bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myeloid Sarcoma of the Urinary Bladder Associated With t(8;21): Case Report and Review of the Literature
Authors: Suárez-Solís María Luisa , González Fernández Fernando Ataulfo , Barrera Ortega Jerónimo , Pérez Romero Natalia , García Roa María , Fernández Aceñero María Jesús , Durán Botia Freddy Fernando , Ortega Medina Luis 
Published: January 2022

Abstract
Myeloid sarcoma is a malignant neoplasm of myeloid lineage that occurs in extramedullary sites, frequently in patients with acute myeloid leukemia and other myeloproliferative and myelodysplastic syndromes. Myeloid sarcoma of the urinary bladder is exceptionally rare, and although the most common cytogenetic abnormality associated with this lesion is t(8;21)/RUNX-RUNX1T1, to the best of our knowledge, there are no previous reports of this in patients with bladder involvement. We report a case of a 30-year-old man with a urinary bladder mass, which was consistent with myeloid sarcoma with t(8;21). The importance of myeloid sarcoma of the bladder is that it could be misdiagnosed and must be differentiated from other poorly differentiated bladder tumors composed of round cells, mainly because it is a malignant neoplasm with a good response to treatment, which does not require surgery.
Soft Tissue Fibroblastic Reticular Cell Tumor With Whole-Exome Sequencing Findings: An Unexpected Presentation of Lynch Syndrome
Authors: Lopez Liurka V. , Marker Daniel F. , Bailey Nathanael , Liu Yen-Chun , McGough Richard L. , Singhi Aatur D. , John Ivy 
Published: January 2022

Abstract
Fibroblastic reticular cell tumor (FRCT) is an exceedingly rare tumor that is histologically reminiscent of follicular dendritic cell sarcoma or interdigitating dendritic cell sarcoma but lacks the immunophenotypic features of these tumors. This tumor is classically described in lymph nodes and spleen, with only 4 cases described in soft tissues. We report a case of FRCT presenting as a right thigh mass in a 67-year-old woman with no prior malignancies. Gross examination showed a 10.6-cm tan well-circumscribed intramuscular mass. Microscopic examination revealed a discohesive population of cells with indistinct pale cytoplasm and large irregular, atypical vesicular nuclei with variably prominent nucleoli in a collagenous background infiltrated by lymphocytes. The tumor cells were positive for smooth muscle actin, cytokeratins (in a dendritic pattern), and CD163, while negative for CD21, CD35, and CD23, supporting the diagnosis of FRCT. Whole-exome sequencing revealed 631 putative somatic mutations in the tumor (>10 mutations/Mb of sequence). Mutational signature analysis suggested DNA mismatch repair deficiency. Germline mutational analysis revealed a heterozygous pathogenic missense mutation of MLH1 (c.2246 T > C, p.Leu749Pro). Subsequent immunohistochemical analysis showed complete loss of MLH1 and PMS2 in tumor cells. To our knowledge, this is the first case of FRCT characterized by sequencing studies and found to be associated with Lynch syndrome (LS), expanding the spectrum of LS-associated neoplasms. This case demonstrates genetic hypermutation similar to that seen in the more common epithelial lesions arising in LS, and it highlights the potential for high-throughput genetic analysis to identify mismatch repair–deficient tumors of atypical histologies, which may have significant clinical implications in the era of immunotherapy.
Optimal Timing of Expander-to-Implant Exchange after Irradiation in Immediate Two-Stage Breast Reconstruction
Authors: Kim Ara , Bae Juyoung , Bang Sa-Ik , Pyon Jai-Kyong 
Published: January 2022

Background:
Time intervals for expander-to-implant exchange from radiation therapy have been reported to reduce device failure. This study investigated the optimal timing of expander-to-implant exchange after irradiation in terms of short- and long-term outcomes.

Methods:
This retrospective review enrolled consecutive patients who underwent immediate two-stage breast reconstruction and radiation therapy to tissue expanders from 2010 to 2019. Receiver operating characteristic curves and the Youden index were used to estimate the optimal time from radiation therapy to implant placement in terms of 49-day (early) and 2-year (late) complications. Logistic regression analysis was performed to identify the risk factors for each complication.

