bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Study of Direct Immunofluorescence Patterns in Linear IgA Bullous Dermatosis Versus Dermatitis Herpetiformis
Authors: Sagut Pelin , Lyles Elliott , Vroman Jenna , Barker Catherine S. , Juratli Hazem A. , Bruner Evelyn , Self Sally , Elston Dirk M. 
Published: November 2024

Background:
Dermatitis herpetiformis (DH) is typically characterized by granular IgA deposition in the papillary dermis on direct immunofluorescence (DIF), and linear IgA bullous dermatosis (LABD) is characterized by linear deposition of IgA along the basement membrane. Other DIF findings in both conditions may include IgG, IgM, and C3 deposition in various patterns. In cases where immunofluorescence findings are unclear, such as continuous but somewhat granular IgA deposition along the dermal–epidermal junction, additional DIF patterns may be helpful in the diagnostic process.

Methods:
Forty-five cases of digitized images of LABD and 48 digitized images of DH cases were analyzed. The data regarding the positivity and patterns of immunoglobulins were documented and analyzed.

Results:
None of the LABD cases had a picket fence pattern, while 47.9% (n = 23) of the DH cases had the pattern. Elevated levels of IgG and IgM were found in LABD compared with DH. In DH, higher IgM and kappa light chain levels were observed in the deposited particles compared with those in LABD.

Conclusions:
The “picket fence pattern” is highly specific for DH (Specificity 100%) but less sensitive (Sensitivity 47.9%). It may be helpful to differentiate between DH and LABD for a more accurate diagnosis.
Single-session Preoperative Embolization and Surgical Resection of Vascular Anomalies: A Case Series
Authors: Rajagopalan Aravind , Shah Nikhil , Reddy Narainsai K. , Aronson Sofia , Yamada Akira , Rajeswaran Shankar 
Published: November 2024

Summary:
Vascular anomalies encompass 2 broad classifications including vascular tumors and vascular malformations. The management of vascular anomalies is best approached by a multidisciplinary team. Surgical treatment can offer definitive treatment, but carries several risks such as intraoperative hemorrhage, recurrence, and collateral vascular formations from incomplete resections. Here, we present a case report of 3 patients with different vascular anomalies who were all treated by a multidisciplinary team including interventional radiology and plastic surgery. All underwent preoperative embolization before surgical excision, accomplished under a single anesthetic. Here, we discuss the surgical planning and overall approach to patients presenting with localized vascular anomalies and support the use of preoperative embolization with surgical excision under a single anesthetic as a treatment approach.
Clinicopathological relevance of SMAD4 and RUNX3 in patients with resected pancreatic cancer
Authors: Hirose Katsuya , Omori Yuko , Higuchi Ryota , Yamamoto Masakazu , Furukawa Toru 
Published: November 2024

Abstract

Objectives
Treating pancreatic ductal adenocarcinoma (PDAC) is a major clinical challenge, owing to its poor prognosis. Understanding the underlying molecular interactions may be crucial in determining PDAC intractability. We elucidated the combinatory role of SMAD family member 4 (SMAD4) and Runt-related transcription factor 3 (RUNX3) in PDAC.

Methods
Formalin-fixed and paraffin-embedded tissues were obtained from 101 patients who underwent surgical resection of PDAC. SMAD4 and RUNX3 expression in the tissues was evaluated using immunohistochemistry. SMAD4 and KRAS mutations were evaluated using Sanger sequencing. SMAD4 copy number variations were evaluated using quantitative real-time PCR. These molecular characteristics were compared with clinicopathological features of patients.

Results
Retained SMAD4 expression in PDAC tissues was associated with higher tumor, node, metastasis (TNM) stage, and metastatic recurrence. Defective RUNX3 expression was associated with higher TNM stages. Further analysis to determine significance of retained SMAD4 indicated that all these cases had defective RUNX3 expression; therefore, the combined expression status of retained SMAD4 and defective RUNX3 expression in tissues was determined to be associated with higher TNM stage and metastatic recurrence than defective SMAD4 expression with defective or retained RUNX3 expression. Survival analysis showed that patients with tumors with retained SMAD4 and defective RUNX3 expression had relatively worse overall survival (OS) rates. KRAS mutations were not associated with SMAD4/RUNX3 expression or OS.

