bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contrast-Enhanced Digital Mammography for the Diagnosis and Determination of Extent of Disease in Invasive Lobular Carcinoma: Our Experience and Literature Review
Authors: Johansson Lipinski Margaret , Friehmann Tal , Tamir Shlomit , Atar Eli , Grubstein Ahuva 
Published: October 2024

Objective
Contrast-enhanced imaging, including magnetic resonance imaging and, more recently, contrast-enhanced digital mammography (CEM), is indicated for the precise diagnosis of invasive lobular carcinoma (ILC). The aim of our study was to further validate the use of CEM for evaluation of extent of disease in ILC cases, with digital breast tomosynthesis (DBT) as an adjunct.

Methods
A retrospective, institutional review board approved study was conducted in a tertiary medical center. All CEM examinations performed on ILC patients between 2017 and 2023 were reread by 2 dedicated breast radiologists. Clinical data and pathology reports were retrieved from electronic medical records. The longest diameter of the enhancing lesion was correlated to pathology findings. In addition, for each case, the readers provided brief commentary on the added value of DBT.

Results
Twenty-four CEM examinations were evaluated. The subjects in the study cohort were on average older than expected for ILC patients (74 vs 63 years) and were unable to undergo breast magnetic resonance imaging due to advanced age and comorbidities. Three subjects were treated with neoadjuvant therapy and thus were excluded from the correlation to pathology analysis. Enhancing lesions, ranging from 4–75 mm, strongly correlated to pathology results, with statistical significance. This was demonstrated for mass and nonmass lesions (r = 0.94, P < 0.001 and r = 0.99, P = 0.002, respectively). For most lesions (17/24, 71%), readers remarked that the addition of DBT allowed for improved characterization of lesion margins, mainly detecting architectural distortion.

Conclusions
When compared with the pathology findings, ILC was accurately diagnosed and assessed using CEM. The addition of DBT was reported by the interpreting radiologists as a valuable adjunct for margin analysis.
Evaluation of Splenic Involvement in Lymphomas Using Extracellular Volume Fraction Computed Tomography
Authors: Xu Suqin , Cao Meimei , Chen Longlan , Shi Jinfang , Wang Xiaoxia , Li Lan , Wang Lu , Zhang Jiuquan 
Published: October 2024

Objective
To evaluate whether the extracellular volume (ECV) fraction can be used to identify splenic involvement in lymphoma patients and whether it can be used to improve the diagnostic performance of conventional computed tomography (CT) in the diagnosis of splenic diffuse involvement.

Methods
Consecutive patients with newly diagnosed lymphoma who underwent abdomen contrast-enhanced CT and 18F-fluorodeoxyglucose positron emission tomography/CT for diagnosis or staging were retrospectively enrolled. Patients were divided into the splenic involvement (diffuse or focal) and noninvolvement groups. The ECV fraction was obtained in all patients. In the splenic diffuse involvement and noninvolvement groups, spleen vertical length (SVL) >13 cm and obliteration of normal heterogeneous enhancement of the spleen in arterial phase were recorded. Receiver operating characteristic curve was used to analyze the diagnostic performance, and area under the curve (AUC) comparison was performed using the Delong test.

Results
A total of 135 patients were included, 56 patients with splenic involvement (36 diffuse and 20 focal) and 79 patients with noninvolvement. Splenic involvement can be identified via the ECV fraction (AUC = 0.839). In distinguishing splenic diffuse involvement, the AUC of the ECV fraction was superior to the SVL >13 cm (0.788 vs 0.627, P = 0.007) and obliteration of normal heterogeneous enhancement of the spleen (0.788 vs 0.596, P = 0.001). The combination of ECV fraction and SVL >13 cm demonstrated superior diagnostic performance, with an AUC of 0.830, surpassing all other parameters.

Conclusion
The ECV fraction can be used to identify splenic involvement. The ECV fraction combined with SVL >13 cm is recommended for the prediction of splenic diffuse involvement.
Application of a Deep Learning–Based Contrast-Boosting Algorithm to Low-Dose Computed Tomography Pulmonary Angiography With Reduced Iodine Load
Authors: Park Minsu , Hwang Minhee , Lee Ji Won , Kim Kun-Il , Ahn Chulkyun , Suh Young Ju , Jeong Yeon Joo 
Published: October 2024

Objective
The aim of this study was to assess the effectiveness of a deep learning–based image contrast-boosting algorithm by enhancing the image quality of low-dose computed tomography pulmonary angiography at reduced iodine load.

