bluuebunny/crossref_metadata_2025_split huggingface dataset:
Updates on treating ductal carcinoma in situ: what's to know in 2021
Authors: Haji Farnaz , Baker Jennifer L. , DiNome Maggie L. 
Published: September 2021

Purpose of review
Ductal carcinoma in situ (DCIS) is a noninvasive stage of disease but understood to be a nonobligate precursor to invasive breast cancer. As such, women with DCIS are routinely recommended for standard breast cancer treatment to prevent progression to invasive disease. DCIS, however, represents a heterogeneous group of lesions that differs in its biologic behavior and risk of progression. Thus, optimal treatment is unclear. This review presents the clinical trials evaluating the de-escalation of therapy, attempts at risk stratification, and future directions in the management of this disease.

Recent findings
The de-escalation of therapy for patients with DCIS is being actively explored. Although no group of patients based on clinicopathologic features has yet been identified as suitable for omission of therapy, molecular tests appear better able to stratify patients at low risk for whom omission of radiation may be considered. Trials considering omission of surgery are ongoing, and the use of Herceptin and vaccine therapy are also being explored.

Summary
The current review provides a centralized summary enabling the clinician to better understand the complexity of DCIS and the controversies over the optimal management of this disease. It highlights the need for better risk stratification to individualize patient care.

Video abstract

http://links.lww.com/COOG/A77.
Evaluation of Radiation-induced Pleural Effusions after Radiotherapy to Support Development of Animal Models of Radiation Pneumonitis
Authors: Aqeel Masooma , Medhora Meetha , Gore Elizabeth , Borkenhagen Jenna , Klawikowski Slade , Eastwood Daniel , Banerjee Anjishnu , Jacobs Elizabeth R. 
Published: September 2021

Abstract
Not all animal models develop radiation-induced pleural effusions (RIPEs) as a form of radiation-induced lung injury (RILI). Such effusions are also not well characterized in humans. The purpose of this study is to identify occurrences of RIPE in humans, provide justification for development of relevant animal models, and further characterize its risk factors in cancer patients. We also aim to identify dose thresholds for cardiopulmonary toxicity in humans to shed light on possible pathogenic mechanisms for RIPEs. We carried out a retrospective review of medical records of 96 cancer patients receiving thoracic irradiation (TRT) at our institution. Fifty-three (53%) patients developed a new pleural effusion post TRT; 18 (19%) had RIPE; and 67% developed RIPE ipsilateral to the site irradiated. None developed “contralateral only” effusions. Median time to development was 6 mo (IQR; 4–8 mo). Of 18, 8 patients (44%) had concomitant asymptomatic (radiographic only) or symptomatic radiation pneumonitis and pericardial effusion. Dosimetric factors, including combined and ipsilateral mean lung dose (MLD), were significantly associated with increased risk of RIPE. Angiotensin converting enzyme inhibition, steroids, or concurrent chemotherapy did not modify incidence of RIPE. Our results substantiate the occurrence and incidence of RIPEs in humans. In cancer patients, a median time to development of effusions around 6 mo also supports the onset of RIPEs concurrent with radiation pneumonitis. Future work needs to include large populations of cancer survivors in whom delayed RIPEs can be tracked and correlated with cardiovascular changes in the context of injury to multiple organs.
The role of biomarker in pancreatic neuroendocrine tumor: a narrative review
Authors: Guo Xiaofan , Gao Song , Li Zekun , Hao Jihui 
Published: September 2021

