bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract
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

Abstract
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

AbstractContext.—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

AbstractContext.—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

Abstract
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

Abstract
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 (&lt;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

Abstract
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.
Human Papillomavirus DNA Testing as an Adjunct to Cytology in Cervical Screening Programs
Authors: Lörincz Attila T. , Richart Ralph M. 
Published: February 2021

Abstract
Our objective was to review current large studies of human papillomavirus (HPV) DNA testing as an adjunct to the Papanicolaou test for cervical cancer screening programs. We analyzed 10 large screening studies that used the Hybrid Capture 2 test and 3 studies that used the polymerase chain reaction test in a manner that enabled reliable estimates of accuracy for detecting or predicting high-grade cervical intraepithelial neoplasia (CIN). Most studies allowed comparison of HPV DNA and Papanicolaou testing and estimates of the performance of Papanicolaou and HPV DNA as combined tests. The studies were selected on the basis of a sufficient number of cases of high-grade CIN and cancer to provide meaningful statistical values. Investigators had to demonstrate the ability to generate reasonably reliable Hybrid Capture 2 or polymerase chain reaction data that were either minimally biased by nature of study design or that permitted analytical techniques for addressing issues of study bias to be applied. Studies had to provide data for the calculation of test sensitivity, specificity, predictive values, odds ratios, relative risks, confidence intervals, and other relevant measures. Final data were abstracted directly from published articles or estimated from descriptive statistics presented in the articles. In some studies, new analyses were performed from raw data supplied by the principal investigators. We concluded that HPV DNA testing was a more sensitive indicator for prevalent high-grade CIN than either conventional or liquid cytology. A combination of HPV DNA and Papanicolaou testing had almost 100% sensitivity and negative predictive value. The specificity of the combined tests was slightly lower than the specificity of the Papanicolaou test alone, but this decrease could potentially be offset by greater protection from neoplastic progression and cost savings available from extended screening intervals. One “double-negative” HPV DNA and Papanicolaou test indicated better prognostic assurance against risk of future CIN 3 than 3 subsequent negative conventional Papanicolaou tests and may safely allow 3-year screening intervals for such low-risk women.
Human Papillomavirus Reporting: Impact on Bethesda Cytology Reports
Authors: Raab Stephen S. 
Published: February 2021

Abstract
In 2001, the Bethesda Committee revised the terminology for reporting Papanicolaou tests. One of the 2001 Bethesda forum groups addressed the use of ancillary tests, and the most commonly used ancillary test is for human papillomavirus (HPV). The Bethesda Ancillary Testing Forum presented terminology related to HPV testing. The Ancillary Testing Forum recommended that the specific HPV test method be presented and the results reported as positive or negative for HPV of a certain type or class. The Papanicolaou test and the HPV test should be reported together or should refer to each other if possible. A number of reporting schema currently are used to report HPV results; these schema include probabilistic reporting, integrated reporting, reporting as a result, and reporting with clinical management recommendations. Few data currently are available to support an optimal reporting method.
Erdheim-Chester Disease: A Unique Presentation With Liver Involvement and Vertebral Osteolytic Lesions
Authors: Ivan Doina , Neto Antonio , Lemos Luciano , Gupta Arpan 
Published: February 2021

Abstract
Erdheim-Chester disease is a very rare xanthogranulomatous, non-Langerhans cell systemic histiocytosis with an unknown etiology and pathogenesis. Histologically, it is characterized by a diffuse infiltration with large, foamy histiocytes, rare Touton-like giant cells, lymphocytic aggregates, and fibrosis. The histiocytes differ from the Langerhans cell group in ontogenesis, immunohistochemistry (positive for CD68 and negative for CD1a and S100 protein), and ultrastructural appearance (lack of Birbeck granules). Although most of the cases have symmetric osteosclerosis of the long bones, an involvement of the axial skeleton has also been described. Extraskeletal lesions are present in more than 50% of the patients and may involve the retroperitoneal space, lungs, kidneys, brain, retro-orbital space, and heart. This study presents the case of a patient with Erdheim-Chester disease with vertebral destruction and, for the first time, to our knowledge, involvement of the liver. The diagnosis is based on radiologic, histologic, immunohistochemical, and ultrastructural findings.
Ectopic Hamartomatous Thymoma: A Case Report Showing CD99+ Lymphocytes and a Low Proliferation Index
Authors: Lee Shi Nae , Cho Min Sun , Koo Heasoo , Han Woon Sup 
Published: February 2021

