bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Web-Based Platforms as a Novel Approach to Tackling Diversity, Equity, and Inclusion in Pathology Education - The PathElective.com Experience
Authors: Lilley C M , Quintanilla-Arteaga A , Mirza K M , Ware A D , White M J 
Published: November 2022

Abstract

Introduction/Objective
Since its creation, PathElective.com has reached approximately 60,000 individuals. This web-based clinical experience has demonstrated itself to be a powerful and accessible educational tool for medical students and residents across the world. However, there is currently limited data on the inclusion and equity impact of pathology education resources. Here, we assess responses from website users to better understand our audience and how this resource impacts equity.

Methods/Case Report
We composed and administered a brief, anonymous survey to assess website user educational, ethnic, gender expression, age, and socioeconomic backgrounds. The one-time user limit survey was composed of multiple-choice, choose-all-that-apply, and short answer questions. The survey was distributed via email to users and was also available via website pop-up and banner.

Results (if a Case Study enter NA)
650 users responded to the survey. 78.9% of respondents used PathElective for &lt;1 year with a plurality (28.2%) of respondents being users for &lt;6 months. 94% of respondents disclosed an ethnicity, and in toto, 29 of the 37 ethnicities provided were represented. 62.9% of respondents identified as female, 35.4% as male, and 0.3% as genderqueer. When asked about sexual orientation, 83.1% responded as straight, 3.5% as bisexual, 3.1% as gay/lesbian, and 1.8% in another category. Importantly, 73.8% of respondents either agreed or strongly agreed that PathElective filled a previously unmet need and 74.4% either agreed or strongly agreed that PathElective was more accessible than other education adjuncts.

Conclusion
Data of a limited cross-section of PathElective.com users demonstrate the website provides accessible educational materials to a diverse group of pathology learners. Our users were more geographically, educationally, and sociodemographically diverse compared to the 2021 Pathology ERAS applicant pool. Moreover, the broader impact was demonstrated by learners responding that the materials filled a previously unmet need.
Intravascular large B-cell lymphoma (IVLBCL): Subtle Presentation and Challenging Diagnosis
Authors: Sham S , Hosseini H , LIN H , Morrar D , Al-Refai R , Guerrero D , Yurovitsky A , BENDARI A 
Published: November 2022

Abstract

Introduction/Objective
Intravascular large B-cell lymphoma (IVLBCL) is a rare, clinically aggressive lymphoma defined by the proliferation of atypical lymphoma cells in the lumen of all sized blood vessels, particularly capillaries. The reasons for this unusual neoplastic cell proliferation are still only partially understood. IVLBCL is considered stage IV lymphoma and manifests with a variety of nonspecific signs and symptoms. Patients with IVLBCL usually do not present with lymphadenopathy. The tumor cells invade the blood vessels of multiple organs such as the central nervous system, skin, lungs, kidneys, and bone marrow. Common presenting symptoms are based on the organ affected and include mental status changes and fever of unknown origin. Although immunochemotherapy has significantly improved the often-poor prognosis of this kind of lymphoma, a large percentage of patients relapse.

Methods/Case Report
We present a 63-year-old man who had been diagnosed with diffuse large B cell lymphoma in the bone marrow in March 2021 and was in remission state after completing six cycles of chemotherapy. There was no abnormal FDG uptake on a post-chemotherapy PET/CT scan. Patient presented to the ER two months later with fever and dyspnea. The entire workup was completed and showed pancytopenia and elevated ESR. While chest CT scan did not show lymphadenopathy or lesions, PET/CT scans revealed a widespread increase in FDG uptake in both the lungs and spleen. Lung biopsy revealed large atypical cells within alveolar septae and vessels.
Immunohistochemical stains demonstrated that these cells were positive for CD20 and PAX-5 and had high proliferation rate based on Ki67.

Results (if a Case Study enter NA)
NA

Conclusion
IVLBCL has a low incidence rate with non-specific clinical presentation. The diagnosis can be easily missed in both clinical, radiological and the corresponding histopathological findings . Radiological finding and CT scan are not sensitive enough and may miss the lesion. Even though the PET/CT scan is more sensitive, the definitive diagnosis of IVLBCL relies mainly on histopathology and immunohistochemistry, at which point awareness of this entity by the Pathologist is most necessary.
BTEX (benzene, toluene, ethylbenzene, and xylene) and risk of cancer - a study from Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey
Authors: Malik P , Hashim T , Varma S , Diaz L , Chowdhary A , Bapat P , Alkhatib L , Centeno L , Poursina O , Pan H , Patil A 
Published: November 2022

Abstract

Introduction/Objective
BTEX (benzene, toluene, ethylbenzene, and xylene) is well know for its toxicity via through environmental, occupational and recreational exposures. However, there is limited literature about the carcinogenic effect of BTEX. Hence, we aim to study the prevalence and association of cancer amongst individuals with exposure of BTEX.

