Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk of febrile neutropenia in very elderly patients aged ≥80 years receiving their first cycle of R‐CHOP regimen: a nationwide real‐world study in Japan

may have included a certain number of patients without neutropenia because neutrophil counts were not included in the database. However, our validation study showed that the definition used in this study had a pos-itive predictive value of 80%. 8 Thus, we consider that patients who developed FN were identified appropriately. Second, the study only evaluated the incidence of FN in the first cycle of R- CHOP. We did not evaluate all cycles of R- CHOP. Finally, the study was restricted by its retrospective nature. Despite these limitations, this study using uniformly registered data for a large number of patients at the nationwide level suggested that very elderly patients, who are difficult to target in clinical trials, had a unique risk of FN. In conclusion, this nationwide analysis showed that reduction in chemotherapeutic dose was commonly practiced and incidence of FN was not high in very elderly patients. Typical strategies with G- CSF for FN prevention may be less effective in very elderly patients.
Hyperproduction of PHA copolymers containing high fractions of 4‐hydroxybutyrate (4HB) by outer membrane‐defected Halomonas bluephagenesis grown in bioreactors

Bacterial outer membrane (OM) is a self‐protective and permeable barrier, while having many non‐negligible negative effects in industrial biotechnology. Our previous studies revealed enhanced properties of Halomonas bluephagenesis based on positive cellular properties by OM defects. This study further expands the OM defect on membrane compactness by completely deleting two secondary acyltransferases for lipid A modification in H. bluephagenesis, LpxL and LpxM, and found more significant advantages than that of the previous lpxL mutant. Deletions on LpxL and LpxM accelerated poly(3‐hydroxybutyrate) (PHB) production by H. bluephagenesis WZY229, leading to a 37% increase in PHB accumulation and 84‐folds reduced endotoxin production. Enhanced membrane permeability accelerates the diffusion of γ‐butyrolactone, allowing H. bluephagenesis WZY254 derived from H. bluephagenesis WZY229 to produce 82wt% poly(3‐hydroxybutyrate‐co‐23mol%4‐hydroxybutyrate) (P(3HB‐co‐23mol%4HB)) in shake flasks, showing increases of 102% and 307% in P(3HB‐co‐4HB) production and 4HB accumulation, respectively. The 4HB molar fraction in copolymer can be elevated to 32 mol% in the presence of more γ‐butyrolactone. In a 7‐l bioreactor fed‐batch fermentation, H. bluephagenesis WZY254 supported a 84 g l−1 dry cell mass with 81wt% P(3HB‐co‐26mol%4HB), increasing 136% in 4HB molar fraction. This study further demonstrated that OM defects generate a hyperproduction strain for high 4HB containing copolymers.
Evaluation of the shear bond strength of zirconia to a self-adhesive resin cement after different surface treatment.

OBJECTIVES The aim of this study was to evaluate the SBS of pre-sintered and sintered zirconia to a selfadhesive resin cement after various treatment (air abrasion and the Nd:YAG laser irradiation at varying power levels -1 W, 2 W and 3 W). MATERIAL AND METHODS Ninety-nine zirconia specimens were prepared and divided into 3 groups: control (with no surface treatment); and pre-sintered and sintered groups with surface treatment. Surface treatment was applied before sintering in the pre-sintered group and after sintering in the sintered group. After following all protocols, a resin cement was layered on the zirconia surface. Shear bond strength was measured using a universal testing machine. The results were subjected to the statistical analysis. The surface topography and phase transformation of zirconia were evaluated using the atomic force microscopy (AFM), scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses after surface treatment. RESULTS The laser irradiation (3 W, 1 W and 2 W) of the pre-sintered zirconia surface resulted in the highest SBS values (p < 0.001), while the lowest SBS values were obtained with airborne particle abrasion of the pre-sintered and sintered zirconia surfaces. CONCLUSIONS Laser irradiation increased the SBS of pre-sintered zirconia to a resin cement. Surface treatment with air abrasion had a lesser effect on the SBS values.
Korean Association for the Study of Intestinal Diseases guidance for clinical practice of adult inflammatory bowel disease during the coronavirus disease 2019 pandemic: expert consensus statements

Many unexpected problems have resulted from the unprecedented coronavirus disease 2019 (COVID-19) pandemic. The optimal management of patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic has also been a challenge. Therefore, the Korean Association for the Study of Intestinal Diseases (KASID) developed a consensus statement of experts regarding the management of IBD during the COVID-19 pandemic. This consensus statement made recommendations regarding the risk and treatment of COVID-19 in IBD patients. This statement emphasizes that IBD is not a risk factor for COVID-19, and care should be taken not to exacerbate IBD in patients in remission state by maintaining their medications, except for corticosteroids.
Gut microbiota-motility interregulation: insights from in vivo, ex vivo and in silico studies