Results:
Of the 1675 patients, 133 were included. The 49-day and 2-year complication rates were 8.3 percent and 29.7 percent, respectively. Capsular contracture was the most common 2-year complication. The Youden index indicated that implant placement at 131 days after radiation therapy was most effective in reducing the 49-day complications, but that the 2-year complication was less significant, with lower sensitivity and area under the curve. Modified radical mastectomy, expander fill volume at radiation therapy, and size of permanent implant increased the odds of 49-day complications; none of them was associated with the odds of 2-year complications.

Conclusions:
To reduce short-term complications, the best time point for permanent implant placement was 131 days after radiation therapy. However, there was no significant time interval for reducing long-term complications. Capsular contracture was an irreversible complication of radiation injury that was not modified by postirradiation variables including the time from irradiation or size of permanent implant.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Ever-Important Role of Ethics in Plastic Surgery Today
Authors: Teven Chad M. , Bluebond-Langner Rachel , Rohrich Rod J. 
Published: January 2022

Summary:
As the field of plastic surgery continues to advance, so too do the number and complexity of ethical challenges faced by plastic surgeons. There is a paucity of literature, however, focusing on ethics in plastic surgery. Therefore, the authors offer a timely special topic series discussing ethical issues relevant to the field of plastic surgery. The goals of this series are four-fold: (1) to increase awareness of both frequently and less commonly encountered ethical issues in plastic surgery, (2) to foster discussion and debate of relevant and significant ethical issues, (3) to facilitate clinical ethics education and scholarship in plastic surgery, and (4) to apply an understanding and analysis of ethical issues in a way that optimizes clinical decision-making and delivery of patient care. In this introductory article, the authors discuss the current state of medical ethics scholarship in plastic surgery and introduce the first of several topics that will be detailed in the series. Ultimately, the hope is that increased awareness of the ethical challenges faced by surgeons and patients will improve the practice of plastic surgery.
Subglandular-to-Subpectoral Conversion with Mastopexy: The Four-Step Approach
Authors: Ono Marcelo T. , Karner Bruno M. 
Published: January 2022

Background:
Because of the multiplying number of patients undergoing breast augmentation, nonprimary augmentation mastopexy will be increasingly requested in the future; this operation represents an even more significant challenge than primary augmentation mastopexy. The authors describe a standardized approach for subglandular-to-subpectoral implant pocket conversion in mastopexy that provides a tight neopocket with inferolateral muscular support, which minimizes implant displacement complications and allows operative strategies to reduce the risk of bacterial load on implants.

Methods:
The authors’ technique proposes the following: (1) modified subpectoral pocket, with muscular inferolateral support for the implant; (2) independent approaches to the submuscular pocket and subglandular (preexisting) pocket; and (3) preestablished four-step surgical sequence. The authors collected data from their private practices for 46 patients who underwent the technique from March of 2017 to April of 2020. Patient perception about aesthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.

Results:
Overall results were positive; 89.1 percent of patients reported satisfaction with their aesthetic outcomes. No major complications occurred. The total revision rate was 15.2 percent, but only 2.1 percent in the last year, as the learning curve progressed.

Conclusions:
Secondary augmentation mastopexy is a complicated procedure. The four-step sequence approach is one reliable option for subglandular-to-subpectoral pocket conversion, once it produced high levels of patient satisfaction while producing low complication rates. Other surgeons’ experiences with the technique and further studies are necessary to validate these findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease
Authors: Wake Rachel M. , Govender Nelesh P. , Omar Shaheed V. , Ismail Farzana , Tiemessen Caroline T. , Harrison Thomas S. , Jarvis Joseph N. 
Published: January 2022

Objective:
Investigation of the diagnostic yield of urine-based tuberculosis (TB) screening in patients with advanced HIV disease.

Design:
A cross-sectional screening study

Setting:
HIV outpatient clinics and wards at two hospitals in Johannesburg, South Africa, between June 2015 and October 2017.

Participants:
Two hundred and one patients living with advanced HIV disease (CD4+ T-lymphocytes <100 cells/μl) attending healthcare facilities following cryptococcal antigen (CrAg) screening.

Intervention:
Screening for TB using sputum for microscopy, culture, and Xpert MTB/Rif and urine for lipoarabinomannan (LAM) and Xpert Ultra.

Main outcome measures:
Proportion of positive results using each testing modality, sensitivity, and specificity of urine-based testing compared with culture, and survival outcomes during 6 months follow up.

