bluuebunny/crossref_metadata_2025 huggingface dataset:
Controllable morphology of Pd nanostructures: from nanoparticles to nanofoams
Authors: Matte Lívia P , Khan Wahidullah , Thill Alisson S , Escudero Carlos , Poletto Fernanda , Bernardi Fabiano
Published: October 2024

Metallic nanofoams offer enhanced surface area and reduced density compared to their bulk counterparts while keeping intrinsic metallic properties. This combination makes nanofoams ideal for many applications, such as catalysis and battery. However, the synthesis of nanofoams is still challenging. This work introduces a non-complex synthesis method of Pd nanofoams employing a polar lipid structured as a sponge phase in water. The Pd nanostructures were characterized using Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), x-ray Diffraction (XRD), N2 adsorption–desorption isotherms, x-ray Photoelectron Spectroscopy (XPS), and x-ray Absorption Near Edge Structure (XANES) at Pd K edge techniques. The morphology of the nanostructure, from nanofoam to nanoparticle, is easily controlled by the presence of the polar lipid and the Pd salt used. The Pd nanostructures synthesized are fully oxidized, but the nanofoams reduce quickly (less than 5 min) to metallic Pd after H2 exposure at room temperature. The nanostructures were applied for hydrogen storage and Pd nanofoams achieved a remarkable gravimetric capacity of 0.76 wt% at room temperature and 1 atm H2 pressure. DFT calculation showed that the changes in the morphology of Pd lead to great changes in the adsorption energy of hydrogen, thus allowing the improvement of the material for hydrogen storage applications through the method developed.
Impact of drilling parameters on the surface roughness of egg shell filled glass fibre/polyester composites
Authors: Kowshik Suhas , Sharma Sathyashankara , Rao Sathish , Naik Nithesh , Bhat Ritesh , Hiremath Pavan , Manjunath Maitri
Published: October 2024

Glass fiber-reinforced polymers (GFRPs) are widely used in domestic applications such as doors, windows, and furniture, where drilling is a common machining process. The surface roughness of drilled hole walls is a critical factor, particularly in fastening applications, where smooth finishes are essential. This study explores the influence of drilling parameters on the surface roughness of GFRPs reinforced with different types of eggshell fillers viz.,un-carbonized, carbonized, and hybrid along with an unfilled variant. The research employs a Central Composite Design within the Response Surface Methodology (RSM) framework to investigate the effects of material type, spindle speed, feed rate, and point angle on surface roughness. Material type and point angle were treated as categorical variables, while spindle speed and feed rate were continuous, each with four levels, resulting in 16 experimental runs. The results showed that surface roughness values varied from 3.04 to 4.99μm, depending on the specific combination of drilling parameters. Statistical analysis using Analysis of Variance (ANOVA) confirmed that spindle speed and feed rate significantly impact surface roughness, with roughness increasing at higher speeds and feeds. Notably, the carbonized eggshell-filled GFRP variant achieved the lowest surface roughness. The study also developed a highly accurate regression model, validated through experimental data. The novel use of different variants of eggshell fillers in GFRPs provides a sustainable and effective way to enhance material properties. Further, conducting the drilling studies to observe the outcomes, offers potential industrial applications in the production of high-quality, durable composite materials.
Effect of filler morphology on mechanical behaviour of Mg/HA nanocomposites for degradable implant applications
Authors: V A Jasir , Vaisakh P , Pratheeshkumar V , Paul Parokkaran Jojo , Sajith Babu C , T Hanas , Rabeeh VP Muhammad
Published: October 2024

Magnesium (Mg) alloys exhibit promising potential for biodegradable orthopaedic applications, with the incorporation of hydroxyapatite (HA), which offers a means to tailor their bioactivity and biodegradation behavior. In this study, the effect of filler morphology on mechanical behaviour and biocorrosion of the Mg/HA composites is analysed. Two distinct morphologies of nano-hydroxyapatite (nHA), needle-like and flake-shaped, were incorporated into Mg using a stir-casting technique. The incorporation of nHA led to a notable increase in hardness, with enhancements of 15% for needle-like nHA and 29% for flake-like nHA. Moreover, the ultimate compressive strength exhibited a significant improvement of 29% for the flake-shaped nHA and 12% for the needle-like nHA. Interestingly, the morphological variation did not impact the degradation behaviour of the composites. Based on these findings, it is proposed that Mg metal matrix composites utilizing bioactive flake-shaped nHA as a filler material hold promise for enhancing the mechanical properties of Mg/HA nanocomposites, particularly for load-bearing implant applications.
Evaluation of bond strength in bamboo reinforced-high grade concrete at elevated temperature
Authors: Kant Lakshmi , Kumar Shashi , Singh Amit Kumar , Kumar Sanjeet
Published: October 2024

Concrete traditionally relies on steel reinforcement to address its weak tensile strength. However, due to concerns such as high production costs, non-renewability, and sustainability issues associated with steel, developing countries like India and African nations are turning to locally available bamboo as a reinforcement material in low-cost buildings. This study explores the feasibility of bamboo reinforcement in fly ash concrete (FAC) by examining the post-fire behavior of the bond strength between bamboo and FAC through pull-out tests. Initial tensile strength assessments of locally available bamboo strips are carried out. Various mechanical and chemical treatments, including grooving, wire wrapping, clamping, and epoxy-based sand coating, are applied to investigate their impact on post-fire bond strength. Despite certain treatments exhibiting higher initial bond strengths, their susceptibility to the fire test emphasizes the need for ongoing research and refinement. Notably, the treatment involving plain bamboo with epoxy-based sand coating and wire wrapping emerges as a promising option, demonstrating resilience with only a 21% drop in bond strength after exposure to fire.
Universal Spiral
Authors: Chepurin Kirill
Published: October 2024

