bluuebunny/crossref_metadata_2025 huggingface dataset:
Melt Treatment-Porosity Formation Relationship in Al-Si Cast Alloys
Authors: Gagnon Dominique , M. Samuel Agnes , H. Samuel Fawzy , H. Abdelaziz Mohamed , W. Doty Herbert
Published: February 2021

The present study focuses on the porosity formation in three Al-Si cast alloys widely used in automotive industries viz. A319.0, A356.0, and A413.0 alloys under various conditions: stirring, degassing. Sr level, amount of grain refining, combined modification and grain refining, as well as hydrogen level. The solidification rate was the same for all alloys in terms of the mold used and its temperature. The microstructural investigations were carried out quantitatively using an optical microscope-image analyzer system scanning systematically over a polished sample area of 25 mm × 25 mm and qualitatively using an electron probe microanalzer equipped with EDS and WDS systems. The results were coupled with hardness measurements.
Conservation of Edible Ectomycorrhizal Mushrooms: Understanding of the ECM Fungi Mediated Carbon and Nitrogen Movement within Forest Ecosystems
Authors: Vaario Lu-Min , Matsushita Norihisa
Published: February 2021

Most edible ectomycorrhizal (ECM) mushrooms are currently harvested from nature and many of them are high-priced. Demand for the wild mushrooms as a culinary delicacy has stimulated research that aims to understand (1) the puzzled role that the ECM fungi play in the forest ecosystem, and (2) nutritional and other requirements for fruiting, which is highly variable. In this review, we focus on understanding of the ECM fungi mediated carbon and nitrogen movement between the symbiotic partners and on the interactions with other fungi in forest ecosystems. Thereby, we better understand the diverse nitrogen requirements for edible ECM fungal growth and mushroom fruiting. We attempt to provide a theoretical basis for the future research of edible ECM mushrooms in wild and controlled conditions.
Impact of Biofeedback Interventions on Driving Performance in Individuals with Persistent Post-Concussive Symptoms
Authors: M. Bonn Marquise , Alvarez Liliana , W.G. Thompson James , P. Dickey James
Published: February 2021

Low resolution electromagnetic tomography (LoRETA) neurofeedback and heart rate variability (HRV) biofeedback may improve driving ability by enhancing attention, impulse control, and peripheral vision, and reducing stress. However, it is unclear whether combined LoRETA neurofeedback and HRV biofeedback can improve driving performance for individuals experiencing persistent post-concussive symptoms (PPCS). In this study, seven individuals with PPCS completed an eight-week LoRETA neurofeedback and HRV biofeedback intervention. Changes in participants’ simulated driving performance and self-reported symptoms were measured and compared to two control groups: individuals with PPCS (n = 9), and healthy control participants (n = 8). Individuals in the intervention and PPCS control groups reported reduced PPCS severity (p < .05) compared to healthy control participants. Interestingly, individuals in the intervention group responded variably. These results indicate that more research is necessary to identify the subgroup of individuals that respond to LoRETA neurofeedback and HRV biofeedback and confirm these preliminary results.
The Impact of Interpersonal Relationships on Dietary Habits
Authors: D. Intiful Freda , Steele-Dadzie Rebecca , Mawusi Amos Patricia , Pobee Ruth , Ainuson-Quampah Joana , Ammah Christina , Antwi Theresa , Nkum Wilson Kwesi , Asante Matilda
Published: February 2021

In recent times, there is significant level of evidence to suggest a transition in the eating pattern and dietary habits of people across the globe. Food, though a physiological necessity and required for good health and functionality, also contributes to the social, cultural, psychological and emotional well-being of our lives. There is no doubt that relationships contribute to how, what and when people eat. This chapter will review the impact of how different categories and levels of interpersonal relationships impact on the development of dietary habits among people. Additionally the chapter will explore how the advent of the novel corona virus, covid-19 has impacted on interpersonal relationships and consequently on dietary habits.
Modeling and Validating Analytic Relations for Electromagnetic Shielding Effectiveness of Fabrics with Conductive Yarns
Authors: Razvan Radulescu Ion , Surdu Lilioara , Visileanu Emilia , Morari Cristian , Costea Marian
Published: February 2021

Electromagnetic (EM) radiation may be harmful for human’s health and for functioning of electronic equipment. The field of Electromagnetic Compatibility approaches various solutions to tackle this problem, while shielding of the radiation is one of the main solutions. Since the development of spinning technology for producing conductive yarns for fabrics, textile electromagnetic shields have become a valuable alternative to metallic shields. Their main advantages are given by the flexibility, the low weight and the good mechanical resistance, as well as by the possibility to precisely design the shield. The scientific literature includes several analytic relations for estimating the electromagnetic shielding effectiveness (EMSE), in case of woven fabrics with conductive yarns, which may be modeled as a grid of electric conductors. This book chapter tackles three different analytic models for estimating EMSE, which are useful to predict this functionality in the design phase of fabrics. The analytic relations are subsequently comparatively validated by EMSE measurements via TEM cell equipment of two woven fabrics with conductive yarns out of stainless steel and silver with a grid of 4 mm. Results of validated analytic relations are used for the approach of designing textile shields with regard to final application requirements.
What Has Happened with C-B M&A Acceptance? A Follow Up Based on 2005 – 2015 Study
Authors: Ovin Rasto , Macek Anita
Published: February 2021

