bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case report of an uncommon presentation of Nephroblastoma (Wilms tumor): in an older child with polycythemia and elevated erythropoietin
Authors: Danyal K , Sybenga A 
Published: October 2021

Abstract

Introduction/Objective
Wilms tumor (nephroblastoma), is a neoplasm that has a prevalence of 1 per 10,000 before the age of fifteen, with 50% occurring before age 3. WT1 (11p13) gene, a zinc finger transcription factor, is expressed in early urogenital system development and mutations here represent one of the primary pathways to the development of Wilms tumor. Although mouse model studies have shown that WT1 may be a transcriptional activator of erythropoietin (EPO) gene, increases in serum erythropoietin are rarely seen in patients with Wilms tumor. Concurrent polycythemia is a further rarity with only 11 such reports in literature. This is intriguing since WT1 mutations represent the most common mutation pathway in Wilms Tumor. Interestingly, other tumor types associated with elevated serum EPO and polycythemia (e.g. renal cell carcinoma and metanephric adenoma) are thought to do so through the generation of hypoxia inducible factor, and induction of VEGF.

Methods/Case Report
Here we present a case of Wilms tumor in a 7-year-old female who was establishing care after moving to Vermont. Physical examination showed possible splenomegaly ultimately discovered to be a large LUQ abdominal mass with a concurrent discovery of polycythemia. Subsequent serum EPO was 308 (Ref: 2.6-18.5 mIU/mL).). The mass was surgically removed with resolution of polycythemia. Histological evaluation showed a triphasic, blastema predominant Wilms tumor with favorable histology. Heterologous, vascular differentiation was seen in the stroma, positive for CD34 and CD31, and negative for D2-40.

Results (if a Case Study enter NA)
NA

Conclusion
Based on these findings, this phenomenon may be related to increased VEGF expression resulting in this patient’s increased serum EPO and polycythemia, and heterologous vascular differentiation within the tumor stroma. This is the first report of histology in a case of Wilms tumor associated with high serum EPO and polycythemia and may indicate an alternative pathway for the generation of EPO in Wilms tumor.
Outcome of primary pulmonary salivary gland-type carcinoma
Authors: Deb P Q , Suster D 
Published: October 2021

Abstract

Introduction/Objective
Primary pulmonary salivary gland-type carcinomas are rare malignancies that arise from minor salivary gland tissue present within seromucinous submucosal glands within the lower respiratory tract. Due to their rarity (~ &lt;1% of all primary lung malignancies), the epidemiological features and outcome of these malignancies are not well documented. Data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was analyzed to identify cases of primary pulmonary salivary gland carcinoma. The most common tumor types included mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ADCC), and epithelial-myoepithelial carcinoma (EMEC). The tumors were analyzed for overall survival across various epidemiological factors.

Methods/Case Report
All patients diagnosed with MEC, ADCC, and EMEC with the lung designated as the primary site between the period of 1975 to 2017 were analyzed. We calculated overall survival and disease-specific survival with Kaplan-Meier curves and Cox proportional hazards models using SPSS v25.

Results (if a Case Study enter NA)
323 cases of MEC, 284 cases of ADCC, and 6 cases of EMEC diagnosed as primary lung carcinoma were identified. Age distribution analysis of the patients showed a unimodal distribution for both MEC and ADCC with most patients being diagnosed after the age of 40. 54% of MEC patients were male, while 48% of ADCC patients were male. The majority of patients were Caucasians (77% for MEC and 83% for ADCC patients). Both disease-specific and overall survival were worse for patients diagnosed at the age of 60 years or above. Race or sex did not significantly affect patients’ survival. High-grade MEC showed significantly worse prognosis than low or intermediate grade MEC. EMEC cases were too few (n=6) to perform reliable survival analysis, however, the age of diagnosis was higher (45 and above) with a higher incidence among black population (50%).

Conclusion
Comprehensive review of clinical and epidemiological features of primary salivary gland-type lung carcinoma show that the age of diagnosis and tumor grade are the most significant factor in determining the survival of these patients.
Quality improvement Initiative to eliminate silver precipitate during Periodic Acid Silver Methenamine Stain (PAMS) automated protocol of renal biopsies at McGill University Health Centre
Authors: Kuk M , Chicoine D , Maedler C , Bernard C 
Published: October 2021

Abstract

Introduction/Objective
Annually, about 400 renal biopsies are processed at the McGill University Health Centre (MUHC) pathology laboratory located in Montreal, Canada. One of the stains used to visualize the glomerular basement membrane is Periodic Acid Silver Methenamine Stain (PAMS). In August 2020, a strong, granular precipitate of silver was noted during PAMS automated staining resulting in uninterpretable results and delay in the diagnosis. Based on a sample analysis, this problem affected 21 % of kidney biopsies.