This chapter reconstructs Schelling’s post-Copernican theo-cosmic epic, or the narrative of universal (divine, natural, and human) history he develops after 1809. Permeated by the antagonism between bliss and the world and the Gnostic contradiction between the hidden divinity and the creator God, this narrative follows the geometric and theodical movement of cosmic revolution, whose figure is that of an ascending spiral generated iteratively by the two-part movement of Fall and redemption or inversion and re-inversion. This movement unfolds in the tension between cosmic war and the peace of the Sabbath, and is governed by the (divine and natural) law of place-assigning justice. The chapter argues that both Schelling’s political conservatism and his affinity with early socialism can be grasped as part of the cosmic revolution thus conceived. Schelling reconfigures history as a rising edifice (Stufenfolge) of human recentering, imposing the logics of telos, hierarchy, and transcendence on the decentered modern universe.
The Race to Bliss
Authors: Chepurin Kirill
Published: October 2024

In dialogue with black studies, this chapter interrogates Schelling’s Romantic vision of the oneness of humanity by revealing his concept of humanness and his vision of conversion to the consciousness of the true God to be racialized and supersessionist in character. The chapter revisits the logics of the universe and the Christian-modern world in Schelling’s lectures on “purely rational” philosophy, in which he justifies the white European subject as the normative demiurgic subject of history and advances his framework of race. The chapter argues that Schelling’s racialization of geo-cosmic darkness as blackness and his legitimation of European colonialism and transatlantic slavery refract the geo-extractive racial logics of the post-1492 global world. Schelling’s world-grammar or his metaphysics of the hierarchized ascent (Stufenfolge) to bliss constitutes, the chapter contends, at once a grammar of racialization, a universal mining operation, a supersessionist conversion narrative, and a racialized theodicy of the global.
Systemic Sweet Syndrome Recurrence in Lung Allograft: Autopsy Findings from First Reported Case
Authors: Lilley C M , Goldstein J D
Published: October 2024

Introduction/Objective

Sweet syndrome is a non-vasculitic neutrophilic dermatosis characterized by acute, neutrophilic inflammation, most classically in the skin. Sweet syndrome can, however, manifest with systemic organ involvement including the lungs. Pulmonary involvement by Sweet syndrome is exceedingly rare, and its recurrence in a pulmonary allograft is understudied.

Methods/Case Report

A 43-year-old female with a history of Sweet syndrome with pulmonary involvement developed chronic bronchiolitis obliterans requiring bilateral lung transplantation. Seven years after transplantation, the patient began exhibiting shortness of breath requiring hospitalization. During the patient’s hospital stay, cytomegalovirus viremia and SARS-CoV-2 positivity were detected, and new oral lesions were concerning for a Sweet syndrome flare. Her respiratory status continued to decline requiring escalating ventilatory support. An autopsy limited to the chest and abdomen was performed after she expired. The pleural cavities had extensive adhesions, and both lungs were heavy. Microscopically, the lungs showed extensive, intralumenal acute inflammation of the bronchi and bronchioles with marked chronic inflammation of the submucosa, histologically similar to the patient’s explanted lung specimen. There was also focal endogenous lipoid pneumonia due to bronchiolar obstruction. In addition to the inflammatory findings, multiple infectious agents were identified in the patient’s respiratory tract including SARS-CoV-2, cytomegalovirus, Epstein-Barr virus, Candida glabrata, Klebsiella pneumoniae, and Stenotrophomonas maltophilia. No underlying malignancy was identified. (This patient’s earlier course was reported previously: PMC8411443)

Results (if a Case Study enter NA)

NA

Conclusion

Pulmonary involvement in Sweet syndrome can cause significant morbidity, and prior to this case, allograft recurrence of Sweet syndrome had not previously been reported. For transplant patients with a history of pulmonary Sweet syndrome, recurrence should be considered in cases of allograft dysfunction. This case also highlights the importance of thorough microbiological studies in autopsies of patients with systemic inflammatory diseases being treated with extensive immunosuppressive therapies.
DICER1 Syndrome in a 25-Year-Old Female: Autopsy Case Report of Mixed Sex Cord-Stromal and Primitive Sarcoma Tumors with Diverse Differentiation Patterns
Authors: Al Hosri R , Prete A R , Smith S C
Published: October 2024

Introduction/Objective

DICER-1 syndrome is a rare disorder characterized by germline mutations in the DICER1 gene, known to confer a lifetime risk of developing a variety of benign and malignant pathologies. This syndrome typically affects young individuals, though it exhibits exceedingly variable and relatively low penetrance of the neoplastic manifestations.

