bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chest wall perforator flaps are safe and can decrease mastectomy rates in breast cancer surgery: multicentre cohort study
Authors: Karakatsanis Andreas , Meybodi Farid , Pantiora Eirini , Elder Elisabeth , Cabel Faustine , Hsu Jeremy , French James , Aristokleous Iliana , Sjökvist Olivia , Önefäldt Daniel , Navia Jaime , O’Connell Rachel L , Rusby Jennifer E , Barry Peter A 
Published: November 2024

Abstract

Background
Chest wall perforator flaps are emerging in oncoplastic breast conservation, mostly as an alternative to mastectomy. However, standardization and consensus on patient selection, techniques, and outcomes have not yet been reached. The aim of this international multicentre collaborative study was to explore practice patterns and outcomes in high-volume centres from different countries.

Methods
Patients with both pre-invasive and invasive breast cancer treated at the Uppsala University Hospital in Uppsala, Sweden, the Royal Marsden Hospital in London, UK, and the Westmead Breast Cancer Institute in Sydney, Australia, were included in this study. The rationale for offering chest wall perforator flaps and surgical outcomes were prospectively documented.

Results
In total, 603 patients were analysed median age of 54 (interquartile range (i.q.r.) 48–63) years, median BMI of 25.0 (i.q.r. 22.5–28.1) kg/m2, median tumour extent of 30 (IQR 19–45) mm, median breast volume of 280 (i.q.r. 216–430) ml, and median calculated resection ratio of 16% (i.q.r. 9%–28%). In 67.7%, the treating surgeon had offered chest wall perforator flaps to avoid mastectomy. The procedure was performed as day surgery in 69.5% of patients, with an overall complication rate of 8.6% and the majority of complications being classified as Clavien–Dindo grade I (5.3% of patients). The re-excision rate was 15.9%, with only 1.5% of patients converting to a mastectomy. There were no flap losses. At a median follow-up of 22 (range 12 to 98) months, rates of local recurrence, distant recurrence, and breast cancer-related mortality were 1.9%, 4.9%, and 1.7% respectively.

Conclusion
Chest wall perforator flaps are a useful option to allow more women to avoid mastectomy. In experienced hands, the procedure is safe and should be offered to suitable patients.
Sternal elevation in pectus excavatum repair: comparison of a unilateral versus bilateral frame crane system
Authors: Janssen Nicky , Coorens Nadine A , Daemen Jean H T , Franssen Aimée J P M , van Polen Elise J , van der Hoven Pelle A , Hulsewé Karel W E , Vissers Yvonne L J , de Loos Erik R 
Published: November 2024

Abstract

OBJECTIVES
Instability in the conventional, unilateral frame crane system occurs when greater sternal elevation forces are required, which potentially limits optimal sternal elevation during Nuss repair of the pectus excavatum. A bilateral frame setup was subsequently developed. We hypothesized that increasing the retractor’s stability with the bilateral frame crane system would yield superior sternal elevation, as reflected by a greater lift of the anterior chest wall.

METHODS
Pectus excavatum patients who underwent the Nuss procedure utilizing sternal elevation between November 2022 and October 2023 were included in this crossover study. Three-dimensional surface imaging was used to evaluate differences in established maximum and average combined chest wall elevation, comparing unilateral to bilateral frame crane systems. The results were also compared to the effect of bar implantation on the deepest point of the deformity.

RESULTS
The 30 patients included in the final analysis were predominantly male (83%) with a median age of 16.0 years (interquartile range 14.3–17.0) and median Haller index of 3.3 (interquartile range 2.9–3.8). The bilateral frame crane system achieved maximum combined chest wall elevation comparable to the effect of definitive bar placement (33 mm vs 38 mm, P = 0.06) and provided significantly greater elevation than the unilateral frame crane system (33 mm vs 24 mm, P &lt; 0.001). Both systems, however, showed similar results for average combined chest wall elevation (4 mm vs 5 mm, P = 0.16).