Methods/Case Report
A cause-and-effect workflow was developed for systematic assessment of potential causes of the granular precipitate including pre-analytical and analytical factors. Some of the pre-analytical factors included length of time spent in transport before fixation and patient factors that predisposed precipitate formation. Analytical factors were categorized as fixation problems (temperature, pH, duration), embedding problems (parafilm temperature, cooling method, type of parafilm), slide preparation (temperature, water bath pH, dehydration and further processing steps), microtone parameters (microtone calibration, thickness, laboratory technologist expertise), automatic staining parameters (cartridge age, hematoxylin counterstain duration, wash-out period etc.) and coverslip placement (adhesive type, temperature, drying).

Results (if a Case Study enter NA)
Following our systematic approach, the cause of granular precipitate was identified as the timing of hematoxylin counterstain. A portion of renal biopsy tissue was taken from parafilm blocks of previouslly reported cases of patients with membranous glomerulonephritis to further test the hypothesis by introduction of various incubation times with the hematoxylin counterstain.

Conclusion
Best PAMS staining was attained when no hematoxylin counterstain was employed (instead, neutral red counterstain for 70 seconds was used). PAMS staining with hematoxylin counter stain for no more than 60 seconds was found to be acceptable for the interpretation of glomerular pathology.
GATA3 Is a Useful Immunohistochemical Marker to Differentiate Variants of Renal Tubular Lesions from Different Segments of Renal Tubules
Authors: Deebajah M , Qu Z , Zhang P 
Published: October 2021

Abstract

Introduction/Objective
GATA3 is found in glomerular mesangial cells, and the distal tubules & collecting ducts in metanephros and eventual kidneys, but not associated with the proximal tubules and loops of Henle. We hypothesize that GATA3 can be used as a marker to identify the origin of tubular differentiation in most renal tumors.

Methods/Case Report
Ten negative controls and 43 renal mass lesions (RCC, papillary, clear cell papillary, and chromophobe carcinomas, oncocytoma, and polycystic kidney disease). GATA3 nuclear stain was graded as negative (absent stain), equivocal and positive (&lt; 5 and &gt; 5% cells, respectively). Details of their GATA3 nuclear expression was analyzed for identifying their tubular segmental origins.

Results (if a Case Study enter NA)
In 10 normal renal parenchyma, GATA3 was positive in mesangial cells, distal tubules, and collecting ducts, but was negative in the proximal tubules and loop of Henle. The cystic lining of glomerulocystic renal disease was stained negatively for GATA3 (proximal tubular origin), whereas pediatric and adult variants of polycystic kidney diseases was positive for GATA3 staining (distal tubular origin). 1/10 ten clear cell RCC and papillary RCC showed focal positive GATA3 stain. GATA3 showed weakly positive staining in some oncocytomas (4/11) and some chromophobe RCC (4/11), indicating that they might be derived from the junctional segment between the loop of Henle and the distal tubules. By contrast, all clear cell papillary RCC (distal tubule origin) were diffusely positive.

Conclusion
Our results indicate that GATA3 is a useful immunohistochemical marker to determine the developmental origin in the specific renal tubular segment for the majority of renal mass lesions. Thus, it may be useful for routine differential diagnosis of these lesions.
The Correlation between Serum Creatinine and PTH Levels in Dialysis Patients in Egypt
Authors: Boraik A S , Abdelmonem M , Shedid M , Abd Elaal H M , Elhusseny A , Mohamed M M , Wasim H 
Published: October 2021

Abstract

Introduction/Objective
Chronic kidney disease (CKD) is affecting about 14% of the general population. CKD is associated with a decrease in calcium level in the body. In the early stages of (CKD), dialysis may not be needed. The late stages of CKD will require dialysis or a kidney transplant to save a life.
Secondary hyperparathyroidism is a crucial disorder in CKD patients. It explains why the illness causes a significant change in bone and mineral metabolism. This study aims to study renal hyperparathyroidism (rHPT) in dialysis patients with late-stage of chronic kidney disease (CKD).

Methods/Case Report
A total of 55 subjects were enrolled in this study for late-stage dialysis patients from Egypt. Serum creatinine and PTH levels were measured. Among the 55 subjects; 41 subjects (74.5%) were males, 14 subjects (25.5%) were females with a mean age of 52.7 and 34.3 years for males and females, respectively.
Subjects were divided into two groups; Study group I consists of 33 dialysis patients; three patients were females (9%) while 30 patients were males (91%), and control group II consists of 22 healthy individuals, 11 subjects were females (50%), and 11 subjects were males (50%).

Results (if a Case Study enter NA)
In our study, in comparison between two groups as regards blood investigations. The means of creatinine and PTH in the study group I were 8.93 mg/dl and 316.8, while in the control group II were 0.9, and 38.4 respectively.
Comparing the two groups shows that mean of Creatinine and PTH in the study group was statistically significantly higher than the control group (p-value less than 0.001).