Methods/Case Report

We report on a 25-year-old woman with a history of metastatic DICER-1 related mixed pattern sex-cord stromal tumor of the ovary and primitive sarcoma of the liver. Her treatment involved extensive surgeries, including oophorectomy, salpingectomy, and partial hepatectomy, and multiple cycles of chemotherapy. Antemortem surgical pathological analyses revealed a poorly differentiated, primitive sarcoma in the liver and a sex cord-stromal tumor with Sertoli-Leydig and juvenile granulosa cell tumor-like features. The liver tumor exhibited a primitive spindle cell sarcoma with anaplastic features as well as chondrosarcomatous and rhabdomyosarcomatous patterns, suggesting a primary DICER1-related sarcoma. Immunohistochemistry confirmed the tumor’s complex multilineage differentiation, showing variable positivity for CD99, vimentin, CD10, BCL2, and Glypican-3. Positivity for Desmin and MyoD1 was focal, while the tumor was negative for inhibin, calretinin, AE1/3, AFP, and beta-catenin, overall supporting a DICER1-associated sarcoma diagnosis. She eventually died from terminal cardiac arrest secondary to complications from her metastatic cancer. An autopsy revealed a significant abdominopelvic mass leading to hemoperitoneum and extensive organ involvement, highlighting the aggressive nature of DICER1-associated malignancies.

Results (if a Case Study enter NA)

NA

Conclusion

This case underscores the importance of recognizing the broad manifestations of DICER-1 syndrome for accurate diagnosis, genetic counseling, and tailored management. Highlighting tumor morphology and immunohistochemical features enriches our understanding of DICER-1 pathology, advancing diagnosis and treatment prospects for affected individuals.
Deaths from asthma: a series of cases and their presentations, and the impact on local and global health
Authors: Padasak C L , Boring S , Engleson A , Hammers J
Published: October 2024

Introduction/Objective

Asthma is a lung disease usually characterized by chronic inflammation that affects at least 300 million people globally at all life stages. Asthma is defined by respiratory symptoms such as coughing, wheezing, shortness of breath, and chest tightness with expiratory airflow limitation.The prevalence of asthma is increasing worldwide. Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.

Severe disease can result in reduced quality of life or even premature death. Epidemiologic studies are being utilized to compare international incidences of asthma between populations so that etiologic mechanisms involved in the development of asthma can be discovered through research. Asthma prevalence studies require large numbers and high response rates amongst a random population to establish prevalence and severity with reasonable precision.

Despite advances in treatments, guidelines, and preventable factors, deaths from asthma account for 250,000 premature deaths each year.

Pathology has a key role in asthma identification through examination endobronchial biopsies and whole lung postmortem examination

Methods/Case Report

We present a series of asthma deaths with variable clinical presentations and histopathologic findings. The postmortem gross and histologic findings highlight the varying severities that asthma can have on the lungs. Knowledge of the clinical symptom presentations, identification of gross findings, appropriate sampling of lung tissue, identification of microscopic acute and chronic features help identify asthma related changes. Understanding common lifestyle, environmental, genetic, and medical care factors that serve as asthma triggers and their role in the onset or continuation of an acute exacerbation will allow for accurate determination of cause, contributing cause, and manner of death. This information, listed on the death certificate, is what helps correlate asthma prevalence with mortality allowing for appropriate allocation of funds for research, prevention and treatment.

Results (if a Case Study enter NA)

EP abstract

Conclusion

Outlined are the impacts that asthma can have on individuals, communities, and health systems globally but also ways to identify when death may be or is likely the result of asthma. While asthma cannot be cured, measuring the prevalence of disease and accurately determining asthma as the cause or contributing cause of death can help raise awareness and mitigate the consequences of severe disease.
Retroperitoneal Myoepithelial Carcinoma with Heterologous Bone Formation and EWSR1::ZNF444
Authors: Choi J , Sahoo S , Hwang H
Published: October 2024

Introduction/Objective

Soft tissue myoepithelial tumors are rare tumors that affect a wide age range and diverse tissue sites. Fewer than five cases have been reported in the retroperitoneum. Most tumors are benign with the only histologic criterion for malignancy being cytologic atypia. The morphology is broad ranging from spindled to epithelioid cells of varying cellularity in sclerotic to myxoid stroma. Heterologous differentiation may be present. These tumors usually express cytokeratin, EMA, S100, and GFAP and show EWSR1 and FUS rearrangements. Here we present an unusual case of retroperitoneal myoepithelial carcinoma.

Methods/Case Report

A 29-year-old female presented with rash and painless jaundice. CT and MRCP revealed a relatively circumscribed 3.7 cm mass in the porta hepatis. On fine needle aspiration, a possible gastrointestinal stromal tumor was considered due to DOG1 expression. The patient underwent a Whipple procedure with negative margins showing tumor in soft tissue adjacent to the common bile duct. The tumor was multinodular and consisted predominantly of mild to moderately pleomorphic epithelioid cells in fibromyxoid stroma with interspersed woven bone. Mitoses were not appreciated, and necrosis not seen. The tumor was focally positive for CK AE1/AE3, GFAP, and DOG1 and negative for S100, SOX10, p63, and CD117. INI1 was retained. NGS identified EWSR1::ZNF44 and a diagnosis of myoepithelial carcinoma was rendered. The patient received no adjuvant therapy and has not shown any evidence of metastasis or recurrence for 17 months.

