bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching Discourse Markers that Mark Trouble With Questions: Applications of Conversation Analysis to Teaching Korean as a Second/Foreign Language
Authors: Kim Stephanie Hyeri
Published: January 2021

This article showcases an example of how conversation analysis (CA) materials can be put to use for teaching Korean as a Foreign/Second Language. The article first reviews a set of CA research on two Korean discourse markers, kulenikka and ani, that occur at response beginnings to mark trouble with the preceding question. Then it discusses the use of the research findings to help teaching oral skills in the classroom. The suggested activities illustrate how teachers can utilize the CA materials—both the information gained from the research as well as the recordings/transcripts of naturally occurring conversation—(a) to help raise learners' awareness of the discourse markers' usage in real-life talk and (b) to develop practice materials to help learners' increased automaticity of the discourse markers and to eventually use them in speaking activities within a communicative context that resembles a real-life situation.
Conocimientos, actitudes y prácticas de prevención sobre enfermedad renal en pacientes diabéticos e hipertensos
Authors: Fuentes Martínez Teresa Del Rosario , Argueta Coca José Benjamín , Ríos Nely Del Carmen
Published: January 2021

Introducción. Según la Organización Mundial de la Salud, la cuarta parte de la población, sufre hipertensión arterial y diabetes mellitus tipo 2, son la segunda causa de enfermedad renal crónica, juntas tienen un riesgo multiplicador para padecerla. Objetivo. Analizar los conocimientos, actitudes y prácticas, sobre la prevención de enfermedad renal crónica, en usuarios con diabetes mellitus tipo 2 e hipertensión arterial, en el municipio de Jocoaitíque, departamento de Morazán.Metodología. Este estudio es transversal, descriptivo, los datos fueron recolectados en visitas domiciliares y en la consulta general, realizando una entrevista a 125 personas, 108 hipertensos y 17 diabéticos, luego fueron analizados, a través del programa Perfect Statistics Professionally Presented versión libre. Resultados. De los participantes el 96 % tiene un bajo nivel educativo, el 4 % ha realizado bachillerato y estudios superiores, el 83 % pertenece al área rural, la ocupación predominante es ama de casa (58 %), el resto son jornaleros y agricultores (38 %). El 73 % tienen un nivel medio de conocimientos, el 66 % actitudes de indiferencia y el 76 % realizan prácticas inadecuadas de autocuidado, en la prevención de la enfermedad renal crónica. Conclusiones. Los conocimientos sobre, la prevención de la enfermedad renal crónica, se encuentra en un nivel medio en la mayoría de los encuestados. Más de la mitad de la población expresa actitudes de indiferencia y más de la tercera parte, realizan prácticas inadecuadas de prevención sobre la enfermedad renal crónica.
Subject Matter Competency Perceptions of Teacher Educators in Education Faculties of Turkey
Authors: Çiçek Fatma Gözalan , Taşpınar Mehmet
Published: January 2021

The purpose of the current study is to determine teacher educators’ level of general subject matter competency perception and to investigate whether this level varies depending on different variables. In the collection of the data of the study employing the survey model, a single dimension and 106-item “scale of teacher educators’ general subject matter competency perceptions” was used. The scale was prepared in the online environment and sent to 8200 faculty members working in education faculties all over Turkey by e-mail. A total of 789 teacher educators responded to the scale. It was found that the teacher educators generally consider themselves highly competent in terms of general subject matter competences. The area with the lowest competence perception level was found to be foreign language. The teacher educators’ general subject matter competence perceptions were found to be not varying significantly depending on their gender, type of the university where they are working (state/foundation), academic title, discipline (educational sciences/subject area education) and teaching experience. In light of these findings, it can be argued that these competences should be considered in the recruitment of teacher educators in education faculties.
Non-destructive testing by the eddy current method of half-shafts after induction hardening
Authors: Kondej Adam , Samborski Tadeusz
Published: January 2021

The non-destructive testing method with applying eddy currents carried out on drive half-shafts used in the car drive systems was described. The aim of the testing was to establish if the tested shafts were inductively hardened. At the Łukasiewicz Research Network - Institute of Precision Mechanics, the control and measurement system was designed and built to detect efficiently the martensite structure and therefore to make possible quick control of any elements. The system has been implemented at the Neapco Europe, the manufacturer of drive-shafts for the automobile industry, in Praszka, Poland.
Study of selected properties of the 98W-1.4Ni-0.6Fe heavy tungsten alloy
Authors: Skoczylas Paweł
Published: January 2021

The aim of the work was to determine the density and tensile strength Rm of the sintered rod measured in selected places along its axis. The test rod with the composition of 98W-1.4Ni-0.6Fe was produced by powder metallurgy and sintering with the participation of the liquid phase. The performed measurements showed that the density of the samples depends on the place where the sample was taken from the bar and the amount of the outer layer removed by rolling. The densities of samples taken from the ends of the bar are higher than those taken from the center of the bar. The lowest density was obtained for ready-made strength samples. The performed measurements showed that for several samples the results of density and strength Rm are correlated. Gradually decreasing sample density translates into a decrease in their tensile strength. The lower density of samples from the central part of the bar can be related both to the linear shrinkage occurring during the process, as well as to the non-uniform temperature distribution in the sintering furnace space.
Critical analysis of legal and economic problems in terms of safety use of autonomous vehicles
Authors: Wojciechowski Andrzej , Gołowicz Artur
Published: January 2021