CONCLUSIONS
The bilateral frame crane system demonstrates superiority in achieving sternal elevation at the deepest point of the deformity, which may theoretically facilitate safer and more optimal bar placement.
Enzymes Repertoires and Genomic Insights into Lycium Barbarum Pectin Polysaccharides Biosynthesis
Authors: Yue Haiyan , Tang Yiheng , Li Aixuan , Zhang Lili , Niu Yiwei , Zhang Yiming , Wang Hao , Luo Jianjun , Zhao Yi , He Shunmin , Chen Chang , Chen Runsheng 
Published: November 2024

Abstract
Lycium barbarum, a member of the Solanaceae family, represents an important eudicot lineage with homology of food and medicine. Lycium barbarum pectin polysaccharides (LBPPs) are key bioactive ingredients of Lycium barbarum, and are among the few polysaccharides with both biocompatibility and biomedical activity. While previous studies have primarily focused on the functional properties of LBPPs, the mechanisms of biosynthesis and transport by key enzymes remain poorly understood. Here, we reported the completion of a 2.18-gigabase reference genome of Lycium barbarum, reconstructed the first entire biosynthesis of pectin polysaccharides and sugar transport, and characterized the important genes responsible for backbone extending, sidechain synthesis, and modification of pectin polysaccharides. Additionally, we characterized long non-coding RNAs (lncRNAs) associated with polysaccharide metabolism and identified a specific rhamnogalacturonan I (RG-I) rhamnosyltransferase, RRT3020, which enhances RG-I biosynthesis in LBPPs. These newly identified enzymes and pivotal genes endow L. barbarum with specific pectin biosynthesis capabilities, distinguishing it from other Solanaceae species. Our findings provide a foundation for evolutionary studies and molecular breeding to enhance the diverse applications of L. barbarum.
Incidence of Pneumonia Following Bronchoscopy and Bronchoalveolar Lavage in Burn Patients
Authors: Murphy Tyler J , Krebs Elizabeth D , Riffert Derek A , Mubang Ronnie , Nordness Mina F , Guidry Christopher , Gondek Stephen , Beyene Robel T 
Published: November 2024

Abstract
The standard modality for diagnosis of smoke inhalational injury in burn patients is bronchoscopy with or without bronchoalveolar lavage (BAL). However, the risks associated with these procedures are poorly described in established literature. We sought to investigate the association between diagnostic BAL at admission and the development of pneumonia in burn patients. This retrospective analysis of intubated burn patients studied those who underwent bronchoscopy on admission, comparing patients who received BAL to those who did not. Demographics and baseline characteristics were analyzed using chi-squared or Student’s t-test. Unadjusted and multivariable logistic regression studies assessed the effect of admission BAL on the development of pneumonia. Out of the 196 patients who underwent bronchoscopy, 98 met our criteria for analysis. The BAL group was more likely to be male and have a higher grade of abbreviated injury score. Patients who received BAL were more likely to develop pneumonia during the admission in both unadjusted and multivariable logistic regression models. These patients also had a longer hospital length of stay, greater number of ventilator days, and were more likely to undergo second bronchoscopy. These findings associate admission BAL with increased risk of pneumonia during the index hospitalization, suggesting a judicious use of BAL during admission bronchoscopy in burn patients.
Analysis of platelet transfusion efficacy during extracorporeal membrane oxygenation (ECMO) treatment in pediatric patients post-cardiac surgery-a retrospective cohort study
Authors: Chen Xusheng , Yang Yongtao 
Published: November 2024

Abstract

Background
Postoperative extracorporeal membrane oxygenation (ECMO) may be necessary for pediatric patients following cardiac surgery, with associated risks of thrombocytopenia and bleeding. Prophylactic platelet transfusions are utilized to mitigate these risks, but the effectiveness of platelet transfusion cannot be reliably predicted. The aim of this study was to investigate the effect of platelet transfusion during postoperative treatment with ECMO in children undergoing cardiac surgery and to explore the optimal transfusion thresholds to reduce the number of platelet transfusions in patients and reduce the risk of death.

Methods
We included in our study patients from the Pediatric Cardiac Surgery Department at the First Affiliated Hospital of Tsinghua University who underwent cardiac surgery and received ECMO treatment from January 1, 2019, to December 31, 2023, and received platelets transfusion at least once during the ECMO therapy. The platelet counts were determined both before and 24 hours posttransfusion of the platelet product. The corrected count increment (CCI) was calculated for the effectiveness estimation of platelet transfusion. The research subjects were divided into 3 groups based on the platelet count before transfusion (pretransfusion platelet count ≤30×109/L was the low-threshold group, pretransfusion count 31-50×109/L was the medium-threshold group, and ≥51×109/L was the high-threshold group) and the effective rates of each group were calculated.