Results (if a Case Study enter NA)

NA

Conclusion

Soft tissue myoepithelial carcinomas are aggressive tumors with approximately 40% recurrence and over 50% metastasis. Standard treatment is complete surgical resection. The efficacy of radiation and chemotherapy is not clear. EWSR1 fusions with various partners including POU5F1, PBX1/3, and ZNF44 have been identified. Due to their rarity and varying histology and immunohistochemical expression, identification of gene fusions can be invaluable in diagnosing soft tissue myoepithelial tumors, especially in unusual locations.
An Anaplastic Lymphoma Kinase (ALK) Immunohistochemical Pitfall: ALK-positive Histiocytosis versus Angiomatoid Fibrous Histiocytoma
Authors: Chang J , Diaz-Perez J , Smith S C
Published: October 2024

Introduction/Objective

The 5th Edition WHO classification expanded the histiocytic/dendritic cell neoplasms to include ALK-positive histiocytosis, which can present as multisystem or single-site disease, affecting various age groups. These tumors lack high-grade cytologic features but express ALK by immunohistochemistry, typically indicating ALK locus rearrangements. In this case study, a cutaneous mass initially suspected as ALK-positive histiocytosis was found to be angiomatoid fibrous histiocytoma (AFH) with ALK expression, highlighting the potential diagnostic pitfall due to overlapping histomorphology and ALK expression.

Methods/Case Report

A previously healthy twelve-year-old boy sought evaluation for a growing and ulcerating mass on his left arm, which developed gradually over a year post-injury. Laboratory tests showed elevated inflammatory markers and mild anemia. A biopsy of the ulcer revealed Staphylococcus aureus infection. Initial histological examination revealed mixed inflammatory infiltrates with focal necrosis, prominent histiocytes, and giant cells. Despite favoring an infectious cause, immunostains were performed. AE1/AE3, ERG, CD34, CD30, S100, SOX10, SMA, and MyoD1 were negative, while INI1 was retained. However, ALK was strongly positive in some histiocytoid cells, suggesting ALK-positive histiocytosis. Surgical resection was subsequently performed to manage the abscess and characterize the lesion. Histologic examination revealed a solid nodule containing spindled and epithelioid cells with a bland histiocytoid appearance, arranged in a compact syncytial growth pattern within the dermis and subcutis.

Surrounding the tumor, there was a distinct cuffing of fibrosis with organized lymphoplasmacytic cells. Break apart fluorescence in situ hybridization studies showed rearrangement of EWSR1 but not ALK. The diagnosis of angiomatoid fibrous histiocytoma was rendered.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the importance of understanding immunohistochemical features, especially those that are unusual and unexpected in rare diseases. With the growing use of minimally invasive sampling techniques, this case study underscores the significance of integrating molecular diagnostics with clinical, histological, and immunophenotypic evaluations to achieve an accurate diagnosis in surgical pathology.
Unexpected Encounters: Ossifying Fibromyxoid Tumor Unveiled During Evaluation for Inguinal Hernia
Authors: Pham T , Vo T , Rao R
Published: October 2024

Introduction/Objective

Soft tissue pathology often presents diagnostic surprises, elucidating the intricate nature of disease processes. In this introduction, we discuss the unexpected discoveries that can arise during clinical evaluations and emphasize the importance of thorough evaluation in soft tissue pathology.

Methods/Case Report

We present the case of a 40-year-old male who underwent evaluation for a right inguinal hernia, during which an ossifying fibromyxoid tumor (OFMT) was incidentally discovered. Imaging modalities intended for hernia assessment revealed a 4.5 cm mass abutting the hernia site. Surgical exploration, initiated for hernia repair, unveiled the unsuspected coexistence of a direct inguinal hernia and an OFMT. Histopathological analysis of the excised mass revealed a complex OFMT architecture, characterized by a plexiform growth pattern, fibrous to fibromyxoid matrix, and distinct cellular features. The neoplastic cells exhibited bland round to ovoid nuclei, occasional multinucleation, and scattered mitotic figures. Immunohistochemistry demonstrated variable positivity for desmin and focal positivity for S-100 protein, while CD34, keratin AE1/AE3, smooth muscle actin, and p63 were consistently negative. Notably, the tumor exhibited areas of hypercellularity and easily identifiable mitotic figures, consistent with morphologic features of malignancy in OFMT.

Results (if a Case Study enter NA)

N/A

Conclusion

This case highlights the intricate interplay between primary clinical concerns and incidental pathological findings, underscoring the necessity for comprehensive evaluation in soft tissue pathology. Understanding the nuanced histological and immunohistochemical characteristics of OFMT is pivotal for accurate diagnosis and optimal patient management. The unexpected discovery of OFMT during evaluation for inguinal hernia emphasizes the importance of thorough assessment and consideration of incidental findings in clinical practice.
The diagnostic challenge of a Papillary lesion of the breast in a patient with Peutz-Jeghers syndrome
Authors: Khan B , Kaur N , Hassan M
Published: October 2024

Introduction/Objective

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder with elevated risk of various neoplasms, including breast cancer. The incidence of cancer among PJS patients is estimated to be 15-fold higher than the general population. The spectrum of breast lesions in PJS varies from benign papillomas to invasive carcinomas, presenting significant diagnostic complexities. The case presented here revolves around a unique papillary lesion in a PJS patient.