The majority of society, including politicians, scientists and visionaries, see only the advantages of implementing autonomous vehicles into road traffic, forgetting about the possible dangers and risks associated with the functioning of such transport. The article presents most of the present and future possible problems and risks of cooperation between autonomous vehicles and the functioning of transport. The conduced legal and economic analysis indicates a number of problems with the implementation of autonomous vehicles, which may cause, apart from obvious positive solutions, also a high risk in terms of road safety and the need to adapt the current legal acts. We should strive for maximum material recovery from end-of-life vehicles, including electronics and electrical installations of modern EV/HEV, particularly “rich” in scarce and critical metals. Electric and electronic scrap is most often classified as hazardous waste in the group of industrial waste. This is mainly due to the content of compounds that are particularly harmful to human health and the environment and at the same time highly desirable.
Die Vormundschaft nach estnischem Recht
Authors: Uusen-Nacke Triin , Hoffmann Thomas
Published: January 2021

The constitution of the Estonian Republic determines the basic elements of the status of people providing for general right to freedom and personality rights. The Civil Code regulates the concepts of full and limited legal capacity of natural persons. The capacity to contract presumes the natural ability to understand and control one’s own actions. Estonian law provides for limitations of the legal capacity, up to full incapacitation, for mentally disordered adults. A guardian must be appointed for such persons to represent them insofar as legal capacity is limited. The law provides for certain safeguards in order to protect such persons from excessive limitation; however, Estonian law still follows the “substituted judgement approach” rather than the “supported decision-making approach” solicitated in the UN Convention on the Rights of Persons with Disabilities. In practice, the flexibility granted by legislation is not always used - e.g. authorities and courts often use full instead of partial incapacitation.
Metadata
Authors: Mayernik Matthew S.
Published: January 2021

Meta­data in various forms pervades our institutions, technologies, and daily lives. Meta­data is a distinct focus of academic research and professional practice for many people within the library and information sciences (LIS). This article is an exploration of the concept of “meta­data.” It presents a high-level introduction to the topic with analysis of key research problems and practical challenges. The paper discusses varying understandings of what “meta­data” means, the origin and evolution of meta­data as an important topic within information and data fields, and the central characteristics of that which gets called “meta­data.” Meta­data can be understood as both process and product and can result from both human effort and computational techniques. Given the central role meta­data have in the establishment of know­ledge, evidence, and truth, it is necessary for researchers and professionals within LIS to think critically about our meta­data practices and systems.
Kollektive Grundrechtseinwirkungen
Authors: Ruschemeier Hannah
Published: January 2021

Die COVID-19-Pandemie ist auch aus verfassungsrechtlicher Sicht ein herausforderndes Phänomen. Nach einer ersten Phase der Unsicherheit und stark dynamischen Entwicklungen, bietet die zeitliche Distanz zu den kurzfristig erlassenen staatlichen Einschränkungen im zweiten Viertel des Jahres 2020 die Chance eines unbefangeneren Blicks auf die rechtliche Einordnung. Im Fokus steht die Betroffenheit aller Bürgerinnen und Bürger in verschiedensten Lebensbereichen durch staatliche Maßnahmen anlässlich der Pandemie. Daraus ergeben sich auch grundrechtsdogmatische Fragen. Der Beitrag untersucht diese Grundrechtseinschränkungen im Hinblick auf ihre personelle und sachliche Breitenwirkung. Die Kollektivität der Grundrechtseingriffe wird als eigener Verfassungsbelang untersucht. Besondere Berücksichtigung findet der faktisch betroffene öffentliche Raum und seine rechtlichen Funktionen. Der Beitrag ergründet, wie das Phänomen der Betroffenheit eines Grundrechtsträgers in besonders vielen Grundrechten verfassungsrechtlich zu qualifizieren ist als auch, ob die Betroffenheit besonders vieler Grundrechtsträgerinnen eine eigene verfassungsrechtliche Relevanz entfaltet.
Literaturstreit und Bocksgesang
Authors: Brokoff Jürgen
Published: January 2021

Nach dem Literaturstreit kommt es im vereinten Deutschland zu einem tiefgreifenden Wandel im Verhältnis von literarischer Autorschaft und öffentlicher Meinung.

Mauerfall und Wiedervereinigung haben die Produktion von Literatur grundlegend verändert. Neue Formen der Erzeugung von medialer Aufmerksamkeit lassen das alte Modell ›kritischer Öffentlichkeit‹ zunehmend fragwürdig erscheinen. An die Stelle von literarischer Autorschaft als moralischer Instanz tritt der »Skandalautor«, der durch intervenierende Texte den Kultur- und Medienbetrieb provoziert und stört.

