bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of the structure of titanium scaffolds reproducing the concellous bone
Authors: Skalski Konstanty , Filipowski Ryszard
Published: January 2021

The paper presents the scopes of examination of the cancellous bone, 3D CAD design of scaffolds of the cancellous bone and their creation with a laser beam in SLM incremental technology. The geometrical size of the scaffold and the material feature corresponding to the Young's modulus are the parameters describing the porous structure of the cancellous bone. In the statistical analysis, these values are defined as independent variables. The physical properties of the scaffold are defined by the strength parameters determined by hardness (e.g. HIT, HM, HV and are dependent variables). The REGMULT multiple regression program was used to develop the research results. However, to optimize the porous structure of the scaffold, the single-criteria optimization program SYEQL3 was used.
Das ukrainische Wirtschaftsgesetzbuch im Lichte der Zivilrechtsreform
Authors: Kurzynsky-Singer Eugenia
Published: January 2021

The coexistence of the Civil Code and the Economic Code is a speciality of the Ukrainian legal system which distinguishes it from the most other jurisdictions in the post-Soviet area. The Economic Code is controversially discussed among legal scholars, whereby the most discussed points are the legislative technique of combining public law and private law issues, as well as the fact that some provisions of the Economic Code contradict provisions of the Civil Code. Having its roots in the Soviet legal system and the academic discourse of the Soviet era, the Economic Code to a certain extent conserves Soviet legal thinking in contemporary Ukrainian law. Thus, the reform of economic law should be one of the priorities of legal reforms in Ukraine. A careful revision of the individual provisions and general principles of Ukrainian commercial law with regard to the question whether they are still functional under the current economic and social conditions would be much more important than a general discussion about the Economic Code as such.
The Challenges of Semantic Interoperability in the Era of eScience on the Web
Authors: Campos Maria Luiza de Almeida , Campos Linair Maria , Barbosa Nilson Theobald
Published: January 2021

This article is an exploratory study that intends to present semantic interoperability initiatives in the area of information science and computer science. It discusses these initiatives, focusing on open science and eScience, aiming at pointing out similarities and differences in the methodologies used for an intelligent retrieval of data in heterogeneous environments that do not benefit a universal language. We will illustrate seminal initiatives regarding the compatibility of languages in information science and the alignment and semantic mapping in the area of computer science, emphasizing what they have in common and their differences, showing that those seminal initiatives are still relevant nowadays. In this perspective, we want to bring up discussions about methodologies that supports a kind of “intermediate language” that allows the compatibility of research resources, semantically interconnecting their contents without forcing the use of a single language, but of a switching language, such as a metalanguage that guarantees to keep the differences of each community of speech.
Das Rechtsgefühl im unternehmerischen Vertragsrecht
Authors: Jung Stefanie
Published: January 2021

Dieser Beitrag beschäftigt sich mit dem Rechtsgefühl, verstanden als Gefühl dafür, wie das Recht ausgestaltet sein sollte. Es wird zunächst herausgearbeitet, dass die empirische Ermittlung eines relevanten Rechtsgefühls möglich ist. Sodann werden die potenziellen, legitimen Auswirkungen eines empirisch ermittelten Rechtsgefühls auf das unternehmerische Vertragsrecht erörtert. Insbesondere wird hier vorgeschlagen, das empirisch gemessene Rechtsgefühl bei Auslegungsspielräumen als ein Wertungsargument im unternehmerischen Vertragsrecht zu etablieren.
Technikregulierung durch doppelte Delegation
Authors: Denga Michael , Pohle Jörg , Hölzel Julian
Published: January 2021

Technikregulierung erfolgt häufig durch doppelte Delegation der konkreten Regelausgestaltung - vom Staat an Private und vom Recht in die Informatik. Dabei besteht nicht nur ein Legitimationsdefizit. Wegen Wechseln zwischen disziplinären Logiken tritt auch eine spezifische Unschärfe auf. Der Staat kann mit interdisziplinärer Behördenarbeit gegensteuern. Für Private sollte eine Technology Judgement Rule gelten.
Ungleichheit – Effekte grundlegender Strukturen des Rechts am Beispiel der Corona-Pandemie
Authors: Mörsch Maie
Published: January 2021

Inequality is one of the great challenges of the 21st century. Crises, such as the Corona Pandemic, have the effect of a burning glass on the distributional conditions of a society. This essay attempts to explore the relationship between capitalism and law in relation to the fundamental structures of inequality. The leading question will be to what extent inequality is not so much the result of economic laws, but is rather rooted in the basic and deep structures of the law. The guiding principle underlying the law is consolidated in different areas of law with their individual statutes, legislations and their jurisdictions. This entrenchment in the deep structure of law establishes, manifests and reproduces structures of inequality, which are exemplified by the measures of the Corona Pandemic.
Castrum, curia, berchvrede
Authors: Zangel Frederic
Published: January 2021

Frederic Zangel zeigt in seiner Arbeit, dass die populäre Verknüpfung der Begriffe »Burgen« mit »Rittertum« zu kurz greift. Das Werk setzt sich gründlich mit der forschungsgeschichtlichen Entwicklung und Definition des Burgenbegriffs auseinander. Anhand der schriftlichen Quellen wird die Bedeutung der Burgen Holsteins und Stormarns als Orte der Macht, Politik und Kirche verdeutlicht. Der Band enthält zahlreiche Abbildungen sowie ein umfangreiches und detailliertes Burgenverzeichnis für Holstein und Stormarn.
Die Formen des Teufels
Authors: Bergengruen Maximilian
Published: January 2021

Wie eignet sich die Literatur des Barock in ihrer Auseinandersetzung mit den Theorien der Hexenverfolgung die teuflische Fähigkeit an, die Imagination des Menschen zu beeinflussen?