Abstract
Pancreatic neuroendocrine tumors (pNET) are heterogenous tumors originated from the diffuse neuroendocrine cells of pancreas, which show the function of synthesis, storage and secretion of peptide hormones and biomimetic amines. Biomarkers play a crucial role in the diagnosing, evaluating prognosis and predicting treatment response for pNET patients. Traditional NET markers such as chromogranin A and Neuron Specific Enolase, as a diagnostic biomarker, have relatively low sensitivity and specificity in pNET patients. The emergence of new types of biomarkers provides more reliable indicators for diagnosis and prognosis evaluation. Among them, NETest score is a promising biomarker with the highest diagnostic sensitivity (80%) and specificity (94%). In addition, this molecule can be also used as a prognostic biomarker, which can predict disease progression and shorter overall survival. Biomarkers related to therapeutic targets, such as vascular endothelial growth factor, vascular endothelial growth factor receptor, and key molecules of mTOR signaling pathway, have capability to predict response of treatment. With the development of next-generation sequencing, chip array, and digital droplet PCR, novel biomarkers such as circulating tumor cells, tumor-derived exosomes, and circulating tumor DNA and mRNA are expected to provide more accurate diagnosis, prognostic information, and prospective therapeutic targets. In this paper, biomarkers of pancreatic neuroendocrine tumor and their role in diagnosis, prognosis, diagnosis, treatment and monitoring are systematically introduced. Our conclusions can provide new basis for clinicians in the diagnosis and treatment process.
Menstrual cycle length and modern living: a review
Authors: Campbell Lily R. , Scalise Ariel L. , DiBenedictis Brett T. , Mahalingaiah Shruthi 
Published: September 2021

Purpose of review
The aim of this review is to evaluate biological, life history, environmental, and lifestyle factors and exposures that cause variability in menstrual cycle length (MCL).

Recent findings
Recent literature has detailed a number of factors that influence MCL, with particular emphasis placed on novel environmental exposures, such as air pollution and endocrine disrupting chemicals.

Summary
MCL varies widely in response to intrinsic and extrinsic inputs and is a useful predictor of reproductive health and fecundability.

Video abstract

http://links.lww.com/COE/A28
Androgen abuse among gay and bisexual men
Authors: Griffiths Scott , Jotanovic Dejan , Austen Emma 
Published: September 2021

Purpose of review
Androgen abuse is more prevalent among gay and bisexual (i.e. sexual minority) men than heterosexual men. We review recent research about androgen abuse in sexual minority men and provide relevant social, cultural, and historical contexts.

Recent findings
Androgen abuse among sexual minority men is shaped by the intersections of sexuality, desirability, masculinity, and race. Muscular male bodies are desired and – in erotic settings especially – prized as literal embodiments of masculinity. Racist stereotypes unjustly diminish the desirability and masculinity of sexual minority men who belong to racial minorities, especially those who are Asian or Black, and the higher rates of androgen abuse among these racial minorities may reflect a compensatory motivation for these diminishments. The historical context for sexual minority men – decades of subjugation alongside stereotypes of masculinity-compromising effeminacy – further complicate the intersections of sexuality with androgen abuse. Harm minimization efforts led by empathetic endocrinologists stand the best chance of achieving positive outcomes for sexual minority men who use androgens.

Summary
More dedicated research on androgen abuse among sexual minority men is needed as this population requires thoughtfully designed research that is incorporative – at a minimum – of the complexities of sexuality, desirability, masculinity, and race.
Improving Low-Density Fat by Condensing Cellular and Collagen Content through a Mechanical Process: Basic Research and Clinical Applications
Authors: Zhu Huidong , Quan Yuping , Wang Jing , Jiang Shenglu , Lu Feng , Cai Junrong , Liao Yunjun 
Published: September 2021

Background:
Large-volume fat grafting results in high absorption and complication rates. Low-density fat includes small numbers of viable cells and considerable oil, resulting in nodules and oil cysts. This study evaluated a strategy for large-volume fat grafting using a mechanical process to condense low-density fat and transplanting it with high-density fat.

Methods:
Low-density fat, defined as the upper half of centrifuged lipoaspirates, was emulsified by intersyringe shifting and centrifuged to obtain condensed low-density fat. Fresh condensed low-density fat was analyzed by counting cells in the stromal vascular fraction, and by electron scanning and Western blotting. The retention rate and histologic changes of the product were analyzed using a fat grafting model in nude mice. Transplantation with a combination of condensed low-density fat and high-density fat was tested in patients undergoing breast reconstruction and breast augmentation.

