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Jonathan I Epstein - One of the best experts on this subject based on the ideXlab platform.

  • benign nerve sheath tumors on urinary Bladder Biopsy
    The American Journal of Surgical Pathology, 2008
    Co-Authors: Wenle Wang, Elizabeth A Montgomery, Jonathan I Epstein
    Abstract:

    Benign nerve sheath tumors (schwannoma and neurofibroma) involving the urinary Bladders are rare with only case reports and limited series. We identified 6 neurofibromas and 2 schwannomas involving the urinary Bladder. Of the 8 cases, 7 were sent to one of the authors in consultation and the last came for treatment to The Johns Hopkins Hospital. Patients (3 males, 5 females) ranged in age from 3 to 69 years old (average 36 y old). Presenting symptoms included recurrent infection in 6 patients, hematuria in 3 patients, and irritative symptoms in 3 patients (some patients with 2 symptoms). Three patients had a pelvic mass on physical examination. Three patients (3/8) had a solitary lesion in the Bladder, 4 patients (4/8) had multifocal lesions, and 1 patient had no information available. Five patients underwent local resection. One patient, who was 3 years old, had multiple plexiform neurofibromas within the Bladder and did not have surgical treatment and another patient is also undergoing surveillance. One patient had no treatment information available. Seven patients had clinical follow-up information available. The length of follow-up varied from 2 to 124 months (average 47 mo). Three out of the seven patients with follow-up information had neurofibromas in other sites, including the skin, uterus, mesentery, and ureter. One patient was known to have other stigmata of neurofibromatosis. Both cases with schwannoma had only Bladder involvement. No family history of neurofibromatosis and no genetic studies were performed on any of the patients. Three neurofibromas were of the diffuse type, with 2 cases plexiform, and 1 case could not be subtyped. Neither recurrence nor malignant transformation was demonstrated on follow-up. The importance of accurately diagnosing plexiform neurofibromas of the Bladder is that a subset harbors neurofibromatosis. If the lesion is focal, conservative excision is the choice of treatment with a low risk of recurrence. Diffuse neurofibromas can be difficult to diagnose leading to delay of treatment and potentially the need for a more extensive excision. Once recognized as a neurofibroma, it is important to identify it as a diffuse neurofibroma, given its lack of relationship to neurofibromatosis.

  • Detection of residual tumor cells in Bladder Biopsy specimens: pitfalls in the interpretation of cytokeratin stains.
    The American journal of surgical pathology, 2007
    Co-Authors: Ecaterina F. Tamas, Jonathan I Epstein
    Abstract:

    Some patients who have had prior Bladder biopsies or transurethral resections undergo a repeat resection within several months for various reasons. The detection of a few residual tumor cells in Bladder specimens with prior Biopsy site changes can be challenging based on histology alone. Immunohistochemistry for cytokeratins may be used as an adjunct in this situation. We have noted several cases in which keratin stains were performed and positive cells were noted, raising the issue as to whether the cytokeratin positive cells were residual tumor cells or stromal cells. Immunohistochemistry for a panel of antibodies [AE1/AE3, CAM 5.2, high molecular weight cytokeratin, smooth muscle actin (SMA), desmin, and anaplastic lymphoma kinase (ALK)] was performed on 29 cases of Bladder biopsies with prior Biopsy site changes. Of 29 patients, 25 had a prior history of Bladder tumor: 17 had invasive high-grade urothelial carcinoma (T1, 5 cases; T2, 11 cases; T3,1 case); 7 had noninvasive high-grade papillary urothelial carcinoma; 1 had noninvasive low-grade papillary urothelial carcinoma). One of the patients with noninvasive high-grade papillary urothelial carcinoma and one of the patents with invasive high-grade urothelial carcinoma had associated carcinoma in-situ. Four patients had prior benign Bladder diagnoses: cystitis cystica et glandularis; polypoid cystitis; follicular cystitis; and neurogenic Bladder with benign prostate hyperplasia. Of the 29 cases, 6 (21%) had cells with staining for at least 2 of the cytokeratin markers. Cytokeratin (CK) AE1/ AE3 was positive for cells in 8/29 cases (28%). In 6 of these cases, cells displayed a spindle cell and 2 cases a more epithelioid morphology. CAM 5.2 was positive in cells in 5/29 cases (17%); 3 of the cases had spindle cell and 2 cases epithelioid morphology. High molecular weight cytokeratin was expressed in cells in 2/29 cases (7%) with 1 case having spindle cell and 1 epithelioid morphology. SMA was positive in cells with a spindle cell morphology and negative in the more epitheloid cytokeratin positive cells. Desmin was positive in 3/6 keratin positive spindle cells and negative in keratin positive epithelioid cells. ALK was negative in all the cases. Three cases with spindle cell morphology and positivity for at least 1 of the keratins and SMA stains were interpreted as aberrant keratin expression in myofibroblastic cells based on the staining and the morphology of the spindle cells. Another 3 cases with concurrent staining for at least 1 of the keratins, SMA and desmin were consistent with smooth muscle cells on the basis of their cellular morphology. Another 2 cases had cells, which expressed at least 2 CK markers but did not express SMA, desmin, or ALK and a more epithelioid morphology. These cells were interpreted as residual tumors cells. When interpreting CK stains for the detection of residual tumor cells, one should pay attention to the nature of the cells and not assume all CK staining cells are residual tumor cells.