Methods/Case Report
A retrospective cross-sectional study was performed between 2013 and 2018 utilizing the NHANES database. Adult individuals having data on socio-demographic questionnaires and lab findings on exposure to BTEX were included. Prevalence of cancer was identified amongst exposure to BTEX (vs no-BTEX). Univariate (chi-squre test and Mann–Whitney U test) and Multivariate (survey logistic regression) analysis was performed to evaluate the epidemiologic characteristics of individuals exposred to BTEX and association of cancer with BTEX exposure in comparison to no BTEX exposure.The p value of &lt;0.05 considered statistically significant.

Results (if a Case Study enter NA)
124,162 participants were identified with BTEX exposure. Individuals with BTEX exposure were young (40 vs 51 year old), male (91% vs female: 87%), and Mexican American (92% vs Non-Hispanic Black: 89% vs Non-Hispanic White: 89% vs other Hispanic: 87%). Univariate analysis showed higher total prevalence of cancer in BTEX (9.3% vs. 1.3%; p&lt;0.0001) compared to no BTEX. Individuals with BTEX exposure had higher prevalnece of blood cancer (0.47% vs 0.00; p&lt;0.0001), leukemia (0.56% vs 0.00; p&lt;0.001), and lymphoma (1.72% vs 0.39%; p&lt;0.0001) in comparison with no exposure. Multivaritate analysis showed participants with BTEX exposure had 10% higher risk of cancer (aOR: 1.10; 95%CI: 1.10-1.10; p&lt;0.0001) compared to no BTEX exposure. Additionally, exposure to individual components of benzene (aOR: 1.24; 95%CI: 1.24; p&lt;0.0001), ethylbenzene (aOR: 1.08; 95%CI: 1.08-1.08; p&lt;0.0001), and o-xylene (aOR: 1.19; 95%CI: 1.19-1.19; p&lt;0.0001) had higher risk of cancer compared to no exposure participants.

Conclusion
Our study conclude higher risk of cancer among participants with exposure to benzene, ethylbenzene and o-xylene. Future studies are warranted to evaluate the association of various types of cancers in BTEX exposure.
Brown Recluse Spider Bite: A Case Report of Severe Hemolysis and Sepsis
Authors: Chinchanikar S , Khalaf Z , Mateescu V 
Published: November 2022

Abstract

Introduction/Objective
The brown recluse spider, Loxosceles reclusa, is commonly found in the southern and central United States and is known for its venomous bite. It has six eyes, uniformly colored abdomen and legs, is around 1 cm in length and prefers to live in warm, dark and dry places. Its bite in humans can cause skin necrosis as well as more severe manifestations including acute hemolytic anemia, disseminated intravascular coagulation (DIC), rhabdomyolysis and renal failure.

Methods/Case Report
We present a case report of a 27 year old male with no known past medical history who was referred from another medical center with a critical hemoglobin of 3.6 g/dl and acute hemolytic anemia that was not responsive to packed red blood cell transfusion and intravenous immunoglobulin treatment. He reported of having bitten by a brown recluse spider 8 days ago on the right scapular region. He started developing wound and pain in the area 2 days later when he was admitted to the hospital for a day and treated with antibiotics. His white blood cell count (WBC) at the time was mildly elevated with near normal hemoglobin and was incidentally found to have COVID 19 positivity. After being discharged, he developed fever with chills, dark urine, body ache, headache, nausea and vomiting. When presented to our hospital, laboratory review exhibited normocytic normochromic anemia with elevated bilirubin and decreased haptoglobin showing a hemolytic picture. The patient also displayed severe leukocytosis (WBC count: 53.50) with absolute neutrophilia, lymphocytosis, and monocytosis. Monocyte distribution width (MDW) was 30.02. These changes were attributed to be reactive to venom effect and sepsis. The patient showed significant improvement with plasmapheresis.

Results (if a Case Study enter NA)
NA.