Maximilian Bergengruen rekonstruiert in diesem Buch die Auseinandersetzung der frühneuzeitlichen Literatur mit der zeitgenössischen Theologie des Bösen und den dämonologischen Theorien der Hexenverfolgung. Mit den »Formen des Teufels« geht es einerseits um die damals vieldiskutierte Frage, ob der Teufel durch Manipulation der Imagination des Menschen die Formen der Schöpfung verändern kann. Andererseits ist die Rede von den literarischen Formen oder Gattungen, deren sich die Literatur bedient, wenn sie den Teufel oder das Böse thematisiert. Die These, die dem Buch zu Grunde liegt, besagt nun, dass diese beiden Form-Begriffe miteinander in Verbindung stehen: Im Rahmen von »teuflischen« Gattungen wie Exempel und Satire wird etwas denkbar, was in der frühneuzeitlichen Theologie oder Dämonologie eigentlich ausgeschlossen ist: eine gewisse Assoziierung, ja Identifizierung der erzählenden Instanz mit dem Teufel. Die Literatur des Barock gibt unter der Hand zu verstehen, dass auch sie sich der teuflischen Fähigkeit bedient, die Imagination des Menschen zu manipulieren.
First find of Cadophora antarctica Rodr.-Andrade, Stchigel, Mac Cormack & Cano in the Arctic
Authors: Iliushin Vadim Alexandrovich
Published: January 2021

Cadophora antarctica Rodr.-Andrade, Stchigel, Mac Cormack & Cano was isolated from spoil tip of coal mine in the Arctic, on the territory of the Svalbard archipelago, and is represented by strain IVA-206. Macro- and micromorphology of the isolate were examined along with partial sequences of Internal transcribed spacer rDNA region (ITS1-5.8S-ITS2) and D1/D2 region of 28S rDNA (LSU). The isolate C. antarctica IVA-206 had a number of features that distinguished it from the strain C. antarctica CBS 143035 from Antarctica. Colonies of Arctic strain had darker pigmentation, ramoconidia and conidia were larger, and the optimal growth temperature was higher. As a result of our study, we first discovered the microfungi C. antarctica Rodr.-Andrade, Stchigel, Mac Cormack & Cano in the Arctic. Our study shows that C. antarctica Rodr.-Andrade, Stchigel, Mac Cormack & Cano is a bipolar species found in both the Arctic and Antarctic region.
Superficial self-diffusion coefficient in Ih-ICE
Authors: Di Prinzio Carlos Leonardo , Stoler Damian , Varela Guillermo Aguirre , Druetta Esteban
Published: January 2021

The evolution of the grain boundary groove in a bicrystalline ice sample was studied in this work. The groove is formed by the intersection of the grain boundary with the free surface. The bicrystalline ice sample had an arbitrary misorientation and was immersed in ultra-pure silicone oil at -5°C in order to avoid evaporation processes. Photographs of the groove were taken every 17 minutes for 100 hours with an optical microscope and the evolution of the groove was determined from these images. Through this study, it was possible to measure the coefficient of surface self-diffusion of the ice at -5°C.
Biometrical analysis and thallus morphology characteristics of Placopsis antarctica from King George Island, Antarctica ( Short Communication )
Authors: Weiss Johanna , Orekhova Alla
Published: January 2021

Placopsis antarctica is an ornithocoprophilous lichen that has been for a long time confused with P. contortuplicata I. M. Lamb. In our study, we focused on morphological characteristics of P. antarctica thalli. We report biometrical data on dominant morphological structures of P. antarctica thallus: cephalodia, marginal lobes, sorediate pits and soralia. Thalli of P. antarctica were collected at the King George Island, Antarctica and analyzed in a laboratory using a digital microscopy approach. Central cephalodium was found rather elliptic then round-shaped. Mean length/width was found 2.424/1.720 mm. Marginal lobes were found wider at the apex (1.415 mm) than basal part (0.495 mm). Side cephalodia were smaller, their mean length/width was found 1.034/0.610 mm.
Low-Grade Monoclonal Epstein-Barr Virus–Associated Lymphoproliferative Disorder of the Brain Presenting as Human Immunodeficiency Virus–Associated Encephalopathy in a Child With Acquired Immunodeficiency Syndrome
Authors: Kingma D. W. , Mueller B. U. , Frekko K. , Sorbara L. R. , Wood L. V. , Katz D. , Raffeld M. , Jaffe E. S.
Published: January 2021