Especially since 1990s when capital flows liberalization took their intensive course, also the literature on foreign direct investment and respectfully cross-border mergers and acquisitions grew. On the other hand, although it was accompanying these processes, foreign divestment attracted much less attention. Speculating about the reasons for such situation, one could stress that following the nature of the balance of payments logic foreign direct divestment was not expected. Nevertheless, these processes were present. This chapter addresses some of the most important impacts of foreign direct investment that had been a subject to inverse processes later. The authors try to confront the drivers of these processes and search for different patterns obviously often deriving outside economic rationale from the position of a developed market economy. Using their expertize the authors connected concrete findings of their study with possible drivers of divestment. According to the finding the common nominator was mixed success with the transition in transition countries.
UHF RFID in a Metallic Harsh Environment
Authors: Rampim Renata , de Pieri Baladei Ivan
Published: February 2021

The use of the UHF RFID system in a warehouse that contains steel coils is a challenge for the technology itself since there are countless reflections of the radio frequency waves in the environment causing the multipath effect, which represents one of the most complex problems for wireless communication. Thus, this effect must be managed with the hardware, such as the antenna radiation diagram, and with the software, in the middleware, the software developed for the application. In this chapter, an application of RFID in metallic items will be discussed, tracking them since the product’s hot rolling, controlling the receiving process, shipping, and inventory, working together with equipment such as overhead crane.
Theoretical and Practical Design Approach of Wireless Power Systems
Authors: Kindl Vladimir , Frivaldsky Michal , Skorvaga Jakub , Zavrel Martin
Published: February 2021

The paper introduces the main issues concerned with the conceptual design process of wireless power systems. It analyses the electromagnetic design of the inductive magnetic coupler and proposes the key formulas to optimize its electrical parameters for a particular load. For this purpose, a very detailed analysis is given focusing on the mathematical concept procedure for determination of the key factors influencing proper coupling coils design. It also suggests basic topologies for conceptual design of power electronics and discusses its proper connection to the grid. The proposed design strategy is verified by experimental laboratory measurement including analyses of leakage magnetic field.
Advances in Breeding in Vegetable Brassica rapa Crops
Authors: Elena Cartea María , Cámara-Martos Fernando , Obregón Sara , Rubén Badenes-Pérez Francisco , De Haro Antonio
Published: February 2021

Brassica rapa includes oil and vegetable crops having a variety of forms, such as oilseeds, leafy vegetables and turnips. Leafy types, which are called turnip greens and turnip tops, are popular crops in NW Spain, and they represent an important part of the diet. However, their cultivation is limited in southern areas or in the Mediterranean basin, probably due to a lack of adaptation. Still, they could occupy a prominent place in the Mediterranean diet, which is based on a high consumption of fruits and vegetables. In this review, we summarize the studies on the agronomical and nutritional value of these crops when grown under Mediterranean climate conditions. Data reported here might be useful for a deeper understanding of these crops for both nutritional quality and bioaccessibility, and for selecting varieties adapted to the two abovementioned Mediterranean conditions, as well as for organic farming systems, thus contributing to the diversification of traditional Brassica vegetable production systems.
Why Al-B4C Metal Matrix Composites? A Review
Authors: F. Ibrahim Mohamed , R. Ammar Hany , M. Samuel Agnes , S. Soliman Mahmoud , Songmene Victor , H. Samuel Fawzy
Published: February 2021

The Al-B4C metal matrix composite (MMC) is characterized by its ability to absorb neutrons which makes it the most suitable shielding material for nuclear reactors. The present work was performed on two series of Al-B4C metal matrix composites made using a powder injection apparatus. In one series, commercially pure aluminum (A5) served as the matrix. For the second set, 6063 alloy was used. In all cases the volume fraction of B4C reinforcement particles (grit size 400 mesh, purity 99.5%) was approximately 15%. The volume fraction of the injected B4C particles was determined using a computer driven image analyzer. Measured amounts of Ti, Zr, and Ti + Zr, were added to the molten composites of both series. Microstructural characterization was carried out employing a field emission scanning electron microscope operating at 20 kV and equipped with an electron dispersive x-ray spectroscopic system (EDS). The same technique was applied to characterize the fracture behavior of the tested composites. Mechanical properties of these composites were investigated using impact testing, and ambient and high temperature tensile testing methods. Almost 1000 impact and tensile samples were tested following different heat treatments. The obtained results from these investigations are reported in this Chapter.
Liver Transplantation and HCV Genotype 4
Authors: Alghamdi Saad , Al-hamoudi Waleed
Published: February 2021

End-stage liver disease secondary to hepatitis C virus (HCV) infection is a major indication for liver transplantation (LT) worldwide. Previous studies have shown a negative impact of HCV on patient and graft survival leading to an inferior transplant outcome when compared to other liver transplant indications. The percentage of HCV patients infected with genotype 4 (G4) among recipients of OLT varies depending on geographic location. In the Middle East HCV-G4 infection is the most common genotype among transplant recipients. Direct antiviral agents (DAAs) have revolutionized the management of HCV infection in the pre- and post-transplant setting. Recent clinical trials have shown high sustained virologic response rates, shorter durations of treatment, and decreased adverse events when compared with the previous treatment of pegylated interferon (PEG-IFN)-based therapy. However, most of these studies were performed in HCV-G1-infected patients. Due to the low prevalence of HCV-G4 in Europe and the USA, this genotype has not been adequately studied in prospective trials evaluating treatment outcomes. The aim of this chapter is to summarize the natural history and treatment outcome of HCV-G4 in the liver transplant setting, with particular attention to new HCV therapies.
Silver Nanoparticles for Photocatalysis and Biomedical Applications
Authors: Leonardo da Silva William , Moro Druzian Daniel , Rodrigues Oviedo Leandro , Cristine Ladwig Muraro Pâmela , Rodrigues Oviedo Vinícius
Published: February 2021