Jürgen Brokoff fragt nach ästhetischen Formen und politischen Funktionen dieser Interventionen im öffentlichen Meinungsbildungsprozess. Am Beispiel von Christa Wolfs Erzählung »Was bleibt« und Botho Strauß’ Essay »Anschwellender Bocksgesang« analysiert er die Verschlingung von Literatur und Politik im vereinten Deutschland und verknüpft auf neue Weise Aspekte der Literaturästhetik und Textinterpretation mit Fragen der Meinungsforschung.
Lernort Auschwitz
Authors: Kuchler Christian
Published: January 2021

Der Debatte um verpflichtende Besuche in KZ-Gedenkstätten für alle deutschen Schülerinnen und Schüler fehlt häufig etwas Grundsätzliches: Grundlegende Ergebnisse zum Lernerfolg solcher Schulfahrten. Auf Basis erstmals ausgewerteter Quellen untersucht Christian Kuchler schulische Auschwitz-Besuche der letzten vier Jahrzehnte. Deutlich wird dabei, wie Schülerinnen und Schüler ihre Zeit am historischen Ort wahrnehmen und bis in die Gegenwart reflektieren. Thematisiert werden beispielsweise die Ängste der Schülerinnen und Schüler im Vorfeld ihrer Ankunft in Oświęcim und der Umgang der Lernenden mit den von der Gedenkstätte ausgelösten Emotionen. Neben der Wahrnehmung der Gedenkstätte unmittelbar nach dem Besuch nimmt der Autor auch den langfristigen Lernerfolg des Aufenthalts am »Lernort Auschwitz« in den Blick. Ergänzt wird die Untersuchung zur Rezeption des historischen Orts um Überlegungen zur Einbeziehung von virtuellen Angeboten in den Schulunterricht: Können sie künftig sogar Besuche an Gedenkstätten wie Auschwitz-Birkenau ersetzen?

Aus den Befunden für die weltweit größte Holocaust-Gedenkstätte werden Thesen abgeleitet, die künftige Schulexkursionen zu Orten des NS-Terrors anregen sollen.
Freundschaftsbande
Authors: Fotiadis Ruža
Published: January 2021

Die griechisch-serbische Freundschaft während der Jugoslawienkriege der 1990er Jahre.

Das Ende des Kalten Krieges und der Ausbruch der Jugoslawienkriege stellten eine Phase grundlegenden Umbruchs in Südosteuropa dar. Die 1990er Jahre führten aber nicht nur im vormals staatssozialistischen östlichen Europa zu vielfältigen Neuorientierungen, sondern auch beim NATO- und EG-Mitglied Griechenland. Als eine signifikante Erscheinung dieser Prozesse lässt sich die griechisch-serbische Freundschaft bezeichnen. Die im öffentlichen Diskurs verbreitete Berufung auf die »traditionell guten Beziehungen« und die »Schicksalsgemeinschaft« von Serben und Griechen wurde dabei vor allem mit der Glaubensbrüderschaft in der Orthodoxie und der Waffenbrüderschaft in verschiedenen Kriegen begründet.

Ruža Fotiadis erkundet die Wirkungsmacht und das Spannungsverhältnis von Freundschaft und Feindschaft im internationalen Kontext. Auf einer breiten Quellenbasis beleuchtet sie dabei die griechisch-serbischen Beziehungen und analysiert in verflechtungs- und emotionsgeschichtlicher Perspektive Vergangenheitsauffassungen und Gegenwartsdeutungen vor dem Hintergrund der Jugoslawienkriege der 1990er Jahre.
Das Geisterreich
Authors: Bormuth Matthias
Published: January 2021

In der Aufklärung prägte Kant die Idee weltbürgerlicher Freiheit. Karl Jaspers und Hannah Arendt sprachen von einem »Geisterreich«, dem die Essays in vielen anderen Werken nachspüren.

Aufklärung soll nach Kant zu weltbürgerlicher Freiheit führen. Die weitreichenden Folgen, welche diese Idee in Religion, Philosophie, Literatur und Politik schaffen kann, erkunden die biographischen Essays bis in die Moderne.

Hannah Arendt und Karl Jaspers sprachen emphatisch vom »Geisterreich«, das Intellektuelle in weltbürgerlicher Absicht zeitübergreifend bilden. Und doch ist alle persönliche Nachdenklichkeit auch von der geschichtlichen Zeit geprägt. So werden nach Kant gegen vielfältige Widerstände Hamann, Humboldt und Hölderlin um 1800 zu besonderen Figuren der Freiheit.

Den politischen Raum der Moderne eröffnet Max Weber, während Jürgen Habermas ihn anders bis ins 21. Jahrhundert denkt. Eigenwillige Geister wie Peter Suhrkamp und Dietrich Bonhoeffer spitzen nach 1933 die deutschen Erfahrungen in ihrem Denken und Handeln zu, während Ingo Schulze sie unter gewendeten Verhältnissen heute literarisch neu ins Gespräch bringt.

