bluuebunny/crossref_metadata_2025_split huggingface dataset:
External Quality Assessment in the Examination of Blood Films for Malarial Parasites Within Ontario, Canada
Authors: Thomson Sam , Lohmann Reinhard C. , Crawford Linda , Dubash Ruby , Richardson Harold 
Published: January 2021

Abstract
Objective.—To assess laboratory practice in the examination of blood films for malarial parasites.
Method.—Ontario medical laboratories, licensed by the Ministry of Health, are required to participate in external quality assessment by the Laboratory Proficiency Testing Program, which assesses performance of laboratory assays and also examines the total testing process. Educational strategies are used to improve performance.
Results.—A 1995 survey indicated shortcomings in detection and identification of malarial parasites in blood films. Consequently, recommendations for the investigation of malarial parasites in blood were issued. In 1996 and 1997, 16 workshops were conducted. A 1997 follow-up external quality assessment survey indicated that problems persist as 27% of laboratories failed to correctly speciate Plasmodium falciparum. Good Practice Guidelines were issued in 1998.
Conclusion.—Further education and assessment are required. Laboratories lacking expertise must establish referral arrangements with more proficient laboratories.
Point-of-Care Glucose Testing
Authors: Louie Richard F. , Tang Zuping , Sutton Demetria V. , Lee Judith H. , Kost Gerald J. 
Published: January 2021

Abstract
Objective.—To assess the clinical performance of glucose meter systems when used with critically ill patients.
Design.—Two glucose meter systems (SureStepPro and Precision G) and a modular adaptation (Immediate Response Mobile Analysis-SureStepPro) were assessed clinically using arterial samples from critically ill patients. A biosensor-based analyzer (YSI 2700) and a hospital chemistry analyzer (Synchron CX-7) were the primary and secondary reference instruments, respectively.
Patients and Setting.—Two hundred forty-seven critical care patients at the University of California, Davis, Medical Center participated in this study.
Outcome Measures.—Error tolerances of ±15 mg/dL for glucose levels ≤100 mg/dL and ±15% for glucose levels &gt;100 mg/dL were used to evaluate glucose meter performance; 95% of glucose meter measurements should fall within these tolerances.
Results.—Compared to the primary reference method, 98% to 100% of SureStepPro and 91% to 95% of Precision G measurements fell within the error tolerances. Paired differences of glucose measurements versus critical care variables (Po2, pH, Pco2, and hematocrit) were analyzed to determine the effects of these variables on meter measurements. Po2 and Pco2 decreased Precision G and SureStepPro measurements, respectively, but not enough to be clinically significant based on the error tolerance criteria. Hematocrit levels affected glucose measurements on both meter systems. Modular adaptation did not affect test strip performance.
Conclusions.—Glucose meter measurements correlated best with primary reference instrument measurements. Overall, both glucose meter systems showed acceptable performance for point-of-care testing. However, the effects of some critical care variables, especially low and high hematocrit values, could cause overestimated or underestimated glucose measurements.
Myocyte Transdifferentiation
Authors: d'Amati Giulia , di Gioia Cira R. T. , Giordano Carla , Gallo Pietro 
Published: January 2021

Abstract
Adipose substitution of ventricular myocardium is characteristic of arrhythmogenic right ventricular cardiomyopathy, but is also found in other heart conditions. It is thought to be a consequence of myocyte loss due to myocarditis or other noxious stimuli. We describe a unique case of cardiomyopathy with a morphologic pattern suggestive of transdifferentiation from myocytes to mature adipocytes. Gross, histologic, and ultrastructural examination were performed on the heart of a female transplant patient with a clinical diagnosis of familial dilated cardiomyopathy. Gross examination showed fibroadipose substitution of the left ventricle and adipose replacement of the right. Histology, immunohistochemistry, and ultrastructure were highly suggestive of transdifferentiation from cardiac muscle to adipose tissue. Myocyte transdifferentiation could represent an alternative pathogenetic pathway to the myocyte-loss and adipose-replacement mechanism in arrhythmogenic right ventricular cardiomyopathy, or it could be the basis of a new type of familial cardiomyopathy.
Acute Myelomonocytic Leukemia With Histologic Features Resembling Sarcomatoid Carcinoma in Bone Marrow
Authors: Hamoudi Walid H. , Jeffrey L. , Townsend Gault , Glassman Armand B. , Bueso-Ramos Carlos E. 
Published: January 2021

