bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement of Coagulation Laboratory Practice in Thailand: The First-Year Experience of the National External Quality Assessment Scheme for Blood Coagulation
Authors: Tientadakul Panutsaya , Opartkiattikul Nisarat , Wongtiraporn Wanida 
Published: February 2021

Abstract
Context.—In Thailand until 2005 there had been no external quality assessment scheme at the national level for blood coagulation tests. Only a few laboratories had an external quality assessment for these tests. In the year 2005, the Thailand National External Quality Assessment Scheme for Blood Coagulation was founded.
Objectives.—To describe the establishment of the Thailand National External Quality Assessment Scheme for Blood Coagulation (including problems encountered and solutions), its progression and expansion, and the improvement of coagulation laboratory practice in Thailand during 2 trial surveys and 4 formal surveys conducted in the first 1;h1 years.
Design.—Between 2005 and 2006, the external quality assessment samples for prothrombin time/international normalized ratio and activated partial thromboplastin time were distributed to the participants as well as the instructions and suggestions for the improvement of laboratory practice. From the data collected, the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time was calculated for each survey.
Results.—The number of participants increased during the first 1;h1 years that the surveys were conducted, from 109 to 127. Survey data demonstrate an improvement in response rate and an increase in the number of laboratories that determine their own reference ranges and repeat this for every change of reagent lot, using the appropriate anticoagulant. The increased precision of tests is indicated by the decrease of the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time. Examples of individual laboratory improvement through feedback are also described.
Conclusions.—The improvement of coagulation laboratory practice both through the instructions provided and liaison with participants was observed during the course of this scheme.
Urine Mercury Excretion Following meso-Dimercaptosuccinic Acid Challenge in Fish Eaters
Authors: Ruha Anne-Michelle , Curry Steven C. , Gerkin Richard D. , Caldwell Kathleen L. , Osterloh John D. , Wax Paul M. 
Published: February 2021

Abstract
Context.—Public awareness of methylmercury in fish has caused patients to seek testing for mercury poisoning. In some patients, the diagnosis of mercury poisoning has been made based on urine mercury excretions following oral dosing of meso-dimercaptosuccinic acid (DMSA), a metal chelator. However, studies comparing urine mercury excretion following DMSA in healthy non–fish eaters with healthy fish eaters could not be located.
Objectives.—To describe urinary mercury excretion before and after DMSA in healthy fish eaters and non–fish eaters, and to determine whether urine mercury excretion after DMSA would rise above baseline levels to a greater extent in fish eaters.
Design.—A total of 24 healthy physicians were assigned to 1 of 3 groups based on fish consumption: non–fish eaters; 1 to 2 fish servings per week; and 3 or more servings per week. Blood mercury concentrations and 12-hour urine mercury and creatinine excretions were measured before and after oral ingestion of 30 mg of DMSA per kilogram of body weight.
Results.—A total of 24 subjects completed the study, and 2 subsequently were excluded. No difference in baseline urinary mercury excretion was detected between groups. All groups demonstrated an increase in urinary mercury excretion following DMSA, which was higher in fish eaters (P = .04). Multiple linear regression found that the best predictor of a rise in urine mercury excretion following DMSA challenge was the prechelation blood mercury concentration.
Conclusions.—In this study of healthy physicians, oral DMSA produced a rise in urine mercury excretion both in non–fish eaters and fish eaters. The increase in chelated mercury excretion was higher in fish eaters. A simple rise in chelated mercury excretion over baseline excretion is not a reliable diagnostic indicator of mercury poisoning.
Optimal Use of Myco/F Lytic and Standard BACTEC Blood Culture Bottles for Detection of Yeast and Mycobacteria
Authors: Kirby James E. , Delaney Meghan , Qian Qinfang , Gold Howard S. 
Published: February 2021