  • Polyoma virus-associated cellular changes in the urine and Bladder Biopsy samples: a cytohistologic correlation
    The American journal of surgical pathology, 2006
    Co-Authors: Mehsati Herawi, Syed Z Ali, Anil V Parwani, Theresa Y. Chan, Jonathan I Epstein
    Abstract:

    Polyoma (BK) virus-type cellular changes are occasionally reported in urine specimens, yet rarely detected in histologic sections of Bladder biopsies. A total of 762 predominantly voided urine specimens with a cytologic diagnosis of polyoma virus-type change were retrieved from the cytopathology files of the Johns Hopkins Hospital over a 15-year period (1988-2003). Biopsies were available for 33 cases (29 patients) following or preceding the urinary cytology (mean interval, 210 days). The biopsies originated primarily from Bladder (n=31) with one Biopsy each from renal pelvis and urethra. Representative paraffin blocks were chosen from each case for immunoperoxidase staining with SV40 large T antigen. There were 22 males and 7 females with an age range of 34 to 79 years (mean, 64.7 years). The histologic diagnoses of the 33 tissue biopsies were: benign urothelium (n=9), urothelial carcinoma (n=21) and 1 case each of dysplasia, small cell carcinoma, and chronic lymphocytic leukemia involving lamina propria of the Bladder. Only 3 of 33 biopsies on hematoxylin-stained sections showed morphologic changes of polyoma virus, which lacked sufficient tissue to perform immunohistochemistry for SV40 large T antigen (LTag). Immunohistochemical staining for LTag was positive in 7 cases. Only 2 cases showed strong/diffuse and moderate/focal staining for LTag with both representing invasive high-grade urothelial carcinoma (where no inclusions were seen on hematoxylin and eosin-stained sections) and both demonstrating positive immunostaining for p53. One of these 2 cases was from an organ transplant recipient and the other from a patient with no known immunosuppression. Our data lead to the following conclusions: 1) cytology appears to be more sensitive than histology in detecting cells with polyoma virus; 2) cytohistologic discordance might be due to: a) polyoma (BK) virus infected cells are shed from the tissue and collected in the urine; b) polyoma virus changes may be focal and not sampled in directed tissue biopsies; c) polyoma virus changes may originate from sites in the genitourinary tract other than the Bladder; d) the lack of a "gold standard" to confirm the cytologic diagnoses of polyoma virus; and e) the discordance in time between the Biopsy and cytology specimens in the current retrospective study. 3) Because some cytologically benign cases of polyoma virus were associated with malignant biopsies, careful morphologic evaluation is required to avoid false-negative urinary cytology samples. This investigation further examined the immunohistochemical staining pattern for SV40 LTag and p53 in noninvasive low-grade papillary urothelial carcinoma using a tissue microarray constructed from Bladder biopsies of 79 randomly selected patients. Weak LTag staining was present in occasional neoplastic urothelial cells of 2 patients. The staining was present in only one of four samples from each tumor (0.63%; 2 of 316 tumor spots), which further illustrates the patchy and focal presence of virion containing cells. p53 staining in these two spots was also patchy and confined to rare nuclei.