Abstract
We report a case of primary acute myelomonocytic leukemia involving the bone marrow that resembled sarcomatoid carcinoma. The neoplastic cells in bone marrow biopsy specimens formed cohesive-appearing clusters and cords separated by an immature fibroblastic proliferation and myxoid stroma. Blasts in the bone marrow aspirate smears formed clusters and sheets, and a subset of blasts exhibited erythrophagocytosis. Dysgranulopoiesis was also present. Lineage was confirmed by immunohistochemical analysis of formalin-fixed, paraffin-embedded tissue. The tumor cells showed strong reactivity for lysozyme, myeloperoxidase, CD45, and CD68 and were negative for keratin, S100, CD20, and CD3. The serum lysozyme concentration (110 μg/mL) was 13 times greater than the normal value (8 μg/mL). Cytogenetic studies performed on bone marrow aspirate material revealed a complex karyotype, including trisomy 8 and abnormalities of chromosome 11q. We report this case of acute myelomonocytic leukemia because the neoplastic cells appeared cohesive and spindled, resembling sarcomatoid carcinoma, and therefore caused diagnostic difficulty. Other monocytic neoplasms with similar resemblance to carcinoma or sarcoma have been reported in the literature, suggesting that the tendency to appear cohesive may be an inherent characteristic of neoplastic cells with monocytic differentiation.
A Unique Method for Mutation Analysis of Tumor Suppressor Genes in Colorectal Carcinomas Using a Crypt Isolation Technique
Authors: Sugai Tamotsu , Habano Wataru , Nakamura Shin-ichi , Uesugi Noriyuki , Sasou Shunichi , Itoh Chuichi 
Published: January 2021

Abstract
Background.—Contamination of nontumor tissue makes genetic analysis difficult. For this reason, it is important to obtain pure tumor tissue to ensure accurate genetic analysis.
Objective.—To accurately assess the incidence of mutation of tumor suppressor genes (p53: exon 5–8; APC: mutated cluster region; NF-2 gene: all exons) in 45 colorectal carcinomas.
Methods.—We developed an application of the polymerase chain reaction–single-strand conformation polymorphism and DNA sequence by coupling them with crypt isolation.
Results.—Mutations of p53 and APC genes were found in 24 and 22 of 45 colorectal carcinomas, respectively. No mutation of the NF-2 gene was observed in this cancer. Single-strand conformation polymorphism using a crypt isolation technique showed a clear migrating band and no false-positive data.
Conclusions.—The crypt isolation technique is a useful method for accurately analyzing genetic alterations. Furthermore, our proposed method confirmed the morphological findings obtained before the genetic analysis.
Analysis of False-Negative Diagnoses on Endoscopic Brush Cytology of Biliary and Pancreatic Duct Strictures
Authors: Logrono Roberto , Kurtycz Daniel F. , Molina Claudia P. , Trivedi Vipul A. , Wong Jick Y. , Block Kevin P. 
Published: January 2021