The association of the Epstein-Barr virus with human immunodeficiency virus–associated primary central nervous system lymphomas is well known. We describe a pediatric patient infected with human immunodeficiency virus who developed a lesion in the central nervous system that appeared to be histologically reactive and that proved to be an Epstein-Barr virus–associated monoclonal B-cell lymphoproliferative disorder by molecular analysis. An 8-year-old girl was diagnosed with vertically transmitted human immunodeficiency virus infection at age 5, for which she was treated empirically with a combination of zidovudine and didanosine. At the age of 7 years, during evaluation for entry into an antiretroviral protocol, a single hypodense frontal lobe lesion was identified by computed tomography. After unsuccessful treatment for presumed toxoplasmosis and progressive neurologic deterioration, a stereotactic brain biopsy was performed. Although the biopsy contained a polymorphic lymphoid infiltrate that appeared to be cytologically reactive, polymerase chain reaction and in situ hybridization studies revealed a monoclonal Epstein-Barr virus–associated B-cell lymphoproliferative disorder, which was reminiscent of polymorphic B-cell hyperplasia observed in the setting of immunosuppression following organ transplantation. Postoperative therapy included steroids and antiretroviral therapy. The lesion decreased slightly in size, and the child's neurologic status was relatively unremarkable for 5 months. Subsequently, she developed cytomegalovirus retinitis, progressive encephalopathy, and died with pancytopenia. This case represents a newly described manifestation of Epstein-Barr virus–associated lymphoproliferative disorder, a diagnosis that should be considered in patients with neurologic symptoms and immunodeficiency. In addition, this case exhibited histologic features reminiscent of posttransplant lymphoproliferative disease, a histologic pattern that to our knowledge has not previously been reported in the setting of acquired immunodeficiency syndrome.
Coexistence of Erythrocyte Agglutination and EDTA-Dependent Platelet Clumping in a Patient With Thymoma and Plasmocytoma
Authors: Bizzaro Nicola , Fiorin Francesco
Published: January 2021

For 8 years, EDTA-dependent pseudothrombocytopenia was observed in a 55-year-old woman with a history of rheumatoid arthritis who had undergone surgery for lymphoepithelial thymoma 11 years earlier. The clinical picture was characterized by the presence of platelet clumps and antiplatelet antibodies of the IgM class. With the recent appearance of a solitary extramedullary plasmocytoma in the right retrobulbar region and the detection of an IgGλ monoclonal gammopathy, blood examination also revealed erythrocyte agglutinates alongside the platelet clumps and the presence of a cold IgG antibody with anti-l specificity. Both phenomena were observed in vitro when the sample temperature declined to 20°C to 25°C, but not at 37°C. While the EDTA-dependent antiplatelet antibodies did not appear to be chronologically correlated with the patient’s diseases, the cold antierythrocyte autoantibodies were strictly related to the plasmocytoma and the IgGλ monoclonal component in serum. To our knowledge, this is the first description of an association between EDTA-dependent platelet and erythrocyte agglutinates, with a clinical picture of pseudothrombocytopenia and pseudoerythrocytopenia due to cold agglutinins.
Severe Intrahepatic Cholestasis Caused by Amiodarone Toxicity After Withdrawal of the Drug
Authors: Chang Chung-Che , Petrelli Mary , Tomashefski Joseph F. , McCullough Arthur J.
Published: January 2021

Cholestasis has been reported as a rare presentation among patients with severe liver injury secondary to amiodarone hepatic toxicity. We report an unusual case of amiodarone-induced cholestatic hepatotoxicity occurring after amiodarone had been discontinued and the initial abnormal liver function findings had improved. The patient, without jaundice at the initial presentation, developed severe jaundice about 4 months after withdrawal of amiodarone. Light and transmission electron microscopic examination of a specimen secured by computed tomographically guided liver biopsy was consistent with amiodarone hepatic toxicity as the cause of intrahepatic cholestasis. An abdominal ultrasound, endoscopic retrograde cholangiography, and dimethyl iminodiacetic acid and computed tomographic scans of the abdomen all failed to demonstrate any other causes for jaundice other than amiodarone toxicity. Thus, amiodarone hepatic toxicity may occur after drug withdrawal even if results of liver function tests improve. Histopathologic examination of a liver biopsy specimen is of value for diagnosis and prognosis. The liver biopsy findings, clinical course, and liver function test results are discussed, and the English-language literature on amiodarone cholestatic hepatotoxicity is reviewed.
Assessment of Laboratory Performance With Streptococcus pneumoniae Antimicrobial Susceptibility Testing in the United States
Authors: Doern Gary V. , Brueggemann Angela B. , Pfaller Michael A. , Jones Ronald N.
Published: January 2021

Objective.—To assess the performance of clinical microbiology laboratories in the United States when conducting in vitro susceptibility tests with Streptococcus pneumoniae.

Methods.—The results of a nationwide College of American Pathologists Proficiency Survey test sample, in which susceptibility testing of an isolate of S pneumoniae was performed, were assessed with respect to precision and accuracy.

Results.—Wide variability was noted among participating laboratories with both minimum inhibitory concentration procedures and disk diffusion susceptibility tests when both methods were applied to S pneumoniae. Despite this high degree of variation, categorical interpretive errors were uncommon. Numerous laboratories reported results for antimicrobial agents that are not recommended by the National Committee for Clinical Laboratory Standards for tests with S pneumoniae.