  • Bladder Biopsy interpretation
    2004
    Co-Authors: Jonathan I Epstein, Mahul B Amin, Victor E Reuter
    Abstract:

    Gross Anatomy and Normal Histology Normal urothelium Muscularis mucosa Muscularis propria Inflammatory condition: Non-infectious Interstitial cystitis Follicular cystitis Eosinophilic cystitis Hemorrhagic cystitis Polypoid cystitis Post-transurethral resection granulomas Inflammatory Conditions: Infectious Malakoplakia Schistosomiasis BK virus infection Condyloma Flat Urothelial Lesion Flat hyperplasia Dysplasia Carcinoma in situ Reactive urothelial atypia Papillary Urothelial Lesions Papillary urothelial hyperplasia Papilloma Papillary urothelial neoplasm of low malignant potential Non-invasive low-grade papillary urothelial carcinoma Non-invasive high-grade papillary urothelial carcinoma Urothelial Lesions with Inverted Growth Pattern Proliferation of Von Brun's nests Inverted urothelial papilloma Urothelial carcinomas with inverted pattern Variants of Urothelial Carcinoma Nested Lymphoepithelioma-like Micropapillary Giant cell Clear cell Plasmacytoid Rhabdoid Undifferentiated Mixed (glandular, squamous) Primary Glandular Lesions Cystitis cystica et cystitis glandularis Villous adenoma In situ adenocarcinoma Invasive adenocarcinoma Squamous Lesions Squamous metaplasia Squamous papilloma Squamous cell carcinoma in situ Invasive squamous cell carcinoma Verrucous carcinoma Miscellaneous Benign Entities Amyloidosis Ectopic prostatic tissue Pneumatosis Endocervicosis Endometriosis Neuroendocrine Neoplasms Paraganglioma Small cell carcinoma Benign Mesenchymal Lesions Pseudosarcomatous fibromyxoid tumor Post-TUR spindle cell nodule Hemangioma Leiomyoma Neurofibroma Malignant and Potentially Malignant Mesenchymal Lesions Including Mixed Epithelial Mesenchymal Malignancies Carcinosarcoma (sarcomatoid carcinoma) Angiosarcoma Hemangiopericytoma Leiomyosarcoma Malignant fibrous histiocytoma Rhabdomyosarcoma Solitary fibrous tumor Secondary Tumors Involving the Bladder Lymphoma Metastases and direct extension from other tumors Treatment-Related Effects Radiation Chemotherapy

  • An objective morphologic parameter to aid in the diagnosis of flat urothelial carcinoma in situ
    Human Pathology, 2001
    Co-Authors: Rolando A. Milord, Kristen Lecksell, Jonathan I Epstein
    Abstract:

    Abstract The diagnosis of carcinoma in situ (CIS) lacks objective criteria and is subject to misdiagnosis. We identified 20 Bladder Biopsy cases each of CIS, urothelial dysplasia, and normal urothelium according to the 1998 World Health Organization/International Society of Urological Pathology consensus classification of urothelial neoplasms. Lymphocytes from 10 Bladder Biopsy specimens were chosen as reference cells. Using an image analysis system, we measured the following nuclear features: area, diameter, roundness, ellipticity, and optical density (maximum, minimum, mean, median, standard deviation, and quartiles). We measured a mean of 75 urothelial nuclei/case and a total of 500 lymphocytes. Roundness and ellipticity were not useful in distinguishing among the 3 groups. The best discriminators were mean nuclear area and mean nuclear area of the 25% largest nuclei (upper quartile) of urothelial cells compared with lymphocytes. The mean nuclear area relative to lymphocytes was 1.8 times (1.2 to 2.5 times) in normal urothelium, 2.4 times (1.6 to 3.0 times) in urothelial dysplasia, and 3.6 times (2.8 to 5.7 times) in CIS. The mean upper quartile nuclear area relative to lymphocytes was 2.2 times (1.4 to 2.8 times) in normal urothelium ( P P P P

John E Tomaszewski - One of the best experts on this subject based on the ideXlab platform.