ABSTRACT The human gastrointestinal tract is home to trillions of microbes. Gut microbial communities have a significant regulatory role in the intestinal physiology, such as gut motility. Microbial effect on gut motility is often evoked by bioactive molecules from various sources, including microbial break down of carbohydrates, fibers or proteins. In turn, gut motility regulates the colonization within the microbial ecosystem. However, the underlying mechanisms of such regulation remain obscure. Deciphering the inter-regulatory mechanisms of the microbiota and bowel function is crucial for the prevention and treatment of gut dysmotility, a comorbidity associated with many diseases. In this review, we present an overview of the current knowledge on the impact of gut microbiota and its products on bowel motility. We discuss the currently available techniques employed to assess the changes in the intestinal motility. Further, we highlight the open challenges, and incorporate biophysical elements of microbes-motility interplay, in an attempt to lay the foundation for describing long-term impacts of microbial metabolite-induced changes in gut motility.
Financial Hardship and Quality of Life Among Patients With Advanced Cancer Receiving Outpatient Palliative Care

Background Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes. Objective The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC). Methods Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL. Results The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health (P = .008), pain (P = .003), and emotional well-being (P = .017) QOL dimensions. Conclusions Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer. Implications for Practice Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.
Sample size calculation in hierarchical 2×2 factorial trials with unequal cluster sizes

Motivated by a suicide prevention trial with hierarchical treatment allocation (cluster‐level and individual‐level treatments), we address the sample size requirements for testing the treatment effects as well as their interaction. We assume a linear mixed model, within which two types of treatment effect estimands (controlled effect and marginal effect) are defined. For each null hypothesis corresponding to an estimand, we derive sample size formulas based on large‐sample z‐approximation, and provide finite‐sample modifications based on a t‐approximation. We relax the equal cluster size assumption and express the sample size formulas as functions of the mean and coefficient of variation of cluster sizes. We show that the sample size requirement for testing the controlled effect of the cluster‐level treatment is more sensitive to cluster size variability than that for testing the controlled effect of the individual‐level treatment; the same observation holds for testing the marginal effects. In addition, we show that the sample size for testing the interaction effect is proportional to that for testing the controlled or the marginal effect of the individual‐level treatment. We conduct extensive simulations to validate the proposed sample size formulas, and find the empirical power agrees well with the predicted power for each test. Furthermore, the t‐approximations often provide better control of type I error rate with a small number of clusters. Finally, we illustrate our sample size formulas to design the motivating suicide prevention factorial trial. The proposed methods are implemented in the R package H2x2Factorial.
Intensive Care Unit–Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial

Background Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up. Trial Registration Netherlands Trial Register NL8835; https://www.trialregister. nl/trial/8835 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-021-05271-z
Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.
Age-dependent Sex Differences in Graft Loss After Kidney Transplantation

Background. Sex differences in kidney graft loss rates were reported in the United States. Whether these differences are present in other countries is unknown. Methods. We estimated the association between recipient sex and death-censored graft loss in patients of all ages recorded in the Scientific Registry of Transplant Recipients, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study registries who received a first deceased donor kidney transplant (1988–2019). We used multivariable Cox regression models, accounting for the modifying effects of donor sex and recipient age, in each registry separately; results were combined using individual patient data meta-analysis. Results. We analyzed 438 585 patients. Young female patients 13–24 y old had the highest crude graft loss rates (female donor: 5.66; male donor: 5.50 per 100 person-years). Among young recipients of male donors, females showed higher graft loss risks than males (0–12 y: adjusted hazard ratio [aHR] 1.42, (95% confidence interval [CI], 1.17-1.73); 13–24 y: 1.24 (1.17-1.32); 25–44 y: 1.09 (1.06-1.13)). When the donor was female, there were no significant differences by recipient sex among those of age <45 y; however, the aHR for females was 0.93 (0.89–0.98) in 45–59 y-old and 0.89 (0.86–0.93) in ≥ 60 y-old recipients. Findings were similar for all 3 registries in most age intervals; statistically significant heterogeneity was seen only among 13–24-y-old recipients of a female donor (I2 = 71.5%, P = 0.03). Conclusions. There is an association between recipient sex and kidney transplantation survival that is modified by recipient age and donor sex.
Hybrid-type, multicomponent interval training upregulates musculoskeletal fitness of adults with overweight and obesity in a volume-dependent manner: A 1-year dose-response randomised controlled trial