Conclusion
The diagnosis of systemic loxoscelism is often difficult and delayed. Brown recluse spider bites may not always present with sharp stings to be noticed and reported by the patient. Presence of another infectious condition, like COVID 19 in this case, may divert the diagnosis. An elaborate patient history, physical examination for bite wound and patient education may help in identifying the cause early. Spider bites should be considered as a differential diagnosis in a patient with dermonecrosis and abrupt onset hemolysis or sepsis. Prompt treatment can prevent development of DIC, renal failure and life threatening conditions.
Assessment of Collagen III as a Non-Invasive Biomarker in HCV Induced Liver Fibrotic Patients
Authors: Abdelmonem M , Wasim H , Elhusseny A , Eldaly R , Abdelmageed M , Saleh Abdelfattah M 
Published: November 2022

Abstract

Introduction/Objective
Liver biopsy is still the gold typical for assessing hepatic fibrosis. Non-invasive serum parameters measurement leads to essential changes in diagnosis. This procedure is painful, carries a risk of bleeding and infection, and is accompanied by a high sampling error rate. New biomarkers that can accurately predict the stage of fibrosis are urgently needed.

Objectives
This study aimed to identify, characterize, and detect serum collagen III in patients with HCV-induced liver fibrosis and healthy subjects.

Methods/Case Report
The study subjects were divided into two groups; group1: included 118 patients with HCV-induced liver fibrosis (60 males and 58 females). Group2: included 50 healthy comparable control subjects (27 males and 23 females). Collagen III was identified in serum samples of group1 at 70 kDa using collagen III polyclonal antibody and western blot analysis techniques. Additionally, it was purified from serum samples using the electroelution technique from preparative slab gels. The purified antigen gives a single sharp band at 70 kDa when resolved by SDS–PAGE (sodium dodecyl sulfate-polyacrylamide gel electrophoresis) and stained with coomassie blue. The 70 kDa purified collagen III showed high reactivity towards the collagen III polyclonal antibody. We used the ELISA method to quantify the collagen III, dose-response curve for purified collagen III as a function of the concentration in serum samples of liver fibrosis patients was done.

Results (if a Case Study enter NA)
The collagen III was identified in 62% of patients, and 38 % were negative collagen III (false negative) in group one. For group two, 96% of total healthy volunteers were negative for collagen III, and 4% were positive for collagen III (false positive). The mean ± SD of serum collagen III concentration was (8.38±3.56) and (3.2±0.59) for groups 1 and 2, respectively, with (P&lt;0.0001).

Conclusion
The non-invasive assessment of liver fibrosis by collagen III has shown promising diagnostic and prognostic potential.
COVID Cholangiopathy Can Occur Despite Mild COVID
Authors: Onuiri J , Fiel M I 
Published: November 2022

Abstract

Introduction/Objective
Post-COVID-19 cholangiopathy is a novel entity first noted in patients recovering from critical COVID-19 infection. Since its initial description in May 2021, all cases reported to date have been in patients with a history of critical COVID-19, defined as requiring ICU admission, the development of respiratory or circulatory failure requiring intubation or ECMO, or vasopressor support. Here we report three cases of post-COVID-19 cholangiopathy arising in patients who recovered from non-severe COVID-19.

Methods/Case Report
Six cases of COVID-19-related cholangiopathy were identified by retrospective review, three of which involved patients who verifiably did not develop critical COVID-19. Histology slides for each case were reviewed and all showed features of secondary sclerosing cholangitis. Patient 1 is a 41yo female who developed COVID-19 after liver transplant (LT). Despite administration of monoclonal antibodies, she required re-transplantation 6 weeks later. Explant histology showed bile infarcts, severe hepatocytic and canalicular cholestasis, ductular reaction, organizing portal vein thrombi, and necrotic bile ducts accompanied by bile lakes. Patient 2 is a 47yo male with alcoholic cirrhosis who was diagnosed with COVID-19 at the time of LT workup, and underwent LT 90 days later. In addition to alcohol-related cirrhosis, explant histology showed dilated bile ducts with periductal fibrosis, as well as severe ductular reaction with proliferating ductules containing thick, inspissated bile. Patient 3 is a 54yo male with history of LT for PSC who developed mild COVID-19 five years after LT. Allograft function subsequently worsened and biopsy 6 months later showed bile duct damage and loss of ~35% of bile ducts; repeat biopsy 14 months after his COVID diagnosis showed periportal fibrosis with edema, ductular reaction, marked hepatocellular and canalicular cholestasis, and ductopenia with loss of 60% bile ducts. Average time between COVID-19 diagnosis and onset of COVID-related cholangiopathy was 3 months (range: 6 weeks-6 months). These patients were also all immunocompromised with two due to prior LT and one being cirrhotic.

