bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase transition of Cd(OH)2 and physical properties of CdO microstructures prepared by precipitation method for optoelectronic applications
Authors: Ismail Walid , El-Shaer Abdelhamid , Abdelfatah Mahmoud 
Published: October 2020

Abstract
Low cost precipitation technique is employed here to have CdO microstructures as a promising material for optoelectronic applications. Cadmium nitrate hexahydrate and sodium hydroxide were mixed together to have white precipitate of cadmium hydroxide. The product white precipitate then dried at 100 °C followed by different annealing temperatures (200, 300, 400 and 700 °C) for 2 h. The formed samples are characterized employing XRD, SEM, and TEM techniques to investigate the structural and morphology properties. The XRD results indicate that as prepared exhibited hexagonal ß-Cd(OH)2 phase. For annealed samples at 200, mixed phases of γ-Cd(OH)2 hexagonal as well as monoclinic were appeared. γ-Cd(OH)2 monoclinic phase and CdO cubic phase were formed with calcined temperature of 300°C. Pure cubic phase of CdO crystal structure was obtained at 400°C. With higher annealed temperature of 700°C, both cubic phases of CdO and CdO2 are appeared. The results designate that CdO microstructures formed with single-phase formation of cubic structure at 400°C, which is the most advantageous for optoelectronic applications.
Truncated Triangular Silver Nanoparticles using low concentration of CTAB
Authors: Saleh Hagar M. , El-Brolossy T. A. , Abdallah T. , Talaat H. 
Published: October 2020

Abstract
Triangular silver nanoparticles have special properties which increase their importance in chemistry, biology, physical and medical applications. This work concerns with fabrication of truncated nanotriangles, using a simple chemical method. The seed mediated growth method that is usually used to synthesize nanorods, is modified to create nanotriangles. By using this modified method, we successfully obtained silver truncated nanotriangles by adding low concentration of cetyltrimethylammonium bromide (CTAB) into seed solution. UV-visible spectroscopy (UV-Vis) was used to characterize the surface plasmon resonance of the formed nanoparticles. Also, the geometrical properties of nanoparticles were characterized by transmission electron microscopy (TEM) and scanning tunneling microscopy (STM). The average edge length of truncated nanotriangle is affected by varying the amount of seed added to the growth solution; it varies from 56 nm up to 75 nm according to the amount of seed used. The degree of truncation (T) for the produced nanotriangle edges has been estimated. Furthermore, the effect of CTAB concentration as well as the speed in which NaBH4 is added to the seed solution on the formed nanoparticles was investigated.
A Shared Diagnostic Stewardship Approach to Autoimmune Encephalopathy Send-Out Testing
Authors: Sharp Cierra , Muluhngwi Penn , Fletcher Anita , Linder Mark , Snyder James , Jortani Saeed 
Published: October 2020

Abstract
As part of our laboratory testing utilization at University of Louisville Hospital (ULH), any send-out test ≥$500 must be assessed by the clinical chemistry fellow or pathology resident for clinical necessity and as a way to provide consultation to the ordering physician on appropriate test utilization. In 2018, we noticed a prominent increase in the volume of panels for autoimmune encephalopathy (AE) and related disorders being ordered. This was met with considerable cost to the hospital, a lack of consensus on which panels should be ordered, and poor understanding of the clinical utility of these panels. These challenges presented an ideal project for our newly-formed diagnostic stewardship committee (DSC) at ULH. Through collaboration with the DSC, we were able to form a sub-committee with the Department of Neurology to develop an algorithm-based approach for ordering of these AE panels. Our goals were to improve diagnostic utility for the betterment of patient care, improve test utilization, and decrease cost associated with panel ordering.
Prior to involvement of the DSC, we analyzed the number and cost of all AE panels ordered in 2018. We also calculated the number of positive panels and reviewed patient data to determine if a positive panel corresponded with a clinical outcome. After presenting our data to the DSC, an evidence-based approach was taken in collaboration with the Department of Neurology to develop an algorithm for AE test ordering. Results were analyzed for true positive rate, defined as a patient testing positive for an antibody with known etiology or association with AE based on result interpretation provided by Mayo Clinical Laboratories. The total cost of tests was also analyzed before implementation of the algorithm (January 1, 2019-July 31, 2019) and post-implementation (August 1, 2019-December 31, 2019).
In 2018, 77 AE panels were ordered with an estimated charge to the laboratory of $137,510. The true positive rate was 10%. Based on these test ordering patterns, we projected that 120 tests would be ordered in 2019, totaling &gt;$200,000. Prior to the implementation of the algorithm in 2019, 55 tests were ordered, totaling $105,210. Total true positive rate was 3.6%. After implementation of the algorithm, 23 tests were ordered, totaling $50,220. The true positive rate was 13%.
Using a shared diagnostic stewardship approach, we were able to develop an evidence-based algorithm for guiding physicians for AE panel ordering. Comparing test ordering patterns pre and post-implementation in 2019, our true positive rate more than tripled (3.6% to 13%), indicating that our algorithm was able to successfully identify the at-risk population for development of AE disorders. This was met with a &gt;50% decrease in the number of tests ordered, and a total cost savings of $54,990 compared to the first half of 2019.
Evidence for Age-Adjusted D-Dimer to Rule out Pulmonary Embolism: An Institutional Study
Authors: Balakrishnan Ridin , Casa Daniel , Gil Morayma Reyes 
Published: October 2020