The present chapter aims to overview the application of silver nanoparticles (AgNPs) in photocatalysis and biomedical field. Firstly, the relevance of AgNPs will be addressed. Then, the discussion about the photocatalytic activity of the AgNPs (either in suspension or impregnation), and correlation with your properties and its potential application to organic pollutants degradation under UV and visible/solar radiation will be described. Thus, applications of the AgNPs as antimicrobial agents, such as Escherichia coli, Schizophyllum commune, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, Bacillus subtilis, Bacillus cereus and Enterobactor faecalis, and in the development of biosensors will be discussed. Therefore, the present work will be important to contextualize different scenarios to AgNPs mainly to wastewater treatment and diagnosis/therapeutic applications.
Vertigo moulinsiana (Dupuy, 1849) et Vertigo angustior Jeffreys, 1830 en Sarthe : bilan de deux années d’étude
Authors: GERBER Rémi , NOËL Franck , MARIOT Romain
Published: February 2021

Une étude de trois ans, de 2017 à 2019, a été menée en Sarthe par le Centre permanent d’Initiatives pour l’Environnement (CPIE) Vallées de la Sarthe et du Loir sur la famille des Vertiginidae (Gastropoda: Pulmonata) et plus spécifiquement sur Vertigo moulinsiana (Dupuy, 1849) et Vertigo angustior Jeffreys, 1830. Cette étude a pour objectifs d’améliorer la connaissance de leur répartition et de leur écologie et de sensibiliser les acteurs locaux : naturalistes et gestionnaires. Nous présentons ici les principaux résultats des deux premières années d’études consacrées à l’inventaire de Vertigo moulinsiana et Vertigo angustior. La sélection des sites à inventorier est réalisée en deux étapes. D’abord le choix d’une zone d’étude, bassin versant ou site Natura 2000, puis celui des stations à prospecter à partir des cartographies existantes ou par photo-interprétation. Ce sont finalement 524 stations qui ont été prospectées sur deux ans. Quarante-neuf stations abritent V. moulinsiana, sept Vertigo angustior et neuf contiennent les deux espèces. Leur répartition dans le département de la Sarthe est très hétérogène. La vallée des Cartes abrite la grande majorité des stations à Vertigo angustior et de nombreuses localités de Vertigo moulinsiana, les deux espèces pouvant être répertoriées au sein du même site. Vertigo moulinsiana est retrouvé ponctuellement sur d’autres bassins versants comme ceux de la Fare et du Tripoulin.
Dengue Fever Mimicking Plasma Cell Leukemia
Authors: Gawoski John M. , Ooi Winnie W.
Published: February 2021

Extreme plasmacytosis in peripheral blood is a rare finding most often associated with plasma cell leukemia but rarely with other malignancies, infectious diseases, or drug reactions. We report the case of a 40-year-old man who was a US expatriate working and traveling in East Asia. He presented with complaints of fever, myalgia, headache, vomiting, and diarrhea of 3 days' duration. An initial evaluation revealed elevated liver function tests, thrombocytopenia (68 × 103/μL), and a white blood cell count of 5.8 × 103/μL with 19% plasma cells (1100/μL), 9% abnormal plasmacytoid lymphocytes (520/μL), 37% polymorphonuclear leukocytes, 3% band forms, 27% lymphocytes, 4% monocytes, and 1% eosinophils. An extensive evaluation was performed, including infectious disease serologies, a bone marrow biopsy, and flow cytometry. During the course of 3 days, his symptoms and hematologic findings improved dramatically. Serologic results were reactive for dengue (immunoglobulin M [IgM] positive, reciprocal IgG titer, 655 360), consistent with a secondary infection of unknown serotype. He remains well 4 years later. To our knowledge, plasmacytosis to this degree has not been described in dengue fever, but atypical lymphocytosis is common. In patients from dengue-endemic areas, even extreme plasmacytosis should be assessed to determine whether it is transient and related to an acute illness before proceeding to an extensive evaluation.
Intranodal Palisaded Myofibroblastoma With Overexpression of Cyclin D1
Authors: Kleist Britta , Poetsch Micaela , Schmoll Juergen
Published: February 2021

Intranodal palisaded myofibroblastoma (IPM) is a rare benign spindle-cell tumor of lymph nodes with myofibroblastic/smooth muscle differentiation. We present another case of IPM that confirms the myofibroblastic differentiation of the tumor cells and identifies the so-called amianthoid fibers as collagen deposits by immunohistochemical and ultrastructural techniques. Because IPM shares histomorphologic characteristics with an inflammatory myofibroblastic tumor that has been associated with a virus-induced alteration of cell cycle regulation, the diagnostic approach was extended in this case. We were able to demonstrate cyclin D1 overexpression but could detect neither amplification of the CCND1 gene nor allelic loss at chromosomes 9p22-21 and 13q (surrounding the genes p16 and Rb, respectively). Furthermore, no evidence of human herpesvirus-8 or Epstein-Barr virus infection could be found by polymerase chain reaction or immunostaining. Nevertheless, our results point to the cell cycle regulatory genes as a factor in the pathogenesis of IPM.
The Role of Molecular Biology and Nucleic Acid Technology in the Study of Human Infection and Epidemiology
Authors: Zaidi Najam , Konstantinou Konstantinos , Zervos Marcus
Published: February 2021

Objective.—In this review, we will focus on recent molecular typing methods that can be applied to different pathogens and assess their values and limitations.

