Rosai-Dorfman Disease Presenting With FDG-Avid Breast Masses and Axillary Lymph Nodes on PET-CT in a Patient With Recent Diagnosis of Endometrial Carcinoma: A Diagnostic Dilemma

Rosai-Dorfman disease (RDD) is a self-limited, idiopathic, non-neoplastic disorder characterized by the proliferation of phagocytic histiocytes, which can mimic malignant lymphoproliferative disease. Cases of RDD most commonly present as bilateral painless cervical lymphadenopathy, with lesser involvement of the axilla, inguinal, and mediastinal lymph nodes. We present the case of a 62-year-old woman with a history of endometrial serous carcinoma who underwent evaluation at a dedicated breast imaging department after positron emission tomography/computed tomography (PET/CT) revealed breast masses and axillary nodes with increased uptake of fluorodeoxyglucose (FDG). Upon clinical examination, she had bilateral palpable lumps in both breasts and axillae. Subsequent dedicated breast imaging with bilateral diagnostic mammography with tomosynthesis and bilateral complete breast ultrasound were suspicious for malignancy detecting bilateral breast masses and axillary lymphadenopathy corresponding to the FDG-avid findings on PET/CT. Ultrasound-guided core needle biopsies, however, revealed a diagnosis of RDD. This case highlights the unique characteristics of RDD with an atypical clinical presentation suspicious for breast cancer both clinically and radiologically

When Does a Firm Fail to Walk the Talk? Decoupling in International Expansion

Neo-institutional theory predicts that when adaptations to institutional pressures contradict a firm's efficiency needs, decoupling may arise. This study systematically investigates the drivers of heterogeneous decoupling in the context of international expansion. We propose that specific configurations - awareness of peers' decoupling, a strong motivation to obtain legitimacy through ceremonial conformity, and a weak capability to couple stated policies with practices - will lead to a high occurrence of decoupling. An empirical analysis of 8918 annual reports of 1974 Chinese-listed companies from the period 2013-17 suggests that the 'Go Global' initiative undertaken by the Chinese government has created high institutional pressure for all Chinese firms to expand globally. However, when the implementation of that move is perceived as too costly or risky for a firm, the firm is likely to choose to decouple its international expansion from its stated commitment to expand under certain configurations of awareness, motivation, and capability conditions. Our theory and empirical findings extend decoupling research and international business research by providing a holistic configurational analysis of firms' decoupling in an international expansion context

States' Accountability for Facilitating Parent Involvement under IDEA

Since the reauthorization of the Individuals with Disabilities Education Act (IDEA) in 2004, state IDEA programs have been required to report annually on a set of performance indicators. Indicator 8 of the Part B State Performance Plan is the "percent of parents who report that schools facilitated parent involvement as a means of improving services and results for children with disabilities." The purpose of this study was to investigate whether changes over time in national and state-level performance on Indicator 8 provide evidence in support of the effectiveness of the accountability requirement related to parent involvement. Data were extracted from states' Annual Performance Reports and other publicly available documents. Findings indicated that national performance on Indicator 8 increased from 63% in 2006 to 76% in 2018. Within-state change in performance from 2014 to 2019 ranged from -13.47% to +42.50%, with several states indicating dramatic year-to-year changes in their reported performance. The findings raise important questions about the extent to which the indicator in its current form can support the dual purpose of holding states accountable for their facilitation of parents' involvement and supporting improvement efforts. Implications for both federal policy and state-level action are discussed

FASTKD5 processes mitochondrial pre-mRNAs at noncanonical cleavage sites

The first post-transcriptional step in mammalian mitochondrial gene expression, required for the synthesis of the 13 polypeptides encoded in mitochondrial DNA (mtDNA), is endonucleolytic cleavage of the primary polycistronic transcripts. Excision of the mtDNA-encoded transfer RNAs (tRNAs) releases most mature RNAs; however, processing of three noncanonical messenger RNAs (mRNAs) not flanked by tRNAs (CO1, CO3, and CYB) requires FASTKD5. To investigate the molecular mechanism involved, we created knockout human cell lines to use as assay systems. The absence of FASTKD5 produced a severe OXPHOS assembly defect due to the inability to translate two unprocessed noncanonical mRNAs and predicted altered folding patterns specifically at the 5'-end of the CO1 coding sequence. Structural features 13-15 nt upstream of the CO1 and CYB cleavage sites suggest FASTKD5 recognition mechanisms. Remarkably, a map of essential FASTKD5 amino acid residues revealed RNA substrate specificity; however, a key, putative active site residue was required for processing all three noncanonical pre-RNAs. Mutating this site did not significantly alter the binding of any client RNA substrate. A reconstituted in vitro system showed that wild-type, but not mutant, FASTKD5, was able to cleave client substrates correctly. These results establish FASTKD5 as the missing piece of biochemical machinery required to completely process the primary mitochondrial transcript

Filling the tank: A multicenter investigation of trauma survival after ultramassive transfusion