Neben Paul Celan stehen Virginia Woolf und Adam Zagajewski exemplarisch für europäische Figuren der Freiheit, die in ganz unterschiedlichen Lebenslagen aus dem poetischen Bewusstsein der eigenen Individualität leben.
Protocols for the Examination of Tumors of Diverse Sites
Authors: Hammond Elizabeth H. , Compton Carolyn C.
Published: January 2021

This issue of the Archives includes previously unpublished protocols for the examination of specimens removed from patients with cancer of diverse sites. We provide a historical context for the development of these protocols and describe the process of development and approval. General information about the structure and content of the protocols is also provided. Cancer protocol development is an important step in the process of standardized cancer reporting. The value of such standardized reporting is discussed.
Sequence of Testing for Monoclonal Gammopathies
Authors: Kyle Robert A.
Published: January 2021

The first test for recognition of monoclonal gammopathies should be serum protein electrophoresis with high-resolution agarose gel. Serum protein electrophoresis should be performed whenever multiple myeloma, Waldenström’s macroglobulinemia, primary amyloidosis, or a related disorder is suspected. Immunofixation is critical for the differentiation of a monoclonal from a polyclonal increase in immunoglobulins. Quantitation of immunoglobulins should be performed with a rate nephelometer. The viscosity of serum should be measured if the patient has signs or symptoms of hyperviscosity syndrome. A 24-hour urine specimen should be obtained for determination of the total amount of protein excreted each day. Immunofixation of the urine should be performed on every patient who has an M-protein level greater than 1.5 g/dL (15 g/L) in the serum or in whom multiple myeloma, Waldenström’s macroglobulinemia, primary amyloidosis, or a related disorder is suspected.
Surgical Pathology Specimens for Gross Examination Only and Exempt From Submission
Authors: Zarbo Richard J. , Nakhleh Raouf E.
Published: January 2021

Objective.—To survey the scope of current written institutional policies for types of surgical pathology specimens exempt from submission to the laboratory and those that may be examined by gross inspection only.

Design and Setting.—In the first quarter of 1997, a total of 413 voluntary participant institutions enrolled in the College of American Pathologists Q-Probes quality improvement program completed a checklist of 115 proffered specimens. Also included was a questionnaire defining demographic, practice, and reimbursement variables.

Main Outcome Measures.—The number and types of specimens exempt from submission and submitted for gross examination only based on written institutional policy rather than on unapproved actual practices.

Results.—Most institutions had a written policy for types of specimens deemed exempt from submission to pathology (87.1%) and for types of specimens subject to gross examination only (76.6%). There was a wide range of numbers of specimen types with a median number of 17 (range, 2–40) in the exempt category and 29 (range, 6–57) in the category of gross examination only. Significantly higher absolute counts of specimens exempt from submission to pathology were reported by institutions with a greater surgical pathology volume in 1996 and by nonteaching institutions. No aspect of practice was associated with numbers of specimens for gross examination only.

Conclusions.—This Q-Probes study creates a multi-institutional reference database of current practices to assist pathologists and clinical staff in the development of written guidelines pertaining to surgical pathology specimen submission exceptions and gross-only examinations.
Composite Ganglioglioma and Dysembryoplastic Neuroepithelial Tumor
Authors: Prayson Richard A.
Published: January 2021

Both ganglioglioma and dysembryoplastic neuroepithelial tumors are well-recognized glial-neuronal neoplasms associated with chronic epilepsy and cortical dysplasia (neuronal migration abnormalities). The exact relationship between these 2 glial-neuronal tumors continues to be debated. This article reports a case of a composite ganglioglioma and dysembryoplastic neuroepithelial tumor occurring in a 36-year-old woman in the left temporal lobe region. The resection histologically demonstrated distinct areas of ganglioglioma and dysembryoplastic neuroepithelial tumor. A focal area of cortical dysplasia is also identified. The MIB-1 labeling indexes in both components were low (<1% of tumor cell nuclei). The coexistence of these 2 lesions and cortical dysplasia suggest a possible etiologic relationship between these 2 tumors.
Herpesvirus 8 Inclusions in Primary Effusion Lymphoma
Authors: Said Jonathan W. , Shintaku I. Peter , Asou Hiroya , deVos Sven , Baker James , Hanson Gerald , Cesarman Ethel , Nador Roland , Koeffler H. Phillip
Published: January 2021

We describe a case of primary effusion lymphoma with T-cell phenotype, mixed genotype, and intranuclear herpesvirus inclusions visible with the light microscope. Cells were studied by immunohistochemical analysis, in situ hybridization, immunoglobulin and T-cell receptor gene rearrangement, and polymerase chain reaction. Primary effusion lymphoma cells with T-cell phenotype revealed herpesvirus 8 inclusions predominantly seen in apoptotic cells, suggesting that productive viral infection is associated with cell death. Clinical features were typical of primary effusion lymphoma. Cytologic, molecular genetic, and phenotypic features demonstrated a unique variant of primary effusion lymphoma.
Linear Epidermal Nevus and Nevus Sebaceus Syndromes
Authors: Prayson Richard A. , Kotagal Prakash , Wyllie Elaine , Bingaman William
Published: January 2021

Background.—Linear epidermal nevus syndrome and linear sebaceus nevus syndrome are rare neurocutaneous syndromes characterized by epidermal nevi, epilepsy, and mental retardation. Pathologic descriptions of the central nervous system findings in such patients are rare.

Design.—We examined the clinicopathologic features of 2 patients with linear epidermal nevus syndrome and 1 with nevus sebaceus syndrome who underwent surgical resections for chronic epilepsy in a tertiary referral center with a high volume of epilepsy surgery.