Background.—Resistant subgroups within a species of pathogenic organisms often emerge as dominant strains under the selective pressures of antibiotics, vaccinations, and new health care practices. The emergence of resistant organisms has added to the burden and cost of health care–related infections. Pathogens derived from a common ancestry are often difficult to distinguish by conventional methods, and the practice of clinical microbiology and infectious disease epidemiology must adapt to this problem.

Discussion.—Conventional strain typing methods provide a limited means of distinguishing epidemic from endemic or sporadic isolates of pathogens. Nucleic acid–based methods complement conventional and serologic methods of organism isolation and typing. Often, these genomic methods offer more discrimination and details than the phenotype-based conventional methods.

Results and Conclusion.—Highly sensitive molecular techniques are capable of detecting single base pair substitutions and resolving the mechanism of underlying complex variation.
Application of Rapid-Cycle Real-Time Polymerase Chain Reaction for Diagnostic Testing in the Clinical Microbiology Laboratory
Authors: Cockerill Franklin R.
Published: February 2021

Context.—Rapid-cycle real-time polymerase chain reaction (PCR) technology combines rapid thermocycling with real-time fluorescent probe detection of amplified target nucleic acids.

Objectives.—To review and compare the method of rapid-cycle real-time PCR to conventional PCR methods. To describe the application of rapid-cycle real-time PCR for diagnostic testing in the microbiology laboratory.

Data Selection.—Information is presented from published literature as well as from personal experience at the Mayo Clinical Microbiology Laboratory (Rochester, Minn).

Conclusions.—Compared to conventional PCR methods, rapid-cycle real-time PCR diagnostics are much faster and easier to perform, and, because both PCR and probe detection occur in the same reaction vessel, the possibility of amplified product (amplicon) contamination is lessened. Furthermore, compared to conventional culture-based or direct antigen detection methods, rapid-cycle real-time PCR assays are frequently more sensitive and much more rapid techniques for detecting or quantifying microorganisms in human samples and for identifying genes or mutations in pathogens associated with antimicrobial resistance.
Epithelioid Sarcoma: New Insights Based on an Extended Immunohistochemical Analysis
Authors: Laskin William B. , Miettinen Markku
Published: February 2021

Context.—Epithelioid sarcoma has a distinctive epithelioid phenotype and characteristically exhibits immunohistochemical reactivity for epithelial markers (keratins and epithelial membrane antigen) and mesenchymal markers (most notably vimentin and CD34). Antibodies to certain keratin subunits and other novel antigens now available to surgical pathologists have not been tested on a large number of cases.

Objective.—To assist in the differential diagnosis of epithelioid sarcoma and to help elucidate its histogenesis through an expanded immunohistochemical profile.

Design.—Immunohistochemical testing with diverse antibodies was performed on 95 archived epithelioid sarcomas including 73 classic and 22 histologically variant subtypes retrieved from the files of the Armed Forces Institute of Pathology.

Results.—Immunohistochemical reactivity (number positive/number of cases tested [percent positive], frequency of staining) included keratin 14 (31/64 [48%], variable), gamma-catenin (35/74 [47%], variable), keratin 5/6 (10/33 [30%], focal), calretinin (8/40 [20%], focal), keratin 20 (11/71 [15%], focal), p63 (3/20 [15%], focal), whereas 9 invasive cutaneous squamous cell carcinomas showed strong p63 positivity, epithelial-specific antigen (10/74 [14%], variable), CD117/Kit (5/37 [14%], focal), keratin 15 (3/23 [13%], rare cell), mesothelin (2/64 [3%], rare cell), and CD10 (1/41 [2%], rare cell). No reactivity was observed for keratins 2, 5, and 10.

Conclusions.—Diagnostically, p63 and keratin 5/6 distinguish cutaneous squamous cell carcinoma (positive) from epithelioid sarcoma (usually negative). No single immunomarker was able to distinguish the main 4 histologic subtypes of epithelioid sarcoma, indicating that they are all histogenetically related lesions. The limited expression of specific keratin subtypes used in our study supports the notion that epithelioid sarcoma is a mesenchymal neoplasm capable of partial epithelial transformation.
Adjunctive Human Papillomavirus Testing in the 2-Year Follow-up of Women With Low-Grade Cervical Cytologic Abnormalities: A Randomized Trial and Economic Evaluation
Authors: Lytwyn Alice , Sellors John W. , Mahony James B. , Daya Dean , Chapman William , Howard Michelle , Roth Paula , Lorincz Attila T. , Gafni Amiran , Walter Stephen D.
Published: February 2021

Context.—Although human papillomavirus (HPV) testing may aid in managing low-grade abnormality on screening cervical cytology, patient compliance with repeat testing programs requires consideration.

Objectives.—To determine effectiveness and costs of repeated Papanicolaou (Pap) test and oncogenic HPV testing for detecting cervical intraepithelial neoplasia 2 or 3.