  • urine markers do not predict Biopsy findings or presence of Bladder ulcers in interstitial cystitis painful Bladder syndrome
    The Journal of Urology, 2008
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski, Marcia A. Wheeler, Christina Stetter, Susan Keay
    Abstract:

    Purpose: We tested for associations between urine markers, Bladder Biopsy features and Bladder ulcers in interstitial cystitis/painful Bladder syndrome.Materials and Methods: Subjects were 72 patients with interstitial cystitis/painful Bladder syndrome undergoing Bladder distention and Biopsy. Urine was collected before the procedure. Urine marker levels were correlated with Biopsy and cystoscopic findings. Patients with no previous interstitial cystitis/painful Bladder syndrome treatments (47) were analyzed separately from previously treated patients (25).Results: For untreated patients urine interleukin-6 and cyclic guanosine monophosphate were associated with urothelial epidermal growth factor receptor staining (for interleukin-6 r = 0.29; 95% CI 0.07, 0.51; p = 0.01 and for cyclic guanosine monophosphate r = 0.34; 95% CI 0.13, 0.55; p = 0.002). Urine interleukin-8 was negatively associated with urothelial heparin-binding epidermal growth factor-like growth factor staining (r = −0.34; 95% CI −0.55, −0....

  • DO THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES CYSTOSCOPIC CRITERIA ASSOCIATE WITH OTHER CLINICAL AND OBJECTIVE FEATURES OF INTERSTITIAL CYSTITIS
    The Journal of urology, 2005
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski, Marcia A. Wheeler, Susan Keay
    Abstract:

    ABSTRACTPurpose: We compared urine markers, Bladder Biopsy findings and clinical features of patients with symptoms of interstitial cystitis (IC) who did or did not meet the cystoscopic criteria defined by the National Institute of Diabetes and Digestive and Kidney Diseases.Materials and Methods: Urine markers and symptom questionnaires were measured before and 1 month after Bladder distention for IC. Bladder biopsies were taken at the time of distention. At distention patients were defined as meeting or not meeting the National Institute of Diabetes and Digestive and Kidney Diseases established cystoscopic criteria for IC. The 2 patient groups were compared.Results: Urine marker levels were similar for the 2 groups, including antiproliferative factor, epidermal growth factor, heparin binding epidermal growth factor-like growth factor, cyclic guanosine monophosphate, interleukins 6 and 8, and methylhistamine. Bladder Biopsy features were similar for the 2 groups. Bladder capacity with the patients under a...

  • IS URINE METHYLHISTAMINE A USEFUL MARKER FOR INTERSTITIAL CYSTITIS
    The Journal of Urology, 2004
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski
    Abstract:

    ABSTRACTPurpose: We determined whether urine methylhistamine (MH) is associated with other clinical features and Bladder Biopsy findings in interstitial cystitis (IC).Materials and Methods: Urine MH and University of Wisconsin symptom scores were measured before and 1 month after Bladder distention for IC. Bladder biopsies were done at the time of distention. In new patients with IC who met cystoscopic criteria urine MH was compared before and after distention, and changes in urine MH were compared with changes in symptom scores. Pre-distention urine MH was tested for associations with the results of a symptom questionnaire, symptom response after distention, cystoscopic findings and Bladder Biopsy findings.Results: There were no significant associations between urine MH and symptom scores, response to Bladder distention, cystoscopic findings or Bladder Biopsy features, including mast cell count by tryptase staining. Urine MH was similar in new patients with IC who did vs did not meet cystoscopic criteria...

