bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive papillary carcinoma of the breast: a rare case report
Authors: Issar Pratibha , Ravindranath M. , Dewangan Manish 
Published: October 2021

Abstract
Background
Invasive Papillary Carcinomas (IPC) are rare and account for approximately 0.5% of all invasive breast carcinomas. Most of them are seen in post-menopausal women and have a good prognosis. These tumors lack the myoepithelial cell layer (MCL) within the papillae or at the periphery of the tumor with areas showing stromal invasion or invasion into lymphovascular spaces. Immunohistochemistry (IHC) for myoepithelial cells and basement membrane is essential for the diagnosis of invasive cancer.

Case presentation
We present a rare case of IPC in a 74-year-old woman who presented with complaints of gradually increasing painless retroaerolar mass in the left breast of two months duration. The mass was irregular, having an oblong as well an adjacent high density mass lesion on mammography. Ultrasound (US), and Magnetic Resonance Imaging (MRI) helped in the diagnosis of the possibility of a malignant breast lesion. Left-sided modified radical mastectomy was performed and the specimen was histopathologically diagnosed as Invasive Papillary carcinoma. Immunohistochemistry confirmed the diagnosis.

Conclusions
Invasive Papillary Carcinomas of the breast are rare cancers in post-menopausal women. We have highlighted the role of Mammography, US, and MRI in early diagnosis so that timely management is possible.
Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study
Authors: Venkatramani Rajkumar , Xue Wei , Randall R. Lor , Wolden Suzanne , Anderson James , Lopez-Terrada Dolores , Black Jennifer , Kao Simon C. , Shulkin Barry , Ostrenga Andrew , Pappo Alberto , Spunt Sheri L. 
Published: October 2021

PURPOSE Synovial sarcoma (SS) is the second most common malignant soft tissue tumor in children. ARST0332 evaluated a risk-based treatment strategy for young patients with soft tissue sarcoma designed to limit therapy for low-risk (LR) disease and to test neoadjuvant chemoradiotherapy for unresected higher-risk disease. METHODS Newly diagnosed patients with SS age < 30 years were assigned to four treatment arms based on disease features: A (surgery only), B (55.8 Gy radiotherapy [RT]), C (ifosfamide and doxorubicin [ID] chemotherapy plus 55.8 Gy RT), and D (neoadjuvant ID and 45 Gy RT, then surgery and RT boost based on margins followed by adjuvant ID). Patients treated in Arms A and B were considered LR, arms C and D without metastases as intermediate-risk (IR), and those with metastases as high-risk (HR). RESULTS Of the 146 patients with SS enrolled, 138 were eligible and evaluable: LR (46), IR (71), and HR (21). Tumors were 80% extremity, 70% > 5 cm, 70% high-grade, 62% invasive, 95% deep, and 15% metastatic. Treatment was on arm A (29.7%), B (3.6%), C (16.7%), and D (50%). There were no toxic deaths and four unexpected grade 4 adverse events. By risk group, at a median follow-up of 6.8 years, estimated 5-year event-free survival was LR 82%, IR 70%, and HR 8%, and overall survival was LR 98%, IR 89%, and HR 13%. After accounting for the features that defined risk category, none of the other patient or disease characteristics (age, sex, tumor site, tumor invasiveness, and depth) improved the risk stratification model. CONCLUSION The risk-based treatment strategy used in ARST0332 produced favorable outcomes in patients with nonmetastatic SS relative to historical controls despite using RT less frequently and at lower doses. The outcome for metastatic SS remains unsatisfactory and new therapies are urgently needed.
Multi-optical effects in two-dimensional photonic crystals of metallic pairs
Authors: Duan Qilin , Chen Ying , Chen Huanyang 
Published: October 2021