Design.—We conducted a randomized controlled trial of combined Pap test and cervical HPV testing by Hybrid Capture 1 test compared with Pap test alone; tests were performed every 6 months for up to 2 years. The study end point was colposcopic examination performed on all women at 2 years, or earlier if an HPV test was positive or if a Pap test showed high-grade squamous intraepithelial lesion.

Setting.—Sixty-six community family practices.

Participants.—Two hundred fifty-seven women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion on screening cervical cytology.

Main Outcome Measures.—Detection of histologically confirmed cervical intraepithelial neoplasia 2 or 3, fully allocated costs, and loss to follow-up.

Results.—Combined Pap test and HPV testing detected 11 (100%) of 11 cases of cervical intraepithelial neoplasia 2/3, whereas Pap test alone detected 7 (63.6%) of these 11 cases (P = .14); corresponding specificities were 39 (46.4%) of 84 and 45 (71.4%) of 63 (P = .005). The cost-effectiveness ratio was Can $4456 per additional case of high-grade cervical intraepithelial neoplasia. Sixty-nine (26.8%) of the 257 women (24.6% combined group vs 29.1% Pap test only group, P = .41) defaulted from testing or from colposcopy when referred with an abnormal result.

Conclusions.—Combined testing was more costly but may detect more cases of cervical intraepithelial neoplasia 2/3 than Pap test alone. However, poor adherence limits usefulness of a management strategy that requires repeated follow-up.
Cardiac Sarcoidosis: Cytokine Patterns in the Course of the Disease
Authors: Schoppet Michael , Pankuweit Sabine , Maisch Bernhard
Published: February 2021

Sarcoidosis is a chronic systemic disease of unknown etiology, which is characterized by noncaseating epitheloid granulomas usually in multiple organs. Here we describe changes in cytokine mRNA expression by peripheral blood mononuclear cells (PBMCs) and changes of cytokine protein levels in plasma over a time course of 12 months in a patient with sarcoidosis confined to the heart as diagnosed by endomyocardial biopsy. Mitogen-stimulated PBMCs exhibited a more TH1 cytokine profile at onset of symptoms before immunosuppressive therapy was initiated, with a change to a TH0 response in the course of the disease as evidenced by multiplex-polymerase chain reaction. In plasma, high levels of interleukin-6 could be detected by an enzyme-linked immunosorbent assay system, with rapid decline correlating with immunosuppression and improving clinical course. These changes may point to a role of TH1 and TH2 cytokines in the pathogenesis and the healing process of cardiac sarcoidosis.
Schnabel Cavernous Degeneration: A Vascular Change of the Aging Eye
Authors: Giarelli Luigi , Falconieri Giovanni , Cameron J. Douglas , Pheley Alfred M.
Published: February 2021

Context.—Schnabel cavernous degeneration is a histologic finding originally attributed to glaucoma; however, its cause and significance have been controversial.

Objective.—To determine the basic cause of the formation of cavernous spaces in the proximal optic nerve and its clinical significance.

Methods.—A retrospective analysis of 4500 autopsy eyes processed for histologic evaluation between 1967 and 1991.

Results.—Ninety-three (2.1% of eyes examined) cases of Schnabel cavernous optic atrophy were identified. The majority of the eyes were from women (81%). The mean age of the entire group was 88 years (reference range, 54–103 years). Severe vascular anomalies were present in 75% of the individuals. Cavernous degeneration was unilateral in 82% of the cases. Loss of ganglion cells and nerve fiber layer consistent with glaucoma was found in 23.7% of the individuals. Clinical information was available for 15 individuals (16%). Half of them were thought to have some clinical optic nerve damage; in the remainder, no specific optic disc abnormalities were noted. Histologic findings of arteriolosclerosis in the optic nerve circulation were common. The prevalence of glaucoma was low.

Conclusions.—Schnabel cavernous optic atrophy appears to be a unilateral condition of elderly women with systemic vascular disease and few characteristic ocular features. Our data indicate that a chronic vascular occlusive disease of the proximal optic nerve is more involved in cavernous atrophic pathogenesis than is a sustained increase of intraocular pressure.
Virtual Microscopy as a Tool for Proficiency Testing in Cytopathology: A Model Using Multiple Digital Images of Papanicolaou Tests
Authors: Marchevsky Alberto M. , Wan Yan , Thomas Premi , Krishnan Lalita , Evans-Simon Helen , Haber Helene
Published: February 2021

Background.—Modern digital cameras can acquire images from cytologic slides at sufficient resolution to allow for digital enlargement and scrolling on a video monitor, allowing for the simulation of microscopy using a computer.

Objective.—The purpose of this study was to develop a tool for proficiency testing in cytopathology using multiple digital images of Papanicolaou tests.

Methods.—Nine images were photographed from each of 10 Papanicolaou tests at ×100 optical magnification, 3400 × 2300-pixel resolution, using a light microscope and a digital camera. All images from each case were tiled in a single canvas with Photoshop 4.0 software. Two cytopathologists and 3 cytotechnologists interpreted these “virtual slides” using a computer and graded diagnostic codes (PAP program, College of American Pathologists). Subjects were retested a year later using the glass slides from the same cases and routine microscopy. Both test results, by diagnostic code, were compared with the McNemar test of symmetry.