  • Is urine methylhistamine a useful marker for interstitial cystitis?
    The Journal of urology, 2004
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski
    Abstract:

    We determined whether urine methylhistamine (MH) is associated with other clinical features and Bladder Biopsy findings in interstitial cystitis (IC). Urine MH and University of Wisconsin symptom scores were measured before and 1 month after Bladder distention for IC. Bladder biopsies were done at the time of distention. In new patients with IC who met cystoscopic criteria urine MH was compared before and after distention, and changes in urine MH were compared with changes in symptom scores. Pre-distention urine MH was tested for associations with the results of a symptom questionnaire, symptom response after distention, cystoscopic findings and Bladder Biopsy findings. There were no significant associations between urine MH and symptom scores, response to Bladder distention, cystoscopic findings or Bladder Biopsy features, including mast cell count by tryptase staining. Urine MH was similar in new patients with IC who did vs did not meet cystoscopic criteria. Urine MH was similar in new vs chronically treated patients with IC. Urine MH is unlikely to be useful as an objective marker of the response to Bladder distention, as a method to predict which patients will respond to Bladder distention or as a noninvasive substitute for Bladder Biopsy and mast cell counts by tryptase staining.

Mohamed Oukabli - One of the best experts on this subject based on the ideXlab platform.

  • Urinary schistosomiasis: report of case diagnosed in Bladder Biopsy
    BMC clinical pathology, 2018
    Co-Authors: Hafsa Chahdi, Amal Damiri, Mohamed Reda El Ochi, Mohamed Allaoui, Abderrahmane Al Bouzidi, Mohamed Oukabli
    Abstract:

    Urinary schistosomiasis is a common parasitic disease in endemic countries. We report the case of a patient who was on a working trip to Mauritania. This parasitosis, suspected in the presence of hematuria and the notion of stay in an endemic zone, was confirmed by the presence of Schistosoma heamatobium eggs during the histological examination of the Bladder Biopsy performed after cystoscopy, highlighting a bilharzial granuloma and of course, the diagnosis was confirmed by the presence of eggs during the direct examination of the freshly collected urine. It should be pointed out that the diagnosis of schistosomiasis must be evoked with the association of hematuria and the particular inflammatory aspect of the vesical mucosa and, of course, the notion of stay in an endemic zone.

  • Urinary schistosomiasis: report of case diagnosed in Bladder Biopsy
    BMC Clinical Pathology, 2018
    Co-Authors: Hafsa Chahdi, Amal Damiri, Mohamed Allaoui, Mohamed Reda Ochi, Abderrahmane Bouzidi, Mohamed Oukabli
    Abstract:

    Background Urinary schistosomiasis is a common parasitic disease in endemic countries. Case presentation We report the case of a patient who was on a working trip to Mauritania. This parasitosis, suspected in the presence of hematuria and the notion of stay in an endemic zone, was confirmed by the presence of Schistosoma heamatobium eggs during the histological examination of the Bladder Biopsy performed after cystoscopy, highlighting a bilharzial granuloma and of course, the diagnosis was confirmed by the presence of eggs during the direct examination of the freshly collected urine. Conclusions It should be pointed out that the diagnosis of schistosomiasis must be evoked with the association of hematuria and the particular inflammatory aspect of the vesical mucosa and, of course, the notion of stay in an endemic zone.

Deborah R Erickson - One of the best experts on this subject based on the ideXlab platform.

  • urine markers do not predict Biopsy findings or presence of Bladder ulcers in interstitial cystitis painful Bladder syndrome
    The Journal of Urology, 2008
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski, Marcia A. Wheeler, Christina Stetter, Susan Keay
    Abstract:

    Purpose: We tested for associations between urine markers, Bladder Biopsy features and Bladder ulcers in interstitial cystitis/painful Bladder syndrome.Materials and Methods: Subjects were 72 patients with interstitial cystitis/painful Bladder syndrome undergoing Bladder distention and Biopsy. Urine was collected before the procedure. Urine marker levels were correlated with Biopsy and cystoscopic findings. Patients with no previous interstitial cystitis/painful Bladder syndrome treatments (47) were analyzed separately from previously treated patients (25).Results: For untreated patients urine interleukin-6 and cyclic guanosine monophosphate were associated with urothelial epidermal growth factor receptor staining (for interleukin-6 r = 0.29; 95% CI 0.07, 0.51; p = 0.01 and for cyclic guanosine monophosphate r = 0.34; 95% CI 0.13, 0.55; p = 0.002). Urine interleukin-8 was negatively associated with urothelial heparin-binding epidermal growth factor-like growth factor staining (r = −0.34; 95% CI −0.55, −0....