Conclusions
Despite inherent limitations of this retrospective study and small sample size, our findings highlight the potential combined role of SMAD4 and RUNX3 in node metastasis and metastatic recurrence in patients with resected pancreatic cancer.
The Effects of Thermal and Pulsed Ultrasound on Pain and Function in Patients with Carpal Tunnel Syndrome: A Randomized Controlled Trial
Authors: ElMeligie Mohamed M. , Ismail Mahmoud M. , Yehia Amr M. , Sakr Hend R. , Amin Doaa I. 
Published: November 2024

ABSTRACT

Objective
While ultrasound therapy is common for carpal tunnel syndrome, the relative merits of thermal versus pulsed ultrasound remain unclear. This study compares their therapeutic effects.

Design
Randomized, double-blinded, placebo-controlled trial. Ninety-two adults aged 30-60 years with mild-moderate carpal tunnel syndrome (characteristic symptoms, positive clinical tests, abnormal electrophysiology) were randomized into 4 groups receiving 4 weeks night splinting plus 12 ultrasound sessions: Group A: 1 MHz, 1.0 W/cm2 continuous ultrasound for 5 minutes; Group B: 1 MHz, 25% duty cycle, 1.0 W/cm2 pulsed ultrasound for 15 minutes; Group C: 5 minutes thermal plus 15 minutes pulsed ultrasound; Group D: sham ultrasound for 15 minutes. Pain (VAS), function (DASH-Arabic), nerve conduction, and grip strength were measured at baseline, 4, and 8 weeks.

Results
Thermal and pulsed ultrasound groups improved in all outcomes versus placebo over 8 weeks (p < 0.05). Pulsed ultrasound decreased pain and distal motor latency more than placebo (p < 0.05). Thermal ultrasound increased sensory nerve action potentials versus placebo (p < 0.05).

Conclusion
Thermal and pulsed ultrasound with splinting improved pain, disability, grip strength, and nerve conduction in carpal tunnel syndrome. Pulsed ultrasound was optimal for pain and motor function, while thermal ultrasound enhanced sensory nerve function.
Ultrasound assessment of muscle and fascia properties and the effects of spasticity and botulinum toxin injections on spastic muscles in chronic stroke survivors
Authors: Magat Elaine , Horstmann Kelly , Francisco Gerard E. , Li Sheng 
Published: November 2024

Abstract

Objective
To objectively quantify changes in muscle properties in chronic stroke survivors and the effects of spasticity and botulinum toxin injections (BoNTi) on muscle properties using ultrasonography.

Design
In this cross-sectional observational study, 24 stroke subjects with history of BoNTi to biceps brachii muscles (BB) but without BoNTi to the triceps (TRI) were included.

Results
12 subjects had spastic TRI, the other half did not. 20 subjects had spasticity in wrist flexors, and 11 subjects received BoNTi to the flexor carpii ulnaris (FCU). On average, a significant decrease in muscle thickness (16.5% loss in TRI), a thicker fascia with higher echo intensity were noted on muscles in the paretic limb. Percent muscle loss (PML) was significantly less (11.0%) in spastic TRI than in non-spastic TRI (22.1%). There was no statistically significant difference in muscle and fascia properties in spastic FCU with and without BoNTi. Spasticity did not correlate significantly with muscle loss, fascia thickness or echo intensity.