Conclusions.—Current susceptibility testing practices with S pneumoniae in the United States indicate limited precision and a tendency for laboratories to test and report results obtained with antimicrobial agents of questionable therapeutic value against this organism. Continued efforts to standardize susceptibility testing of S pneumoniae in the United States are warranted. In addition, modifications of existing interpretive criteria may be necessary.
Zygomycosis Due to Apophysomyces elegans
Authors: Kimura Masatomo , Smith Michael B. , McGinnis Michael R.
Published: January 2021

Objective.—The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen.

Methods.—Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A elegans that have been reported in the literature were reviewed.

Results.—Both patients developed infection due to A elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A elegans, was isolated from each case.

Conclusion.—Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. Infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin B. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy.
Testicular Fibroma of Gonadal Stromal Origin With Minor Sex Cord Elements
Authors: de Pinieux Gonzague , Glaser Claire , Chatelain Denis , Perie Guy , Flam Thierry , Vieillefond Annick
Published: January 2021

Objective.—To report the histologic and immunohistochemical features of 2 cases of intratesticular fibromatous tumors.

Results.—Microscopically, these tumors were composed of short, randomly interweaving fascicles of spindle cells dispersed within a fibrocollagenous stroma. A sex cord component was detected in one case by microscopic examination and in both cases by immunohistochemical study using MIC2 and anti-inhibin antibodies.

Conclusions.—The presence of minor sex cord elements, morphologically or by immunohistochemistry, suggests that these fibromatous tumors are related to and are a subset of sex cord–stromal tumors. Intratesticular fibromatous tumors, of which 11 other cases lacking sex cord elements have been reported, could be considered as the testicular equivalent of ovarian fibroma. These tumors could then be referred to as testicular fibroma of gonadal stromal origin, with or without minor sex cord component.
An Overview of State Efforts to Improve Transfusion Medicine: The New York State Model
Authors: Linden Jeanne V. , Schmidt Gale B.
Published: January 2021

Objective.—New York State must provide effective oversight for more than 400 facilities that provide blood services, ensuring the safety of transfusion recipients.

Program Structure.—Oversight is based on educated, trained program staff; a council of transfusion medicine experts; regulations governing laboratories and blood banking services; proficiency testing; requirements for reporting transfusion-related errors and incidents; tracking collection, testing, and disposition of all blood; inspections; partnership with the Food and Drug Administration; and investigation of incident reports. Policy letters and guidelines (eg, umbilical cord blood, transfusion-associated infections, intraoperative blood recovery) supplement regulations.

Observations.—Standards are maintained through education by a responsive, proactive oversight program. Areas warranting stricter regulation or supplemental educational guidelines are identified by periodic assessment of standards of practice and review of reported information.

Conclusion.—The multifaceted oversight program contributes to efforts to improve transfusion medicine.
How to Improve Transfusion Medicine: A Treating Physician's Perspective
Authors: Alving Barbara , Alcorn Kirsten
Published: January 2021

As transfusion medicine becomes more complex, cooperative strategies are gaining increasing importance in relaying information to the treating physician and in incorporating the treating physician into the education and quality control processes. The broad domain of transfusion medicine is illustrated by the variety of disciplines involved in defining the use of products such as fresh frozen plasma and the newly released solvent-detergent–treated plasma, fibrin glue and highly purified fibrin sealant, and leukoreduced and irradiated blood products. Cooperative efforts among physicians and other personnel of multiple disciplines are essential to ensure appropriate use and continuous evaluation of blood products.
The “P's and Q's” of Quality Systems
Authors: Hanson Margaret
Published: January 2021

Quality improvement in blood collection centers has been a priority of regulatory and accrediting agencies for the past several years. The Food and Drug Administration and the American Association of Blood Banks have developed guidelines for quality assurance activities. Inspection programs have focused on evaluation of processes and how they are controlled to assure the safety and efficacy of blood components. A review of Food and Drug Administration enforcement actions shows that all such actions cite similar deficiencies related to management control, personnel training, error, and record management policies. A quality program that includes management commitment to compliance and continuous improvement, defined personnel training, internal audit, and error management policies provides documented evidence to management and regulatory agencies that operations are in control.
Outcomes in Transfusion
Authors: Sherman Laurence A.
Published: January 2021

Outcomes data in medicine can be limited by subjective methodologic issues such as poor selection of end points and use of nonvalidated systems for quality adjustment. Blood transfusion analyses are further complicated by the fact that transfusion seldom is primary therapy but is usually supportive or adjunctive. Thus, much of the outcome data in transfusion medicine are either unavailable or in one of two areas. The first area is prevention of bad sequelae of various cytopenias or factor deficiencies. The second is decreasing adverse effects of transfusion itself. A different useful area for outcome and root cause approaches in individual institutions is examining preanalytical and postanalytical processes of their own. Examples are sample labeling accuracy, quality and timeliness of blood suppliers, internal delivery processes and times, and product wastage. Use review can be changed to real time from retrospective time. By reducing complaints about service to objective data, realistic change can be made in internal and external processes.
Necessity of Clinical Information in Surgical Pathology
Authors: Nakhleh Raouf E. , Gephardt Gordon , Zarbo Richard J.
Published: January 2021

Objectives.—To examine the frequency and nature of problems caused by inadequate clinical data provided on surgical pathology requisition forms.