Methods
This study included 179 patients who underwent low-dose computed tomography pulmonary angiography with a reduced iodine load using 64 mL of a 1:1 mixture of contrast medium from January 1 to June 30, 2023. For single-energy computed tomography, the noise index was set at 15.4 to maintain a CTDIvol of <2 mGy at 80 kVp, and for dual-energy computed tomography, fast kV-switching between 80 and 140 kVp was employed with a fixed tube current of 145 mA. Images were reconstructed by 50% adaptive statistical iterative reconstruction (AR50) and a commercially available deep learning image reconstruction (TrueFidelity) package at a high strength level (TFH). In addition, AR50 images were further processed using a deep learning–based contrast-boosting algorithm (AR50-CB). Quantitative and qualitative image qualities and numbers of involved vessels with thrombus at each pulmonary artery level were compared in the 3 image types using the Friedman test and Wilcoxon signed rank test.

Results
Five hundred thirty-seven reconstructed image datasets of 179 patients were analyzed. Quantitative image analysis showed AR50-CB (30.8 ± 10.0 and 28.1 ± 9.6, respectively) had significantly higher signal-to-noise ratio and contrast-to-noise ratio values than AR50 (20.2 ± 6.2 and 17.8 ± 6.2, respectively) (P < 0.001) or TFH (28.3 ± 8.3 and 24.9 ± 8.1, respectively) (P < 0.001). Qualitative image analysis showed that contrast enhancement and noise scores of AR50-CB were significantly greater than those of AR50 (P < 0.001) and that AR50-CB enhancement scores were significantly higher than TFH enhancement scores (P < 0.001). The number of subsegmental pulmonary arteries affected by thrombus detected was significantly greater for AR50-CB (30 for AR50, 30 for TFH, and 55 for AR50-CB, P < 0.001).

Conclusions
The use of a deep learning–based contrast-boosting algorithm improved image quality in terms of signal-to-noise ratio and contrast-to-noise ratio values and the detection of thrombi in subsegmental pulmonary arteries.
Clinical Outcomes and Applicability of Serratus Anterior Muscle Flap With Split Thickness Skin Graft in Thin Resurfacing Reconstructive Surgeries
Authors: Ha Yooseok , Kim Youn Hwan 
Published: October 2024

Abstract
This retrospective study evaluates the efficacy of the serratus anterior muscle (SAm) free flap combined with a split thickness skin graft (STSG) for thin resurfacing in reconstructive surgery, presenting an alternative to pure skin perforator flaps. It analyzes 14 SAm free flap procedures performed between January 2015 and December 2023. The study cohort comprised 5 women and 9 men, aged 31–80 years, addressing defects caused by infection, malignancy, burn, and trauma, located in various body parts.
The study involves harvesting the SAm flap while focusing on anatomical features such as the distinct direction of muscle fibers and the surface location of the vascular pedicle for efficient dissection. It emphasizes the anatomical advantages of the SAm flap, such as robust vascular supply, controlled flap thickness, and preservation of the long thoracic nerve, making it suitable for a range of surgical needs. Complications included STSG loss, partial necrosis, and infection, all managed effectively. Postoperative shoulder function assessment showed no significant impairment.
Results demonstrated the successful application of the SAm flap in all cases, with an average flap dimension of 38.21 cm2 and pedicle length of 7.3 cm. The average operation time was 122.1 minutes. The study underscores the SAm flap's adaptability, versatility, and minimal donor site morbidity.
It concludes that the SAm flap, in conjunction with STSG, is a viable alternative for thin resurfacing in reconstructive surgery. However, limitations such as the small sample size and procedural variability suggest the need for further research to fully establish the flap's potential in diverse surgical contexts.
One-Stage Surgical Resection and Functional Reconstruction for Upper Limb Soft Tissue Sarcoma
Authors: Gatto Arianna , Cavalli Erica M. , Stucchi Sara , Giacomini Giorgio , Belingheri Michael , Radaelli Stefano , Gronchi Alessandro , Marchesi Andrea 
Published: October 2024

Background
Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature.

Methods
A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation “Istituto Nazionale dei Tumori.” The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters “(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma).”

Results
Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review.

Conclusions
Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.
Assessing the Readability of Online English and Spanish Resources for Polydactyly and Syndactyly
Authors: Shin Ashley , Paidisetty Praneet S. , Chivukula Surya , Wang Leonard Kuan-Pei , Chen Wendy 
Published: October 2024

Introduction
Online patient education materials (PEMs) that are difficult to read disproportionately affect patients with low health literacy and educational attainment. Patients may not be fully informed or empowered to engage meaningfully with providers and advocate for their goals. We aim to assess the readability of online PEMs regarding polydactyly and syndactyly.

Methods
Google was used to query “polydactyly” and “syndactyly” in English and Spanish. The first 50 results were categorized into institutional (government, medical school, teaching hospital), noninstitutional (private practice, blog), and academic (journal articles, book chapters). Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales.