Abstract
Context.—The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice.
Objectives.—To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture.
Data Sources.—Retrospective review of laboratory records.
Results.—Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 ± 1.1 days in standard to 1.8 ± 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage.
Conclusions.—Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
Sino-Orbital Osteoma: A Clinicopathologic Study of 45 Surgically Treated Cases With Emphasis on Tumors With Osteoblastoma-like Features
Authors: McHugh Jonathan B. , Mukherji Suresh K. , Lucas David R. 
Published: February 2021

AbstractContext.—Osteomas are limited almost exclusively to craniofacial and jaw bones. Histologically, they can be divided into ivory, mature, or mixed types. Osteomas may have osteoblastoma-like areas and distinguishing it from true osteoblastoma can be challenging. Some believe osteomas with osteoblastoma-like features behave more aggressively.Objective.—To perform a clinicopathologic comparison of sino-orbital osteomas both with and without osteoblastoma-like features.Design.—We studied 45 surgically excised sino-orbital osteomas. Tumors were categorized as ivory, mature, or mixed type and presence of osteoblastoma-like areas and Paget-like bone were noted. Clinical features of those with and without osteoblastoma-like areas were compared.Results.—Men outnumbered women (3:2); median age was 37 years. Frontal sinus was the most common location (62%) followed by ethmoid and maxillary sinuses. Twelve tumors (27%) involved the orbit, 2 primarily and 10 secondarily. All cases were symptomatic with headache, sinusitis, visual changes, pain, and proptosis being most common. Seventeen tumors (38%) had osteoblastoma-like areas. Extension into an adjacent sinus/anatomic compartment was more common in osteoblastoma-like tumors (47% versus 29%), including more frequent orbital involvement (41% versus 13%). Visual changes were more frequent in the osteoblastoma-like group. Distribution of histologic subtypes and Paget-like bone were similar between the 2 groups. Osteomas with osteoblastoma-like features were more often incompletely excised (25% versus 14%). However, clinical recurrence was less common (8% versus 27%).Conclusions.—Osteoblastoma-like features are common in sino-orbital osteomas, but it does not correlate with more adverse clinical features or worse outcome. Osteoblastoma-like areas appear to represent active remodeling within an osteoma rather than defining a distinct clinicopathologic entity. Distinguishing it from osteoblastoma may require careful histologic evaluation and radiographic correlation.
Association of Cystic Neck Metastases and Human Papillomavirus–Positive Oropharyngeal Squamous Cell Carcinoma
Authors: McHugh Jonathan B. 
Published: February 2021

Abstract
Human papillomavirus is an established cause of oropharyngeal squamous cell carcinoma. Similar to cervical cancer, these cancers are usually caused by high-risk human papillomavirus types 16 and 18 and are associated with high-risk sexual behaviors. Human papillomavirus–associated oropharyngeal squamous cell carcinoma typically affects the palatine and lingual tonsils and frequently results in cystic neck metastases. The histopathology of this subset of head and neck squamous cell carcinoma is unique and typically characterized by poorly differentiated, nonkeratinizing morphology with a basaloid appearance. These tumors occur in younger patients and are more often seen in nonsmokers compared with conventional oral cavity and oropharyngeal squamous cell carcinomas. The incidence of human papillomavirus–associated squamous cell carcinoma is increasing. Recognition of this unique clinicopathologic subset of head and neck carcinoma is important because these patients typically respond more favorably to organ-sparing treatment modalities and have an improved prognosis.
Current Perspectives on the Gleason Grading of Prostate Cancer
Authors: Shah Rajal B. 
Published: February 2021