Design.—Participants in the 1996 Q-Probes voluntary quality improvement program of the College of American Pathologists were asked to document prospectively all surgical pathology cases with inadequate information. Inadequate clinical information was defined as the pathologist's need for additional clinical information before a diagnosis could be rendered, regardless of the amount of information already present on the requisition slip. Cases that had no clinical information on a requisition slip were not counted if the lack of history did not hinder diagnosis. The study concluded when 3 months had elapsed or 40 surgical pathology cases were documented. The following data were recorded for each case: anatomic site, type of procedure, nature of disease, method of obtaining additional information, importance of obtained information, and the length of delay in the final diagnosis.

Participants.—Three hundred forty-one laboratories, 322 of which were from the United States.

Results.—A total of 5594 cases (0.73%) required additional clinical information for diagnosis (10th through 90th percentile range, 3.01% to 0.08%). Institutions with greater average occupied bedsize, a greater number of cases accessioned per year, and a greater number of pathologists had a lower percentage of cases with inadequate clinical data (P < .05). Sixty-eight percent of these cases had no delay in completion of a case, 16.2% had a delay of 1 day or less, and 15.1% of cases were delayed more than 1 day. In 59.4% of cases, the additional clinical information obtained confirmed the initial diagnostic impression. In 25.1%, the information was not relevant to the pathologic diagnosis. In 6.1% there was a substantial change in the diagnosis or a revised report was issued, and in 2.2% no additional information could be obtained. Specific anatomic sites that correlated with a higher rate of changed diagnoses or revised reports in cases with inadequate information included the small bowel, the bronchus/lung, and the ovary. Resection specimens were also significantly associated with a higher rate of changed diagnoses or revised reports when additional information was obtained, as were malignant neoplasms and therapy-induced changes.

Conclusions.—This study establishes an aggregate rate of cases with inadequate clinical information for diagnosis (0.73%) and documents the extent of problems caused by inadequate clinical information. The criticality of appropriate clinical information provided to the pathologist is identified for specific anatomic sites and disease processes and is reflected in changed diagnoses or revised reports.
Comparison of the Vitek GPS-TB Card With Disk Diffusion Testing for Predicting the Susceptibility of Enterococci to Vancomycin
Authors: Williams-Bouyer Natalie , Reisner Barbara S. , Woodmansee Carla E. , Falk Pamela S. , Mayhall C. Glen
Published: January 2021

Objective.—To compare the ability of the Vitek GPS-TB card with disk diffusion testing for determining the susceptibility of enterococci to vancomycin.

Design.—Vitek susceptibility testing was performed using the GPS-TB card and software version R05.03. Disk diffusion susceptibility testing was performed according to National Committee for Clinical Laboratory Standards guidelines. When discrepancies occurred between the interpretation of Vitek and disk diffusion, both tests were repeated and the epsilometer test (E test) and agar screen containing 6 μg/mL vancomycin were performed.

Results.—Of 415 isolates tested, 313 were susceptible to vancomycin and 97 were resistant to vancomycin by both test methods. Two isolates were intermediate by Vitek and resistant by disk diffusion, 2 were intermediate by Vitek and susceptible by disk diffusion, and 1 was susceptible by Vitek and intermediate by disk diffusion. All but 1 of these latter 5 isolates (intermediate by Vitek and susceptible by disk diffusion) were available for retesting. On repeat testing, the 2 isolates that were intermediate by Vitek and resistant by disk diffusion were resistant by both methods, the 1 isolate that was intermediate by Vitek and susceptible by disk diffusion was susceptible by both methods, and the isolate that was susceptible by Vitek and intermediate by disk diffusion was also susceptible by both methods. These results were confirmed by E test and agar screen.

Conclusion.—We found the results of the GPS-TB card compared well with disk diffusion. However, isolates with intermediate results by Vitek should be retested using another method, such as the E test.
Immunohistochemical Detection of Parathyroid Hormone–Related Protein in a Cutaneous Squamous Cell Carcinoma Causing Humoral Hypercalcemia of Malignancy
Authors: Crespo Manuel , Sopeña Bernardo , Orloff John J. , Teijeiro Jorge F. Cameselle , Dann Pamela , Andrade María A. , Freire Mayca , de la Fuente Javier , Martinez-Vazquez César
Published: January 2021

Humoral hypercalcemia of malignancy is a cancer-related hypercalcemia caused by production of humoral factors by malignant cells in patients without bone metastases. Squamous cell carcinomas are the tumors most frequently associated with humoral hypercalcemia of malignancy, and parathyroid hormone–related protein is the main humoral factor implicated. In spite of the fact that normal keratinocytes produce parathyroid hormone–related protein, it is highly unusual for patients with squamous cell carcinomas of the skin to present with humoral hypercalcemia of malignancy. We present a well-documented case of cutaneous squamous cell carcinoma complicated by hypercalcemia in a patient with high levels of plasma parathyroid hormone–related protein and immunohistochemical evidence of high parathyroid hormone–related protein production by the tumoral cells.
Amplicor Enterovirus Polymerase Chain Reaction in Patients With Aseptic Meningitis
Authors: Hadziyannis Emilia , Cornish Nancy , Starkey Colleen , Procop Gary W. , Yen-Lieberman Belinda
Published: January 2021

Objective.—To evaluate the sensitivity and specificity of reverse-transcription polymerase chain reaction (RT-PCR) and routine cell culture for the detection of enterovirus in cerebrospinal fluid.