Results
A total of 11 patients received 47 platelet transfusions, an average of 4.27 ± 1.67 per patient. According to the 24-hour postinfusion platelet (Plt) corrected critical control increase index (24-hour CCI) ≥4500, the infusion was considered to be effective, and ineffective when the CCI was &lt;4500. Out of these, 22 transfusions (46.8%) proved effective, whereas 25 (53.2%) were deemed ineffective. The effective transfusion rates across the 3 groups were 69.2%, 50%, and 27.7%, respectively.

Conclusion
The efficacy of platelet transfusion may be higher if a low threshold of platelet transfusion is chosen during ECMO treatment, on the premise of ensuring life safety.
Chloroplast redox state mediates the short-term regulation of leaf isoprene emission
Authors: Wang Wen-Lin , Yu Yuan , Kang Huixing , Yang Yanrong , Li Shao-Meng , Yuan Xiangyang , Wang Yin , Tang Yanhong 
Published: November 2024

Abstract
Isoprene emission from plants not only confers thermoprotection, but also has profound impacts on atmospheric chemistry and the climate. Leaf isoprene emission is dynamically regulated in response to various environmental cues, but the exact mechanism remains unclear. It has been proposed that chloroplast redox/energy state or cytosolic phosphoenolpyruvate carboxylation regulates isoprene biosynthesis and consequently emission, and the latter has been disproven by recent literature. However, the possible covariation of chloroplast redox/energy state and cytosolic PEP carboxylation in previous experiments impedes the independent examination of the former hypothesis. We developed an index of chloroplast redox state and showed its validity by examining the relationships between the index and the rates of certain processes that have been demonstrated to be affected or unaffected by chloroplast redox/energy state. According to the former hypothesis alone, we modeled how isoprene emission rate (IER) responded to different short-term environmental variations and compared theoretical predictions with experimental data. We predicted that no matter which environmental factor was varied, IER would respond to the index of chloroplast redox state with similar velocities. We found that IER showed comparable increasing rates in response to the increase in the index of chloroplast redox state caused by different environmental variations (0.0479, 0.0439 or 0.0319 when ambient CO2 concentration, photosynthetic photon flux density or leaf temperature was varied, respectively). These results support that chloroplast redox/energy state regulates isoprene biosynthesis, leading to dynamic isoprene emission in nature.
HIV-1 reservoir landscape of post-treatment control
Authors: Charre Caroline , Merad Yanis , Avettand-Fenoel Véronique 
Published: November 2024

Purpose of review
This review explores the viral reservoir landscape in individuals who control viral replication after treatment interruption (TI), designated as post-treatment controllers (PTCs). Identifying their virologic features is crucial to inform drug-free HIV remission strategies.

Recent findings
Traditionally characterized as small, likely due to early treatment, the viral reservoir of PTCs, after TI, exhibits limited transcriptional activity, residual viral replication and subsequent proviral diversity. Intact proviruses are found to be restricted. In nonhuman primate PTCs, this depletion of intact proviruses is already observed in lymph nodes before TI, suggesting that control mechanisms begin during antiretroviral therapy. Furthermore, recent studies suggest immune-driven proviral deep latency associated with repressive epigenetic features and integration sites in PTCs. While molecular mapping of virological features of PTCs is increasingly precise and coupled with in-depth immunologic assays, robust predictive biomarkers of PTCs are still lacking.

Summary
Despite limited sample sizes and heterogeneous definitions, common virologic features of PTCs include restricted reservoir size and transcriptional activity, fewer intact proviruses and deep proviral latency. Ongoing research using innovative technologies will further elucidate the mechanisms underlying post-treatment control, paving the way for successful HIV cure interventions.
Modified Early-Warning Score combined with early-warning symptoms and electrocardiographic findings in predicting in-hospital cardiac arrest in critically ill patients: a retrospective cohort study
Authors: Zhang Wenbo , Gu Wei 
Published: November 2024

Abstract

Background
We aimed to investigate the clinical value of the Modified Early-Warning Score (MEWS) combined with early-warning symptoms and electrocardiogram (ECG) findings in predicting in-hospital cardiac arrest (IHCA) in critically ill patients, to assess and reduce the occurrence of IHCA.

Methods
This retrospective cohort study examined critically ill patients who were enrolled in a hospital from January 2019 to March 2023 and divided into an IHCA group and NO-IHCA group. The critically ill patients were randomly divided into 2 sets at the ratio of 7:3, for the training set and test set. The training set used to develop the model and the test set used to test the model. Univariate and multivariate logistic regressions were used to determine the independent predictors. The generated prediction models were evaluated using 10-fold cross verification, and the areas under the curve (AUCs), accuracy, sensitivity, and specificity were reported. Hosmer-Lemeshow goodness of fit test was used to compare the calibration degree of the model and Delong test was used to compare the AUC.