Results.—The 5 test subjects provided 42 and 50 correct diagnostic codes by “virtual microscopy” and light microscopy, respectively. No significant asymmetry in results obtained by virtual microscopy and light microscopy was encountered with the McNemar test of symmetry. All test answers were correctly classified by selection series, using both virtual microscopy and light microscopy, and the responses would have been graded as 100% by current PAP program scoring guidelines. This suggests that virtual microscopy could be used for proficiency testing purposes.

Conclusions.—A simple virtual microscopy method designed to challenge participants to locate and diagnose cells of interest was effective for the administration of standardized proficiency tests. Virtual microscopy methods that rely on single-plane images to locate and diagnose cells of interest could provide effective proficiency testing tools prior to the development of more computationally intensive systems that represent an entire Papanicolaou test at multiple focal planes.
Mammaglobin Expression in Lymph Nodes Is an Important Marker of Metastatic Breast Carcinoma
Authors: Han Jae-Ho , Kang Yup , Shin Ha-Chul , Kim Hyun-Soo , Kang Young-Mo , Kim Young-Bae , Oh Seung-Yeon
Published: February 2021

Context.—Organ specificity is a desirable property of a tumor marker, especially in metastatic adenocarcinomas of unknown primary origin. Mammaglobin, a mammary-specific member of the uteroglobin family, is known to be overexpressed in human breast cancer.

Objective.—We investigated mammaglobin A expression in metastatic carcinomas of lymph nodes from the breast and various other organs and its usefulness in identifying metastatic carcinoma of the breast. For comparative purposes, we also investigated BRST-1 and BRST-2 expression.

Design.—We produced recombinant mammaglobin and polyclonal antimammaglobin antibodies. Mammaglobin expression was analyzed by immunohistochemical staining using a tissue microarray and by reverse transcription–polymerase chain reaction in 210 carcinomas, including those of the breast (n = 70), lung (n = 30), stomach (n = 30), colorectum (n = 25), hepatobiliary tract (n = 20), urinary tract (n = 10), thyroid gland (n = 10), ovary and endometrium (n = 10), and salivary gland (n = 5).

Results.—Mammaglobin expression was observed in 59 cases (84.3%) of breast cancer and in 21 cases (15.0%) of nonbreast cancer. The BRST-1 and BRST-2 expression rates were 75.7% and 44.3% in breast cancer and 26.4% and 2.1% in nonbreast cancer, respectively. Mammaglobin is superior to BRST-1 for both specificity and sensitivity and is superior to BRST-2 for sensitivity.

Conclusion.—Our data suggest that mammaglobin is one of the first relatively mammary-specific and mammary-sensitive markers. Mammaglobin and BRST-2 appear to represent useful markers for breast cancer and should be used as a component of panels evaluating tumors of unknown primary sites.
Congenital Anerythremic Erythroleukemia Presenting as Hepatic Failure
Authors: Lazure Thierry , Beauchamp Anne , Croisille Laure , Ferlicot Sophie , Feneux Danielle , Fabre Monique
Published: February 2021

We report an atypical case of congenital erythroleukemia in a child born with hepatosplenomegaly and abnormal liver tests. The initial peripheral blood cell count showed anemia and hyperleukocytosis with erythroblastosis that disappeared 1 week later. During the next 5 weeks, no blasts were found in the blood, and less than 5% were found on 2 successive bone marrow aspirates. The infant died of hepatic failure. The suspected diagnosis on a premortem liver biopsy was confirmed by an autopsy that showed a blastic infiltration in many organs. These cells expressed only erythroid markers glycophorin A and C. Rearrangement of the myeloid lymphoid leukemia gene was not found by fluorescence in situ hybridization. The main differential diagnoses include metabolic diseases, Langerhans histiocytosis, Pepper syndrome, transient myeloproliferative disorder, and leukemoid reactions. Although some of these can be excluded by the pathologist, others require a multidisciplinary confrontation: clinical, biologic, genetic, and pathologic examinations.
Autopsy Findings in an Outbreak of Severe Systemic Illness in Heroin Users Following Injection Site Inflammation: An Effect of Clostridium novyi Exotoxin?
Authors: Finn Stephen P. , Leen Eamon , English Liam , O'Briain D. Sean
Published: February 2021

Context.—An epidemic of unexplained illness among injecting drug users characterized by injection site inflammation and severe systemic toxicity occurred in Ireland and the United Kingdom from April to August 2000. One hundred eight persons became ill, and 43 persons died. In Dublin, 8 of 22 patients died. Six of the 8 fatal cases were epidemiologically linked to a source of heroin. Most had experienced local injection site lesions for 7 to 14 days before developing a rapidly fatal systemic illness characterized by hypotension, thirst, pulmonary edema, pericardial and pleural effusions, and leukocytosis.

Objective.—To document the clinical course and autopsy findings of the fatal cases in Dublin.

Design.—To study the clinical, autopsy, microbiologic, and toxicologic findings from the 8 fatal cases in Dublin.

Results.—In Dublin, there were 6 men and 2 women who were fatally involved in the epidemic, with the mean age being 34 years (range, 22–51 years). The injection site inflammations involved the buttock (n = 4), leg, iliac region, arm, and a Portacath site. At autopsy, the local lesions were ulcerated, swollen, and indurated but were inconspicuous in 2 patients. All the deceased had pulmonary edema. There were pleural effusions in 7, 2 of whom had pericardial effusions. Five had prominent left ventricular subendocardial hemorrhages. Five had splenomegaly. Microscopy showed pulmonary edema and a granulocytic reaction mainly in the spleen, marrow, and myocardium. Toxicology showed a range of narcotic drugs in the toxic or fatal range. Clostridium novyi type A, a fastidious toxin-producing anaerobe, was identified in 2 cases.