Abstract
Context.—Endoscopic brush cytology is a valuable technique for the diagnosis of pancreatobiliary malignancy. Despite its widespread use, the sensitivity of this method has been reported as approximately 50%. The specificity is usually higher than 95%. Few reports have systematically analyzed the reasons for this relatively low sensitivity.
Objectives.—To determine the rate and reasons for false-negative diagnoses in endoscopic brushing cytology of biliary and pancreatic ducts based on the results of sensitivity, specificity, accuracy, and positive and negative predictive values.
Design.—Retrospective analysis of laboratory data and slide review of false-negative cases.
Setting.—Two tertiary care state university hospitals.
Patients.—A total of 183 pancreatobiliary brushing specimens obtained from patients undergoing endoscopic retrograde cholangiopancreatography for biliary or pancreatic duct disease for a 4- to 5-year period.
Intervention.—Endoscopic retrograde cholangiopancreatography brushings.
Main Outcome Measures.—Determination of sensitivity, specificity, accuracy, and positive and negative predictive values. Analysis of false-negative results.
Results.—The sensitivity, specificity, accuracy, and positive and negative predictive values, overall, were 48%, 98%, 79%, 92%, and 76%, respectively. Sampling error was a major cause of false-negative diagnoses (67%), followed by interpretive (17%) and technical errors (17%).
Conclusions.—Improvements in sensitivity and diagnostic accuracy for cancer of the pancreatobiliary tract can be achieved by optimizing slide preparatory techniques. Also, enhancement of the cytologist's diagnostic skills enables the identification of the morphologic features of premalignant lesions. Repeat brushings are indicated for suspicious or negative results not consistent with the clinical or radiologic findings.
Esophageal Collision Tumor (Large Cell Neuroendocrine Carcinoma and Papillary Carcinoma) Arising in a Barrett Esophagus
Authors: Wilson Christopher I. , Summerall Janna , Willis Irvin , Lubin Jack , Inchausti Beria Cabello 
Published: January 2021

AbstractWe report herein a unique case of an esophageal collision tumor composed of a papillary adenocarcinoma and a large cell neuroendocrine carcinoma arising in a Barrett esophagus. Hematoxylin-eosin and silver staining patterns, immunohistochemistry, and electron microscopy of the large cell neuroendocrine component are discussed.
The Cytomorphology of Pleuropulmonary Blastoma
Authors: Nicol Kathleen K. , Geisinger Kim R. 
Published: January 2021

Abstract
Pleuropulmonary blastoma is a rare, primitive primary neoplasm of the thorax in young children. The tumor, which is often but not always associated with cystic lung lesions, may arise in pulmonary parenchyma, the mediastinum, and pleura. Histologically, it is characterized by a biphasic neoplastic population of undifferentiated-appearing small round cells and larger spindle-shaped cells. A proportion of these cancers may also manifest more specific mesenchymal differentiation. In contrast to the pulmonary blastoma of adults, a malignant epithelial component does not occur. We present herein the third known case of a fine needle aspiration biopsy of a pleuropulmonary blastoma in a 5-year-old girl. The smears were moderately cellular and included an admixture of the characteristic small ovoid blastemal elements and scattered spindled mesenchymal tumor cells.
Morning Rounds Inpatient Test Availability
Authors: Novis David A. , Dale Jane C. 
Published: January 2021

Abstract
Objectives.—To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service.
Design.—Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services.
Setting and Participants.—A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam.
Main Outcome Measure.—The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines.
Results.—Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results.
Conclusions.—Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.
Immunoexpression of Inhibin α Subunit, Inhibin/Activin βA Subunit and CD99 in Ovarian Tumors
Authors: Choi Yoon-La , Kim Hy-Sook , Ahn Geunghwan 
Published: January 2021