Results:
Urine was obtained from 177 of 181 (98%) participants and sputum from 91 (50%). Urine-based screening increased same-day diagnostic yield from 7 (4%) to 31 (17%). A positive urine test with either LAM or Xpert Ultra had 100% sensitivity (95% confidence interval, 59–100%) for detecting culture-positive TB at any site. Patients with newly diagnosed TB on urine-based screening were initiated on treatment and did not have excess mortality compared with the remainder of the cohort.

Conclusion:
Urine is an easily obtainable sample with utility for detecting TB in patients with advanced HIV disease. Combining urine and sputum-based screening in this population facilitates additional same-day TB diagnoses and early treatment initiation, potentially reducing the risk of TB-related mortality. Urine-based as well as sputum-based screening for TB should be integrated with CrAg screening in patients living with advanced HIV disease.
Prophylactic Central Neck Lymph Node Dissection in Low-risk Thyroid Carcinoma Patients Does Not Decrease the Incidence of Locoregional Recurrence
Authors: Sanabria Alvaro , Betancourt-Agüero Carlos , Sánchez-Delgado Juan G. , García-Lozano Carlos 
Published: January 2022

Objective:
To evaluate the effectiveness of T + prophylactic CND (T+CND) compared to T alone on locoregional recurrence in patients with PTC.

Summary background data:
Few RCTs have assessed the risks and benefits of prophylactic CND in patients with PTC. Most recommendations are still based on meta-analyses that include observational studies, which are prone to selection bias.

Methods:
We included RCTs involving adult patients with clinically negative neck (cN0) PTC that compared T versus T+CND. The main outcomes assessed were structural and biochemical recurrence and complications. For methodological quality assessment, we used the Revised Cochrane risk-of-bias tool for randomized trials instrument, and for robustness, we used the fragility index.

Results:
Five RCTs with 763 patients were included (354 in the T group and 409 in the T+CND group). Most studies were classified as having a low risk of bias. Publication bias was not found. Structural recurrence occurred in 11/409 (2.7%) patients in the T+CND group and 9/354 (2.5%) patients in the T group, with a risk difference (RD) =0% [95% confidence interval (CI) –2% to 2%]. For biochemical recurrence, the RD was 0% (95% CI –5% to 4%). The number needed to treat was 500. The rate of permanent hypoparathyroidism was higher in the T+CND group than in the T group [RD 3% (95% CI 0%–6%)].

Conclusions:
We did not find a beneficial effect of prophylactic CND associated with T on locoregional or biochemical recurrence but did confirm a higher risk of permanent hypoparathyroidism associated with this procedure.
Impact of N-Acetyl-Cysteine on Ischemic Stumps Following Major Lower Extremity Amputation
Authors: Lee Jin Vivian , Engel Connor , Tay Shirli , DeSilva Gayan , Desai Kshitij , Cashin John , Semenkovich Clay F. , Zayed Mohamed A. 
Published: January 2022

Objective:
To evaluate the impact of N-acetyl-cysteine (NAC) on amputation stump perfusion and healing in patients with critical limb-threatening ischemia (CLTI).

Background:
Patients with CLTI are at increased risk of poor amputation site healing leading to increased procedure-associated morbidity.

Methods:
In a pilot, double-blind, placebo-controlled, randomized controlled trial, patients with CLTI undergoing major elective lower extremity amputation were randomized 1:1 to intravenous NAC (1200 mg twice-daily) or placebo for up to 5 days postoperatively. Primary outcomes were change in stump perfusion at postoperative day 3 (POD3) and POD5, and healing at POD30. Stumps were serially evaluated for wound healing, and tissue perfusion was evaluated using noninvasive laser-assisted fluorescent angiography.

Results:
Thirty-three patients were randomized to NAC (n = 16) or placebo (n = 17). Thirty-one patients were eligible for intent-to-treat analysis (NAC14; placebo17). Twenty patients (NAC7; placebo13) had amputation stump perfusion defects at POD0 and were considered high-risk for poor healing. Intent-to-treat analysis revealed no significant differences between treatment groups. Subgroup analysis of high-risk patients revealed differences in stump perfusion defect size (NAC–0.53-fold, placebo +0.71–fold; 95% confidence interval -2.11 to–0.35; P < 0.05) and healing (NAC [100%], placebo [46%]; P < 0.01) between study treatments.