Results
All polydactyly PEMs and >95% of syndactyly PEMs exceeded the National Institutes of Health recommended 6th-grade reading level. Altogether, English PEMs had an average reading level of a university freshman and Spanish PEMs had an average reading level of nearly a high school sophomore. For both diagnoses, English PEMs were harder to read than Spanish PEMs overall and when compared across the 3 categories between the 2 languages. Generally, noninstitutional PEMs were more difficult to read than their institutional counterparts.

Conclusions
To improve patient education, health literacy, and language equity, online resources for polydactyly and syndactyly should be written at the 6th-grade level. Currently, these PEMs are too advanced, which can make accessing, understanding, and pursuing healthcare decisions more challenging. Understanding health conditions and information is crucial to empower patients, regardless of literacy.
The Role of Tissue Expansion Before Baclofen Pump Insertion in the Pediatric Population
Authors: Atkinson Connor , Rawicki Barry , Low Nelson 
Published: October 2024

Background
Tissue expansion is a well-established technique for soft tissue reconstruction in the pediatric population. We present a case series of this technique to create a safe pocket for baclofen pump insertion to minimize risk of complications including pump migration, extrusion, wound dehiscence and infection.

Methods
A case series of 3 pediatric patients undergoing tissue expansion prior to baclofen pump insertion at a single center in Melbourne. The expansion procedure was performed by senior surgeon N Low in all cases, and patients followed up 6 months after expander-pump exchange. The study was conducted over a 4-year period 2019 to 2023.

Results
We suffered 2 minor complications with the tissue expansion process including cellulitis and pump deflation. Neither complication precluded further tissue expansion nor led to premature removal of the expander. All patients proceeded to safely complete expander-pump exchange. One patient suffered a small (6 mL) abdominal seroma associated with pump insertion, which required no intervention. All patients have had a successful outcome 6 months after pump insertion.

Conclusions
We describe a reliable and reproducible approach in creating a safe abdominal wall pocket to better accommodate baclofen pump insertion. Our series has overcome the imbalance between device size and abdominal wall pocket, now offering an alternative approach to achieve the safe delivery of intrathecal baclofen in the pediatric population.
Archetypal Analysis of Kidney Allograft Biopsies Using Next-generation Sequencing Technology
Authors: Cortes Garcia Esteban , Giarraputo Alessia , Racapé Maud , Goutaudier Valentin , Ursule-Dufait Cindy , de la Grange Pierre , Letourneur Franck , Raynaud Marc , Couderau Clément , Mezine Fariza , Dagobert Jessie , Bestard Oriol , Moreso Francesc , Villard Jean , Halleck Fabian , Giral Magali , Brouard Sophie , Danger Richard , Gourraud Pierre-Antoine , Rabant Marion , Couzi Lionel , Le Quintrec Moglie , Kamar Nassim , Morelon Emmanuel , Vrtovsnik François , Taupin Jean-Luc , Snanoudj Renaud , Legendre Christophe , Anglicheau Dany , Budde Klemens , Lefaucheur Carmen , Loupy Alexandre , Aubert Olivier 
Published: October 2024

Background.
In kidney transplantation, molecular diagnostics may be a valuable approach to improve the precision of the diagnosis. Using next-generation sequencing (NGS), we aimed to identify clinically relevant archetypes.

Methods.
We conducted an Illumina bulk RNA sequencing on 770 kidney biopsies (540 kidney recipients) collected between 2006 and 2021 from 11 European centers. Differentially expressed genes were determined for 11 Banff lesions. An ElasticNet model was used for feature selection, and 4 machine learning classifiers were trained to predict the probability of presence of the lesions. NGS-based classifiers were used in an unsupervised archetypal analysis to different archetypes. The association of the archetypes with allograft survival was assessed using the iBox risk prediction score.

Results.
The ElasticNet feature selection reduced the number of the genes from a range of 859–10 830 to a range of 52–867 genes. NGS-based classifiers demonstrated robust performances (precision-recall area under the curves 0.708–0.980) in predicting the Banff lesions. Archetypal analysis revealed 8 distinct phenotypes, each characterized by distinct clinical, immunological, and histological features. Although the archetypes confirmed the well-defined Banff rejection phenotypes for T cell–mediated rejection and antibody-mediated rejection, equivocal histologic antibody-mediated rejection, and borderline diagnoses were reclassified into different archetypes based on their molecular signatures. The 8 NGS-based archetypes displayed distinct allograft survival profiles with incremental graft loss rates between archetypes, ranging from 90% to 56% rates 7 y after evaluation (P < 0.0001).