Methods.—Thirty-eight cerebrospinal fluid specimens were included. Cell culture was inoculated immediately and incubated for 14 days. An aliquot was kept frozen for Amplicor RT-PCR. Chart review was performed to determine the validity of the results.

Results.—Nine of 38 specimens were positive for enterovirus by culture, and 14 were positive by RT-PCR. There were 7 discrepancies between the 2 methods. Six specimens were positive by RT-PCR and negative by the culture method. The 1 culture-positive but RT-PCR–-negative specimen was determined to contain PCR inhibitors. All discrepant results were confirmed as true positives by chart review. Patients whose cerebrospinal fluid was negative by both methods had a final diagnosis other than enterovirus infection.

Conclusion.—Amplicor PCR is more sensitive than cell culture (93.3% vs 60%) and is very specific. With the incorporation of appropriate controls for the detection of amplification inhibitors, RT-PCR could be a valuable tool in the diagnosis of enteroviral meningitis.
Lipomatous Hemangiopericytoma
Authors: Ceballos Katherine M. , Munk Peter L. , Masri Bassam A. , O'Connell John X.
Published: January 2021

Hemangiopericytoma of soft tissue is a controversial pathologic entity. The relative nonspecificity of the characteristic branching capillary pattern and cytologic features of the constituent cells, in addition to the lack of a distinct immunohistochemical staining profile, has resulted in uncertainty and a lack of consensus regarding this subgroup of tumors. Notwithstanding the doubt surrounding this entity, a morphologically unique variant, designated lipomatous hemangiopericytoma, was reported in 1995. To our knowledge, there have been no further reports of these tumors since the original description. We describe a lipomatous hemangiopericytoma that arose within the thigh of a 41-year-old woman. The tumor presented as a slowly enlarging, minimally tender, pulsatile mass. The tumor was completely excised and was found to be composed of an admixture of typical hemangiopericytoma and predominantly mature adipose tissue. Unlike previous descriptions of this entity, the current example exhibited a full range of adipocyte differentiation, including many multivacuolated adipocytes of variable size with characteristic nuclear scalloping (lipoblast-like cells). The mitotic count was less than 2 per 10 high-power fields examined. The clinical course has been benign during the short follow-up period. We discuss the pathologic features, including the immunohistochemical staining profile and ultrastructural appearance of this distinctive tumor, and briefly discuss the relationship between hemangiopericytoma and solitary fibrous tumor of soft tissue, a neoplasm with many clinical and pathologic similarities.
Metastatic Leydig Cell Tumor With Sarcomatoid Differentiation
Authors: Gulbahce H. Evin , Lindeland Arthur T. , Engel William , Lillemoe Tamera J.
Published: January 2021

Leydig cell tumors of the testis are uncommon. Only about 10% of cases have a malignant course. It has been stated that the only definite criterion for malignancy is presence of metastasis. We present a 47-year-old patient with metastatic Leydig cell tumor 17 years after initial diagnosis, to our knowledge the longest reported interval between diagnosis and the development of metastasis. The primary tumor did not exhibit convincing features of malignancy. The initial metastasis in the right perirenal fat tissue showed a biphasic tumor with sarcomatoid differentiation not described previously in a metastatic Leydig cell tumor.
Lymphoma of the Breast
Authors: Topalovski Margarita , Crisan Domnita , Mattson Joan C.
Published: January 2021

Background.—Primary lymphomas of the breast are rare, accounting for 1.7% to 2.2% of extranodal lymphomas and 0.38% to 0.7% of all non-Hodgkin lymphomas. Although secondary breast lymphomas are also rare, they represent the largest group of metastatic tumors of the breast.

Objectives.—To investigate the clinicopathologic and immunophenotypic characteristics of breast lymphomas, the relative frequency of primary and secondary mammary lymphomas, and in selected cases, the role of gene rearrangement analysis in diagnosis and staging of these lymphomas.

Results.—We conducted a retrospective review of 22 cases of breast lymphoma diagnosed at William Beaumont Hospital, Royal Oak, Mich, during a 30-year period (1963–1994). Eleven of the 22 cases fulfilled the criteria for primary breast lymphoma; these cases represented 0.6% of all non-Hodgkin lymphomas seen in our hospital. Of the 11 cases, 5 were diffuse large B-cell lymphomas, 2 were follicle center lymphomas, 2 were marginal zone B-cell lymphomas (mucosa-associated lymphoid tissue type), 1 was a lymphoplasmacytoid lymphoma, and 1 was a peripheral B-cell neoplasm, unclassified. Using a panel of immunohistochemical stains (CD45RO, CD45RA, CD43, CD3, CD20, CD30, CD68, and HLA-DR), 8 cases demonstrated unequivocal B-cell phenotype and 3 cases had equivocal or weak staining patterns for B-cell markers. We identified no cases of T-cell lymphoma. Of 7 cases that had bone marrow biopsies for staging, 3 were positive morphologically for bone marrow involvement. Molecular analysis of B- and T-cell gene rearrangement was used to exclude bone marrow involvement in one case with bone marrow lymphoid aggregates and to confirm negativity in a case that was morphologically negative. Of the 11 secondary breast lymphomas, 5 were diffuse large B-cell lymphomas; 1 was diffuse large B-cell, primary mediastinal subtype; and 5 were follicle center lymphomas.