Results:
The condensed low-density fat derived from low-density fat contained a large number of stromal vascular fraction cells and collagens, comparable to that of high-density fat and much higher than in low-density fat and Coleman fat. Retention rates 12 weeks after transplantation were higher for condensed low-density fat (55.0 ± 7.5 percent) than for low-density fat (31.1 ± 5.7 percent) and Coleman fat (41.1 ± 6.8 percent), with condensed low-density fat having fewer oil cysts and lower macrophage infiltration. Patients grafted with combined condensed low-density fat and high-density fat showed good long-term volume retention.

Conclusions:
Using mechanical methods to condense low-density fat to a level comparable to that of high-density fat is a practical method of improving fat graft retention and avoiding severe complications. This new strategy may improve the quality of lipoaspirates for patients requiring large-volume augmentation.
USP15 Enhances the Proliferation, Migration, and Collagen Deposition of Hypertrophic Scar–Derived Fibroblasts by Deubiquitinating TGF-βR1 In Vitro
Authors: Tu Longxiang , Lin Zunwen , Huang Qin , Liu Dewu 
Published: September 2021

Background:
Hypertrophic scar is a fibroproliferative disorder caused by skin injury. The incidence of hypertrophic scar following trauma or burns is 40 to 70 percent or 70 percent, respectively. It has been shown that transforming growth factor (TGF) β1/Smad signaling plays a crucial role in hypertrophic scar, and that USP15 can regulate the activity of TGFβ1/Smad signaling to affect the progression of the disease. However, the underlying mechanism of USP15 in hypertrophic scar remains unclear. The authors hypothesized that USP15 was up-regulated and enhanced the proliferation, migration, invasion, and collagen deposition of hypertrophic scar–derived fibroblasts by deubiquitinating TGF-β receptor I (TβRI) in vitro.

Methods:
Fibroblasts were isolated from human hypertrophic scars in vitro. The knockdown and overexpression of USP15 in hypertrophic scar–derived fibroblasts were performed using lentivirus infection. The effect of USP15 on hypertrophic scar–derived fibroblast proliferation, migration, and invasion, and the expression of TβRI, Smad2, Smad3, α-SMA, COL1, and COL3, were detected by Cell Counting Kit-8, scratch, invasion, quantitative real-time polymerase chain reaction, and Western blot assays. The interaction between USP15 and TβRI was detected by co-immunoprecipitation and ubiquitination assays.

Results:
The authors demonstrated that USP15 knockdown significantly inhibited the proliferation, migration, and invasion of hypertrophic scar–derived fibroblasts in vitro and down-regulated the expression of TβRI, Smad2, Smad3, α-SMA, COL1, and COL3; in addition, USP15 overexpression showed the opposite trends (p < 0.05). Co-immunoprecipitation and ubiquitination assays revealed that USP15 interacted with TβRI and deubiquitinated TβRI.

Conclusion:
USP15 enhances the proliferation, migration, invasion, and collagen deposition of hypertrophic scar–derived fibroblasts by deubiquitinating TβRI in vitro.
Robotic Inguinal Hernia Repair After Prostatectomy: How to Navigate Safely
Authors: Salas-Parra Ruben D. , Lima Diego L. , Pereira Xavier , Cavazzola Leandro T. , Sreeramoju Prashanth , Malcher Flavio 
Published: September 2021

Introduction:
In recent decades, minimally invasive approaches have found their place in treating a specific subset of patients with inguinal hernias, predominantly those with recurrent or bilateral disease. Classically, prior history of urologic pelvic operations, such as prostatectomy, has been listed as relative contraindication for minimally invasive inguinal hernia repair. As the adoption of the robotics platform continues to grow, we aim to outline a feasible robotic-assisted inguinal hernia repair technique in patients with previous prostatectomies. We report the outcomes of 15 patients who underwent repair at 2 institutions.

Methods:
This is a retrospective case series of 15 patients who underwent robotic transabdominal preperitoneal approach repair of their inguinal hernias after prostatectomy. Demographics, intraoperative variables, and outcomes of our cases are described.