Conclusion.—The clinicopathologic findings of a local inflammatory lesion followed 7 to 14 days later by a rapidly fatal systemic illness are consistent with the effect of exotoxin produced by organisms growing in the local inflammatory site. Clostridium novyi–derived exotoxin is the likely cause of such a syndrome, although the fastidious organism was isolated from only 2 of 8 cases (from none of the 14 surviving patients and from only 13 of 60 cases in Scotland). In the setting of an epidemic, the toxic and fatal range blood levels of narcotics are unlikely to explain these events, and no other candidate organism could be isolated. The heroin is likely to have come from Afghanistan, but local contamination at a putative distribution site in the United Kingdom is more likely than international terrorism to be the initiating factor.
Three-Millimeter Apocrine Adenoma in a Man: A Case Report and Review of the Literature
Authors: Pasquale-Styles Melissa A. , Milikowski Clara
Published: February 2021

We describe a rare case of apocrine adenoma of the breast in a 45-year-old man. The patient presented with a tender lump in his left breast that had been present for 6 months. A mammogram identified a 3-mm nodular density in the breast, which was described as a hypoechoic nodule on ultrasound. Microscopic examination of tissue from an excisional biopsy revealed a 3-mm group of benign glands with abundant granular, eosinophilic cytoplasm and apical luminal blebbing, consistent with an apocrine adenoma. After reviewing other reported apocrine adenomas in the literature, we determined that our case was the smallest detected apocrine adenoma to be reported to date.
Monocytes With Altered Phenotypes in Posttrauma Patients
Authors: Kampalath Bal , Cleveland Ronald P. , Chang Chung-Che , Kass Lawrence
Published: February 2021

Context.—Posttrauma patients show impaired immune responsiveness and increased susceptibility to infections. Although monocytes in these patients have been known to express decreased HLA-DR, induction of HLA-DR using interferon gamma failed to reduce susceptibility to infection, suggesting additional factors also may be involved in the impaired immune responsiveness. CD4 plays an integral role in most of the functions of HLA-DR. In newborn infants, who have impaired immune responsiveness, we found a concomitant reduction of CD4 on monocytes with decreased HLA-DR expression.

Objective.—Because monocytes in posttrauma patients have not been previously studied for morphology, coexpression of CD4 and HLA-DR, and activity of α-naphthyl butyrate esterase, the purpose of this study was to analyze these factors in this population.

Design.—Monocyte morphology; expression of CD4, CD11b, CD13, CD16, and HLA-DR by 3-color flow cytometry; and analysis of α-naphthyl butyrate esterase activity by cytochemical staining were studied in 27 posttrauma patients and 20 control subjects.

Results.—Monocytes in posttrauma patients showed significant differences in the following characteristics compared with controls: (1) increase of subsets displaying the phenotypes CD4−/CD14+/HLA-DR− and CD4−/CD14+/CD16−, (2) decrease in mean fluorescence intensity of CD4 and HLA-DR expression in monocytes that were positive for these markers, (3) decrease in α-naphthyl butyrate esterase activity, and (4) decreased amount of cytoplasm and cytoplasmic vacuoles.

Conclusion.—Our study suggests that in posttrauma patients, as in newborns, there is a marked increase of monocytes with decreased expression of CD4 and HLA-DR, as well as decreased α-naphthyl butyrate esterase activity. Concomitant reduction in CD4 and HLA-DR expression on monocytes may contribute to impaired immune responsiveness in these patients.
Primary Cervical Adenocarcinoma With Intestinal Differentiation and Colonic Carcinoma Metastatic to Cervix: An Investigation Using Cdx-2 and a Limited Immunohistochemical Panel
Authors: Raspollini Maria Rosaria , Baroni Gianna , Taddei Antonio , Taddei Gian Luigi
Published: February 2021

Context.—Cdx-2 is expressed in normal colonic epithelia and in most colorectal adenocarcinomas. No data exist on Cdx-2 expression in primary cervical adenocarcinoma with colonic differentiation.

Objective.—To ascertain the utility of Cdx-2 and a limited immunohistochemical panel in differentiating between primary cervical adenocarcinoma with intestinal differentiation and secondary (colonic) cervical adenocarcinoma, which call for different surgical and chemotherapeutic treatment protocols.

Design.—We examined cervical tract adenocarcinomas in women with previously negative medical histories for neoplastic disease and in women with colonic carcinoma. An immunohistochemical panel consisting of cytokeratin 7, cytokeratin 20, carcinoembryonic antigen, and a new marker, Cdx-2, was evaluated in all cases. The clinical data, the morphologic features, and the immunohistochemical staining patterns were compared.

Results.—Of the tumors diagnosed as metastatic intestinal adenocarcinoma of the cervix, based on clinical data and hematoxylin-eosin–stained sections, all were Cdx-2 positive, whereas Cdx-2 was not expressed in any of our cases of primary cervical adenocarcinoma with colonic differentiation. Carcinoembryonic antigen was expressed both in primary cervical tumor and in secondary (intestinal) cervical adenocarcinoma. Cytokeratin 20 was not expressed in our cases of cervical adenocarcinoma, and it was not expressed in 7.15% of cervical metastases from intestinal carcinoma. Immunostaining with cytokeratin 7 was positive in cervical adenocarcinoma, but was negative in secondary (intestinal) cervical adenocarcinoma.