Abstract
The diagnostic approach for ruling out suspected acute pulmonary embolism (PE) in the ED setting includes several tests: ultrasound, plasma d-dimer assays, ventilation-perfusion scans and computed tomography pulmonary angiography (CTPA). Importantly, a pretest probability scoring algorithm is highly recommended to triage high risk cases while also preventing unnecessary testing and harm to low/moderate risk patients. The d-dimer assay (both ELISA and immunoturbidometric) has been shown to be extremely sensitive to rule out PE in conjunction with clinical probability. In particularly, d-dimer testing is recommended for low/moderate risk patients, in whom a negative d-dimer essentially rules out PE sparing these patients from CTPA radiation exposure, longer hospital stay and anticoagulation. However, an unspecific increase in fibrin-degradation related products has been seen with increase in age, resulting in higher false positive rate in the older population. This study analyzed patient visits to the ED of a large academic institution for five years and looked at the relationship between d-dimer values, age and CTPA results to better understand the value of age-adjusted d-dimer cut-offs in ruling out PE in the older population. A total of 7660 ED visits had a CTPA done to rule out PE; out of which 1875 cases had a d-dimer done in conjunction with the CT and 5875 had only CTPA done. Out of the 1875 cases, 1591 had positive d-dimer results (&gt;0.50 µg/ml (FEU)), of which 910 (57%) were from patients older than or equal to fifty years of age. In these older patients, 779 (86%) had a negative CT result. The following were the statistical measures of the d-dimer test before adjusting for age: sensitivity (98%), specificity (12%); negative predictive value (98%) and false positive rate (88%). After adjusting for age in people older than 50 years (d-dimer cut off = age/100), 138 patients eventually turned out to be d-dimer negative and every case but four had a CT result that was also negative for a PE. The four cases included two non-diagnostic results and two with subacute/chronic/subsegmental PE on imaging. None of these four patients were prescribed anticoagulation. The statistical measures of the d-dimer test after adjusting for age showed: sensitivity (96%), specificity (20%); negative predictive value (98%) and a decrease in the false positive rate (80%). Therefore, imaging could have been potentially avoided in 138/779 (18%) of the patients who were part of this older population and had eventual negative or not clinically significant findings on CTPA if age-adjusted d-dimers were used. This data very strongly advocates for the clinical usefulness of an age-adjusted cut-off of d-dimer to rule out PE.
Pregnancy-Related RBC Alloimmunization in Sickle Cell Trait Patients; A Single-Center Experience
Authors: Barouqa Mohammad , Castrodad-Rodriguez Carlos , Gil Morayma Reyes , Nelson Randin , Szymanski James , Paroder Monika 
Published: October 2020

Abstract

Background
Sickle Cell Disease (SCD) is an autosomal recessive disorder, which results from a point mutation in the Î²-globin gene. The production of mutant Hb S (V6E) leads to hemolytic anemia and numerous clinical complications. Patients homozygous for HbS gene (SS) typically rely on life-long transfusion therapy. Alloimmunization to foreign RBC antigens in multiply transfused patients is significantly more frequent in SS patients (observed in 7–47%) compared to patients with HbA (AA), and can pose a significant hurdle in finding compatible RBCs. However, the mechanism for enhanced alloimmunization in SS patients has not yet been elucidated. Patients heterozygous for HbS (SA) have a no distinct clinical phenotype and do not typically require transfusions. We investigated the rate of RBC antigen alloimmunization and specificity in SA patients.