  • DO THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES CYSTOSCOPIC CRITERIA ASSOCIATE WITH OTHER CLINICAL AND OBJECTIVE FEATURES OF INTERSTITIAL CYSTITIS
    The Journal of urology, 2005
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski, Marcia A. Wheeler, Susan Keay
    Abstract:

    ABSTRACTPurpose: We compared urine markers, Bladder Biopsy findings and clinical features of patients with symptoms of interstitial cystitis (IC) who did or did not meet the cystoscopic criteria defined by the National Institute of Diabetes and Digestive and Kidney Diseases.Materials and Methods: Urine markers and symptom questionnaires were measured before and 1 month after Bladder distention for IC. Bladder biopsies were taken at the time of distention. At distention patients were defined as meeting or not meeting the National Institute of Diabetes and Digestive and Kidney Diseases established cystoscopic criteria for IC. The 2 patient groups were compared.Results: Urine marker levels were similar for the 2 groups, including antiproliferative factor, epidermal growth factor, heparin binding epidermal growth factor-like growth factor, cyclic guanosine monophosphate, interleukins 6 and 8, and methylhistamine. Bladder Biopsy features were similar for the 2 groups. Bladder capacity with the patients under a...

  • IS URINE METHYLHISTAMINE A USEFUL MARKER FOR INTERSTITIAL CYSTITIS
    The Journal of Urology, 2004
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski
    Abstract:

    ABSTRACTPurpose: We determined whether urine methylhistamine (MH) is associated with other clinical features and Bladder Biopsy findings in interstitial cystitis (IC).Materials and Methods: Urine MH and University of Wisconsin symptom scores were measured before and 1 month after Bladder distention for IC. Bladder biopsies were done at the time of distention. In new patients with IC who met cystoscopic criteria urine MH was compared before and after distention, and changes in urine MH were compared with changes in symptom scores. Pre-distention urine MH was tested for associations with the results of a symptom questionnaire, symptom response after distention, cystoscopic findings and Bladder Biopsy findings.Results: There were no significant associations between urine MH and symptom scores, response to Bladder distention, cystoscopic findings or Bladder Biopsy features, including mast cell count by tryptase staining. Urine MH was similar in new patients with IC who did vs did not meet cystoscopic criteria...

  • Is urine methylhistamine a useful marker for interstitial cystitis?
    The Journal of urology, 2004
    Co-Authors: Deborah R Erickson, Allen R Kunselman, Christina M Bentley, Kenneth M Peters, Eric S Rovner, Laurence M Demers, John E Tomaszewski
    Abstract:

    We determined whether urine methylhistamine (MH) is associated with other clinical features and Bladder Biopsy findings in interstitial cystitis (IC). Urine MH and University of Wisconsin symptom scores were measured before and 1 month after Bladder distention for IC. Bladder biopsies were done at the time of distention. In new patients with IC who met cystoscopic criteria urine MH was compared before and after distention, and changes in urine MH were compared with changes in symptom scores. Pre-distention urine MH was tested for associations with the results of a symptom questionnaire, symptom response after distention, cystoscopic findings and Bladder Biopsy findings. There were no significant associations between urine MH and symptom scores, response to Bladder distention, cystoscopic findings or Bladder Biopsy features, including mast cell count by tryptase staining. Urine MH was similar in new patients with IC who did vs did not meet cystoscopic criteria. Urine MH was similar in new vs chronically treated patients with IC. Urine MH is unlikely to be useful as an objective marker of the response to Bladder distention, as a method to predict which patients will respond to Bladder distention or as a noninvasive substitute for Bladder Biopsy and mast cell counts by tryptase staining.

Carole Eldin - One of the best experts on this subject based on the ideXlab platform.