Conclusion
Our results provided evidence that muscles on the spastic-paretic side had less muscle mass, thicker fascia and greater echo intensity. Our results showed that spasticity helped maintain muscle mass, but failed to reveal additional muscle loss after botulinum toxin injection.
A Different View of the Issue: Seeing Disability Through the Lens of Diversity and Inclusivity in Healthcare in the United States
Authors: Brose Steven W. , Suarez Kevin O. , Cenberoglu Mine A. , Weber Robert , Turk Margaret A. 
Published: November 2024

ABSTRACT
Advocacy for diversity, inclusion and equity within healthcare continues to be an issue of importance and attention nationally. However, definitions of diversity often do not include people with disability. This commentary describes barriers to healthcare utilization experienced by people with disabilities in the United States (U.S.) and presents a rationale to refocus disability through this lens of diversity, equity, and inclusion within the U.S. systems of care. Bringing light to the ongoing challenges and inequities faced by our patients with disability is an essential first step toward improved inclusivity, leading to improved welfare of persons with disability as a whole.
A Novel Technique for Top Surgery in Small-Breasted Individuals Who Experience Gender Dysphoria – Concentric Periareolar Mastectomy, Interlocking Suture and Waterjet-Assisted-Liposuction
Authors: Wolter Andreas , Fertsch Sonia M , Daniels Marc , Munder Beatrix , Hagouan Mazen , Janku Dirk , Musmann Robert J , Oramary Alan , Andree Christoph , Hammond Dennis 
Published: November 2024

Background:
In small-breasted individuals, who experience gender dysphoria, the concentric periareolar approach is typically the preferred method for mastectomy. However, this method carries a notable risk of hypertrophic scars and changes in the areolar dimensions. This study introduces the periareolar interlocking suture (PIS) as a new scar-minimizing procedure, with a low complication rate and high patient satisfaction.

Patients and Methods:
We performed a concentric periareolar mastectomy (CPM) combined with PIS and waterjet-assisted liposuction (WAL) in patients with small breasts (A to B-Cup) and good skin quality/elasticity. Outcome measures included complication rates, patient satisfaction (assessed via the BODY-Q Chest and Nipples Scale and scar appearance), nipple sensitivity, and the rate of surgical corrections.

Results:
Between April 2017 and December 2023, we conducted 2312 mastectomies in 1156 people who experience gender dysphoria, with 410 breasts treated using CPM combined with PIS and WAL. The mean patient age was 23 years, mean hospital stay was 4 days, and mean operation time was 96.1 minutes. The overall complication rate was 7.8%, with acute hematomas occurring in 4.6% of the cases. Secondary revisions were necessary in only 2.2% of cases. Patient satisfaction, measured using the BODY-Q scale, was statistically significant and very high.

Conclusion:
Individuals with gender dysphoria are well-informed and increasingly demand aesthetic outcomes. Whenever feasible, procedures with minimal scarring are preferred. The technique presented here resulted in very high patient satisfaction, preserved nipple sensitivity, and a low rate of complications and secondary aesthetic corrections in a carefully selected cohort of patients with small breasts.
Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting
Authors: Waidley Monica , Taylor Nikki , Shever-Doletzky Leah L. 
Published: November 2024

Abstract

PURPOSE:
The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.

PARTICIPANTS AND SETTING:
This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.

APPROACH:
The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.

OUTCOMES:
Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.

IMPLICATIONS FOR PRACTICE:
The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.
The Association Between Parity and Fecal Problems Differs by Urinary Status
Authors: Brinkman Lauret A.M. , Hierink G. Marije , Malmberg G.G. Alec , Lammers Rianne J.M. , Visser Ellen , van Eijndhoven Hugo W.F. , Trzpis Monika , Broens Paul M.A. 
Published: November 2024

Importance
Urinary incontinence, fecal incontinence, and constipation frequently manifest and are risk factors for one another. Studies investigating the association between parity and fecal problems in urinary continent and urinary incontinent women are lacking.

Objectives
The aim of this study was to examine whether the association between parity and fecal problems differs in urinary continent and urinary incontinent women.

