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August 2014

Molecular Pathology Selected Abstracts, 8/14

August 2014—The dystrophin gene is the largest known human gene, comprising 2.2 Mb of the genome and 79 coding exons: Through the use of multiple tissue-specific promoters and alternative splicing of RNA, several isoforms of the protein dystrophin are encoded by the dystrophin (DMD) gene. The primary 427-kDA dystrophin isoform (Dp427) is found in the cytoplasm of skeletal and cardiac muscle cells, where it is involved in physically linking the cytoskeleton to protein structures outside the cell and, therefore, strengthens and protects muscle fibers during contraction and relaxation.

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From the President’s Desk: From representation to RUC, reasons to join AMA, 8/14

August 2014—It was my good fortune to be introduced to practice by a group of pathologists with a tradition of robust professional engagement. In residency or shortly thereafter, all of us joined the CAP, our state pathology society, state medical society, and the AMA because we were brought to understand it was the right thing to do. Explicitly and by example, mentors and partners have taught me a lot.

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Latest lineup of chemistry analyzers for low-volume settings

August 2014—This year’s guide to chemistry analyzers for low-volume laboratories consists of information supplied by 17 companies on 33 analyzers, three of which are new to this guide. Vital Diagnostics, an ElitechGroup Company, launched the Eon 300 Clinical Chemistry system. The system is sold exclusively by McKesson Medical Surgical to small to midsize physician offices and satellite and hospital laboratories.

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Too few studies to steer test protocols for pediatrics

August 2014—Are children equivalent to miniature adults? Common sense and years of research on age-related differences in microbiota, immune system development, and infectious disease susceptibility point to a resounding no. But in clinical microbiology practice, if not in theory, pediatric patients are too often worked up as miniature adults, says Jennifer Dien Bard, PhD, D(ABMM), FCCM, director of the clinical microbiology laboratory and acting director of the clinical virology laboratory at Children’s Hospital Los Angeles, and an assistant professor of clinical pathology at the University of Southern California’s Keck School of Medicine.

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Evalumetrics—a performance measurement tool and more

August 2014—Change takes time. Ask anyone who’s ever joined a gym, coached an underperforming sports team, or felt themselves growing older—cell by graying, wrinkling cell—in the change-of-address line at the DMV. Or just ask Donald Karcher, MD. Since 2008, when the Joint Commission began mandating that health care organizations rigorously evaluate physician performance when granting or renewing practice privileges, Dr. Karcher has watched laboratories gradually move from noncompliance to curiosity to comprehension and finally to compliance.

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Cytopathology and More | The Pap test under fire

August 2014—The humble Pap test is perhaps one of the most lauded and disdained laboratory tests, lauded because it is the lab test with the best track record of preventing cancer and disdained because the test is labor-intensive, the results are operator dependent, and the regulations are burdensome. Recently the Pap test has come under fire, threatened to be replaced with HPV tests and maligned by patients and physicians for its sometimes unexpected high cost.

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Cytopathology and More | Pap proficiency testing—for whom, when, and why

August 2014—It has been almost 10 years since gynecologic cytology proficiency testing, or Pap PT, was implemented in the United States. The CAP is one of three organizations with a Pap proficiency testing program. Pap PT is unique in medicine. In no other situation are licensed physicians or certified technologists required to pass a federally mandated, annual proficiency test before they can practice a skill for which they were trained. Individuals who do not pass Pap PT after two tests cannot practice the interpretation of gynecologic cytopathology until they pass the test.

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Cytopathology and More | ATHENA design, data—and the FDA’s decision

August 2014—The Food and Drug Administration Microbiology Devices Panel of the Medical Devices Advisory Committee held a hearing March 12 on a proposal by Roche Molecular Systems for a new application of human papillomavirus first-line primary cervical cancer screening for women age 25 and older. The 13-member panel unanimously approved the test as safe and effective with benefits to women’s health. The FDA formally approved the additional testing indication on April 24.

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Study hints at new directions on LAMNs

August 2014—A slow leak in a tire may not be all that interesting— until one is cruising down the highway at 75 m.p.h. Suddenly, that same leak becomes much more compelling. Joseph Misdraji, MD, recalls a conversation he had at a meeting about pseudomyxoma peritonei that skirted a similar curve in the road. Approached by a pathologist who expressed a desire to collaborate with him, Dr. Misdraji suggested a study he was working on, looking at the significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms, or LAMN.

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Where smart labs go when the money’s gone

August 2014—Payment rates declining. Bad debt rising. Test orders falling. Diagnostic equipment manufacturers checking in on test-volume commitments. A wrenching transition from fee-for-service care to population-based medicine. These are a few of the trends that laboratories across the country are seeing and that keep lab directors up at night, heavy lidded, checking their email, illuminated by the glow of their smartphones.

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