Results (if a Case Study enter NA)
NA.

Conclusion
Although previously reported only in patients with severe COVID-19, the cases described represent the first evidence that cholangiopathy, manifested by sclerosing cholangitis, can arise even in patients who were not critically ill, although this may require an immunocompromised state to develop.
Limited Diagnostic Utility of Alpha Defensin in the Diagnosis of Periprosthetic Joint Infection
Authors: Vasconez M M , Wolk D , Tice A , Martinez R M 
Published: November 2022

Abstract

Introduction/Objective
A key component of laboratory stewardship is appropriate test utilization. We evaluated the utility of alpha defensin (AD), a synovial fluid biomarker, in the diagnosis of periprosthetic joint infection (PJI). Since PJI remains a diagnostic challenge in the orthopedic community, the Musculoskeletal Infection Society (MSIS) created the PJI score, a point-based criteria to help risk stratify the likelihood of infection. The score includes AD, synovial fluid white blood cell count, synovial fluid percent neutrophils, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). AD is a specialized test which adds substantial cost to the evaluation of PJI .The purpose of this study was to investigate the diagnostic utility of the PJI score with AD and without AD (routine laboratory testing of serum and synovial fluid).

Methods/Case Report
Retrospective chart review was completed on 222 patients with suspected PJI identified at Geisinger Health between January 2019 – March 2021. Data was retrieved through Geisinger’s Phenomic and Analytics Data Core and imported into Excel and JMP v.12 for analysis. All available components of MSIS diagnostic criteria were collected for each patient.

Results (if a Case Study enter NA)
Of the 222 patients with AD testing, 81% of results were negative (n=178) and 19% results were positive (n=44). AD results corresponded with synovial fluid white blood cell count in 96 % of patients (213/ 222). All components of the PJI diagnostic criteria were collected in 69% of the patients (157/222). Diagnostic criteria calculated without AD showed 43% infected (68/157), 37% possibly infected (58/157), and 20% infected (31/157). Diagnostic criteria calculated with AD showed 43% infected (68/157), 35% possible infected (55/157), and 22% infected (34/157). PJI score including AD compared to PJI score excluding AD showed similar correlation (R2 = 0.93).

Conclusion
It was found that AD testing does not provide substantial diagnostic value in the evaluation of PJI. Synovial fluid cell count was found to directly correlate with alpha defensin suggesting it’s potential use as a surrogate marker for clinical decision making. Diagnostic criteria obtained through routine testing of serum (ESR, CRP) and synovial fluid (WBC, percent neutrophils) provides sufficient data for diagnosis.
Endometrial Cancer and Molecular Methods: A Case Study of MSI Heterogeneity based on Metastatic Location with IdyllaTM
Authors: Degner A , Nam M , Hoo-Fatt N 
Published: November 2022

Abstract

Introduction/Objective
MMR deficiency (dMMR) and Microsatellite Instability (MSI) are hallmarks of not only Lynch Syndrome and Colorectal Cancer (CRC), but Endometrial cancer. Endometrial cancer is the most common female gynecological cancer, yet molecular tests for MSI often focus solely on CRC validation. MSI in Endometrial cancer correlates with higher staging and more aggressive pathology, resulting in a need for reliable testing methods. Immunohistochemistry (IHC) staining is the current standard for MSI detection, due to the known association between dMMR and MSI-H. Direct detection of MSI requires molecular methods, however, there is a lack of standardization of protocol between labs. Idylla™ (Biocartis, Jersey City, NJ), an automated cartridge-based PCR assay, could help eliminate this ambiguity.

Methods/Case Report
To determine whether the Idylla™ MSI assay can be reliably used to detect MSI in Endometrial cancers, both primary and metastatic sites for two known MSI-H patients were examined using the Idylla ™ MSI assay and an IHC MMR panel (MLH1, MSH2, MSH6, PMS2).

Results (if a Case Study enter NA)
The results showed MSI-H for both patients uterine primary sites on the Idylla™. Examination of the Idylla™ results for metastatic sites found they contradicted the IHC panel results for some sites. Idylla™ produced expected results for the omentum and intestinal metastases in patient IN-20-1. The Idylla™ results for the ovarian and abdominal metastatic lesions in patient IN-15/17-2 directly contradicted the MMR findings and the MSI-H result provided for the uterine primary site.