Methods/Case Report

A 40-year-old African American female, with PJS presented with a palpable abnormality in the right subareolar region with sanguineous nipple discharge. Multiple prior biopsies revealed intraductal papillomas with no atypia. Imaging showed a 7.0 cm complex solid and cystic subareolar mass, which had increased in size by 42% within a short period. Given the rapid increase in size, malignant transformation was clinically suspected. The patient underwent bilateral mastectomy. Macroscopic examination showed a 9.0 cm tan firm subareolar nodule with solid and cystic components. Histopathology revealed areas consistent with intraductal papilloma, however, additional complexities, including epithelial and myoepithelial proliferations with mild cytologic atypia, squamous, apocrine, and sebaceous metaplasia made the diagnosis challenging. No necrosis or increased mitotic activity was identified.

Immunostaining for CK5/6 and p63 highlighted the myoepithelial layer, while estrogen receptor demonstrated heterogeneous positive staining. This picture raised suspicion of adenomyoepithelioma, but there was a significant overlap with intraductal papilloma. A final diagnosis of intraductal papillary neoplasm with epithelial and focal myoepithelial atypia was rendered.

Results (if a Case Study enter NA)

NA

Conclusion

This case presented a complex diagnostic dilemma. The rapid growth of the lesion, coupled with cytological atypia, raised significant concern necessitating precise differentiation between adenomyoepithelioma and intraductal papilloma. Further research is imperative to explore the pathophysiology of breast lesions in PJS, their impact on surveillance, management, potential for malignancy, and prognosis. Investigating additional diagnostic modalities and molecular markers to aid in accurate differentiation between benign and malignant papillary neoplasms in PJS patients warrants consideration.
Risks of Tacrolimus and Paxlovid Therapy in SARS-CoV-2 Positive Transplant Recipients: A Case Discussion and Institutional Data Review
Authors: Olp M D , Higginson E , Gherasim C
Published: October 2024

Introduction/Objective

Transplant recipients maintained on immunosuppressants like tacrolimus continue to be at high risk for morbidity due to SARS-CoV-2 infection and are strong candidates for antiviral therapies. However, co- administration of the antiviral Paxlovid (nirmatrelvir/ritonavir) poses a significant risk to these patients due to ritonavir- mediated inhibition of CYP3A, an important mediator of tacrolimus metabolism. Consequently, Paxlovid therapy in post-organ transplant patients on tacrolimus requires careful consideration. Our investigation aims to assess the continuing risk posed by this drug-drug interaction and better understand clinical circumstances linked to critically high tacrolimus levels due to Paxlovid co-administration.

Methods/Case Report

We conducted a large-scale retrospective analysis of tacrolimus measurements at the University of Michigan Medicine beginning in January 2020. We also performed a detailed review of patients with critically high tacrolimus levels coinciding with Paxlovid administration.

Results (if a Case Study enter NA)

Of 39,752 tacrolimus measurements examined, 682 correspond to 329 patients with recent positive SARS-CoV-2 nucleic acid testing, and 37 correspond to 18 patients with documented Paxlovid co- administration. Patients receiving concurrent Paxlovid and tacrolimus demonstrate 1.6- and 1.8-fold higher mean tacrolimus levels (14.1 ng/mL, p = 3e-5) compared to other SARS-CoV-2 positive (8.7 ng/mL) and negative/untested (7.9 ng/mL) patients, respectively. Among SARS-CoV-2 patients, those prescribed Paxlovid are more likely to present with supratherapeutic tacrolimus levels (OR 4.1, 95% CI 1.6 – 10.7). A detailed case review of three organ transplant recipients presenting with tacrolimus levels >60 ng/mL and creatinine levels increased by 0.45 ± 0.27 mg/dL from baseline shows Paxlovid was prescribed at outside facilities, and regular tacrolimus dose was continued. Three other patients exhibited supratherapeutic tacrolimus levels (20 – 30 ng/mL), and creatinine levels increased by 0.41 ± 0.23 mg/dL from baseline despite dose reduction or cessation before initiating Paxlovid.

Conclusion

Our findings highlight the importance of communication between primary and tertiary care providers and caution when prescribing Paxlovid in populations managed with tacrolimus therapy.
Evaluation of an Alternate Diluent for Tests to Ensure Timely Patient Management
Authors: Hettwer S , Gallegos A , Kumar V
Published: October 2024

Introduction/Objective

Recently, backorder of Multi-diluent (MD) for various assays on ADVIA Centaur analyzer (Siemens Healthineers) led to delay in reporting numeric values to the clients when results above the analytical measurement range (AMR) had to be reported as “> value”. The samples were stored frozen (-20 degrees Celsius or - 80 degrees Celsius) for over 2 weeks until the diluent became available, then thawed and re-analyzed upon appropriate dilution. Delay in reporting results beyond AMR may impact patient management; therefore, this study evaluated saline as an alternative diluent for serum folate, carbohydrate antigen 19-9 (CA 19-9), and carbohydrate antigen 27-29 (CA 27.29).

Methods/Case Report

For each test, samples from 5 patients were tested in duplicate, and average of the results was considered the target value (results within undiluted AMR). Subsequently, the samples were diluted 20-fold with either MD or saline, tested in duplicate and average of the results was compared to the target value. The diluent was considered acceptable for use if the difference or % difference between diluted vs target value was less than the Total Allowable Error (TEA).