Aim
The aim of this study was to determine and compare the rate and specificities of RBC antigen pregnancy-related alloimmunization in SA and AA patients.

Methods
In our retrospective study, we identified females who delivered a newborn between January 2014 to October 2019, for whom prenatal hemoglobin electrophoresis testing, and prenatal and perinatal antibody screening and identification was performed. R (V.3.6.2) statistical computing program was used for analysis.

Results
A total of 41735 subjects were identified: 40058 (AA) and 1677 (SA). African Americans were more prevalent in the SA compared to the AA group (55.8% vs 29.4%, P&lt;0.01)and were more likely to have received ≥ 1 transfusion during pregnancy (4.5% vs 3.3%, P&lt;0.01). A total number of 267 alloantibodies were detected in 246 patients (0.6% of the studied population) during pregnancy, 228 patients (0.6%) in the AA group and 18 patients (1.1%) in the SA group.229/246 (93%) of patients with antibodies did not receive transfusion during pregnancy, and thus antibodies were considered to represent pregnancy-related alloimmunization. In non-transfused subjects the SA group were more likely to have developed alloantibodies in pregnancy compared to the AA group [OR= 1.94, P=0.015]. The median age of patients with antibodies in the SA was older [33.5 vs 27 (p=0.008)] as compared to those in the AA group [29 vs 27 (p=0.002)].
The most common antibody identified was anti-E (SA 42% vs AA 28%), anti-Lea (SA 21% vs AA 13%) and anti-C (SA 5% vs AA 12%). Subjects with pre-existing alloantibodies had a 5.4x increased risk of forming a new allo-antibody. However only 0.1% of subjects had a history of prior allo-antibodies, with no significant difference identified between AA and SA.

Conclusions
SA patients were found to have an increased rate of pregnancy-related alloimmunization (OR 1.75, P=0.02) after adjusting for the effects of increasing age, RH type, ethnicity, number of previously existing antibodies and number of transfusions in pregnancy.
Symptomatic Cerebral Metastases In Malignant Pleural Mesothelioma: A Rare Case Report
Authors: Jadhav N C , Krasnozhen-Ratush O , Hicks R , Schapiro R 
Published: October 2020

Abstract
Casestudy: Malignant mesothelioma is an aggressive tumor with dismal prognosis. Incidence in the United States is approximately 3300 cases/year, and the most common site is the pleura. Although mesothelioma is usually a locally invasive tumor, distant metastases to liver, adrenal glands, kidney and contralateral lung have been described. Brain metastases are observed in less than 3% of metastatic cases and most have been detected incidentally at autopsy. Symptomatic brain metastases are unusual. We describe a case of a 77 year old gentleman with history of occupational asbestos exposure who presented with shortness of breath and dry cough. The radiological investigations revealed left pleural thickening with pleural effusion, which on biopsy proved to be biphasic malignant mesothelioma. Despite multi-modality therapy, the patient showed local disease progression. Following 37 months of initial diagnosis, he developed progressive left-sided weakness. Brain MRI revealed a 1.7 cm enhancing mass involving right posterior frontal lobe, with extensive edema in the surrounding tissue. On biopsy, mass was composed of nests and sheets of round-to-spindled cells with scant eosinophilic cytoplasm, separated by fibrous septa. Brisk mitotic activity and necrosis were present. There was a sharp border with adjacent brain parenchyma. The tumor was positive for WT-1, calretinin, and cytokeratins and negative for Ber-Ep4 and glial fibrillary acid protein by immunohistochemistry. The histological appearance of the tumor was similar to that of the pleural biopsy. Thus a diagnosis of metastatic malignant mesothelioma was made. This solitary metastasis was treated with resection and post-operative stereotactic radiation. The 3-month follow-up brain MRI revealed nodular enhancement within the cavity with multiple supra- and infra-tentorial enhancing lesions, and leptomeningeal enhancement, most consistent with progressing metastatic disease. With the advancements in treatment options that has improved survival in malignant mesothelioma patients, the pathologist and neurosurgeon should be aware of the diagnostic possibility intra-operatively which may alter the management.
Endometrioid Carcinoma with Hepatoid Differentiation: A Case Report and Comparison to Literature
Authors: Bowers K A , Johannesen E , Nguyen V 
Published: October 2020

Abstract

Introduction/Objective
High-risk endometrial carcinomas comprise only 15% of all uterine malignancies but are responsible for over 50% of deaths. Hepatoid malignancies of the endometrium (HME) are rare entities with a distinct morphology that is important to recognize because it is associated with rapid progression and high mortality.