Abstract
Beam steering in photonic crystals is significant in manipulating light beams. In this paper, we design self-collimation, beam splitting, and negative refraction effects in photonic crystals based on metallic pairs immersed in dielectric background. By using a single array of metallic pairs, a broadband and wide-angle self-collimation effect is achieved. Meanwhile, due to the extreme anisotropy, a beam splitting effect is achieved by utilizing the kissing of equi-frequency contours. We then restructure the unit cell with glide symmetry to achieve negative refraction effect in a wide frequency range and realize the effect of flat lens. To illustrate this phenomenon, a flat lens based on the restructured unit cell is designed and numerically demonstrated.
Brain Death/Death by Neurologic Criteria Determination
Authors: Lewis Ariane , Kirschen Matthew P. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
This article describes the prerequisites for brain death/death by neurologic criteria (BD/DNC), clinical evaluation for BD/DNC (including apnea testing), use of ancillary testing, and challenges associated with BD/DNC determination in adult and pediatric patients.

RECENT FINDINGS
Although death determination should be consistent among physicians and across hospitals, states, and countries to ensure that someone who is declared dead in one place would not be considered alive elsewhere, variability exists in the prerequisites, clinical evaluation, apnea testing, and use of ancillary testing to evaluate for BD/DNC. Confusion also exists about performance of an evaluation for BD/DNC in challenging clinical scenarios, such as for a patient who is on extracorporeal membrane oxygenation or a patient who was treated with therapeutic hypothermia. This prompted the creation of the World Brain Death Project, which published an international consensus statement on BD/DNC that has been endorsed by five world federations and 27 medical societies from across the globe.

SUMMARY
The World Brain Death Project consensus statement is intended to provide guidance for professional societies and countries to revise or develop their own protocols on BD/DNC, taking into consideration local laws, culture, and resource availability; however, it does not replace local medical standards. To that end, pending publication of an updated guideline on determination of BD/DNC across the lifespan, the currently accepted medical standards for BD/DNC in the United States are the 2010 American Academy of Neurology standard for determination of BD/DNC in adults and the 2011 Society of Critical Care Medicine/American Academy of Pediatrics/Child Neurology Society standard for determination of BD/DNC in infants and children.
Palliative Care and Shared Decision Making in the Neurocritical Care Unit
Authors: Creutzfeldt Claire J. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
This article reviews the evidence on integrating palliative care into the care of patients with various types of serious neurologic illness, emphasizes the importance of palliative care in the neurocritical care unit, and suggests tools for clinicians to improve their communication skills and decision making.

RECENT FINDINGS
Palliative care is a holistic approach to medical care that aims to relieve physical, psychological, social, and spiritual suffering. It is both a medical specialty as young as neurocritical care itself and an approach to patient care by all clinicians who manage patients with serious illness. Patients presenting to the neurocritical care unit and their families have unique palliative care needs that challenge communication and shared decision making.

SUMMARY
Palliative care, effective communication, and shared decision making require a set of core skills that all neurology clinicians should master.
Intracerebral Hemorrhage
Authors: Nobleza Christa O’Hana S. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
Nontraumatic intracerebral hemorrhage (ICH) is the second most common type of stroke. This article summarizes the basic pathophysiology, classification, and management of ICH and discusses the available evidence on therapy for hematoma, hematoma expansion, and perihematomal edema.

RECENT FINDINGS
Current available data on potential therapeutic options for ICH are promising, although none of the trials have shown improvement in mortality rate. The literature available on reversal of anticoagulation and antiplatelet agents after an ICH and resumption of these medications is also increasing.

SUMMARY
ICH continues to have high morbidity and mortality. Advances in therapeutic options to target secondary brain injury from the hematoma, hematoma expansion, and perihematomal edema are increasing. Data on reversal therapy for anticoagulant-associated or antiplatelet-associated ICH and resumption of these medications are evolving.
Moderate and Severe Traumatic Brain Injury
Authors: Robinson Christopher P. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
Traumatic brain injury (TBI) encompasses a group of heterogeneous manifestations of a disease process with high neurologic morbidity and, for severe TBI, high probability of mortality and poor neurologic outcomes. This article reviews TBI in neurocritical care, hence focusing on moderate and severe TBI, and includes an up-to-date review of the many variables to be considered in clinical care.