Abstract
Context.—Since its description in 1966 by Donald Gleason, the Gleason grading has remained a cornerstone in the diagnosis and management of prostate cancer. With widespread use of the prostate specific antigen screening, the diagnosis and management patterns of prostate cancers have dramatically changed. In addition, better understanding of the morphologic spectrum of prostate cancer and its subsequent outcome have prompted the refinement of the grading criteria and reporting practices applicable to contemporary practice management.
Objective.—To present contemporary perspectives and approaches to the Gleason grading of prostate cancer.
Data Sources.—Personal practice experience, review of medical literature, and excerpts from the 2005 International Society of Urological Pathology Consensus Statement on Gleason Grading of Prostate Cancer.
Conclusions.—This review addresses the trend in contemporary practice toward a grading shift, with rare utilization of Gleason patterns 1 and 2, and discusses the refinement of histologic criteria for Gleason patterns 3 and 4; approaches to Gleason grading in the setting of unusual variant morphologies of prostate cancer; significance of higher tertiary pattern 5; and practice recommendations for reporting in the setting of extended multiple core biopsies and multifocal prostate cancers in radical prostatectomy. Finally, the impact of consensus recommendations in current practice, its limitations and pitfalls, are also addressed.
Apocrine Ductal Carcinoma In Situ Involving a Sclerosing Lesion With Adenosis: Report of a Case
Authors: Visscher Daniel W. 
Published: February 2021

Abstract
Apocrine metaplasia is a ubiquitous component of the mammary fibrocystic change spectrum. Although mostly associated with cysts, apocrine metaplasia can also present as a proliferative lesion, rarely with cytologic atypism. Apocrine atypia is characterized by 3-fold nuclear enlargement, multiple nucleoli, and hyperchromatism and generally arises in florid adenosis or radial sclerosing lesions. Dramatic apocrine atypia may be very difficult to distinguish from apocrine ductal carcinoma in situ. The latter is distinguished from apocrine atypia by greater extent of the lesion (&gt;0.4 cm) and the presence of greater nuclear pleomorphism with nuclear membrane irregularity. The clinical significance of apocrine atypia is poorly understood and reflects the lack of published outcome studies. Herein, I report a case in which apocrine ductal carcinoma in situ presented as “atypical apocrine adenosis” in a needle core breast biopsy. It illustrates the problem of assessing apocrine atypia and apocrine ductal carcinoma in situ in small samples.
Dieulafoy Disease of the Colon
Authors: Jain Richa , Chetty Runjan 
Published: February 2021

Abstract
Dieulafoy disease is a rare cause of upper gastrointestinal hemorrhage (usually gastric) and an even rarer cause of colonic bleeding. There is a sudden onset of catastrophic bleeding in a previously healthy individual, which cannot be managed conservatively. Although this entity can be diagnosed and treated by endoscopy and angiography, the knowledge of its existence in colon is critical to making the diagnosis because of its small size. In an era of widespread use of endoscopy, the pathologists uncommonly receive resection specimens for Dieulafoy lesions. However, the diagnosis can be missed because of the small size of the lesion and the almost normal appearance of the mucosa. Awareness of its existence will provide an answer for otherwise unexplained gastrointestinal hemorrhage.
Nephrogenic Systemic Fibrosis: A Pathologic Study of Autopsy Cases
Authors: Koreishi Aashiyana F. , Nazarian Rosalynn M. , Saenz Adam J. , Klepeis Veronica E. , McDonald Anna G. , Farris Alton Brad , Colvin Robert B. , Duncan Lyn M. , Mandal Rajni V. , Kay Jonathan 
Published: February 2021