Conclusions.—Breast lymphomas represented 1.2% of all non-Hodgkin lymphomas in this study; the frequency of primary and secondary cases was equal. In both groups, right breast lesions were predominant, and the most frequent morphologic type was diffuse large B-cell lymphoma. Gene rearrangement analysis is helpful in selected cases to rule out bone marrow involvement, especially in older patients, in whom lymphoid aggregates are common.
Relevance of Apolipoprotein E Polymorphism for Coronary Artery Disease in the Saudi Population
Authors: Dzimiri Nduna , Meyer Brian F. , Hussain Syed S. , Basco Chona , Afrane Barima , Halees Zohair
Published: January 2021

Background.—The apolipoprotein E alleles ε2 and ε4 have been reported as independent risk factors for coronary artery disease (CAD) and as predictors for the development of atherosclerosis.

Methods and Results.—We determined by polymerase chain reaction the distribution of apolipoprotein E polymorphism in 320 Saudi blood donors (BD), 96 CAD patients, and 40 control subjects who had undergone angiography. Compared to controls, only ε4 was elevated in CAD patients. More than 61% (P < .0001) of the patients had angina, and 52.1% (P < .05) were diabetic; both of these factors were strongly associated with the presence of allele ε2. The ε2 allele was also associated with hypertension, elevated serum triglycerides, and total cholesterol. On the other hand, the allele ε4 appeared to be associated with increased risk of CAD and was also associated with hypertension, 3-vessel disease, and restenosis.

Conclusions.—Accordingly, ε4 may be associated with increased risk of CAD, whereas ε2 appears to be a predictor of several risk factors for atherosclerosis.
Very Low-Density Lipoprotein Receptor in Fetal Intestine and Gastric Adenocarcinoma Cells
Authors: Nakamura Yasuhiro , Yamamoto Munehiko , Kumamaru Eriko
Published: January 2021

Background.—A very low-density lipoprotein receptor (VLDLR) was recently identified. This receptor reportedly binds specifically to very low-density lipoproteins; however, its distribution and functions in vivo have yet to be elucidated. We investigated the expression and regulation of VLDLR in fetal and carcinoma cells.

Objective.—The expression of VLDLR was examined by immunohistochemistry and reverse-transcriptase polymerase chain reaction using several specimens, including a fetus of 12 to 15 weeks' gestation, various tumors, AGS cells, and INT407 cells.

Results.—Immunoreactive VLDLR was abundantly present in human fetal intestinal epithelial and gastric adenocarcinoma cells. This receptor was also noted in the intestinal cell line, INT407, and gastric cancer cell line, AGS. In addition, the VLDLR that was expressed in INT407 cells, AGS cells, and gastric adenocarcinoma tissue was present mainly in a variant form lacking the O-linked sugar domain.

Conclusions.—These data suggest that an important function of VLDLR may be the mediation of cell growth in developing tissues, such as fetal intestinal and cancer cells. The INT407 and AGS cell lines appear to be useful for examining the regulation of VLDLR expression.
Expression of Telomerase Activity and Telomerase RNA in Human Soft Tissue Sarcomas
Authors: Yoo Jinyoung , Robinson Robert A.
Published: January 2021

Objective.—To investigate whether telomerase is reactivated in soft tissue tumor and whether telomerase activity is regulated at the transcriptional level.

Design.—Fresh tissue samples of 24 soft tissue sarcomas were analyzed for telomerase activity by a radioactive polymerase chain reaction–based telomeric repeat amplification protocol assay and for human telomerase RNA (hTR) by an in situ hybridization assay.

Setting.—Tertiary care teaching hospital.

Patients.—Twenty-four patients with soft tissue tumor were surgically treated. Twelve patients had malignant fibrous histiocytoma, 5 had liposarcoma, 6 had leiomyosarcoma, and 1 had rhabdomyosarcoma.

Results.—Telomerase activity was detected in 4 sarcoma samples (17%), all of which were positive for hTR. Expression of hTR was demonstrated in 13 sarcomas (54%), 4 of which were positive for telomerase and 9 of which were negative for telomerase. One (50%) of 2 grade 1 tumors, 9 (50%) of 18 grade 2 tumors, and 3 (75%) of 4 grade 3 tumors showed hTR expression.

Conclusions.—The relatively low frequency of telomerase activity in soft tissue sarcomas suggests that telomerase may not play an important role in tumorigenesis in these tumors. Telomerase ladders were demonstrated only in association with tumors expressing hTR. It is noteworthy that half of the patients with grade 1 and 2 tumors expressed hTR, suggesting that telomerase RNA may be useful as a marker for identifying tumor aggressiveness earlier than the conventional histopathologic grading scale.
Salivary Gland Basal Cell and Canalicular Adenomas
Authors: Zarbo Richard J. , Prasad Anil R. , Regezi Joseph A. , Gown Allen M. , Savera Adnan T.
Published: January 2021

Objective.—To evaluate cellular composition of salivary gland adenomas using 3 monoclonal antibodies that recognize a smooth muscle phenotype confirmed to be sensitive for myoepithelial differentiation.