RECENT FINDINGS
With advances in medicine and biotechnology, understanding of the impact of TBI has substantially elucidated the distinction between primary and secondary brain injury. Consequently, care of TBI is evolving, with intervention-based modalities targeting multiple physiologic variables. Multimodality monitoring to assess intracranial pressure, cerebral oxygenation, cerebral metabolism, cerebral blood flow, and autoregulation is at the forefront of such advances.

SUMMARY
Understanding the anatomic and physiologic principles of acute brain injury is necessary in managing moderate to severe TBI. Management is based on the prevention of secondary brain injury from resultant trauma. Care of patients with TBI should occur in a dedicated critical care unit with subspecialty expertise. With the advent of multimodality monitoring and targeted biomarkers in TBI, patient outcomes have a higher probability of improving in the future.
Neurologic Complications in the Postoperative Neurosurgery Patient
Authors: Sarwal Aarti 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
This article discusses neurologic complications encountered in the postoperative care of neurosurgical patients that are common or key to recognize in the immediate postoperative period. The major neurosurgical subspecialty procedures (cerebrovascular neurosurgery, neuro-oncology, epilepsy neurosurgery, functional neurosurgery, CSF diversion, endovascular neurosurgery, and spinal surgery) are broadly included under craniotomy procedures, endovascular/vascular procedures, and spinal procedures. This article focuses on the range of complications inherent in these approaches with specific scenarios addressed as applicable.

RECENT FINDINGS
The morbidity and mortality related to neurosurgical procedures remains high, necessitating ongoing research and quality improvement efforts in perioperative screening, intraoperative management, surgical approaches, and postoperative care of these patients. Emerging research continues to investigate safer and newer options for routine neurosurgical approaches, such as coiling over clipping for amenable aneurysms, endoscopic techniques for transsphenoidal hypophysectomy, and minimally invasive spinal procedures; postoperative monitoring and care of patients after these procedures continues to be a key component in the continuum of care for improving outcomes.

SUMMARY
Postoperative care of patients undergoing major neurosurgical procedures is an integral part of many neurocritical care practices. Neurosurgeons often enlist help from neurologists to assist with evaluation, interpretation, and management of complications in routine inpatient settings. Awareness of the common neurologic complications of various neurosurgical procedures can help guide appropriate clinical monitoring algorithms and quality improvement processes for timely evaluation and management of these patients.
Subarachnoid Hemorrhage
Authors: Chou Sherry Hsiang-Yi 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
Subarachnoid hemorrhage (SAH) remains an important cause of mortality and long-term morbidity. This article uses a case-based approach to guide readers through the fundamental epidemiology and pathogenesis of SAH, the approach to diagnosis and management, the results of clinical trials and evidence to date, prognostic considerations, controversies, recent developments, and future directions in SAH.

RECENT FINDINGS
Historically, management of SAH focused on prevention and treatment of subsequent cerebral vasospasm, which was thought to be the primary cause of delayed cerebral ischemia. Clinical and translational studies over the past decade, including several therapeutic phase 3 randomized clinical trials, suggest that the pathophysiology of SAH-associated brain injury is multiphasic and multifactorial beyond large vessel cerebral vasospasm. The quest to reduce SAH-associated brain injury and improve outcomes is shifting away from large vessel cerebral vasospasm to a new paradigm targeting multiple brain injury mechanisms, including early brain injury, delayed cerebral ischemia, microcirculatory dysfunction, spreading cortical depolarization, inflammation, and the brain-body interaction in vascular brain injury with critical illness.
Despite multiple negative randomized clinical trials in search of potential therapeutic agents ameliorating the downstream effects after SAH, the overall outcome of SAH has improved over recent decades, likely related to improvements in interventional options for ruptured cerebral aneurysms and in critical care management. Emerging clinical evidence also suggests potential harmful impact of historic empiric treatments for SAH-associated vasospasm, such as prophylactic induction of hypertension, hypervolemia, and hemodilution (triple H therapy).
With decreasing mortality, long-term SAH survivorship and efforts to reduce chronic morbidity and to improve quality of life and patient-centered outcome are growing areas of unmet need. Despite existing guidelines, significant variabilities in local and regional practices and in scientific terminologies have historically limited advancement in SAH care and therapeutic development. Large global collaborative efforts developed harmonized SAH common data elements in 2019, and studies are under way to examine how existing variabilities in SAH care impact long-term SAH outcomes.