Results (if a Case Study enter NA)

For serum folate and CA 19-9, the bias between diluted and target value for each diluent (saline and Multi-diluent) was < TEA, and the average bias was also < TEA. For CA 19-9, the average difference from target for saline was smaller than that for Multi-diluent, suggesting it performs better (p-value of 0.0035). However, saline was not an acceptable diluent for CA 27.29 as the bias exceeded TEA.

Conclusion

Saline was an acceptable alternative diluent for serum folate and CA 19-9 but not for CA27.29.
Berberine and Berberine Nanoparticles Mitigate Scopolamine-Induced Amnesia in Rats
Authors: Abdelmonem M , Hemdan A , Ghareeb D , El demellawy M , El sayed M , Wasim H
Published: October 2024

Introduction/Objective

Berberine (BER) has garnered attention in research for its multifaceted biochemical and pharmacological properties, positioning it as a promising natural remedy. Conversely, scopolamine (SCO) functions as a non-selective muscarinic receptor antagonist, disrupting central cholinergic neurotransmission and impairing learning and short-term memory.

Methods/Case Report

Forty-two male Wistar rats were procured from the National Research Center in Cairo, Egypt, and allocated randomly into seven groups, each comprising six rats. The groups were as follows: Sham Control (no treatment), BSA Control (received oral administration of 1 ml Bovine Serum Albumin-NP solution daily for 28 days), BRB-NP Control (received oral administration of BRB-NP nanoparticles at 5 mg/kg/day for 28 days), Induced Group (intraperitoneal injection of SCO at 2 mg/kg dissolved in saline once daily for 28 days), BER Treated Group (received BER at 50 mg/kg suspended in saline followed by intraperitoneal injection of SCO at 2 mg/kg after 40 minutes daily for 28 days), BSA Treated Group (received oral administration of 1 ml BSA-NP solution followed by intraperitoneal injection of SCO at 2 mg/kg after 40 minutes daily for 28 days), and BER-NP Treated Group (received oral administration of BER-NP at 5 mg/kg followed by intraperitoneal injection of SCO at 2 mg/kg after 40 minutes daily for 28 days). Whole blood was collected via heart puncture, and brain tissue was promptly extracted for brain homogenate preparation. Routine biochemical assays were conducted on serum and brain samples.

Results (if a Case Study enter NA)

Statistically significant differences were observed among the seven experimental rat groups concerning plasma AST, albumin, total protein, and triglyceride levels, while differences in ALT and total cholesterol were non-significant.

Regarding brain parameters, significant differences were noted among groups in total protein, cholesterol, phospholipids, and uric acid levels.

Conclusion

Treatment with BRB NPs or free berberine led to a progressive increase in brain protein levels and a decrease in cholesterol content (p<0.05). Additionally, SCO administration resulted in a gradual reduction in brain phospholipid content, while treatment with BER NPs, regardless of the rat’s condition, exhibited the highest phospholipid levels (p<0.05). Furthermore, administration of BSA or free BRB improved brain uric acid levels (p<0.05).
Evaluating Antioxidant Enzyme Parameters in Rats Treated with Berberine-Loaded Bovine Serum Albumin Nanoparticles and Scopolamine
Authors: Abdelmonem M , Hemdan A , Ghareeb D , El demellawy M , Wasim H , El sayed M
Published: October 2024

Introduction/Objective

Introduction: Berberine (BER) has garnered attention for its antioxidant properties demonstrated in various studies, showing its ability to scavenge or inhibit reactive oxygen species (ROS) and reactive nitrogen species (RNS), including nitric oxide, superoxide anion, and peroxynitrites.

Methods/Case Report

Methods: Forty-two male Wistar rats were randomly assigned to seven groups, each comprising 6 rats: Sham control (no treatment), BSA-NPs orally administered, BRB-NPs orally administered, SCO intraperitoneally injected, BER followed by SCO injection, BSA-NPs with SCO injection, and BER-NPs with SCO injection. Treatments were administered daily for 28 days. The cholinergic status was evaluated by assessing acetylcholinesterase (AChE) activity in brain homogenates, and brain homogenate Aβ-42 levels were measured using the ELISA technique. Additionally, brain prooxidant markers (NO, TBARS, XO), nonenzymatic antioxidants (GSH), and enzymatic antioxidants (GPx, GST, and SOD) were measured.

Results (if a Case Study enter NA)

Results: The study revealed that treatment with BRB NPs resulted in the lowest AChE activity and Aβ-42 levels. Scopolamine administration significantly increased brain NO, TBARS, and XO activity, accompanied by a progressive depletion in GSH content (p<0.05). Treatment with BRB-free or BSA decreased NO levels, while the BSA or BRB-NPs groups exhibited higher brain TBARS levels than the sham group. All treated groups exhibited similar activity to the sham control, except for the BSA-treated group. Furthermore, all treated groups showed comparable GSH levels to the sham control, except for the scopolamine group. Treatment with BRB NPs normalized GPx activity and showed the highest GST activity. The BRB-NPs treated group also exhibited the highest SOD level. The p-value was <0.001 among all studied groups.

