED)
55. • BLUING
• THE MOST OF THE REGRESSIVE STAINING OF HAEMATOXYLIN NEEDS BLUING.
• THE REMOVAL OF EXCESS HYDROGEN ION FROM THE STAIN IS KNOWN AS
BLUING.
• HERE THE HAEMALUM WHICH IS SOLUBLE IS CONVERTED TO INSOLUBLE FORM.
• BLUING GIVES CRISP BLUE COLOUR OF THE NUCLEI.
• IN THE PROCESS OF BLUING, THE PH OF THE SOLUTION IS RAISED TO 8.5
(ALKALINE SIDE).
• THE TISSUE SECTION IS TREATED WITH ALKALINE REAGENT, AND THE ACIDIC
REAGENTS ARE NEUTRALIZED IN BLUING PROCESS.
• METHODS:
• RUNNING TAP WATER FOR SEVERAL MINUTES
• TREATING THE SECTION BY SCOTT’S TAP WATER (PH IS 8): 2–3 MIN
• AMMONIUM HYDROXIDE (5%): 2–3 MIN
• AMMONIA VAPOUR: FEW SECONDS
61. REFERENCES-
1. BASIC AND ADVANCED LABORATORY TECHNIQUES IN HISTOPATHOLOGY AND
CYTOLOGY
– PRANAV DEY
2. BANCROFT’S THEORY AND PRACTICE OF HISTOLOGICAL TECHNIQUES- 8TH
ED.-
S. KIM SUVARNA, CHRISTOPHER LAYTON, JOHN D. BANCROFT
Additives and Modification of Paraffin Wax To alter the physical characteristics of paraffin wax, the following modifications may be done: 1. To increase hardness: addition of stearic acid 2. Reduction of melting point: addition of phenanthrene 3. Improving adhesiveness with tissue and wax: addition of 0.5% of ceresin Dimethyl Sulphoxide (DMSO) The addition of small amount of DMSO in paraffin wax reduces the infiltration time of the wax and removes the residual clearing agent. It produces a homogenous matrix and better support.
Microwave Processing Microwave processing in histopathology reduces the time of processing significantly [2]. It is suitable for small number of delicate tissues. The microwave oven usually has: 1. System to control the temperature 2. System to control the time duration of particular temperature 3. Proper exhaust to remove the toxic gas The microwave processing may be used for all the steps of processing.
Paraffin wax: As described in the previous chapter, paraffin wax is a solid polycrystalline hydrocarbon. The paraffin wax is sold in the market with different melting point. Paraffin wax with melting points ranging from 56 to 62 °C is used in our laboratory. Paraffin wax is cheaper and easy to use. Little supervision is needed to make block by it. (b) Epoxy resin: Epoxy resin is mainly used in electron microscopy as it provides better resolution and greater details of tissue. (c) Acrylic medium: Methacrylate monomer is miscible with ethanol. In the presence of catalyst (benzoyl peroxide 2%), methacrylate monomer is polymerized and provides a hard and clear block. Methacrylate monomer is available in the market along with hydroquinone which should be removed by treating with weak alkali solution followed by thoroughly washing with water. The presence of water may lead to small bubbles within the block. (d) Agar gel: Agar gel helps in cohesion of friable and fragmented tissue particularly in cytology sample and also endometrial curetting and small endoscopic biopsies. It does not provide good support of the tissue for section cutting. Agar-paraffin wax double embedding is more suitable technique than agar alone
Gelatin: It is also used in small friable tissues and frozen section containing friable and necrotic tissue. The melting point of gelatin is 35–40 °C, and this low melting point makes it unsuitable for embedding. (f) Celloidin medium: Celloidin is nitrocellulose and was mainly used for embedding hard tissue. Nowadays it is not used in the laboratory.
India ink: This is the most commonly used marker in the routine surgical pathology laboratory. It takes 15 min time to mark the tissue. • silver nitrate: This is also a good marker. It produces brown-black colour. •
Usually 3% acetic acid or 50% white vinegar is used as fixer.
The strong acids: • Hydrochloric acid • Nitric acid Weak acids: • Formic acid • Trichloroacetic acid
Nitric acid may give yellow colour to the tissue that can be removed by urea
Nitric acid formaldehyde (10%) Nitric acid 10 ml Formalin 10 ml Distilled water 80 ml
Von Ebner’s fluid Saturated solution of sodium chloride: 175 g Hydrochloric acid (concentrated): 15 ml Distilled water: make it up to 1000 ml Advantages: 1. Rapid action 2. Ideal decalcifying agent for the tooth
Perenyi’s fluid Nitric acid (10%) 40 ml Chromic acid (0.5%) 30 ml Absolute alcohol 30 ml Advantages: 1. Provides excellent result 2. Softens the fibrous tissue 3. Cellular morphology well-preserved Disadvantages: 1. Slower in action. 2. End point detection is difficult
Weak acids Gooding and Stewart solution Formic acid 5 ml Formalin (40% formaldehyde) 5 ml Distilled water 90 ml
Water bath is used to float the tissue after cutting (Fig. 5.5). The temperature of the water bath is usually controlled automatically by a thermostat. The temperature of water in the water bath should be 10 °C below the melting point of the embedded paraffin wax and is usually kept in 40–50 °C. It is necessary to prevent formation of any air bubbles within the water bath. For adequate floating of the tissue, one can add a few drops of alcohol or little amount of detergent. This reduces the surface tension of the water and tissue floats smoothly.
White part of egg: 100 ml. – Glycerol: 100 ml. – Homogenize the mixture thoroughly, and filter it by gauze piece. Add few crystals of thymol to prevent bacterial growth.
This medium is used to hold the tissue over the chuck. Presently optimum cutting temperature (OCT) compound is used as embedding medium. The OCT is made of water-soluble glycols and resin
Toluidine Blue Stain This is a very simple stain and takes only a few seconds. The drops of toluidine blue stain are put on the section, and the coverslip is put on the section. The slide is now ready to see. The histopathologist feels more comfortable in H&E stain than this unfamiliar toluidine blue stBrain, liver, spleen −7 °C to −10 °C Rectum, uterus, adrenal, muscle, skin −12 °C to −15 °C Heart, lung, intestine, pancreas, ovary, cervix, prostate −16 °C to −20 °C Bone marrow, breast −20 °C to −25 °Brain, liver, spleen −7 °C to −10 °C Rectum, uterus, adrenal, muscle, skin −12 °C to −15 °C Heart, lung, intestine, pancreas, ovary, cervix, prostate −16 °C to −20 °C Bone marrow, breast −20 °C to −25 °ain.
Scott's tap water: Sodium bicarbonate: 2 g Magnesium sulphate (anhydrous): 10 g Water: 1 l Slowly add magnesium sulphate in water so that it dissolves and heat is dissipated. Warning The higher pH of the bluing agent makes the bluing more deeper blue colour quickly. However be careful the tissue section in high pH may be shed out from the slide.