Conclusions:
Postoperative NAC administration may improve amputation stump perfusion and healing in patients with CLTI and tissue perfusion defects at the time of amputation. Intraoperative laser-assisted fluorescent angiogra-phy may help surgeons identify high-risk patients with stump perfusion defects and provide early adjunctive interventions. Future studies can further explore the therapeutic benefits of NAC in the healing and perfusion of other surgical operative sites in high-risk individuals.

Trial Registration:
clinicaltrials.gov, Identifier: NCT03253328.
Lysobacter terrestris sp. nov., isolated from soil
Authors: Woo Chae Yung , Kim Jaisoo 
Published: January 2022

A yellow-pigmented, non-motile, Gram-stain-negative, rod-shaped bacterium, designated II4T was obtained from soil sampled at Seongnam, Gyeonggi-do, Republic of Korea. Cells were strictly aerobic, grew optimally at 20–28 °C and hydrolysed casein. A phylogenetic analysis based on its 16S rRNA gene sequence revealed that strain II4T formed a lineage within the family

Xanthomonadaceae

and clustered as members of the genus

Lysobacter

. The closest members were

Lysobacter terrae

THG-A13T (97.88 % sequence similarity),

Lysobacter niabensis

GH34-4T (97.82 %),

Lysobacter oryzae

YC6269T (97.74%),

Lysobacter yangpyeongensis

GH19-3T (97.53 %) and

Lysobacter enzymogenes

ATCC 29487T (96.18 %). The principal respiratory quinone was Q-8 and the major polar lipids were phosphatidylethanolamine, phosphatidylglycerol and diphosphatidylglycerol. The predominant cellular fatty acids were summed feature 9 (C16 : 0 10-methyl and/or iso-C17 : 1
ω9c) and iso-C15 : 0 and iso-C16 : 0. The DNA G+C content was 68.2 mol%. The average nucleotide identity and in silico DNA–DNA hybridization relatedness values between strain II4T and its closely related genus members with possible full genome sequences were ≤79.6 and 23.7 %, respectively. Based on genomic, chemotaxonomic, phenotypic and phylogenetic data, strain II4T represents novel species in the genus

Lysobacter

, for which the name Lyobacter terrestris sp. nov. is proposed. The type strain is II4T (=KACC 21196T=NBRC 113956T).
3D Capsule Networks for Brain Image Segmentation
Authors: Avesta Arman , Hui Yongfeng , Aboian Mariam , Duncan James , Krumholz Harlan M. , Aneja Sanjay 
Published: January 2022

AbstractBackground and PurposeCurrent auto-segmentation models of brain structures, UNets and nnUNets, have limitations, including the inability to segment images that are not represented during training and lack of computational efficiency. 3D capsule networks (CapsNets) have the potential to address these limitations.MethodsWe used 3430 brain MRIs, acquired in a multi-institutional study, to train and validate our models. We compared our CapsNet with standard alternatives, UNets and nnUNets, based on segmentation efficacy (Dice scores), segmentation performance when the image is not well-represented in the training data, performance when the training data are limited, and computational efficiency including required memory and computational speed.ResultsThe CapsNet segmented the third ventricle, thalamus, and hippocampus with Dice scores of 95%, 94%, and 92%, respectively, which were within 1% of the Dice scores of UNets and nnUNets. The CapsNet significantly outperformed UNets in segmenting images that are not well-represented in the training data, with Dice scores 30% higher. The computational memory required for the CapsNet is less than a tenth of the memory required for UNets or nnUNets. The CapsNet is also more than 25% faster to train compared with UNet and nnUNet.ConclusionWe developed and validated a CapsNet that is effective in segmenting brain images, can segment images that are not well-represented in the training data, and are computationally efficient compared with alternatives.
Pan-cancer analysis reveals the prognostic potential of THAP9/THAP9-AS1 Sense-Antisense gene pair in human cancer
Authors: Rashmi Richa , Majumdar Sharmistha 
Published: January 2022