Conclusion

Conclusion: Injection of SCO induced oxidative impairments in brain tissue, evidenced by increased prooxidants such as NO and depletion of antioxidant capacity (GPx, GST, and GSH). SCO also disrupted glutathione metabolism, enhancing the level of lipid peroxidation in the brain. Treatment with BRB-NPs or free BRB progressively increased antioxidant capacity and mitigated the harmful effects of oxidative damage in the brain by reducing prooxidant levels.
HPV-Independent Cervical Adenocarcinoma Discovered by Cytology-Based Screening: A case report of gastric type adenocarcinoma of the uterine cervix from cytopathology to histopathology
Authors: Hull A , Guo T
Published: October 2024

Introduction/Objective

In recent years, the relative prevalence of adenocarcinoma has increased, comprising 20–25% of all cervical carcinomas in developed countries. Approximately 15% of cervical adenocarcinomas are unrelated to human papilloma virus (HPV) infection. With the shift toward HPV primary testing, an increased understanding of HPV-independent cervical adenocarcinomas becomes more important.

Methods/Case Report

This case report demonstrates a rare case of gastric-type adenocarcinoma (GAS) of the cervix discovered during a routine well-woman exam. Patient-reported episodes of vaginal spotting were noted prior to screening. HPV testing by PCR on the initial pap smear was negative. Cytology findings raised concerns about endocervical glandular cell abnormalities. Subsequent cervical biopsy revealed GAS, a finding supported by positive CK7, MUC5AC, CDX2, and aberrant (mutant) p53 expression by immunohistochemistry. HPV independence was further confirmed by negative results on mRNA ISH for high-risk HPV and HPV16/18.

Results (if a Case Study enter NA)

NA

Conclusion

Here we discuss the impact of cytology-based screening on HPV-independent cervical cancers, with focus on adenocarcinoma. While the move to primary HPV screening has been shown to be effective at identifying HPV-related neoplasms, it ineffectively addresses HPV-independent malignancies. In this particular population, cytology-based screening remains indispensable.

The described case demonstrated subtle cytologic features consistent with endocervical glandular abnormality, ultimately correlating with subsequent histologic findings of HPV-independent GAS. Negative HPV results combined with subtle cytomorphologic changes displayed by some adenocarcinomas on PAP smear could present a significant diagnostic pitfall. Additionally, p16+ expression attributable to aberrant p53 pathways (rather than HPV) may further contribute to potential diagnostic errors.

While further research into best practices for early detection of HPV-independent cervical neoplasias should be conducted, this team suggests both clinical survey and referral for cytologic screening following reports of abnormal vaginal bleeding and/or watery discharge and screener education focused on cervical GAS.
Rare Case of Cutaneous Rosai Dorfman Disease Involving the Nail
Authors: Tahir M , Phung T , Nguyen Luu T , Nguyen H T
Published: October 2024

Introduction/Objective

Rosia-Dorfman Disease (RDD) is a rare benign non-Langerhans cell histiocytic disorder of unknown etiology with heterogeneous clinical features. RDD was first described by Destombes in 1965 under the term “adenitis with lipid excess.” However, it is named after Rosai and Dorfman, who characterized the further histopathological features of the disease in 1969. The characteristic presentation of RDD is lymphadenopathy, and extra nodal sites include bone, upper respiratory tract, central nervous system, retroperitoneum, and skin. The management of RDD depends on the site of involvement and the presence or absence of the symptoms. Multifocal and refractory diseases require systemic treatment. Surgical resection can be considered in symptomatic and resect- able diseases.

Methods/Case Report

A 16-year-old Asian female with no significant past medical history presented with a painful verrucous lesion on the left 5th finger for one year with bleeding and purulent discharge. Excision was performed, and histologically, there was extensive infiltration of large histocytes in the dermis with occasional lymphocytes and plasma cells. The histiocytes were engulfing the intact inflammatory cells, exhibiting the emperipolesis phenomenon.

Immunohistochemically, S100 and CD68 were positive in the large histiocytes, and leukocyte common antigen (LCA) was positive in the background lymphocytes. Based on histology and immunohistochemistry, RDD diagnosis was rendered.

Results (if a Case Study enter NA)

N/A

Conclusion

RDD is a rare condition that poses challenges in diagnosis and management. The key diagnostic factors are histological features and immunohistochemistry to exclude other pathological disorders. Treatment should be tailored according to the needs of each patient and as required to optimize the outcome. We recommend an appropriate diagnosis of this entity in a timely manner to prevent any further long-term complications.
Pigmented Purpuric Dermatoses in Children: A case Report & Importance of Clinicopathological Correlation
Authors: Fatima F , Khurram M S , Siddiqui H F , Zahid H
Published: October 2024

Introduction/Objective

Pigmented purpuric dermatoses are characterized by chronic but benign cutaneous eruptions featuring petechiae, purpura, or yellow to brown patches. It is more common in adult males and adolescents is generally localized on the lower limbs and has been reported in children multiple times. Our objective is to bring to consideration that it is not very uncommon in children and clinicopathological correlation is very important for a confirmed diagnosis.

Methods/Case Report

In our study, we report a case of 9 years 9-year-old girl with asymptomatic brown patches on lower legs bilaterally but asymmetrically since > 6-8 months. Histopathology was suggestive of typical features suggestive of PPD, including dilated blood vessels, endothelial cell swelling, hemosiderin deposition, red cell extravasation, and perivascular lymphocytic-macrophage infiltration. Pediatric instances of PPD are infrequently documented, due to their exclusion from the other differential diagnosis of purpura, post-inflammatory hyperpigmentation, and atopic dermatitis in this age group. Because these conditions lack systemic findings and share similar clinical presentations with other skin disorders, they may be overlooked or mistaken for more common conditions in pediatric patients. Histopathology plays a vital role in case of patches of persistent pigmentation on the skin especially lower limbs to rule out PPD. In many cases of pediatric PPD, it is usually considered self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside, narrow-band ultraviolet B treatment, and topical corticosteroids.