Results.—Patients included 3 females, aged 11 months (patient 1), 8 years (patient 2), and 2½ years (patient 3) at the time of surgery. The duration of seizures prior to surgery was 11 months, 6 years, and 28 months, respectively. Two patients had epidermal nevi involving the head region (patients 1 and 3), and 1 had a nevus sebaceus of Jadassohn (patient 2); patient 2 had a choristoma, and patient 3 had a dermoid cyst in the eye region. Patient 1 demonstrated hemimegalencephaly radiographically. Histologic examination of resected cortical tissue in patients 1 and 2 demonstrated severe diffuse cortical dysplasia characterized by a disorganized cortical architectural pattern, a haphazard orientation of cortical neurons, and increased molecular layer neurons. Gyral fusion was seen in patient 1. Pial glioneuronal hamartomas were observed in patient 1. Prominent cortical astrocytosis was seen in patients 1 and 2, and foci of microcalcification were evident in patient 1. Cortical dysplasia was milder in patient 3 and consisted of an increased number of molecular layer neurons. Neuronal heterotopia was observed in all 3 patients.

Conclusion.—The spectrum of neuronal migration abnormalities in the setting of these syndromes may be variable in terms of its histologic phenotypic manifestations.
Staphylococcal Coronary Arteritis as a Complication of Septicemia
Authors: Dishop Megan K. , Yoneda Kokichi
Published: January 2021

We describe a case of staphylococcal coronary arteritis in the setting of sepsis due to arteriovenous fistula and dialysis catheter infection. The left circumflex coronary artery was the only vessel involved. The patient was a 77-year-old, insulin-dependent diabetic man with chronic renal failure. The immunosuppressed state in diabetes with subsequent septicemia may have facilitated a large number of bacteria to lodge in the atheromatous plaque of the coronary artery. We briefly review previously reported cases and suggest that bacterial arteritis may be an underrecognized cause of acute coronary occlusion.
Mucin Stain on Frozen Sections
Authors: Soans Suchetha , Galindo Lorenzo M. , Garcia Fernando U.
Published: January 2021

Context.—The importance of frozen-section diagnoses in the practice of pathology cannot be overemphasized. In some cases, the use of a mucin stain can greatly aid in the diagnosis. Since few methods for mucin staining have been described that can be used in the frozen-section setting, we developed one such staining procedure for mucin.

Objective.—To develop a rapid mucicarmine staining technique to be used on frozen sections that does not significantly delay overall turnaround time.

Design.—A standard mucicarmine staining technique was modified by using a concentrated mucicarmine stain and a microwave oven, to reduce the total staining time to 3 minutes or less. Frozen tissue from normal colonic mucosa was used as a control, and skin from extramammary Paget disease for evaluation of margins was used as a case.

Results.—The rapid mucicarmine stain successfully demonstrated the presence of mucin on frozen-tissue sections. Mucin stained deep rose, and the connective tissue stained green.

Conclusion.—This rapid and simple mucin staining technique can be used on frozen sections with no significant effect on the overall turnaround time, thereby aiding rapid diagnosis on frozen sections.
Transfusion Medicine's Role in Hospital Performance Improvement: An Administrator's View
Authors: Krempel George , Jarosz Colleen
Published: January 2021

Historically, hospital administrators have viewed all laboratory sections as cost centers. The major expenses in the transfusion service are those associated with labor and blood products. However, few administrators take the time to look past this cost to see the impact of an active transfusion medicine section in other areas of the hospital. This article examines the impact of inventory management, blood component utilization and waste, group purchasing, and new program implementation on transfusion service expense and revenue.
The Costs and Consequences of Management Fads and Politically Driven Regulatory Oversight: The Case of Blood Transfusion
Authors: Blumberg Neil
Published: January 2021

Context.—The period from the mid-1980s to the present has seen a virtual revolution in how blood collection, testing, and transfusion are carried out. Most of the changes that have occurred represent changes in organization, underlying paradigms of transfusion safety, and approaches to solutions to perceived problems, rather than technical or scientific advances. These changes were instituted with little or no data to support their safety and efficacy, much less their cost-effectiveness.

Design.—Using data on changes in fees charged by regional blood centers during this period, an estimate was generated of the costs attending the purely administrative and organizational changes in the field of transfusion medicine.

Results.—The additional expenditures, excluding inflation, are in the range of $226 million per year. This figure does not include changes in infectious disease testing on donated blood, the substantive scientific advance during this period.

Conclusions.—In addition to the questions of safety and efficacy, which are traditionally considered prior to clinical or procedural changes of this magnitude, the question remains whether these expenditures are a reasonable trade-off of cost versus benefit. Similar applications of federal regulatory standards intended for manufacturing (eg, good manufacturing practices) and industrial management theory (eg, total quality management) are now being implemented or proposed for hospitals, health care delivery systems, and individual physician's practices. Thus, the case of transfusion medicine may provide some cautionary lessons for future proposed changes in health care delivery and medical practices.
Adenosquamous Carcinoma of the Small Intestine
Authors: Ngo Nhu , Villamil Carlos , Macauley William , Cole Solon R.
Published: January 2021

Primary adenosquamous carcinomas of the intestine are rare tumors, particularly those occurring in the small bowel. We report the third case of an adenosquamous carcinoma of the ileum in a 55-year-old-man. Histologically, the tumor consisted of malignant glandular and squamous elements. A review of the literature is presented.
Massive Myocardial Necrosis in Thrombotic Thrombocytopenic Purpura
Authors: Podolsky Scott H. , Zembowicz Artur , Schoen Frederick J. , Benjamin Richard J. , Sonna Larry A.
Published: January 2021