Abstract
Context.—Nephrogenic systemic fibrosis (NSF) is a rare but serious disorder initially described as a purely dermatologic process. Isolated autopsy reports have described multiorgan involvement by this disease.
Objective.—To further illustrate the varied and systemic involvement of NSF by describing the autopsy experience at the Massachusetts General Hospital.
Design.—We describe the findings in a series of 4 autopsy cases of patients diagnosed with NSF. This report describes the history of renal dysfunction, exposure to gadolinium-containing contrast agents, specific laboratory parameters, and the extent of systemic involvement identified by postmortem examination.
Results.—Causes of death included systemic thromboembolic disease (n = 3) and pneumonia (n = 1). Laboratory parameters and type, dose, or timing of gadolinium-containing contrast-agent exposure did not correlate with clinical findings and outcomes. All patients demonstrated cutaneous manifestations of the disease and nephrocalcinosis, with some exhibiting calcification and fibrosis of the dura, thyroid, and heart including the cardiac conduction system, on postmortem examination. Soft tissue calcification was associated with concurrent hyperparathyroidism or high serum parathyroid hormone levels.
Conclusions.—Thromboembolic disease can be a significant clinical complication of NSF. Patients with NSF may also develop characteristic histologic features of fibrosis and calcification in multiple organs, with significant morbidity and mortality. This autopsy series highlights the variability of systemic manifestations of NSF.
Whole-Slide Imaging Digital Pathology as a Platform for Teleconsultation: A Pilot Study Using Paired Subspecialist Correlations
Authors: Wilbur David C. , Madi Kalil , Colvin Robert B. , Duncan Lyn M. , Faquin William C. , Ferry Judith A. , Frosch Matthew P. , Houser Stuart L. , Kradin Richard L. , Lauwers Gregory Y. , Louis David N. , Mark Eugene J. , Mino-Kenudson Mari , Misdraji Joseph , Nielsen Gunnlauger P. , Pitman Martha B. , Rosenberg Andrew E. , Smith R. Neal , Sohani Aliyah R. , Stone James R. , Tambouret Rosemary H. , Wu Chin-Lee , Young Robert H. , Zembowicz Artur , Klietmann Wolfgang 
Published: February 2021

Abstract
Context.—Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized.
Objective.—To determine whether interpretation of whole-slide images differed from glass-slide interpretation in difficult surgical pathology cases.
Design.—Diagnostically challenging pathology slides from a variety of anatomic sites from an outside laboratory were scanned into whole digital format. Digital and glass slides were independently diagnosed by 2 subspecialty pathologists. Reference, digital, and glass-slide interpretations were compared. Operator comments on technical issues were gathered.
Results.—Fifty-three case pairs were analyzed. There was agreement among digital, glass, and reference diagnoses in 45 cases (85%) and between digital and glass diagnoses in 48 (91%) cases. There were 5 digital cases (9%) discordant with both reference and glass diagnoses. Further review of each of these cases indicated an incorrect digital whole-slide interpretation. Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic disease (88%). Comments on discordant cases related to digital whole technology focused on issues such as fine resolution and navigating ability at high magnification.
Conclusions.—Overall concordance between digital whole-slide and standard glass-slide interpretations was good at 91%. Adjustments in technology, case selection, and technology familiarization should improve performance, making digital whole-slide review feasible for broader telepathology subspecialty consultation applications.
Alport Syndrome and Thin Glomerular Basement Membrane Nephropathy: A Practical Approach to Diagnosis
Authors: Haas Mark 
Published: February 2021

AbstractContext.—Alport syndrome and thin glomerular basement membrane nephropathy (TBMN) are genetically heterogenous conditions characterized by structural abnormalities in the glomerular basement membrane and an initial presentation that usually involves hematuria. Approximately 40% of patients with TBMN are heterozygous carriers for autosomal recessive Alport syndrome, with mutations at the genetic locus encoding type IV collagen α3 [α3(IV)] and α4 chains. However, although the clinical course of TBMN is usually benign, Alport syndrome, particularly the X-linked form with mutations in the locus encoding the α5 chain of type IV collagen [α5(IV)], typically results in end-stage renal disease. Electron microscopy is essential to diagnosis of TBMN and Alport syndrome on renal biopsy, although electron microscopy alone is of limited value in distinguishing between TBMN, the heterozygous carrier state of X-linked Alport syndrome, autosomal recessive Alport syndrome, and even early stages of X-linked Alport syndrome.Objectives.—To review diagnostic pathologic features of each of the above conditions, emphasizing the need for immunohistology for α3(IV) and α5(IV) in addition to electron microscopy to resolve this differential diagnosis on a renal biopsy. The diagnostic value of immunofluorescence studies for α5(IV) on a skin biopsy in family members of patients with Alport syndrome also is reviewed.Data Sources.—Original and comprehensive review articles on the diagnosis of Alport syndrome and TBMN from the past 35 years, primarily the past 2 decades, and experience in our own renal pathology laboratory.Conclusions.—Although Alport syndrome variants and TBMN do not show characteristic light microscopic findings and can be difficult to differentiate from each other even by electron microscopy, using a combination of electron microscopy and immunohistology for α3(IV) and α5(IV) enables pathologists to definitively diagnose these disorders on renal biopsy in most cases.
Renal Lesions Associated With Plasma Cell Dyscrasias: Practical Approach to Diagnosis, New Concepts, and Challenges
Authors: Herrera Guillermo A. 
Published: February 2021