Conclusion
In patients with CKD, accurate measurement of (PTH) is critical for treatment decision-making to reduce the risk of bone and cardiovascular diseases.
We recommend that patients with diabetes and high blood pressure be aware that they must take their medications consistently to avoid kidney problems.
Service Learning is Action Learning: A Novel Way to Increase Classroom Learning Retention
Authors: Brunson-Pitt E 
Published: October 2021

Abstract

Introduction/Objective
As educators, how do we ignite students to become effective and engaging ambassadors for the medical laboratory profession while making learning difficult concepts fun? This case study explores the use of service learning as an effective tool in nurturing advocacy for issues affecting the health and longevity of minority populations within the community, while learning hematological and blood banking concepts.

Methods/Case Report
Four MLT student cohorts comprised of twelve to sixteen students each participated in a ten- week, service-learning assignment as part of their Medical Laboratory Technician Curriculum. Assignment objectives were to: (1) understand racial /cultural history that preclude individuals from participating in hematopoietic stem cell donation and transplant; and, (2) develop and implement a strategy to recruit donors for the screening event. Students actively recruited across their college campus and surrounding communities to enroll one hundred new stem cell donors, with over fifty percent of these donors identifying as people of color. This activity represented ten percent of their course grade. Examples of assignments students were required to complete included: creating and implementation a donor recruitment strategy; reflection journal entries; host an in-person /virtual stem cell donor drive; and submission of an outcome assessment summarizing goal achievement along with lessons learned.

Results (if a Case Study enter NA)
N/A

Conclusion
As a result, students enrolled over 300 new stem cell donors into Be The Match™ - National Marrow Donor Program® resulting in seven successful transplants. Students learned how to effectively inform their community of the importance of clinical laboratory scientists, raising awareness of the need for clinical laboratory professionals and the need of genetically diverse individuals to volunteer as donors to provide the life-saving therapies.
Bleeding Patient with Anti-PP1Pk – Revisiting Autologous Frozen Red Blood Cells
Authors: Pacheco M C , Fedda F , Mignogna D , Meena-Leist C 
Published: October 2021

Abstract

Introduction/Objective
A 34-year-old Amish woman G11P8A2L8, with a known PP1Pk antibody, presented to her OB with vaginal hemorrhage secondary to an incomplete spontaneous abortion. Despite medical treatment, her hemoglobin decreased from 12 g/dL to 8.4 g/dL. She was air transferred to a tertiary care hospital for further management and antigen negative RBC transfusion.
Upon arrival, her hemoglobin had decreased to 7.1 g/dL and her BP decreased to 92/64 mm Hg. Additional blood draws were discontinued to save blood wastage. Her blood pressure continued to decrease over the next several hours to a low of 78/36. The patient was briefly stabilized, and a successful dilation and curettage was performed.

Methods/Case Report
A national search was conducted for PP1Pk antigen negative blood. Her RBC phenotype: C+, c-, E-, e+, K-k-, Fy(a + b-), Jk(a+ b+), MN+, p, Le(a-b-). There was no history of blood product transfusion and the prior miscarriages where thought to be the source of alloimmunization. There was no known family history of the p (P- P1- Pk-) phenotype.

Results (if a Case Study enter NA)
One unit of PP1Pk antigen negative PRBCs was located approximately 48 hours after the patient’s admission, however, the consulting hematology team suggested withholding transfusion due the possibility of alloimmunization from other blood groups complicating future transfusions. She was treated with IV iron and discharged four days later with a hemoglobin level of 6 g/dL. She was asymptomatic upon discharge.

Conclusion
Anti-PP1Pk is a rare antibody (5.8 per 1 million people). In the Amish population, the incidence is approximately 1 in 5000 individuals. Our patient is planning for future pregnancies. Upon our suggestion, the patient was encouraged to consider frozen autologous blood donation after recovery and before the next pregnancy as well as close monitoring in high-risk maternal fetal medicine settings.
In a patients and donors with anti PP1PK, we recommend advance planning including frozen autologous blood donation and family members RBC antigen studies. They should be encouraged to become regular blood donors for themselves and others.
Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage
Authors: Toprak M , Asuzu I M , Morvillo G , Kiran F , Chae B , Desai D S , Opitz L M 
Published: October 2021

Abstract

Introduction/Objective
Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage.

Methods/Case Report
A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned.

Results (if a Case Study enter NA)
Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1).