Thrombotic thrombocytopenic purpura (TTP) is an uncommon syndrome resulting from diffuse occlusion of small arterioles and capillaries by hyaline microthrombi. It is characterized by fever, thrombocytopenic purpura, microangiopathic hemolytic anemia, and neurologic and renal dysfunction. While cardiac pathology in TTP is commonly seen at autopsy, clinical cardiac dysfunction is rare and typically results from conduction system involvement. While 3% to 8% of patients with TTP report chest pain on admission, reports of fatal ventricular pump failure are extremely rare. We now report a case of TTP resulting in death from widespread myocardial necrosis. This patient presented with elevated cardiac enzymes and electrocardiographic disturbances that mimicked viral myocarditis, as well as a profound thrombocytopenia. Such a case may represent the extreme of a distribution of cardiac involvement in TTP or the consequence of an unidentified autoimmune process capable of precipitating severe myocardial TTP.
Benign Metastasizing Leiomyoma of the Uterus
Authors: Esteban Jose M. , Allen Warren M. , Schaerf Raymond H.
Published: January 2021

Benign uterine leiomyoma metastasizing to the lung is a recognized entity that has been reported infrequently in the medical literature. There is persisting controversy regarding the pathogenesis and biology of these lesions. We report a well-studied and well-characterized case of benign leiomyoma metastasizing to the lung. The patient was a 72-year-old woman with an enlarged uterus that contained several leiomyomas with usual histology. Areas of fibrosis, hyalinization, edema, and focal infarction together with small foci with mildly increased cellularity and minimal nuclear pleomorphism were seen. Careful and repeated mitotic counts ranged from 0 to 2 mitoses per 10 high-power fields. In summary, based on histopathologic criteria, the neoplasm was determined to be a focally cellular benign leiomyoma. Four years later, the patient underwent surgical resection of a single nodule in the lung, which had been detected on routine radiographs. Histopathologic evaluation showed a low-grade leiomyosarcoma with moderate nuclear pleomorphism, necrosis, and brisk mitotic activity. Immunohistochemical studies performed on both neoplasms showed them to be of mesenchymal derivation with smooth muscle differentiation. Both neoplasms expressed estrogen receptors with moderate to strong intensity. The patient received no further treatment and, to date, shows no evidence of recurrent disease. The diagnosis of benign metastasizing leiomyoma can only be made with certainty after careful and extensive sampling of the primary tumor to exclude small foci of sarcoma and of the pulmonary tumor to rule out a primary neoplasm. Although it is biologically peculiar, benign metastasizing leiomyoma should continue to be recognized as a distinct entity because current morphologic criteria do not allow primary myometrial tumors to be reclassified as leiomyomas of uncertain malignant potential even if they have metastasized to the lung.
Colon Cancer Testing and Screening
Authors: Hamilton Stanley R.
Published: January 2021

Laboratory testing has the potential to favorably affect the outcome of patients with neoplasia by applications in screening, risk identification, surveillance, diagnosis, prognosis, prediction of tumor response or resistance to therapies, and prediction of toxic effects from therapies. Molecular testing directed at colorectal neoplasia is currently in use for diagnosis and characterization of rare, highly penetrant inherited syndromes due to germline mutation of the APC suppressor gene or DNA nucleotide mismatch repair genes. Routine application of molecular assays of colorectal tumors as prognostic and predictive markers is likely to occur in the near future, but major advances in technology are needed to begin to move molecular testing into screening of the general population and surveillance of subjects at increased risk. It seems certain that molecular methods will become increasingly important in improving the outcome of patients with colorectal neoplasia and in contributing to continued decline of the death rate from this common cancer.
Minimal Residual Disease in Hematologic Disorders
Authors: Faderl Stefan , Kurzrock Razelle , Estrov Zeev
Published: January 2021

In almost no other area of medical oncology has the introduction of new drugs, combinations of chemotherapeutic agents, and novel biologic treatments caused such dramatic responses as it has in the treatment of malignant hematologic disorders. However, despite some therapeutic success, many patients relapse and die from recurrence of their disease. The implications of minimal residual disease (MRD), a term referring to disease that is undetectable by conventional morphologic methods, have therefore attracted increasing attention in recent years. New and powerful laboratory tools such as polymerase chain reaction assays have extraordinary sensitivity and provide exciting new insights into the detection, nature, quantification, and kinetics of MRD. This article summarizes methods used in the identification of MRD and its importance as exemplified in the case of acute leukemias and chronic myelogenous leukemia.
Molecular Diagnosis and Prognosis in Gynecologic Oncology
Authors: Silverberg Steven G.
Published: January 2021

Currently, molecular pathology plays a limited role in improving patient outcome in gynecologic oncology. However, molecular investigation is providing important insights into the epidemiology, pathogenesis, and progression of female genital cancers. Future roles should include prediction of poor outcome in low-risk cases, more accurate staging of multifocal tumors, identification of new precursor lesions, and prediction of response to specific therapeutic regimens. Gene therapy of some malignant tumors may become important in the near future. In the immediate future, however, the most significant role of molecular pathology may be in the screening and triage of putative cervical cancer precursors and in the possible prophylaxis of these lesions by means of a vaccine or vaccines against human papillomaviruses.
Impact of DNA Typing on Standards and Practice in the Forensic Community
Authors: Reeder Dennis J.
Published: January 2021