Conclusion
This discrepancy between primary and metastatic site results is likely due to MSI heterogeneity in these metastatic lesions than test errors. At this time, it is not recommended to use the Idylla™ MSI test for Endometrial cancers, particularly those with abdominal or ovarian metastasis. Further testing will be needed to verify if intestinal metastatic sites are consistently MSI-H. IHC should remain the prime mode of detection for possible dMMR MSI-H Endometrial tumors until an assay catered specifically towards Endometrial cancers is made.
Contribution of the Hashtag #PathTweetAward to Pathology Education: From the Perspective of a Medical Student
Authors: Demirci M , Emiroğlu F , Oltulu P , Mukhopadyay S 
Published: November 2022

Abstract

Introduction/Objective
Pathology education reaches a wide audience through social media platforms. Sharing the findings and educational material of studies in the field of pathology with a large audience through social media will accelerate the scientific and educational progress. By utilizing social media, pathologists can increase their impact on educating other physicians along with medical students. In this study, we aimed to evaluate the contribution of the hashtag #PathTweetAward to the pathology education of medical students, pathologists, pathology residents, and physicians in other branches. We tried to measure the awareness of #PathTweetAward among people who use social media for educational purposes.

Methods/Case Report
Our population is Full-time Medical Students(63/67) and Physicians(4/67) from various medical faculties in Turkey. We applied the survey via Online Google Forms Questionnaire(47 participants) and Face- to-face Questionnaire(20 participants). We collected demographical and qualitative data for the cross-sectional study, and statistical analyses were performed by comparing/contrasting.

Results (if a Case Study enter NA)
With survey results, it is clear that using PathTwitter is a great educational tool and discussion platform. Nevertheless, it is being used for educational purposes by only 22,39% of respondents, PathTwitter had heard by only 20,90% of respondents, and the numerical value of how useful the posts shared with PathTwitter is 5,86 (1-10). Also, it should not be forgotten that the percentage of usage of Twitter by respondents is 67,69%, meaning that they are aware of and can use the platform. Most people who have used social media for educational purposes have not heard of #PathTweetAward. However, 89,55% (60/67) of respondents find #PathTweetAward helpful (with an average of 5,85/10). 50,94% (27/53) said they would use #PathTweetAward for educational purposes after hearing it for the first time(response 79,10% (53/67), average 3,48/5).

Conclusion
This study aimed to determine whether social media users were familiar with #PathTweetAward and whether they found it to be a helpful educational resource. We hypothesized that people who have used social media for educational purposes have heard of #PathTweetAward. Given these points, pathology is a field that uses Twitter best and most in education, communication, and collaboration. Although the proportion of respondents familiar with #PathTweetAward was low, the majority of those familiar with this initiative found it to be a helpful educational resource.
Monitoring Direct Thrombin Inhibitors With Calibrated Diluted Thrombin Time vs Activated Partial Thromboplastin Time in Pediatric Patients
Authors: Hasan Rida A , Pak Jennifer , Kirk Christa Jefferis , Friedland-Little Joshua M , Chandler Wayne L 
Published: November 2022

AbstractObjectivesActivated partial thromboplastin time (aPTT) is the primary test used to monitor intravenous (IV) direct thrombin inhibitors (DTIs) but has many limitations. The plasma diluted thrombin time (dTT) has shown better correlation with DTI levels than aPTT. This study compared dose-response curves for dTT and aPTT in pediatric patients receiving argatroban and bivalirudin.MethodsA retrospective review of pediatric patients treated with argatroban (n = 45) or bivalirudin (n = 14) monitored with dTT and aPTT.ResultsThe dTT assay was calibrated to report DTI concentrations in µg/mL for argatroban and bivalirudin with good analytic sensitivity and specificity. The dTT was fivefold more likely to show a stable dose-response slope than the aPTT (P &lt; .0002; odds ratio, 4.9). For patients in whom both dTT and aPTT showed a significant correlation between dose and assay results, dTT had a higher average correlation factor compared with aPTT (P = .007). Argatroban dose-response slopes showed more inter- and intrapatient variation than bivalirudin (dose-response slope coefficient of variation, 132% vs 52%).ConclusionsThe dTT assay was more likely to show a stable dose response and have a stronger correlation with DTI dose than aPTT. Argatroban shows more variation in dose response than bivalirudin.