SUMMARY
Although the overall incidence and mortality of SAH is decreasing with advances in preventive and acute care, SAH remains a major cause of long-term morbidity in survivors. Significant variabilities in care settings and empiric treatment protocols and inconsistent scientific terminologies have limited advancement in patient care and therapeutic clinical studies. Large consensus efforts are under way to introduce clinical guidelines and common data elements to advance therapeutic approaches and improve patient outcome.
Neurologic Outcome Prediction in the Intensive Care Unit
Authors: Maciel Carolina B. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
The burden of severe and disabling neurologic injury on survivors, families, and society can be profound. Neurologic outcome prediction, or neuroprognostication, is a complex undertaking with many important ramifications. It allows patients with good prognoses to be supported aggressively, survive, and recover; conversely, it avoids inappropriate prolonged and costly care in those with devastating injuries.

RECENT FINDINGS
Striving to maintain a high prediction performance during prognostic assessments encompasses acknowledging the shortcomings of this task and the challenges created by advances in medicine, which constantly shift the natural history of neurologic conditions. Embracing the unknowns of outcome prediction and the boundaries of knowledge surrounding neurologic recovery and plasticity is a necessary step toward refining neuroprognostication practices and improving the accuracy of prognostic impressions. The pillars of modern neuroprognostication include comprehensive characterization of neurologic injury burden (primary and secondary injuries), gauging cerebral resilience and estimated neurologic reserve, and tying it all together with individual values surrounding the acceptable extent of disability and the difficulties of an arduous convalescence journey.

SUMMARY
Comprehensive multimodal frameworks of neuroprognostication using different prognostic tools to portray the burden of neurologic injury coupled with the characterization of individual values and the degree of cerebral reserve and resilience are the cornerstone of modern outcome prediction.
A preferred sequence for organelle inheritance during polarized cell growth
Authors: Li Kathryn W. , Lu Michelle S. , Iwamoto Yuichiro , Drubin David G. , Pedersen Ross T. A. 
Published: October 2021

ABSTRACT
Some organelles cannot be synthesized anew, so they are segregated into daughter cells during cell division. In Saccharomyces cerevisiae, daughter cells bud from mother cells and are populated by organelles inherited from the mothers. To determine whether this organelle inheritance occurs in a stereotyped manner, we tracked organelles using fluorescence microscopy. We describe a program for organelle inheritance in budding yeast. The cortical endoplasmic reticulum (ER) and peroxisomes are inherited concomitantly with bud emergence. Next, vacuoles are inherited in small buds, followed closely by mitochondria. Finally, the nucleus and perinuclear ER are inherited when buds have nearly reached their maximal size. Because organelle inheritance timing correlates with bud morphology, which is coupled to the cell cycle, we tested whether disrupting the cell cycle alters organelle inheritance order. By arresting cell cycle progression but allowing continued bud growth, we determined that organelle inheritance still occurs when DNA replication is blocked, and that the general inheritance order is maintained. Thus, organelle inheritance follows a preferred order during polarized cell division and does not require completion of S-phase.
Feeding effects on liver mitochondrial bioenergetics of Boa constrictor (Serpentes: Boidae)
Authors: da Mota Araujo Helena Rachel , Sartori Marina Rincon , Navarro Claudia D. C. , de Carvalho José Eduardo , Luis da Cruz André 
Published: October 2021