Study Design
This study was a cross-sectional, retrospective questionnaire-based study. The population was a representation of the general Dutch female population (n = 5,670), including nulliparous (n = 2,790) and parous women (n = 2,880). Data were collected using the Groningen Defecation and Fecal Continence questionnaire, addressing urinary and fecal problems according to validated criteria. Parametric test, χ2 test, Fisher exact test, and univariable and multivariable logistic regression analyses were used.

Results
Of the urinary incontinent women, 13.7% nulliparous and 6.3% parous women reported a combination of fecal incontinence with constipation. This made urinary incontinent nulliparous women 1.90 times more prone to have both fecal incontinence and constipation (P < 0.001), especially nulliparous women with stress urinary incontinence (odds ratio, 2.76; 95% confidence interval, 1.44–5.31; P = 0.002). In the urinary continent women, nulliparous women reported significantly more often fecal incontinence as a solitary problem than parous women (4.3% vs 2.5%; P = 0.016; odds ratio, 1.73; 95% confidence interval, 1.06–2.81; P = 0.028).

Conclusions
The association between parity and fecal problems is different in urinary continent and incontinent women. In urinary incontinent women, especially with stress urinary incontinence, nulliparous women experience more often the coexistence of fecal incontinence and constipation than parous women. In urinary continent women, nulliparous women had more frequently a solitary problem of fecal incontinence than parous women.
Multi-stain modelling of histopathology slides for breast cancer prognosis prediction
Authors: Sharma Abhinav , Gustafsson Fredrik K. , Hartman Johan , Rantalainen Mattias 
Published: November 2024

AbstractBackgroundPathologic assessment of the established biomarkers using standard hematoxylin & eosin (H&E) and immunohistochemical (IHC) stained whole slide images (WSIs) is central in routine breast cancer diagnostics and contributes prognostic and predictive information that guides clinical decision-making. However, other than only aggregated protein-expression values from IHC WSIs, a spatial combination of histo-morphological information from IHC and H&E WSIs can potentially improve prognosis prediction in breast cancer patients. In this study, we aim to develop a deep learning-based risk-stratification method for breast cancer using routine H&E and IHC-stained histopathology WSIs from resected tumours.MethodsThis is a retrospective study including WSIs from surgical resected specimens from 945 patients from the South General Hospital in Stockholm. One H&E and four IHC (ER, PR, HER2, and Ki-67) stained sections were included from each patient, retrieved from the same tumour block. The IHC WSIs with the H&E WSI were registered, and corresponding images patches (tiles) were extracted for each image modality. Features from the registered tiles were extracted using two existing and publicly available histopathology foundation models (UNI and CONCH). Using the extracted features together with time-to-event data, we optimised an attention-based multiple instance learning (MIL) model using the Cox loss (negative partial log-likelihood loss) and recurrence-free survival (RFS) as the survival endpoint.ResultsUsing cross-validation we observed a prognostic performance with a C-index of 0.65 (95%CI: 0.56 - 0.72) for the risk score prediction using only H&E WSIs and UNI as the tile-level feature extractor. Combinations of H&E with one or more IHC modalities were subsequently evaluated, with the highest performance observed in the model combining the H&E and PR WSI data and the model combining all the stains, obtaining a C-index of 0.72 (95% CI: 0.65 - 0.79) and 0.72 (95% CI: 0.64 - 0.79) respectively.ConclusionMultiple stain modalities are used in routine breast cancer pathology, but has not been considered together for prognostic modelling. The results in this study suggests that models combining morphological features extracted by histopathology foundation models across multiple stain modalities can improve prognostic risk-stratification performance compared to single-modality models.
Transforming diagnostic capacity by syndromic infection testing for remote isolated communities
Authors: Dryden Matthew , Lee John , Toplass Janice , Cortes Nicholas , Russo Del Piano Fabio , Skerritt Tiffanie , St.Hill Mykala A S. , Crowie Chester , Benjamin Geoffrey , Siebs Arlene A S. , Smellie Jonathan , Hardy Bill , Duncan Everette S. , Wright Natalie 
Published: November 2024