Conclusions.
Using molecular phenotyping, 8 archetypes were identified. These NGS-based archetypes might improve disease characterization, reclassify ambiguous Banff diagnoses, and enable patient-specific risk stratification.
Normothermic Ex Vivo Perfusion Before Transplantation of the Kidney (NEXT-Kidney): A Single-center, Nonrandomized Feasibility Study
Authors: Hameed Ahmer M. , Wang Zane , Yoon Peter , Boroumand Farzaneh , Singla Animesh , Roberston Paul , Gaspi Renan , Zhang Chris , Laurence Jerome , Nahm Christopher , Yao Jinna , Yuen Lawrence , Lee Taina , Teixeira-Pinto Armando , Hawthorne Wayne J. , Rogers Natasha M. , Wong Germaine , Pleass Henry C. 
Published: October 2024

Background.
There is conflicting evidence regarding the efficacy of normothermic machine perfusion (NMP) in suboptimal deceased donor kidneys. We aimed to assess the feasibility and short-term efficacy of brief preimplantation NMP in circulatory death (DCD) kidneys.

Methods.
In this nonrandomized, single-center, prospective clinical trial, DCD kidneys underwent 1 to 3 h of NMP before implantation, aiming to achieve short ischemic times off NMP. The primary outcomes included feasibility and safety. Secondary outcomes included efficacy outcomes (delayed graft function and estimated glomerular filtration rate (eGFR) at 1, 6, and 12 mo), which were compared with the contralateral kidney that did not receive NMP.

Results.
Eighteen DCD kidneys underwent NMP between 2020 and 2022, with at least 1 h completed in 16 (88.9%) of these kidneys (median 1 h); one kidney was removed after 5 min because of cannula failure and another at 54 min because of a sudden drop in blood flows. There was no episode of graft loss on the machine or postoperative vascular thromboses. All 18 kidneys were transplanted, with no cases of PNF or graft loss at 12 mo. Seventeen of the contralateral CS kidneys were transplanted. Compared with the contralateral kidneys, a lower incidence of delayed graft function (23.5% versus 64.7%; P = 0.046) was observed. There were no differences in the eGFR slopes between the two groups over time (P = 0.254).

Conclusions.
NMP is safe, feasible and efficacious in the Australian setting, with this relatively small cohort demonstrating good early outcomes compared to CS alone in our study of DCD kidneys.
Dysregulation of locus-specific repetitive elements in TCGA pan-cancers
Authors: Wang Chao , Liang Chun 
Published: October 2024

AbstractUnderstanding the role of repetitive elements (REs) in cancer development is crucial for identifying novel biomarkers and therapeutic targets. This study investigated the locus-specific dysregulation of REs, including differential expression and methylation of REs, across 12 TCGA cancer types stratified by their genomic context (i.e., genic and intergenic REs). We found uniquely dysregulated genic REs co-regulated with their corresponding transcripts and associated with distinct biological functions in different cancer types. Uniquely dysregulated intergenic REs were identified in each cancer type and used to cluster different sample types. Recurrently dysregulated REs were identified in several cancer types, with genes associated with up-regulated genic REs involved in cell cycle processes and those associated with down-regulated REs involved in the extracellular matrix. Interestingly, 4 out of 5 REs consistently down-regulated in all 12 cancer types were located in the intronic region of the TMEM252, a recently discovered tumor suppressor gene. TMEM252 expression was also down-regulated in 10 of 12 cancer types, suggesting its potential importance across a wide range of cancer types. With the corresponding DNA methylation array data, we found a higher prevalence of hypo-methylated REs in most cancer types (10 out of 12). Despite the slight overlaps between differentially expressed REs and differentially methylated REs, we showed that methylation of locus-specific REs negatively correlates with their expression in some cancer types.
Paracrine regulations of IFN-γ secreting CD4+T cells by lumican and biglycan are protective in allergic contact dermatitis
Authors: Maiti George , Frikeche Jihane , Loomis Cynthia , Chakravarti Shukti 
Published: October 2024

AbstractThe extracellular matrix (ECM) is known to regulate innate immune cells but its role in T cell functions is poorly understood. Here, we show a protective role for ECM proteoglycans, lumican and biglycan in hapten-induced contact dermatitis that is achieved through limiting proinflammatory CD4+T cells. Lumican and biglycan-null mice develop significant inflammation with greater numbers of CD4+T cells in hapten-challenged ear pinnae, while their draining lymph nodes show increased T-bet-STAT1 signaling, Th1 commitment, and IFN-γ secreting CD4+T cell proliferation. Wild type mouse lymph node fibroblastic reticular cells secrete lumican, biglycan and decorin, a related proteoglycan, while none are expressed by naive or activated T cells.In vitro, lumican and biglycan co-localize with LFA-1 on T cell surfaces, and all three proteoglycans suppress LFA-1 mediated T cell activation. Overall, this study elucidates a novel paracrine regulation of Th1 cells by ECM proteoglycans to limit inflammation and tissue damage.