This article reviews the history of DNA-based human identification from its inception in 1985. Since the development of the technology, experts called for setting of standards and use of proficiency tests for quality assurance measures. The response of the National Institute of Standards and Technology to DNA forensic standards needs was catalyzed by the Technical Working Group on DNA Analysis Methods, sponsored by the Federal Bureau of Investigation with funding provided by the National Institute of Justice. Standard reference materials were developed for the original technologies used in DNA identification and for the newer polymerase chain reaction–based technologies. Adoption of recommended standards developed through the Federal Bureau of Investigation–commissioned DNA Advisory Board show the acceptance of National Institute of Standards and Technology standards for calibration of laboratory protocols. New technologies will require a process of validation and continued testing through the use of proficiency tests, such as those provided through the College of American Pathologists. Robotics and parallel processing of samples will lead to increased efficiency in DNA testing. The use of DNA data banks of convicted felons will increase dramatically with the the Federal Bureau of Investigation's national implementation of a computerized identification system known as the Combined DNA Index System. This system that will make major use of short, tandem, repeat genetic systems and will be the major driver of technology for the next 5 to 10 years. Finally, sample collection and training are of major concern for those who look at the long-term impact of DNA testing in forensic laboratories.
Ethical Issues in Molecular Pathology
Authors: Sobel Mark E.
Published: January 2021

Recent advances in molecular pathology and molecular genetics have created new concerns about the use of human biologic materials in research. Since researchers now have the ability to extract and amplify DNA from minuscule archived samples, virtually any human tissue sample can potentially become the template for a test that provides information that may relate to the inherited genes of an individual. Researchers using human biologic materials should follow the 3 basic principles that have been defined for all ethical human subjects research: respect for persons, beneficence, and justice. Institutional Review Boards are responsible for providing review of the risks and benefits of research proposals to safeguard the rights and welfare of human subjects. Currently, there is considerable debate concerning the role of informed consent procedures and the Institutional Review Board oversight process in situations when researchers use human biologic materials that have been anonymized or coded. In 1999, the National Bioethics Advisory Commission is expected to make recommendations to President Clinton and the National Science and Technology Council that are expected to clarify the balance between respect for personal autonomy and the societal need to pursue biomedical research to improve the health and welfare of all individuals.
Immunohistochemical Detection of p53 Protein Could Improve the Management of Some Patients With Barrett Esophagus and Mild Histologic Alterations
Authors: Giménez A. , de Haro L. M. , Parrilla P. , Bermejo J. , Pérez-Guillermo M. , Ortiz M. A.
Published: January 2021

Objective.—To determine the usefulness of p53 immunostaining in identifying the subgroup of patients with Barrett esophagus who may be at increased risk of developing adenocarcinoma of the esophagus.

Materials and Methods.—Tissue samples of 41 patients with Barrett esophagus and available sequential histologic data were processed for p53 immunostaining. Results from each patient were compared over time, and the results of a subset of patients were compared with each other.

Results.—We observed a significant correlation between the percentage of samples with p53 expression and the severity of dysplasia. Moreover, in a subset of patients with mild dysplasia (cases classified as showing indefinite dysplasia), we observed a statistically significant difference in the percentage of p53-positive samples between the group that progressed to more severe dysplasia and the group that did not progress.

Conclusion.—Our results suggest that this procedure, which is technically simple, economical, and quick, could play a role in the evaluation and follow-up of patients with Barrett esophagus.
Pheochromocytoma Associated With Neuroendocrine Carcinoma
Authors: Juarez Douglas , Brown Richard W. , Ostrowski Mary , Reardon Michael J. , Lechago Juan , Truong Luan D.
Published: January 2021

The coexistence of pheochromocytoma and other tumor types in a single adrenal gland has been rarely documented. This type of pheochromocytoma is designated “composite” or “mixed,” depending on whether the pheochromocytoma and the nonpheochromocytoma components show the same embryologic origin. The nonpheochromocytoma components reported in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The components found in the mixed pheochromocytoma include adrenal cortical neoplasms and spindle cell sarcoma. We report a unique case of composite pheochromocytoma in which the nonpheochromocytoma element is a neuroendocrine carcinoma. The histologic and the immunohistochemical profiles of the 2 distinct components of this tumor were typical for those of pheochromocytoma and neuroendocrine carcinoma. This dual differentiation was also supported by ultrastructural findings. This case not only broadens the morphologic spectrum of composite pheochromocytoma but also provides some additional insight into the histogenesis of this rare but fascinating type of tumor.
Protocol for the Examination of Specimens From Patients With Endocrine Tumors of the Pancreas, Including Those With Mixed Endocrine and Acinar Cell Differentiation
Authors: Compton Carolyn C.
Published: January 2021

No Abstract Available
Evaluation of the BBL MGIT (Mycobacterial Growth Indicator Tube) AST SIRE System for Antimycobacterial Susceptibility Testing of Mycobacterium tuberculosis to 4 Primary Antituberculous Drugs
Authors: Bergmann John S. , Fish Geoffrey , Woods Gail L.
Published: January 2021

Objective.—To evaluate the performance of the BBL MGIT (Mycobacterial Growth Indicator Tube) AST SIRE system for the antimycobacterial susceptibility testing of Mycobacterium tuberculosis to isoniazid (at a concentration equivalent to the lower concentration used for testing by the method of proportion), rifampin, ethambutol, and streptomycin.