AbstractObjectiveMany of the UK overseas territories are small with limited microbiological diagnostic capacity for pathogens and antimicrobial resistance detection. The Covid-19 pandemic highlighted the particular vulnerability of these territories for the emergence of novel infections and antimicrobial resistance.MethodsThe UKHSA program with its territory partners implemented rapid automated syndromic molecular diagnostics (RASM), aiming to improve diagnostic capacity. Local laboratory staff were trained in the use of the diagnostics, and guidance was provided to clinicians for requesting tests. Syndromic diagnoses included enteric, respiratory, bloodstream, neurological infection, and antibiotic resistance mechanisms. Data on diagnostic capacity, turnaround times and clinical impact were collected from records before and after implementation of RASM.ResultsTurnaround time for results went from an average 14 days to 1 day, and often much shorter. Previously undiagnosed conditions, could now be identified to the microbiological level rapidly in territory, allowing appropriate specific clinical management, infection prevention, improved antimicrobial stewardship and rapid public health response. This technology is simple to operate and maintain with little scope for user error. The speed of microbiological diagnosis for patient management and public health detection and response was greatly enhanced.ConclusionRapid microbiological diagnosis on site transformed patient management, the timely investigation and management of outbreaks and clusters, accurate surveillance and antimicrobial stewardship. Targeted RASM is cost effective, reducing the requirement for highly trained scientific staff and expensive logistics around rapid transport to reference laboratories. This innovation improves clinical care and strengthens local preparedness in communicable disease and public health response.
Top-Down Effects on Translucency Perception in Relation to Shape Cues
Authors: Nagai Takehiro , Kiyokawa Hiroaki , Kim Juno 
Published: November 2024

0.AbstractIt is well established that object shape perception significantly influences the perception of translucency. However, how object shape cues such as motion and binocular disparity affect the perception of translucency in rich environments, like virtual reality or real visual environments, remains unclear. This study aims to psychophysically measure the extent to which multiple object shape cues influence the perception of translucency. Additionally, we examined whether top-down factors, such as changes in cognitive attitude caused by the sequence of experiments, affect translucency perception. The results revealed that while motion and binocular disparity enhance translucency perception, this effect is confined to situations where shape cues are poor. Moreover, the effect became particularly pronounced when the experiments began with weak specular reflection stimuli, followed by the experiments using stimuli with specular reflection. In the case of translucent objects without specular reflection, strong shape information cannot be derived solely from shading patterns. These findings thus suggest that top-down factors related to shape modulate the influence of shape cues on translucency perception.
High-resolution Cryo-EM visualises hydrated type I and IV pilus structures from enterotoxigenicEscherichia coli
Authors: Kawahara Kazuki , Oki Hiroya , Iimori Minato , Muramoto Ryuki , Imai Tomoya , Gerle Christoph , Shigematsu Hideki , Matsuda Shigeaki , Iida Tetsuya , Nakamura Shota 
Published: November 2024

AbstractTo efficiently colonise intestinal epithelium, enteric pathogens utilise a wide variety of pilus filaments, including those synthesised by the chaperone–usher or type IV pilus assembly pathway. Despite the importance of these filaments as potential drug and vaccine targets, their large size and dynamic nature present challenges for atomic-resolution structural determination. Here, we used cryo-electron microscopy (cryo-EM) and whole genome sequencing to identify and determine the structures of type I and IV pili expressed in enterotoxigenicEscherichia coli. The well-defined cryo-EM maps at resolutions of 2.20 and 1.78 Å for Type I and Type IV pilus, respectively, facilitatedde novostructural modelling for these filaments, revealing side chain structures in detail. Further, we resolved thousands of hydrated water molecules around and within the inner core of the filaments, functioning as a buffer to stabilise the otherwise metastable subunit assembly. The high-resolution structures offer novel insights into the subunit–subunit interactions, providing important clues to understand pilus assembly, stability, and flexibility.