Results:
Fifteen patients were included in our cohort. All patients had a history of prostatectomy (7 open, 2 laparoscopic, and 6 robotic) due to prostate cancer. Median age was 70 years old (range: 60 to 89 y), with a median body mass index of 26.3 kg/m2 (range: 20.5 to 37.4 kg/m2). Hernia defects were bilateral in 6 patients and unilateral in the remaining 9 (right; 6, left; 3). The shortest interval between prostatectomy and subsequent hernia repair was 4 months (range: 4 to 216 mo). The median operative time was 139 min (range: 91 to 281 min). All defects were repaired using a polypropylene mesh except in 1 case, where a coated monofilament polyester mesh was used after having a large peritoneal defect to close, preventing future adhesions to the bowel. Mesh sizes used were large (16×11 cm), extra-large (17×12 cm) for anatomic mesh, and 20×15 cm for the monofilament polyester mesh. The mesh was fixed in 14 of 15 cases. Fixation was accomplished with absorbable suture (n=13), barbed suture (n=1), and fibrin sealant (n=1). Peritoneal closure was always performed using a continuous running v-loc suture. There were no documented major intraoperative complications, no 30-day readmission, or recurrences recorded within the follow-up period. Postoperatively, only 2 seromas and 1 hematoma were documented during the follow-up period.

Conclusions:
Robotic inguinal hernia repairs in patients with previous prostatectomy is safe and feasible in most patients. Larger patient series are needed to confirm these findings.
Disseminated sporotrichosis in a person with human immunodeficiency virus disease
Authors: Tshisevhe Vhudzani , Skosana Lebogang , Motse Kagiso , Maphosa Tinashe , Mitton Barend 
Published: September 2021

Introduction.Disseminated sporotrichosis is an incapacitating infection caused by the dimorphic fungusSporothrix schenckii. Because this condition may mimic the presentation of tuberculosis, syphilis and other bacterial infections, the diagnosis may be missed or delayed.Case Presentation.We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole.Conclusion.This report highlights the importance of having a high index of suspicion of endemic mycoses when managing immunocompromised patients. The report also demonstrates that a delay in the diagnosis of sporotrichosis increases morbidity and results in unnecessary and inappropriate treatment with associated costs and adverse effects.
Evolution of COVID-19 mortality over time: results from the Swiss hospital surveillance system (CH-SUR)
Authors: Roelens Maroussia , Martin Alexis , Friker Brian , Sousa Filipe Maximiano , Thiabaud Amaury , Vidondo Beatriz , Buchter Valentin , Gardiol Céline , Vonlanthen Jasmin , Balmelli Carlo , Battegay Manuel , Berger Christoph , Buettcher Michael , Cusini Alexia , Flury Domenica , Heininger Ulrich , Niederer-Loher Anita , Riedel Thomas , Schreiber Peter W. , Sommerstein Rami , Troillet Nicolas , Tschudin-Sutter Sarah , Vetter Pauline , Bernhard-Stirnemann Sara , Corti Natascia , Gaudenz Roman , Marschall Jonas , Nussbaumer-Ochsner Yvonne , Senn Laurence , Vuichard-Gysin Danielle , Zimmermann Petra , Zucol Franziska , Iten Anne , Keiser Olivia ,   CH-SUR study group
Published: September 2021