Results
Multivariate logistic analysis showed that MEWS, early-warning symptoms, and ECG findings were independent risk factors for IHCA in critically ill patients (P < 0.05). The AUC values for MEWS, early-warning symptoms, and ECG findings were 0.671, 0.527, and 0.723, respectively. The AUC value for the combination of MEWS, early-warning symptoms, and ECG findings was 0.792 (P < 0.001), which was higher than MEWS.

Conclusion
MEWS combined with early-warning symptoms and ECG findings can predict IHCA in critically ill patients, which may help reduce IHCA in this population.
Predicting long-term survival among patients with HCC
Authors: Goldberg David , Reese Peter P. , Kaplan David A. , Zarnegarnia Yalda , Gaddipati Neelima , Gaddipati Sirisha , John Binu , Blandon Catherine 
Published: November 2024

Background:
Prognosticating survival among patients with HCC and cirrhosis must account for both the tumor burden/stage, as well as the severity of the underlying liver disease. Although there are many staging systems used to guide therapy, they have not been widely adopted to predict patient-level survival after the diagnosis of HCC. We sought to develop a score to predict long-term survival among patients with early- to intermediate-stage HCC using purely objective criteria.

Methods:
Retrospective cohort study among patients with HCC confined to the liver, without major medical comorbidities within the Veterans Health Administration from 2014 to 2023. Tumor data were manually abstracted and combined with clinical and laboratory data to predict 5-year survival from HCC diagnosis using accelerated failure time models. The data were randomly split using a 75:25 ratio for training and validation. Model discrimination and calibration were assessed and compared to other HCC staging systems.

Results:
The cohort included 1325 patients with confirmed HCC. A risk score using baseline clinical, laboratory, and HCC-related survival had excellent discrimination (integrated AUC: 0.71 in the validation set) and calibration (based on calibration plots and Brier scores). Models had superior performance to the BCLC and ALBI scores and similar performance to the combined BCLC-ALBI score.

Conclusions:
We developed a risk score using purely objective data to accurately predict long-term survival for patients with HCC. This score, if validated, can be used to prognosticate survival for patients with HCC, and, in the setting of liver transplantation, can be incorporated to consider the net survival benefit of liver transplantation versus other curative options.
MFRP GENE MUTATION: NOVEL MANIFESTATION AND INSIGHTS ON PATHOPHYSIOLOGY - A CASE REPORT.
Authors: Bezerra Fernandes João Arthur , Alves Pereira Arthur Maerllyson , Cardoso Pinto Nayara Queiroz , de Queiroz Tavares Ferreira Felipe , Nascimento Maurício Abujamra 
Published: November 2024

Purpose:
The aim of this study is to delineate a novel manifestation linked to the mutation of the MFRP gene: a macular neovascular membrane (MNV). The authors provide detailed insights into this rare condition, shedding light on a previously unreported observation and proposing potential pathophysiological mechanisms.

Methods:
A single case report from a tertiary center in Brazil was conducted for evaluation.

Results:
A female patient presenting with microphthalmos, retinal pigmentary alterations, and optic disc drusen, which had previously been misdiagnosed as Intracranial Idiopathic Hypertension (IIH), was diagnosed with MNV and inherited retinal dystrophy. Genetic testing confirmed the presence of an MFRP mutation, revealing novel manifestation of heterozygous gene mutations (c.498del p. Asn167Thrfs*25 and c.650G>A p. Gly217Glu).

Conclusion:
MNV in the context of retinal dystrophies is a rare occurrence and has not been previously associated with an MFRP mutation. The documentation of this novel observation is crucial for enhancing our understanding of the potential disease presentations, aiding in diagnosis, elucidating the underlying pathophysiology, and guiding appropriate management strategies in such cases.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AND HENLE FIBER LAYER HEMORRHAGE IN DENGUE FEVER: MULTIMODAL IMAGING AND REVIEW OF THE LITERATURE
Authors: Ferreira Bruno F. A. , Sakuno Gustavo , Kato Juliana M. , Sato Rodrigo H. , Ferreira Álvaro F. , Missaka Ruy F. B. G. , Nakashima Yoshitaka 
Published: November 2024

Purpose:
To use multimodal imaging to report a case of dengue fever presenting with Henle fiber layer hemorrhage (HH) and acute paracentral acute middle maculopathy (PAMM).