Methods
We report a case of a HME and compare it to a collective review of 17 HME cases from the literature.

Results
A 61-year old female presented with post-menopausal bleeding and was diagnosed with endometrioid carcinoma with hepatoid differentiation. The hepatoid component was strongly positive for hepatocyte specific antigen (HepPar-1/OCH1E5). The entire tumor was negative for alpha-fetoprotein (AFP) and was negative for MLH-1 and PMS-2, indicating microsatellite instability. This is the first reported case of AFP-negative HME. HME unanimously present in the 6th decade or later with post-menopausal bleeding and elevated serum AFP. Histologically, hepatoid morphology is most commonly admixed with endometrial adenocarcinoma (56%) or carcinosarcomas (28%), but rare pure hepatoid carcinomas (11%) also occur. Hepatoid differentiation is often found in the myometrium, within vasculature, or lymph node metastases and is often positive for AFP and other hepatoid-markers (HepPar-1, Arginase-1, Glypican-3). Like hepatoid malignancies in other organs, HME have an aggressive clinical course. There was statistically significant (p = 0.046) difference between disease stages, with death from disease occurring in 12% of the stage I/II compared to 75% of the stage III/IV cases. Of those who died of disease, 71% had a survival of one year or less, often from early locoregional recurrence and/or lung metastases.

Conclusion
This case series is the largest review of HME to date and summarizes the features common to this rare, but histologically distinct, highly aggressive variant. This highlights the importance of thorough examination of uterine resections for variant histology as it is an important component of prognosis and treatment.
Cutaneous Eccrine Adenolipoma with a Spindle Cell Component
Authors: Karimi S S , Braniecki M , Bain M , Jetter N , Murray T 
Published: October 2020

Abstract

Introduction/Objective
Cutaneous adenolipoma is a rare, benign variant of solitary lipoma characterized by a mature adipocytic proliferation with entrapped eccrine or apocrine sweat glands. It is found predominately in middle-aged females, with a predilection for lower extremities including the thigh and gluteal regions. Cutaneous adenolipoma is presumed to be a hamartomatous process. Herein, we report a unique case of a cutaneous eccrine adenolipoma with a spindle cell component, namely, an early evolving spindle cell adenolipoma.

Methods
A 43-year-old female with a recurrent history of hidradenitis presented with a 2.7 cm x 1.5 cm x 0.7 cm soft, mobile nodule on the right posterior thigh. It had been present for at least four months and clinically resembled a lipoma. An excisional punch biopsy was performed for pathological evaluation. A concurrent nevus lipomatosus superficialis was diagnosed from the right perineum.

Results
Gross examination of the thigh nodule revealed fragments of a tan-yellow, lobulated, fatty lesion. Microscopic examination demonstrated a benign lipomatous proliferation with entrapped eccrine glands associated with a surrounding spindle cell stroma. Initial differential diagnosis included a cutaneous eccrine adenolipoma variant and a cutaneous mixed solitary hamartoma composed of admixed neural, eccrine and lipomatous components.
Immunohistochemical staining showed uptake for CD34 and CD10 in the spindle cell stromal component, but negative for desmin and S100. Based on our histopathological findings, our diagnosis of an eccrine cutaneous adenolipoma with a spindle cell component was rendered. This unique lesion displayed features of an evolving spindle cell lipoma with entrapped sweat glands, which may be viewed as an early stage of a dermal spindle cell adenolipoma.