Design.—Thirty-one clinical isolates and 30 challenge strains provided by the Centers for Disease Control and Prevention (CDC) were tested by MGIT AST SIRE using 2 methods of inoculum preparation, and results were compared with those of the method of proportion, which was considered the reference method. Clinical isolates for which the results of the 2 methods were discordant also were tested at 2 reference laboratories.

Results.—Based on data from our site and the reference laboratories, agreement rates between initial MGIT AST SIRE results and the method of proportion for the clinical isolates with the inoculum prepared from a McFarland equivalent and from a positive MGIT tube, respectively, were 100% and 96.8% for isoniazid, 100% and 100% for rifampin, 96.8% and 100% for ethambutol, and 100% and 100% for streptomycin, excluding the isolate for which the discordant streptomycin result could not be resolved. For the 30 challenge isolates, agreement rates between MGIT AST SIRE and expected results and between method of proportion and expected results, respectively, were 96.7% and 93.3% for isoniazid, 93.3% and 100% for rifampin, 83.3% and 100% for ethambutol, and 93.3% and 100% for streptomycin. For the clinical isolates, the mean time to an MGIT AST SIRE result of susceptible was 6.15 ± 0.13 days (range, 5–8 days). For a result of resistant, the mean time overall was 5.00 ± 0.24 days (range, 3–8 days).

Conclusion.—These data suggest that the MGIT AST SIRE system, using either method of inoculum preparation, is an acceptable alternative to the BACTEC 460 TB method of susceptibility testing of clinical isolates of M tuberculosis to isoniazid, rifampin, ethambutol, and streptomycin. Reasons for the lower agreement with the CDC challenge isolates should be investigated. Further evaluation of the MGIT AST SIRE system using a concentration of isoniazid equivalent to the higher concentration tested by the method of proportion would be useful, because the decision concerning use of this agent generally is based on the susceptibility test result at the higher concentration.
Massive Noninflammatory Periportal Liver Necrosis Following Concentrated Acetic Acid Ingestion
Authors: Kamijo Yoshito , Soma Kazui , Iwabuchi Keiichi , Ohwada Takashi
Published: January 2021

In a fatal occurrence of massive liver necrosis following ingestion of concentrated (90%) acetic acid, the patient showed evidence of hemolysis, disseminated intravascular coagulation, and liver dysfunction at only 45 minutes after exposure. With refractory to vigorous supportive care, the patient's condition deteriorated until death occurred 39 hours after ingestion, despite some improvement of coagulopathy. Autopsy revealed corrosive injuries in the upper gastrointestinal tract and massive hepatic necrosis in a periportal distribution without significant inflammation. A direct effect of the noxious agent on hepatocytes involving the portal circulation is suggested.
Benign Papillary Mesothelioma of the Tunica Vaginalis Testis
Authors: Xiao Shu-Yuan , Rizzo Paola , Carbone Michele
Published: January 2021

We report a case of benign mesothelioma of the tunica vaginalis testis in a 69-year-old man who presented with a 4-month history of scrotal swelling. A polypoid pedunculated nodule, 1.5 cm in diameter, was found near the head of the right epididymis. Histologically, the tumor exhibited features characteristic of a well-differentiated papillary mesothelioma. The mesothelial origin of this tumor was further supported by immunohistochemical analysis. The tumor cells exhibited nuclear p53 protein accumulation, despite the benign histologic findings and a 3-year uneventful follow-up after resection. A polymerase chain reaction analysis for simian virus 40 DNA was negative. The papillary configuration seen in this tumor is uncommon for this site, inasmuch as benign mesotheliomas of the tunica vaginalis testis usually exhibit an adenomatous pattern. One should be aware of this pattern, and benignity should be mentioned in the pathologic report to prevent overtreatment. In addition, positive p53 immunohistochemical staining should not be taken automatically as evidence for malignancy in this type of lesion.
Low-Grade B-Cell Lymphoma and Concomitant Extensive Sarcoidlike Granulomas
Authors: Dunphy Cherie H. , Panella Michael J. , Grosso Leonard E.
Published: January 2021

Sarcoidlike granulomas may occur in association with Hodgkin lymphoma and non-Hodgkin lymphoma. The granulomas may be concomitant and so extensive that they obscure the malignant process. In addition, a sarcoidosis-lymphoma syndrome has been described in which there appears to be a relationship between sarcoidosis and the development of a lymphoproliferative disorder. We report a case of a low-grade B-cell lymphoma with concomitant extensive sarcoidlike granulomas. The patient had no diagnostic clinical evidence of sarcoidosis, although she had an elevated serum calcium level and increased serum angiotensin converting enzyme activity. Increased serum calcium and serum angiotensin-converting enzyme activity have been associated with clinical sarcoidosis but have also occasionally been described in association with Hodgkin lymphoma and non-Hodgkin lymphoma without evidence of sarcoidosis. We describe our findings and illustrate the usefulness of immunoperoxidase immunophenotyping techniques in such a case.