Conclusion
Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.
Leukostasis aggravated by red blood cell transfusion in a chronic lymphocytic leukemia patient
Authors: Jum’ah H , Chitsaz M , Kundrapu S 
Published: October 2021

Abstract

Introduction/Objective
Leukostasis/symptomatic hyperleukocytosis is commonly seen in acute leukemias and is characterized by high blast counts and symptoms of decreased tissue perfusion with a one-week mortality of 20-40%, if left untreated. It is a rare complication in chronic lymphocytic leukemia (CLL) and is seen in CLL patients with white blood cell (WBC) counts &gt; 500x10^9/L. Studies have shown that transfusion of blood products prior to decreasing the WBC count may lead to increased blood viscosity and worsen leukostasis. We report a CLL patient with a lower WBC count presenting with symptoms of leukostasis, further worsened by a red blood cell (RBC) transfusion prior to leukapheresis.

Methods/Case Report
A 73-year-old male with history of CLL for 5 years, hypertension and chronic kidney disease presented with acute dyspnea for 1 day. The WBC count was 208x10^9/L, hemoglobin was 6.5 g/dL, troponin I was 1.554 ng/mL, creatinine was 1.68 mg/dL and chest x-ray showed bilateral interstitial lung edema. The patient was diagnosed with acute hypoxic respiratory failure, acute kidney injury and myocardial infarction due to leukostasis. He received RBC transfusion, shortly after which his dyspnea worsened. There were no other signs or symptoms that could suggest a transfusion reaction. A single leukapheresis was performed following which there was a significant improvement in symptoms with a drop in WBC count to 123.1x10^9/L and creatinine to 1.3 mg/dL.

Results (if a Case Study enter NA)
NA

Conclusion
CLL may present with symptomatic hyperleukocytosis at lower leukocyte counts than has been described in the literature. Symptoms due to leukostasis can be precipitated/worsened by transfusion of blood products due to increased blood viscosity. It is critical to identify the signs and symptoms of this medical emergency as prompt diagnosis and management with leukapheresis significantly reduces the leukocyte count and blood products should be transfused slowly during or after leukapheresis.
Effects of Fasting Blood Glucose on the Progression of Arterial Stiffness in Nondiabetic Population
Authors: Han Xu , Liu Qian , Ma Yi-han , Zheng Xiao-ming , Ruan Chun-yu , Cui Kai , Song Ming-zhu , Wu Shou-ling , Wu Yun-tao 
Published: October 2021

Abstract

Background
To investigate the relationship between baseline fasting blood glucose levels and the progression of arterial stiffness in nondiabetic population.

Methods
In this research, the individuals participated in the Kailuan research cohort and completed 2 tests of brachial–ankle pulse wave velocity (baPWV) from 2010 to 2018 and were not diabetic at the first baPWV testing were included. A multiple linear regression was applied to analyze the impact of baseline fasting blood glucose levels on baPWV and its progress during the follow-up.

Results
A total of 16,875 with 10,453 male (61.94%) subjects met the inclusion criteria. The average age at baseline (the first baPWV measurement) was (45.9 ± 13.0) years old and the average baPWV was (1,439.0 ± 309.3) cm/s. During the follow-up (the second baPWV measurement), the average age was (49.6 ± 13.3) years old, and the average baPWV was (1,494.6 ± 334.3) cm/s. The baPWV progression in the observed subjects was (55.7 ± 233.4) cm/s. After adjusted for other confounding factors, multiple linear regression analysis found that there was a positive correlation between the baseline fasting blood glucose levels and the follow-up baPWV. With every 1 mmol/l baseline fasting blood glucose increase, the follow-up baPWV increased 16.89 cm/s. With every 1 mmol/l fasting blood glucose level increase, the progress of baPWV increased by 3.70 cm/s.

Conclusions
Fasting blood glucose levels in nondiabetics affect arterial stiffness during follow-up. Elevated fasting blood glucose levels during the follow-up period are a risk factor that may increase the progression of arterial stiffness.
Seasonal reproduction and gonadal function: a focus on humans starting from animal studies
Authors: Beltran-Frutos Ester , Casarini Livio , Santi Daniele , Brigante Giulia 
Published: October 2021

Abstract
Photoperiod impacts reproduction in many species of mammals. Mating occurs at specific seasons to achieve reproductive advantages, such as optimization of offspring survival. Light is the main regulator of these changes during the photoperiod. Seasonally breeding mammals detect and transduce light signals through extraocular photoreceptor, regulating downstream melatonin-dependent peripheral circadian events. In rodents, hormonal reduction and gonadal atrophy occur quickly and consensually with short-day periods. It remains unclear whether photoperiod influences human reproduction. Seasonal fluctuations of sex hormones have been described in humans, although they seem to not imply adaptative seasonal pattern in human gonads. This review discusses current knowledge about seasonal changes in the gonadal function of vertebrates, including humans. The photoperiod-dependent regulation of hypothalamic–pituitary–gonadal axis, as well as morphological and functional changes of the gonads is evaluated herein. Endocrine and morphological variations of reproductive functions, in response to photoperiod, are of interest as they may reflect the nature of past population selection for adaptative mechanisms that occurred during evolution.