Conclusion
Cutaneous eccrine adenolipoma is a rare, benign lipomatous neoplasm with entrapped sweat glands that can also show a spindle cell component. We share this rare lesion exemplifying the histomorphological spectrum of a lipomatous hamartoma and to highlight the recognition of a cutaneous adenolipoma.
Platy Talc, Asbestos, and Talc Fibers in the Female Genital Tract in Patients with Ovarian Cancer
Authors: McDonald S A , Godleski J J 
Published: October 2020

Abstract

Introduction/Objective
Recent analyses on human tissue help inform the discussion regarding talc and ovarian cancer, by showing that, in some patients, considerable talc can migrate to multiple organ sites in the pelvic region from perineal application. Recently, we showed that birefringent particles were seen by polarized light microscopy and shown to be talc by scanning electron microscopy/energy dispersive X-ray analysis (SEM/EDS) and/or Raman spectroscopy in surgically resected tissues from patients with ovarian carcinoma and perineal talc exposure. These sites included ovary, cervix, fallopian tube, uterine serosa, and regional lymph nodes. Fibrous talc, with greater carcinogenic potential as determined by the International Agency for Research on Cancer, may be observed in pelvic tissues. Besides ascension through the reproductive tract, particles and fibers may gain entry to pelvic organs by accessing small submucosal lymphatics in the lower part of the tract. Both platy and fibrous talc have an Mg-Si elemental signature, weight % Mg/Si ratio within 5% of the theoretical value of 0.649, and thus are distinguishable from other exogenous substances including the various subtypes of asbestos.

Methods
Tissue-based analytic methods (including in situ SEM, where a paraffin block is examined directly under variable pressure) are critical in the detection of talc and asbestos, particularly since they preserve architecture, and demonstrate talc and/or fibrous particles within their histologic environment; this may help inform exposure origin and pathophysiologic significance.

Results
We reviewed the analytic outcomes of our consultative experience to date. This showed that 180 of 196 patients with a history of perineal talc exposure had birefringent particles seen by light microscopy in surgically resected pelvic tissues, and 82 of 91 had talc confirmed by SEM/EDS. Carcinogenic fibers were found in 28/82 (34%) of these patients, with talc fibers only (19/82 patients, 23%), asbestos (7/82, 9%) or both (2/82, 2%) confirmed by SEM/EDS.

Conclusion
Our study confirms that talc and toxic fibers may be found in human pelvic tissues of talc-exposed patients. Because the SEM/EDS method samples only a small amount of tissue relative to what is in the paraffin block, the finding of exogenous particles by this method typically translates to a high overall particle burden, when scaled mathematically to bulk tissue.
Metastatic Mucoepidermoid Carcinoma to the Pleura: An Unusual Presentation
Authors: Mashiana S S , Martinez Duarte E 
Published: October 2020

Abstract

Casestudy
Mucoepidermoid carcinoma is the most common malignant tumor arising in salivary glands. Predictors of poor prognosis include high-grade tumors, positive surgical margins, lymph node metastasis, or distant metastasis. The most common sites for distant metastasis include skin, lung, liver, and bone. We herein present a case of salivary gland mucoepidermoid carcinoma with pleural involvement, which is an infrequent site for metastasis. A 64-year-old female presented with worsening dyspnea and cough, which showed no improvement with antibiotics. Imaging showed a right lung nodule measuring 1.2 cm along with bilateral pleural effusion and pleural based nodularities. The dominant nodules in right and left chest measured 5.8 cm and 4.8 cm in greatest dimension, respectively. The findings were suspicious for metastatic disease. Cytological examination of pleural fluid showed reactive mesothelial cells and inflammatory cells. Subsequent biopsy of the right pleural nodule showed sheets of tumor cells with abundant eosinophilic cytoplasm and few scattered clear cells. Mucocytes were absent. The tumor cells were positive for p40 and negative for TTF-1 by immunohistochemistry. A review of patient’s medical history was significant for high-grade salivary gland mucoepidermoid carcinoma, which was resected and radiated six years prior. A comparison of both lesions showed similar morphologic features. Mucicarmine stain was positive in resection specimen but negative in pleural biopsy, confirming the absence of mucocytes. Molecular studies on both specimens showed positivity for fusion of CRTC1 (19p13) and MAML2 (11q21) loci. The overall findings were consistent with metastatic mucoepidermoid carcinoma to pleura.

Conclusion
Pleura is an uncommon site for metastasis from primary salivary gland mucoepidermoid carcinoma but should be part of differential diagnosis. Extensive review of patient’s past medical history plays a crucial role in correctly classifying these lesions as primary or metastatic. Differential diagnoses should include primary squamous cell carcinoma, mesothelioma, and the rare primary mucoepidermoid carcinoma of pleura.