Design.—Immunohistochemical evaluation of 25 salivary gland basal cell and canalicular adenomas.

Setting.—Archival pathology material from the files of Henry Ford Hospital, Detroit, Mich, and the University of California at San Francisco.

Results.—All basal cell adenoma variants exhibit some degree of myoepithelial cell participation with periductal, epithelioid, and spindled (stromal-like) morphologic structures. Only the canalicular adenomas, even if mixed with trabecular and solid patterns, are devoid of staining with these 3 antibodies, suggesting an adenoma composed exclusively of ductal luminal cells.

Conclusions.—There is an overlapping histomorphologic and common cellular composition of the basal cell adenoma variants with other recognized adenomas, such as pleomorphic adenoma and myoepithelioma. Relative differentiation toward 3 cell phenotypes (ductal luminal, basal, and myoepithelial) and the character of extracellular matrix production in varying proportions by the neoplastic myoepithelial cells distinguishes the spectrum of salivary gland adenomas identified in current classification schemes.
Pleomorphic Hyalinizing Angiectatic Tumor of Soft Parts
Authors: Groisman Gabriel M. , Bejar Jacob , Amar Mary , Ben-Izhak Ofer
Published: January 2021

We report morphologic, flow cytometric, and immunohistochemical findings in two cases of pleomorphic hyalinizing angiectatic tumor of soft parts. Both patients were middle-aged women with subcutaneous lesions located in the lower extremity. The tumors consisted of sheets of spindled and pleomorphic cells with frequent intranuclear pseudoinclusions associated with clusters of ectatic vessels surrounded by prominent perivascular hyaline material. Numerous, nonhyalinized vessels were also present, mostly in the peripheral areas of the lesions. Some of these vessels had their walls permeated by numerous small capillaries. Immunostaining for vascular endothelial growth factor (VEGF), a secreted protein that has been implicated in tumor-associated angiogenesis, demonstrated positive staining in both tumoral and endothelial cells. Tumor cells were also reactive to vimentin and CD34. Focal positivity for CD99 and factor XIIIa was also present. Flow cytometry yielded a diploid DNA histogram with S-phase fraction of 7%. Our findings corroborate those from previously reported cases. They further suggest that angiogenesis and the angiogenic factor VEGF may play a role in the development of this peculiar tumor.
Fulminant Parvovirus Infection Following Erythropoietin Treatment in a Patient With Acquired Immunodeficiency Syndrome
Authors: Borkowski Joanna , Amrikachi Mojghan , Hudnall S. David
Published: January 2021

We report the case of a 41-year-old black man with acquired immunodeficiency syndrome who developed a severe chronic anemia due to parvovirus infection. Bone marrow biopsy revealed erythroid aplasia. The infectious nature of the anemia was not recognized, and the patient was treated with erythropoietin. The patient's reticulocyte response was inadequate, however, and he remained anemic. A second bone marrow biopsy showed erythroid hyperplasia and prominent intranuclear parvovirus inclusions within erythroid progenitors. Erythropoietin was discontinued and was followed by a course of intravenous immunoglobulin, which resulted in rapid correction of anemia. To our knowledge, this is the first reported case of fulminant human parvovirus infection exacerbated by erythropoietin administration and documented by sequential bone marrow histologic examination. This case illustrates the critical importance of considering parvovirus in the etiology of chronic anemia with erythroid aplasia in immunocompromised patients.
Laboratory Abnormalities in Former Blood Donors Seropositive for Human T-Lymphotropic Virus Types 1 and 2
Authors: Glynn Simone A. , Murphy Edward L. , Wright David J. , Sacher Ronald A. , Fridey Joy , Schreiber George B.
Published: January 2021

Context.—The human T-lymphotropic viruses types 1 and 2 (HTLV-1 and HTLV-2) are highly prevalent among injection drug users in the United States. However, the clinical course of infection has not been well characterized.

Objective.—To understand HTLV-1–and HTLV-2–associated laboratory abnormalities, which may provide insights into their underlying pathophysiology.

Design.—Cohort study.

Setting.—Five US blood centers.

Participants.—A total of 133 HTLV-1–and 332 HTLV-2–seropositive former blood donors and 717 HTLV-seronegative donors followed up prospectively since 1991.

Main Outcome Measures.—Selected serum chemistry tests and complete blood cell counts were analyzed at enrollment and approximately 2 years later in participants. Repeated-measures analyses were conducted to evaluate the effect of HTLV infection on laboratory measures.

Results.—Compared with seronegative subjects, HTLV-1–seropositive subjects had 13% higher creatine kinase (P = .02) and slightly elevated lactate dehydrogenase (P = .03) levels at follow-up. The HTLV-2–seropositive participants had 11% higher absolute lymphocyte counts than seronegative subjects (P = .0001). Infection with HTLV-2 also appeared to be associated with slightly higher hemoglobin levels (P = .03) and hematocrit (P = .03) and with lower albumin levels (P = .01).

Conclusions.—These results further our understanding of the biological mechanisms underlying HTLV and suggest that HTLV-associated laboratory changes are unlikely to alter clinical evaluation or counseling of otherwise healthy HTLV-infected subjects.