Conclusions.—Our immunohistochemical analysis shows that Cdx-2 has good specificity and would be a good marker to use in a limited panel of immunohistochemical markers, such as cytokeratin 7, cytokeratin 20, and carcinoembryonic antigen, to distinguish primary cervical adenocarcinoma from intestinal metastases to the cervix.
The Utility of Estrogen Receptor and Progesterone Receptor Immunohistochemistry in the Distinction of Metastatic Breast Carcinoma From Other Tumors in the Liver
Authors: Nash Jason W. , Morrison Carl , Frankel Wendy L.
Published: February 2021

Context.—The distinction of metastatic breast adenocarcinoma (MBA) to the liver from hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), and metastatic adenocarcinoma from other sites may require the use of immunohistochemistry. The use of antibodies directed against estrogen receptor (ER) and progesterone receptor (PR) has been suggested to help make this distinction.

Objective.—To examine the utility of ER and PR immunohistochemistry in the distinction of MBA from HCC, CC, and other metastatic adenocarcinomas in the liver.

Methods.—Ninety-two previously characterized hepatic neoplasms were identified, including HCC (n = 14), CC (n = 16), and metastatic tumors from breast (n = 17), colorectal (n = 14), pancreatic (n = 15), and esophageal/gastric (n = 16) origins. For all cases of metastatic tumor, the primary tumor was reviewed to verify the diagnosis. All tumors were graded as well, moderately, or poorly differentiated. Estrogen receptor and PR immunohistochemical staining was performed on all cases and evaluated by 2 pathologists.

Results.—Immunoreactivity for ER was identified only in MBA, with 6 (35%) of 17 cases positive. Positive immunoreactivity for PR was not restricted to MBA, but was seen in HCC, CC, esophageal/gastric, and pancreatic metastases. Positive immunostaining with PR was nearly as frequent in poorly differentiated carcinomas of nonbreast origin (3/16 cases, 19%) as in poorly differentiated breast carcinomas (2/8 cases, 25%).

Conclusion.—Progesterone receptor exhibited poor specificity and sensitivity for the distinction of MBA from HCC, CC, and other metastatic adenocarcinomas. Estrogen receptor exhibited poor sensitivity for MBA, although the specificity was good. The finding that PR positivity was present with a similar frequency in poorly differentiated tumors of breast and nonbreast origin limits the usefulness of this marker. Therefore, ER and PR staining have limited utility in the distinction of MBA from HCC, CC, and other metastatic adenocarcinomas in the liver.
Measurement of Mercury Levels in Concentrated Over-the-Counter Fish Oil Preparations: Is Fish Oil Healthier Than Fish?
Authors: Foran Stacy E. , Flood James G. , Lewandrowski Kent B.
Published: February 2021

Context.—Fish consumption has been associated with a decreased risk of coronary artery disease. Recent studies have illustrated that the high mercury content in cold-water fish may negate the cardiovascular benefits of fish meals. Fish oils have similar antiatherogenic properties to fish, and similar studies should be performed to determine the level of mercury in fish oils.

Objective.—To determine the concentration of mercury in 5 over-the-counter brands of fish oil.

Results.—The levels of mercury in the 5 different brands of fish oil ranged from nondetectable (<6 μg/L) to negligible (10–12 μg/L). The mercury content of fish oil was similar to the basal concentration normally found in human blood.

Conclusions.—Fish are rich in omega-3 fatty acids, and their consumption is recommended to decrease the risk of coronary artery disease. However, fish such as swordfish and shark are also a source of exposure to the heavy metal toxin, mercury. The fish oil brands examined in this manuscript have negligible amounts of mercury and may provide a safer alternative to fish consumption.
Systemic Tropheryma whippleii Infection Associated With Monoclonal B-Cell Proliferation: A Helicobacter pylori–Type Pathogenesis?
Authors: Wang Sa , Ernst Linda M. , Smith Brian R. , Tallini Giovanni , Howe John G. , Crouch Jill , Cooper Dennis L.
Published: February 2021

We report a case of Whipple disease in a 55-year-old woman who presented with arthralgia, weight loss, and lymphadenopathy. Tropheryma whippleii bacilli were identified in the mesenteric lymph nodes by diastase-resistant periodic acid–Schiff stain and confirmed by electron microscopy. Retrospectively, previous biopsy specimens from the duodenum and right axillary lymph node of this patient, which were initially considered to demonstrate reactive changes, also showed features consistent with involvement by Whipple disease. At the time of presentation, a large κ-restricted monoclonal B-cell population with the phenotype CD20+CD19+CD5−CD10− was identified in the patient's peripheral blood, lymph nodes, and bone marrow by flow cytometry study. The monoclonality of the mesenteric lymph node B cells was confirmed by immunohistochemical stain for κ chain after antigen retrieval and also by polymerase chain reaction with the primer set targeting FR2-VH. Routine cytogenetic study failed to reveal any chromosomal abnormalities, and polymerase chain reaction for Bcl-2 major and minor breakpoint cluster of t(14:18) was not detected. The monoclonal B cells have persisted in blood for the entire follow-up period (10 months). The possibility of reactive monoclonal B-cell proliferation versus Whipple disease–related B-cell lymphoma is discussed.