AbstractObjective.—Anti–inhibin α and inhibin/activin βA subunit and anti-CD99 monoclonal antibodies (mAbs) have recently been demonstrated to be able to label ovarian granulosa cells; thus, they may be of value in the diagnosis of granulosa cell tumors. The present study aimed to determine what combination of these mAbs may be useful for the differential diagnosis of sex cord–stromal tumors of ovary.Design.—Immunohistochemical analyses with anti–inhibin α and inhibin/activin βA subunit antibody and anti-CD99 mAb were performed on 42 ovarian tumors, including sex cord–stromal tumors (29), ovarian epithelial cancers (10), and Krukenberg tumors (3).Results.—All sex cord–stromal tumors were positive for inhibin α subunit, and 17 cases (58.6%) of sex cord–stromal tumors were immunoreactive for inhibin/activin βA subunit. Epithelial tumors and Krukenberg tumors were all negative for inhibin/activin βA subunit except mucinous carcinoma, which showed strong cytoplasmic immunoreactivity. All sex cord–stromal tumors except one granulosa cell tumor showed membranous staining for CD99. A case of serous carcinoma and a case of mucinous carcinoma were positive for CD99, and the remaining epithelial tumors and Krukenberg tumor were all negative for CD99.Conclusions.—The results of immunohistochemical analysis, together with literature review, suggest that inhibin α subunit may be a useful diagnostic marker for sex cord–stromal tumor of the ovary. In addition, anti-CD99 antibody may be useful for the differential diagnosis between ovarian tumors. Inhibin/activin βA subunit has a limited usefulness in the differential diagnosis of ovarian tumor because of its wider immunoreactivity for both sex cord–stromal tumors and mucinous carcinomas. The differential diagnosis of sex cord–stromal tumors of the ovary would be better made with a combined use of both anti–inhibin α subunit and anti-CD99 mAbs.
Cytologic Atypia in a 53-Year-Old Man With Finasteride-Induced Gynecomastia
Authors: Zimmerman Robert L. , Fogt Franz , Cronin Dennis , Lynch Randall 
Published: January 2021

Abstract
Finasteride has been associated with the development of gynecomastia. Although cytoplasmic vacuolization has been noted in prostatic epithelium in men taking this drug, we found no documentation of the cytologic changes in finasteride-associated gynecomastia. We present the case of a 53-year-old man who developed unilateral gynecomastia following finasteride therapy for alopecia. A fine-needle aspiration biopsy of the mass was diagnosed as adenocarcinoma on the basis of nuclear atypia and particularly because of cytoplasmic vacuolization. Subsequent excisional biopsy revealed benign gynecomastia with no evidence of malignant change. The ductal epithelium did exhibit cytoplasmic vacuolization similar to that described in the prostate following finasteride therapy. We believe this is the first reported case documenting the cytologic changes seen in gynecomastia secondary to finasteride therapy. Cytoplasmic vacuolization in this setting should not be considered evidence of malignancy in men with gynecomastia. As with gynecomastia in general, extreme caution should be used before rendering a cytologic diagnosis of malignancy.
Statistical Issues in Tumor Marker Studies
Authors: Pajak Thomas F. , Clark Gary M. , Sargent Daniel J. , McShane Lisa M. , Hammond M. Elizabeth H. 
Published: January 2021

Abstract
Context.—Inferences from tumor marker studies are complicated by a variety of statistical concerns, which can make proper interpretation of results difficult. This article focuses on important issues that should be addressed when designing, conducting, and analyzing tumor marker studies.
Objective.—To highlight the importance of considering statistical significance, risk ratios, statistical power, reproducibility, multiple testing, confirmatory studies, and missing data in the design of marker studies used for prognosis.
Results.—Suggestions are provided for more effectively conducting marker studies. These include more careful attention to adequacy of the number of subjects for a marker study and improved documentation and standardization of assay methods. The importance of complete reporting of study results and description of the statistical analysis methods used is also emphasized.
Conclusion.—Cooperation among clinicians, laboratory scientists, and statisticians will be required to conduct statistically sound tumor marker studies and to facilitate prioritizing markers for new and confirmatory studies in an environment of limited patient and specimen resources.
Urinary Cytologic Findings in Patients With Benign and Malignant Adenomatous Polyps of the Prostatic Urethra
Authors: Schnadig Vicki J. , Adesokan Adekunle , Neal Durwood , Gatalica Zoran 
Published: January 2021