AbstractContext.—Patients with plasma cell dyscrasias (myeloma) may exhibit a variety of renal manifestations as a result of damage from circulating light- and heavy-chain immunoglobulin components produced by the neoplastic plasma cells. The renal alterations can occur in any of the renal compartments, and in a significant number of the cases more than one compartment is affected. Research in the laboratory has helped considerably in providing a solid conceptual understanding of how renal damage occurs.Objectives.—To detail advances that have been made in the diagnosis of these conditions and to provide an account of research accomplishments that have solidified diagnostic criteria. The new knowledge that has been acquired serves to provide a solid platform for the future design of new therapeutic interventions aimed at ameliorating or abolishing the progressive renal damage that typically takes place.Data Sources.—Translational efforts have substantially contributed to elucidate mechanistically the molecular events responsible for the renal damage. The spectrum of renal manifestations associated with plasma cell dyscrasias has expanded significantly in the last 10 years. Diagnostic criteria have also been refined. This information has been summarized from work done at several institutions.Conclusions.—A number of significant challenges remain in the diagnosis of these conditions, some of which will be discussed in this article. Dealing with these challenges will require additional translational efforts and close cooperation between basic researchers, clinicians, and pathologists in order to improve the diagnostic tools available to renal pathologists and to acquire a more complete understanding of clinical and pathologic manifestations associated with these conditions.
Emerging Therapy-Related Kidney Disease
Authors: Arend Lois J. , Nadasdy Tibor 
Published: February 2021

AbstractContext.—Many new therapies have emerged within the last 5 to 10 years to treat a variety of conditions. Several of these have direct or indirect renal toxicities that may go undiagnosed without careful attention of the pathologist to a patient's clinical history, particularly the addition of new medications or treatments.Objective.—To discuss patterns of renal injury resulting from medications or therapeutic regimens that have been introduced within the last 10 years. Recognition of these patterns may allow the pathologist to alert the attending clinician to a possible drug-induced renal injury and prevent further deterioration of renal function and possible chronic kidney disease.Data Sources.—A review of recent literature and unpublished observations of case-derived material.Conclusions.—A number of newer therapies have emerged as agents of renal toxicity, producing a variety of pathologic changes in the kidney. The outcome can be acute or chronic glomerular, tubular, interstitial, and/or vascular injury. Some drugs will result in irreversible changes and end-stage renal disease, whereas many of the alterations can be reversed with removal of the offending agent, avoiding potential long-term kidney injury.
Pancreatic Cytopathology: A Practical Approach and Review
Authors: Bellizzi Andrew M. , Stelow Edward B. 
Published: February 2021

AbstractContext.—Pancreatic cytopathology plays an important role in the diagnosis and management of patients with solid and cystic lesions of the pancreas.Objective.—To serve as a practical guide to pancreatic cytopathology for the practicing pathologist.Data Sources.—A comprehensive assessment of the medical literature was performed.Conclusions.—We review pancreatic cytopathology, with specific discussions of its role in patient management, specimen types and specimen processing, specific diagnostic criteria, and the use of ancillary testing and advanced techniques.