Methods:
Fundus photography and autofluorescence, fluorescein angiography, and optical coherence tomography (OCT) were acquired over a month, and a literature review of dengue fever-associated maculopathy was performed.

Results:
A 19-year-old man presented with a sudden loss of vision in both eyes 12 days after experiencing initial systemic symptoms suggestive of dengue fever. His best-corrected visual acuity (BCVA) was counting fingers in the right eye (OD) and 20/200 in the left eye (OS). Pupillary light reflex was reduced in both eyes (OU). Dilated fundoscopic examination revealed optic disc swelling and a small deep hemorrhage near the fovea in OU. OCT revealed a petaloid shape hyperreflectivity involving both outer nuclear and plexiform layers in OU and a subtle hyperreflectivity thinning the inner nuclear layer (INL) in OS, findings compatible with HH and PAMM, respectively. Immunoglobin M was positive for dengue fever. Thus, a diagnosis of dengue fever-associated maculopathy was performed and oral steroids were started. After a month, the final BCVA reached 20/25 (OD) and 20/20 (OS), the HH reabsorbed utterly, and a INL thinning in the area of the PAAM was observed.

Conclusion:
Dengue fever-associated maculopathy can present with PAAM and HH. Multimodal imaging is helpful to characterize the extension of the changes in the retina and to monitor its recovery. In such cases, structural and functional damage may occur despite treatment with oral steroids.
Central Retinal Artery Occlusion Following Sphenopalatine Artery Embolization: A Case Report and Review of the Literature
Authors: Zhou Henry W , Foulsham William , Rossin Elizabeth J 
Published: November 2024

Purpose:
Report of a case of central retinal artery occlusion following sphenopalatine artery (SPA) embolization. A review of the literature describing complications following SPA embolization and ligation.

Methods:
Retrospective case report and literature review.

Results:
A 68-year-old woman with a history notable for hypertension, hyperlipidemia, and eight years of intermittent right-sided epistaxis previously requiring blood transfusions underwent right-sided embolization of the SPA with the neurosurgery service. SPA embolization was achieved with Embosphere microspheres and Concerto coils. No thromboembolic complications were noted at the conclusion of the case. On waking from general anesthesia, the patient reported painless right sided vision loss and was found to have best-corrected visual acuity of light perception, a relative afferent pupillary defect, and a cherry-red spot with vascular attenuation consistent with central retinal artery occlusion (CRAO).

Conclusions:
CRAO can be a complication of ipsilateral SPA embolization.
Intraepithelial Sebaceous Gland Carcinoma: A Multicenter Retrospective Case Series
Authors: Liu Ebony , Juniat Valerie , Tong Jessica Y. , Wu Albert , Tsirbas Angelo , Hersh Dov , O’Donnell Brett A. , James Craig , Huilgol Shyamala C. , Selva Dinesh 
Published: November 2024

Purpose:
Intraepithelial sebaceous gland carcinoma is a rare form of sebaceous gland carcinoma, with 10 published case reports to date. The authors report the clinical, histological, and prognostic features of this rare carcinoma.

Methods:
This is a multicenter retrospective case series of patients from 3 Australian sites. Information collected included patient demographics, clinical risk factors, initial and subsequent presentations, histology results, management, and outcomes.

Results:
Twelve cases were identified. The average age of presentation was 72 years (range 52–92 years), with more females (n = 8) affected than males. The most common symptoms and signs were ocular irritation (n = 9) and eyelid mass (n = 8), with a predilection toward upper lid involvement. Five cases of sebaceous gland carcinoma were confirmed on initial histology. Initial management included wide local excision with margin control (n = 11), and primary topical mitomycin C (n = 1). Adjunctive conjunctival mapping biopsy was performed in 5 cases. Recurrence occurred in 7 cases, at an average of 31 months (range 7–83 months) after initial treatment. There were no cases of distant metastasis, however, 2 cases developed local invasion. Management of recurrences included exenteration (n = 2), further excisions alone (n = 3), and excision with adjuvant mitomycin C (n = 2).

Conclusions:
Clinicians and pathologists should have a high index of suspicion for primary intraepithelial sebaceous gland carcinoma on the upper eyelid. Close follow-up is recommended, given the high risk of local recurrence.