ABSTRACT
Snakes are interesting examples of taxa that can overcome energy metabolism challenges, as many species can endure long periods without feeding, and their eventual meals are of reasonably large sizes, thus exhibiting dual extreme adaptations. Consequently, metabolic rate increases considerably to attend to the energetic demand of digestion, absorption and protein synthesis. These animals should be adapted to transition from these two opposite states of energy fairly quickly, and therefore we investigated mitochondrial function plasticity in these states. Herein, we compared liver mitochondrial bioenergetics of the boid snake Boa constrictor during fasting and after meal intake. We fasted the snakes for 60 days, and then we fed a subgroup with 30% of their body size and evaluated their maximum postprandial response. We measured liver respiration rates from permeabilized tissue and isolated mitochondria. From isolated mitochondria, we also measured Ca2+ retention capacity and redox status. Mitochondrial respiration rates were maximized after feeding, reaching an approximately 60% increase from fasting levels when energized with complex I-linked substrates. Interestingly, fasting and fed snakes exhibited similar respiratory control ratios and citrate synthase activity. Furthermore, we found no differences in Ca2+ retention capacity, indicating no increase in susceptibility to mitochondrial permeability transition, and no changes in mitochondrial redox state, although fed animals exhibited increases in the release of H2O2. Thus, we conclude that liver mitochondria from B. constrictor snakes increase respiration rates during the postprandial period and quickly improve the bioenergetic capacity without compromising redox balance.
Diagnostic Musculoskeletal Ultrasound for the Acute Evaluation and Management of Soccer Players
Authors: Bailowitz Zachary , Visco Christopher J. , Christen Kevin , Ahmad Christopher S. 
Published: October 2021

Abstract
Musculoskeletal ultrasound (US) has many applications in the care of athletes. This article reviews the current literature and identifies research gaps regarding musculoskeletal US in the athletic training room setting to evaluate and manage soccer players. The best evidence for US in the training room setting is for diagnosis and prognosis of muscle injuries, where studies show that it is equivalent to other imaging modalities. US also has been used for injury risk prediction, although the data are mixed. Many applications of US are described in other sport settings and may have crossover applications to soccer.
Adaptations to Protect Sideline Providers as They Respond to Sudden Cardiac Arrest During Sars-CoV-2
Authors: Colbenson Kristin , Asplund Chad A. , Raukar Neha 
Published: October 2021

Abstract
The 2019 severe acute respiratory syndrome coronavirus 2 has dramatically changed the sports landscape, compelling sports medical providers to adapt to evolving scientific discoveries and adopt ever-changing guidelines that protect our athletes, ourselves, and our staff. To best serve our athletes, providers need to be proactive and anticipate potential complications in providing care for athletes as athletic events resume.
Evolving Expectations of the Orthopedic Team Physician: Managing the Sidelines and Landmines
Authors: Miller Timothy L. , Jones Grant L. , Hutchinson Mark , Vyas Dharmesh , Borchers James 
Published: October 2021

Abstract
The role of orthopedic team physicians has evolved greatly over the past decade having been influenced by advances in sports science and performance, new surgical and biologic technologies, social media, medicolegal liability, marketing, and sexual misconduct cases by some team physicians. The great variety of events and sports that are covered from high school and collegiate to the Olympic and professional levels requires a myriad of skills outside of the traditional medical training curriculum. In the current climate of increasing media scrutiny from a 24-h news cycle it is imperative for orthopedic team physicians, whether operative or nonoperative, to continually adapt to the needs and expectations of athletes who also are patients. This is especially true in the wake of the COVID-19 pandemic. Orthopedic team physicians' responsibilities continue to evolve ensuring their relevance and necessity on the sidelines and in the training room as well as in the operative suite.