Abstract
Context.—Urethral adenomatous polyps with prostatic epithelium (also known as benign prostatic epithelial polyps [BPEPs]) are a documented cause of hematuria, dysuria, and hematospermia, conditions that may prompt cytologic evaluation of urine.
Design.—The urine cytologic test findings in 5 cases of biopsy-proven BPEPs and in 1 case of prostatic ductal adenocarcinoma (PDA) that presented as a urethral polyp were retrospectively evaluated. Immunocytochemical stain for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and high-molecular-weight cytokeratin (34βE12) were used in evaluation of the lesions.
Results.—In 4 of 5 cases of BPEPs, clusters of bland columnar cells with uniform, oval nuclei were seen. Positive immunostaining for PSA and PAP confirmed the prostatic origin of the clusters in 2 cases. One urine sample contained abundant goblet cells and extracellular mucin, consistent with intestinal metaplasia coexisting in the bladder biopsy specimen. The urine sample in the fifth case of BPEPs contained no columnar cells. The last case had multiple urine cytologic evaluations that demonstrated PSA-positive, malignant-appearing clusters of columnar cells. A biopsy specimen of the polyps was described as a high-grade prostatic intraepithelial neoplasm in adenomatous polyp. However, in this patient, PDA was diagnosed on transurethral resection of the prostate specimen 4 years after the initial urine cytologic test.
Conclusion.—Benign prostatic epithelial polyps should be considered in the differential diagnosis of clusters of columnar cells in urine cytologic testing. Cells with malignant nuclear features should instigate a careful search for a (prostatic) neoplasm, which may present as urethral polyps (eg, PDA). Stains for PSA or PAP are useful adjuncts in differential diagnosis of this condition.
Improvement in Physician's Office Laboratory Practices, 1989–1994
Authors: St. John Tina M. , Lipman Harvey B. , Krolak John M. , Hearn Thomas L. 
Published: January 2021

Abstract
Background.—In 1986 and 1989, the Centers for Disease Control and Prevention sponsored institutes on Critical Issues in Health Laboratory Practice. It was noted during the institutes that physician's office laboratories were a rapidly emerging site for clinical laboratory testing, yet no comprehensive data were available regarding the practice of clinical laboratory medicine in physician's office laboratories. As a mechanism to begin addressing this void, the Centers for Disease Control and Prevention added questions on clinical laboratory practice to the National Ambulatory Medical Care Survey, a national probability sample of ambulatory care provided by office-based physicians. Data were collected for survey years 1989, 1991, 1993, and 1994.
Methods.—Each survey was conducted among a nationally representative, random sample of office-based physicians who provide ambulatory patient care. Sample physicians were enlisted using both mail and telephone contacts. Clinical laboratory data were obtained via telephone by trained field representatives. Weighted univariate and multivariate analyses were performed on responses from each of the 4 survey years. Analyses were repeated after combining survey responses from years 1989 and 1991 and 1993 and 1994 as representative of physician's office laboratory practices before and after implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) final rule in 1992.
Results.—Quality laboratory practice indicators showed significant increases during the study interval, with implementation of the CLIA ’88 final rule in 1992 playing a pivotal role. Relative to 1992, enrollment in proficiency testing programs increased from 32.4% to 52.7% (P &lt; .001), use of daily quality control samples increased from 79.2% to 89.0% (P &lt; .001), and use of daily quality control with written instructions for action following a questionable quality control result (quality control with action step documentation) increased from 62.6% to 77.2% (P &lt; .001). The presence of a medical technologist or technician in the office laboratory was also significantly and independently associated with each of the quality indicators. Although the percentage of physician's offices performing on-site testing decreased from 56% to 45% during the survey interval, overall testing volume appeared unchanged.
Conclusions.—The quality of clinical laboratory practice in physician's office laboratories improved during the study interval (1989–1994) as measured by the quality indicators used in the study. The association of this improvement with implementation of the CLIA ‘88 final rule and the presence of a trained laboratory professional in the testing site indicate the importance of minimum practice standards and professional expertise in ensuring use of quality laboratory practices. Overall test volume appeared to be stable despite a decreased proportion of physician's offices at which on-site testing was performed.