Results (if a Case Study enter NA)

In many cases of pediatric Pigmented purpuric dermatosis is usually considered as self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside [3] narrow-band ultraviolet B treatment and topical corticosteroids.

Conclusion

Our study aims to emphasize improving diagnostic accuracy, especially in pediatric cases, enhancing outcomes, and understanding the necessity of histopathological diagnosis in pediatric PPD cases. We also seek to abate the risk of misdiagnosis or underdiagnosis, and the need for increased awareness of this diagnosis in pediatric cases so that we can counsel and manage patients and their families accordingly. Through a comprehensive review of existing literature, we advocate for the inclusion of Schamberg’s type purpura as a differential diagnosis for purpuric eruptions or cutaneous discoloration in childhood.
Phyllodes - like Tumor of the Anogenital Mammary - like Glands – A Rare Entity
Authors: Mukherjee R , Szeto W , Zerhouni Y , Mannan R , Centeno L
Published: October 2024

Introduction/Objective

Phyllodes tumor (PT), a biphasic fibroepithelial tumor typically found in the breast, is an exceedingly rare finding outside the mammary gland, with only about 160 cases reported to date. We describe a rare case of PT arising from anogenital mammary-like glands (AGMLG).

Methods/Case Report

A 68-year-old woman presented with a small perianal mass that was incidentally detected during hemorrhoidectomy procedure. It appeared as a pedunculated olive-sized mass on the perianal skin. A papillectomy was performed, and upon sectioning, a solid-cystic lesion measuring 2.0 x 1.4 x 0.9 cm was observed. Microscopic examination revealed a biphasic pattern comprising of glandular epithelium and a stromal component, with a predominance of the latter and together they formed leaf-like slits. These spaces were lined by a bilayered epithelium consisting of secretory (apocrine)-type cells and myoepithelial cells resembling mammary glandular epithelia. Focal clusters of benign glands, morphologically consistent with AGMLGs, were identified at the periphery of the tumor. Immunohistochemically, epithelial components reacted positively for GATA3, mammoglobin, CK7, estrogen receptor and progesterone receptor, while the myoepithelial cells were highlighted by calponin and p63. The AGMLGs in the periphery also stained for GATA3, estrogen receptor and progesterone receptor. The mitotic rate was low (1 to 2 per 50 high-power fields), without atypical mitoses. The lesion was diagnosed as a benign PT.

Results (if a Case Study enter NA)

NA

Conclusion

The current case highlights the importance of recognizing PT when it occurs at extra-mammary locations. The entity merits greater attention not only for its malignant potential but also due to the mystery surrounding its origin and the histogenetic link to breast tissue.
A case of Russell body gastritis associated with psychiatric disorder
Authors: Kumar V , Hammad A
Published: October 2024

Introduction/Objective

Russell body gastritis is a benign and rare entity characterized by infiltration of lamina propria with plasma cells stuffed with spherical eosinophilic cytoplasmic inclusions known as Russell bodies which represent immunoglobulins. Russell bodies accumulate due to dysfunction in secretion pathway of plasma cells. Plasma cells with Russell bodies are also termed Mott cells. Although exact etiology is unknown, but it can be seen in association with other conditions like mucosa associated lymphoid tissue (MALT) lymphoma, multiple myeloma and plasmacytoma. This condition most commonly affects the antrum and may present as erythema or sometimes nodular lesion. Definitive diagnosis is based on histology.

Methods/Case Report

A middle-aged male with past medical history significant for polysubstance use disorder, bipolar disorder, and osteoarthritis was evaluated for bleeding per rectum and dyspepsia in the setting of chronic nonsteroidal anti-inflammatory drugs (NSAID) and ethanol use. Physical examination was remarkable for an external hemorrhoid and complete blood count showed anemia. Upper GI endoscopy and colonoscopy was performed. Patchy erythema was seen in antrum and duodenal bulb, and colonoscopy was unremarkable. Microscopic examination showed numerous plasma cells with Russell bodies (Mott cells) in the lamina propria and mild chronic inflammation in gastric mucosa. H. Pylori was negative by immunohistochemistry (IHC). Plasma cells were polyclonal and positive for CD138, and negative for cytokeratin which excluded plasmacytoma and signet-ring adenocarcinoma, respectively.

Patient was placed on proton pump inhibitor therapy and discharged.

Results (if a Case Study enter NA)

Russell body gastritis can be seen in patients with and without H. Pylori infection. Cytokeratin, kappa and lambda immunohistochemistry stains, and gene rearrangement studies may be needed to exclude frequent lesions that may enter in the differential diagnosis. Long term effects and clinical significance of russell bodies accumulation is yet to be determined.

Conclusion

Russell body gastritis is a rare morphologic variant of chronic gastritis that may enter in the differential diagnosis with other more serious lesions. A careful morphologic examination and occasionally IHC stains / molecular studies are needed to make the correct diagnosis.