AbstractBackgroundWhen comparing the periods of time during and after the first wave of the ongoing SARS-CoV-2/COVID-19 pandemic in Europe, the associated COVID-19 mortality seems to have decreased substantially. Various factors could explain this trend, including changes in demographic characteristics of infected persons, and the improvement of case management. To date, no study has been performed to investigate the evolution of COVID-19 in-hospital mortality in Switzerland, while also accounting for risk factors.MethodsWe investigated the trends in COVID-19 related mortality (in-hospital and in-intermediate/intensive-care) over time in Switzerland, from February 2020 to May 2021, comparing in particular the first and the second wave. We used data from the COVID-19 Hospital-based Surveillance (CH-SUR) database. We performed survival analyses adjusting for well-known risk factors of COVID-19 mortality (age, sex and comorbidities) and accounting for competing risk.ResultsOur analysis included 16,030 episodes recorded in CH-SUR, with 2,320 reported deaths due to COVID-19 (13.0% of included episodes). We found that overall in-hospital mortality was lower during the second wave of COVID-19 compared to the first wave (HR 0.71, 95% CI 0.69 – 0.72, p-value < 0.001), a decrease apparently not explained by changes in demographic characteristics of patients. In contrast, mortality in intermediate and intensive care significantly increased in the second wave compared to the first wave (HR 1.48, 95% CI 1.42 – 1.55, p-value < 0.001), with significant changes in the course of hospitalisation between the first and the second wave.ConclusionWe found that, in Switzerland, COVID-19 mortality decreased among hospitalised persons, whereas it increased among patients admitted to intermediate or intensive care, when comparing the second wave to the first wave. We put our findings in perspective with changes over time in case management, treatment strategy, hospital burden and non-pharmaceutical interventions. Further analyses of the potential effect of virus variants and of vaccination on mortality would be crucial to have a complete overview of COVID-19 mortality trends throughout the different phases of the pandemic.
Making colonoscopy-based screening more efficient: a ‘gateopener’ approach
Authors: Heisser Thomas , Cardoso Rafael , Niedermaier Tobias , Hoffmeister Michael , Brenner Hermann 
Published: September 2021

AbstractObjectivesTo assess the potential of an innovative approach to colonoscopy-based screening for colorectal cancer (CRC), by use of a single, low threshold fecal immunochemical test (FIT) as a ‘gateopener’ for screening colonoscopy.DesignSimulation study using COSIMO, a validated Markov-based simulation model, in a hypothetical German population.SettingModelled scenarios included either direct invitation to screening colonoscopy or mailing a single (‘gateopener’) FIT along with an invitation to colonoscopy contingent on a FIT value above a low threshold yielding a 50% positivity rate (i.e., every other pre-test will be positive). The main analyses focused on scenarios assuming identical colonoscopy uptake, resulting from higher adherence to the gateopener FIT than to primary use of colonoscopy and avoidance of colonoscopy in those with below-threshold FIT values.ParticipantsHypothetical cohorts of 100,000 previously unscreened men and women using screening at different ages and with varying levels of adherence.InterventionsScreening colonoscopy without and with preceding gateopener FIT.Main outcome measureDetected and prevented CRC cases and deaths within 10 years.ResultsAcross all ages and both sexes, use of screening colonoscopy contingent on a positive gateopener FIT yielded approximately doubled cancer detection rates as compared to conventional screening. In those spared from undergoing screening colonoscopy due to a negative FIT pretest, numbers needed to screen were 10-times higher as compared to those for individuals with a positive FIT, peaking in more than 2500 and more than 3800 (hypothetically) needed colonoscopies to detect one case of cancer in 50-year-old men and women, respectively. At identical levels of colonoscopy use, gateopener screening resulted in 51-53% and 63-68% more prevented CRC cases and deaths, respectively.ConclusionsBy directing colonoscopy capacities to those most likely to benefit from it, offer of screening colonoscopy contingent on a ‘gateopener’ low-threshold FIT would substantially enhance efficiency of colonoscopy screening.Summary BoxWhat is already known on this topicScreening colonoscopy as primary examination is inefficient as most of the screened subjects would never develop colorectal cancer even without screening.Efficiency could be enhanced by pre-selecting those most likely to benefit, e.g., by use of a single low-threshold faecal immunochemical test (‘gateopener’ FIT)What this study addsA simulation where only individuals with positive gateopener FIT proceeded to screening colonoscopy resulted in 50% fewer colonoscopies required to detect one case of cancer vs conventional screening colonoscopy.At identical colonoscopy uptake rates, the gateopener approach implied approximately 50% and 70% more prevented colorectal cancer cases and deaths, respectively.Inviting subjects to undergo pre-testing with low-threshold FITs would markedly improve efficiency of colonoscopy-based screening.