INTRODUCTION : Ultramassive transfusion (UMT), transfusion of >= 20U of red blood cell products in the first 24 hours, is rare, requires significant resource utilization, and is associated with high mortality. The aim of this study was to describe the characteristics of trauma patients undergoing UMT and determine patterns associated with survival after UMT. METHODS : This retrospective, multicenter analysis from 11 high-volume trauma centers included traumatically injured patients older than 14 years who received UMT from 2016 to 2024. Demographic, clinical, and outcome data were obtained and compared between survivors and nonsurvivors. The primary outcome was survival with secondary outcome of need for specific operative interventions. RESULTS : A total of 1,155 patients received UMT with a mortality rate of 62.9%. Between survivors and nonsurvivors, there was no difference in mechanism of injury. Survivors presented were tachycardic (120 vs. 98 beats per minute, p < 0.001) and had a higher initial Glasgow Coma Scale score (14 vs. 3, p < 0.001), higher initial platelet count (189 vs. 149 10(3)/mu L, p < 0.001), and smaller initial base deficit (8 vs. 11.8 mmol/L, p < 0.001). Survivors underwent more extremity explorations (25.2% vs. 14.4%, p < 0.001) and had more extremity vascular injuries (22.9% vs. 13.2%, p < 0.001). The odds of mortality increased with age (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.015-1.037; p < 0.001), Injury Severity Score (OR, 1.025; 95% CI, 1.013-1.036; p < 0.001), initial lactate (OR, 1.119; 95% CI, 1.079-1.161; p < 0.001), and emergency department thoracotomy (OR, 3.92; 95% CI, 2.129-7.223; p < 0.001). The odds of mortality decreased with higher Glasgow Coma Scale score (OR, 0.93; 95% CI, 0.897-0.962; p < 0.001), heart rate (OR, 0.995; 95% CI, 0.990-0.9997; p = 0.04), and initial platelet count (OR, 0.998; 95% CI, 0.996-0.999; p = 0.04). CONCLUSION : This study affirms known factors influencing mortality in UMT and describes new patterns associated with reduced mortality including higher initial heart rate, extremity exploration, and concomitant extremity vascular injury. These findings can inform clinical decision making in the care of this challenging patient population. (c) 2025 Wolters Kluwer Health, Inc. All rights reserved

Use of social media for academic and professional purposes by gynecologic oncologists

ObjectiveTo investigate the prevalence and patterns of social media use among gynecologic oncologists for professional and academic purposes.MethodsA prospective online survey between November and December 2022 targeted gynecologic oncology practitioners (gynecologic oncologists, surgical oncologists, medical oncologists, radiation/clinical oncologists, and onco-pathologists/pathologists). The survey, distributed via various social media platforms, included 40 questions to capture qualitative and quantitative data on social media use.ResultsOf 131 respondents from 32 countries, 106 (80.9%) were gynecologic oncologists and affiliated with academic institutions (84.7%). Facebook (n=110, 83.9%), Twitter (n= 108, 82.4%), and Instagram (n=100, 76.3%) were the most used platforms. Respondents used social media to stay updated (n=101, 77.1%), network (n=97, 74%), learn about conferences and webinars (n=97, 74%), and engage in academic discussions (n=84, 64.1%). Following the COVID-19 pandemic, 100/129 (77.5%) reported increased social media use. However, only 32 (24.4%) used it to connect with patients, and concerns were raised about privacy and the need for separate professional and personal accounts. A quarter of respondents hesitated to share their opinions on social media due to the fear of controversy, with 26 (20%) experiencing cyberbullying, yet 120/130 (92.3%) believed it enabled junior professionals to express their views. Concerns about differentiating valid content, information reliability, and the professional perception of sourcing knowledge from social media were noted. Gender, age, specialty, and income level influenced patterns of social media use, with variations in preferences for platforms, content engagement, and purposes, highlighting a complex landscape of social media interaction among gynecologic oncologists.ConclusionWhile the use of social media among gynecologic oncologists is prevalent, particularly for academic and professional development, challenges such as cyberbullying, privacy concerns, and the need for formal training in social media navigation persist. Tailored training programs and guidelines could enhance social media’s effective and ethical use in this field, promoting a safe environment for professional expression and engagement

Advancing the state of the art in congenital obstructive uropathy

In March 2024, we convened a symposium to consider the state of the art regarding the mechanisms and management of congenital obstructive uropathy caused by bladder outlet obstruction, at which overarching themes emerged and opportunities for research were discussed to fill key knowledge gaps in achieving the best future for children with congenital obstructive uropathy

Surface quotient singularities and bigness of the cotangent bundle: Part II

In Part I, we presented the CMS-criterion giving a sufficient condition for bigness of the cotangent bundle of a birational class X of surfaces of general type. The CMS-criterion has the term Lh(Omega)(1)(X) coming from the singularities of the canonical model of X, where each singularity contributes with h(Omega)(1)(y), the first cohomological 2-asymptotics of the singularity y. We give a method to find the invariant h(Omega)(1)(A(n)), where y is an A, singularity, and obtain a closed formula in n that allows us to understand the range of the CMS-criterion. To find h(Omega)(1) (A(n)), we give a complete answer to the (holomorphic) extension problem along E for symmetric m-differentials on the complement UA(n)\E, where U-An is the resolution of a germ of an A(n) singularity and E its exceptional locus. We show that, for fixed n, the function h(0)(A(n), m) = dim [H-0(U-An\E, S-m Omega 1/U-An)/H-0(U-An, S-m Omega 1/U-An)] is a quasi-polynomial An in m of degree 3 with constant cubic and quadratic coefficients, for which we give a formula. We also determine the precise extent to which the poles along E of the symmetric differentials on U-An\E are milder than logarithmic poles