AbstractHuman THAP9 is a domesticated transposon homologous to the Drosophila P-element transposase (DmTNP). However, the exact functional role of THAP9 is unknown. THAP9-AS1 (THAP9-anti sense1) is a lncRNA involved in various cancers. Together they are arranged head-to-head on opposite DNA strands forming a sense and anti-sense gene pair. No studies have analyzed THAP9 and THAP9-AS1 from a pan-cancer perspective. First, we analyzed the bidirectional promoter region between THAP9 and THAP9-AS1 for core promoter elements and CPG Islands. Moreover, we analyzed the expression, prognosis, and biological function of the two genes across different types of tumors included in The Cancer Genome Atlas and GTEx datasets. The results showed that the expression of both genes varies in different tumors. Expression of the THAP9 and THAP9-AS1 gene pair was observed to be strongly correlated with prognosis in patients with tumors; higher expression of the two genes was usually linked to poor overall and disease-free survival. Therefore, they may serve as a potential biomarker of clinical tumor prognosis. Further, we performed gene coexpression analysis using WGCNA followed by differential gene correlation analysis (DGCA) across 22 cancers to study which genes share the expression pattern THAP9 and THAP9-AS1 and if their interacting partners change in various conditions. Gene ontology & KEGG pathway analysis of genes coexpressed with the two genes identified gene enrichment related to DNA binding and Herpes simplex virus 1 infection.
Mutations of SARS-CoV-2 variants of concern escaping Spike-specific T cells
Authors: Le Bert Nina , Tan Anthony , Kunasegaran Kamini , Chia Adeline , Tan Nicole , Chen Qi , Hang Shou Kit , Qui Martin DC , Chan Bianca SW , Low Jenny GH , Young Barnaby , Ng Kee Chong , Chan Derrick Wei Shih , Lye David Chien , Bertoletti Antonio 
Published: January 2022

AbstractThe amino acid (AA) mutations that characterise the different variants of concern (VOCs), which replaced the ancestral SARS-CoV-2 Wuhan-Hu-1 isolate worldwide, provide biological advantages such as increased infectivity and partial escape from humoral immunity. Here we analysed the impact of these mutations on vaccination- and infection-induced Spike-specific T cells. We confirmed that, in the majority of infected or vaccinated individuals, different mutations present in a single VOC (Delta) or a combined mosaic of more than 30 AA substitutions and deletions found in Alpha, Beta, Gamma, Delta and Omicron VOCs cause modest alteration in the global Spike-specific T cell response. However, distinct numerically dominant Spike-specific CD4 and CD8 T cells preferentially targeted regions affected by AA mutations and do not recognise the mutated peptides. Importantly, some of these mutations, such as N501Y (present in Alpha, Beta, Gamma, and Omicron) and L452R (present in Delta), known to provide biological advantage to SARS-CoV-2 in terms of infectivity also abolished CD8 T cell recognition.Taken together, our data show that while global mRNA vaccine- and infection-induced Spike-specific T cells largely tolerate the diverse mutations present in VOCs, single Spike-specific T cells might contribute to the natural selection of SARS-CoV-2 variants.
Safety and Efficacy of Navigational Bronchoscopy with Archimedes Virtual Bronchoscopic Platform in Patients with Advanced Pulmonary Disease
Authors: Verga Steven R. , Marron Robert , Criner Gerard J. , Veselis Clinton , Dass Chandra , Zhao Hauqing 
Published: January 2022

AbstractBackgroundPatients with advanced lung disease who present with suspicious pulmonary nodules (SPNs) undergoing transthoracic needle aspiration pose a diagnostic challenge given risk for complications. Virtual bronchoscopic navigation (VBN) is an alternative means to biopsy patients.Study DesignThe study was a retrospective chart review of all patients who underwent VBN with the Archimedes platform. Demographic information, radiographic evidence of parenchymal lung disease and pulmonary function testing were gathered. Peri-procedure complications and clinical data on biopsy results were gathered to assist in determining both adequate tissue sample (defined if adequate specimen was obtained as per pathology/cytology report) and diagnostic yield (defined as if after further testing/CT imaging from 1 year post-procedure the diagnosis did not change). Univariate analysis was performed to determine the impact of clinical factors on diagnostic yield.ResultsNinety-six patients with 110 nodules underwent VBN. Eight-eight patients (92%) had radiographic emphysema with 56% having moderate to severe. Fourteen patients (17%) had radiographic ILD. Adequate tissue sample at time of VBN was 93%. Overall diagnostic yield in 80 patients (excluding 16 patients who were initially benign/non-diagnostic that were lost to follow-up) was 72%. Overall complication rate was 7% with 1-pneumothorax (1%), 3-significant bleeding and 3-hospitalized for respiratory failure.ConclusionIn our cohort of patients the diagnostic yield and complication rate were comparable to other studies where there were fewer patients with advanced lung disease. This data suggests that VBN-guided bronchoscopic biopsy of SPNs is a viable diagnostic option with an acceptable safety profile.