Abstract
Ectopic hamartomatous thymoma is a rare benign tumor that consists of spindle, epithelial, and adipose cell elements. We present a case of this lesion arising in the supraclavicular region of a 59-year-old man, including the characteristic immunohistochemical and ultrastructural findings. DNA flow cytometry revealed diploidy with a low proliferation index (6.73%). The tumor contained CD99+ lymphocytes; CD99 (MIC2) can serve as a useful marker of immature T cells. These findings suggest that ectopic hamartomatous thymoma may develop from the third branchial pouch or thymic anlage.
Ossifying Adult Xanthogranuloma
Authors: Salamanca Javier , Rodriguez-Peralto Jose Luis , Gonzalez-Lois Carmen , Azorin Daniel 
Published: February 2021

Abstract
Although a xanthogranuloma is a relatively common benign cutaneous condition and ossification has been observed within many cutaneous lesions, the association between ossification and xanthogranuloma has not, to our knowledge, been reported previously. We believe we describe for the first time the case of a xanthogranuloma with marked osseous metaplasia on the trunk of a 41-year-old woman. Microscopically, the lesion showed typical features of a xanthogranuloma, with the exceptional feature of exuberant bone formation. The presence of bone within this lesion is likely secondary to a metaplastic process.
Revisitando estudos brasileiros sobre capacidade absortiva das organizações
Authors: Martins Aurea de Carvalho , Sinay Maria Cristina Fogliatti 
Published: February 2021

A concorrência impõe às empresas investimentos constantes em melhorias dos seus processos e na oferta de novos produtos aos seus clientes. Terá vantagem competitiva a empresa que conseguir rapidamente perceber as mudanças no meio externo e aprimorar seus processos e produtos. Compreender como a geração e a disseminação do conhecimento é gerada, implementada ou inibida e dificultada podem contribuir para melhores resultados da empresa. Estudos sobre a construção do conhecimento começaram a ser sistematizados por Cohen et al. (1990) e foram aprimorados por Zahra et al. (2002). A dinâmica de todo esse processo é conhecida como Capacidade Absortiva – CA que+ necessita de quatro etapas para que a inovação seja implementada. Reconhecendo que os estudos acadêmicos podem atuar como dinamizadores no processo de desenvolvimento e distribuição do conhecimento, este estudo teve como objetivo verificar as publicações brasileiras sobre CA e regiões geográficas onde o assunto foi desenvolvido. A pesquisa foi realizada em maio de 2020 no repositório de artigos científicos gratuitos da Scientific Periodicals Electronic Library - SPELL. A amostra compreendeu 66 artigos, cujos autores observaram prioritariamente a região Sul do Brasil, e evidenciaram que CA é um tema muito próximo à inovação, capacidade dinâmica, capital intelectual, conhecimento, internacionalização e empresas incubadoras.
Desafios na implementação de política de gestão de projetos na Universidade Tecnológica Federal do Paraná
Authors: Moura Tiago de , Theodorovicz James Carlo , Proner Marina Sandrini , Oliveira Jair de , Michaloski Ariel Orlei 
Published: February 2021

A Administração Pública é vista por muitos leigos como desorganizada, cara e ineficiente. A partir disso, este estudo busca otimizar recursos humanos e financeiros, apresentando o cenário e as variáveis de um processo de implantação de gestão de projeto em uma organização pública; projeto este que envolve um número significativo de recursos da instituição. O artigo aborda uma investigação das barreiras que impedem a implantação da gestão de projetos. Trata-se de uma ferramenta que certamente não resolveria todos os problemas que a Administração Pública enfrenta, mas que se aplicada corretamente traria ganhos e sucesso nos projetos públicos, gerando vantagem competitiva para a instituição pública objeto do estudo. O caso apresentado ilustra os conceitos apresentados na revisão, assim como a influência do aprendizado no desenvolvimento da gestão de projetos. Ao final, o trabalho abre possibilidades para a continuidade das pesquisas sobre os temas abordados.