ABSTRACT This study examined the dose-response effects of a 1-year hybrid-type, multicomponent interval training programme (DoIT) on various musculoskeletal fitness parameters in inactive overweight and obese adults in a gym setting. Ninety-seven middle-aged (44.8 ± 5.2 years) individuals with overweight/obesity (31.2 ± 5.7 kg/m2) (66% female) were randomly assigned to the following groups: (i) no-intervention control (CON, n = 29), (ii) DoIT performed once weekly (DoIT-1, n = 24), (iii) DoIT performed twice weekly (DoIT-2, n = 23) and (iv) DoIT performed thrice weekly (DoIT-3, n = 21). DoIT was a time-efficient, intermittent-based, multicomponent exercise protocol using progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:3–2:1) in a circuit format (2–3 rounds). Muscular strength, muscular endurance, flexibility, passive range of motion (PRoM), static balance and functional movement screen (FMS®) were assessed at baseline, 6 and 12 months following intervention. At post-training, all exercise groups exhibited superior changes than CON in (i) muscular strength (+13%–38%, p < 0.001); (ii) muscular endurance (+42%–159%, p < 0.001); (iii) flexibility (+12%–42%, p < 0.001); (iv) PRoM (+6%–50%, p = 0.001–0.026); (v) static balance (+61%–163%, p < 0.001); and (vi) FMS (+18%–39%, p < 0.001). Although a single exercise session/week improved musculoskeletal fitness, changes demonstrated a step-wise improvement with two and three sessions/week suggesting a dose-dependent response. The response rate to training was 100% for all exercise groups. These findings suggest that a multicomponent exercise approach incorporating bodyweight drills and resistance-based alternative modes performed under real-world conditions may improve several musculoskeletal fitness indicators in a dose-dependent manner in inactive, middle-aged adults with overweight/obesity. Trial registration: ClinicalTrials.gov identifier: NCT03759951.
Prognostic Value of the Immunohistochemical Expression of RAD51 and BRCA2 in Gastric Adenocarcinoma

Current scientific literature lacks data on the prognostic value of the expression of RAD51 and BRCA2 in gastric adenocarcinoma. Therefore, we aimed to evaluate those and other homologous recombination-related proteins (ATM, ATR, BRCA1, CHK2, γH2AX, p53) in gastric cancer, assessing their correlation with clinical prognosis. Paraffin-embedded samples were obtained from surgical specimens collected in total or subtotal gastrectomy procedures. Between 2008 and 2017, 121 patients with advanced gastric adenocarcinoma underwent surgical resection and were included in this study. Negativity for nuclear RAD51 correlated with vascular invasion, lymph node metastasis, larger tumor size, and lower overall survival and disease-free survival in univariate analysis. However, nuclear RAD51-negative cases presented better response rates to adjuvant therapy than the positive ones. Nuclear ATR negativity correlated with larger tumor size and a higher histological grade. Positivity for ATM was associated with more prolonged disease-free survival. Positivity for nuclear BRCA2 correlated with lower overall survival and diffuse histological type, whereas its high expression was associated with vascular invasion. Nevertheless, tumors positive for nuclear BRCA2 were more frequently low grade in the intestinal histological type. Our findings indicate that RAD51 and BRCA2 are valuable immunohistochemical prognostic markers in gastric adenocarcinoma.
Health professionals’ perspectives on shared decision-making in secondary mental healthcare: a qualitative study

Abstract Background Shared decision-making is widely recommended but has not been widely implemented in mental healthcare. There is a lack of direct evidence about health professionals’ perspectives on shared decision-making in Asian cultures, particularly Taiwan. Such knowledge is of key importance to facilitate shared decision-making. Therefore, further studies are needed to clarify this issue. Aim To explore health professionals’ perspectives of shared decision-making in secondary mental healthcare in Taiwan. Method Qualitative semi-structured interviews were used. Purposive sampling was applied to recruit health professionals. Data were analysed using thematic analysis. Results Twenty-four health professionals were recruited. This study found the absence of shared decision-making was acceptable to them. Barriers included: powerful status of health professionals and families, patients with impaired decisional ability due to mental illness, health professionals’ lack of understanding of shared decision-making, and insufficient time. Facilitators included: awareness of patients’ right to autonomy and understanding of potential benefits of shared decision-making. Conclusions The study found that the absence of patient involvement in decision-making was widely reported. A discussion of barriers and facilitators is provided. Barriers and facilitators are highlighted to build a foundation for implementing shared decision-making in the future.
HLA 1–3 antigen‐mismatched related peripheral blood stem cells transplantation using low‐dose antithymocyte globulin versus unrelated cord blood transplantation

Little information is available regarding whether unrelated cord blood transplantation (CBT) or an HLA 1–3 antigen–mismatched related donor peripheral blood stem‐cell transplantation (PBSCT) using low‐dose anti‐thymocyte globulin (ATG) is superior as an alternative transplantation for patients who lack an HLA‐matched sibling or unrelated donor. Therefore, we evaluated 7861 patients with hematologic malignancies (aged 0 to 70 years) who received either a CBT without ATG (CBT‐no ATG, n = 7034) or an HLA 1‐3 antigen–mismatched related donor PBSCT using low‐dose ATG (PBSCT‐ATG, n = 827). CBT‐no ATG was associated with significantly better overall survival (OS) than the use of a PBSCT‐ATG (hazard ratio [HR], 0.77; p < .001), although PBSCT‐ATG patients with an HLA 1 antigen‐mismatch showed OS comparable to that in the CBT‐no ATG group. Neutrophil and platelet engraftment was significantly delayed, whereas the incidences of nonrelapse mortality, and severe graft‐versus‐host disease (GVHD) were significantly lower in the CBT‐no ATG group. The incidences of relapse and chronic GVHD were comparable between these donors. In conclusion, CBT‐no ATG may be a better alternative than HLA‐mismatched related donor PBSCT using low‐dose ATG. Notably, HLA 2‐3 antigen mismatch‐related transplantation with low‐dose ATG had significant adverse effects on transplantation outcomes.