bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential long-term tamoxifen therapy benefit by menopausal status in breast cancer patients: secondary analysis of a controlled randomized clinical trial
Authors: Johansson Annelie , Dar Huma , Nordenskjöld Anna , Perez-Tenorio Gizeh , Tobin Nicholas P , Yau Christina , Benz Christopher C , Esserman Laura J , van ‘t Veer Laura J , Nordenskjöld Bo , Stål Olle , Fornander Tommy , Lindström Linda S 
Published: December 2024

Abstract

Background
Estrogen receptor–positive breast cancer patients have a long-term risk of distant metastatic disease, and premenopausal patients have a higher risk. Randomized studies with long-term follow-up are essential to understand treatment benefit. We elucidated the long-term tamoxifen therapy benefit by menopausal status in the Stockholm tamoxifen trials with 20 years complete follow-up.

Methods
Secondary analysis of 1242 estrogen receptor–positive and HER2-negative patients that were randomly assigned to 2-5 years of 40 mg adjuvant tamoxifen or no endocrine therapy. Distant recurrence-free interval in tamoxifen-treated vs endocrine untreated patients was assessed by Kaplan–Meier, Cox proportional hazards regression, and time-varying analyses.

Results
In premenopausal patients, a statistically significant tamoxifen benefit was observed for lymph node–negative (adjusted hazard ratio [HR] = 0.46, 95% confidence interval [CI] = 0.24 to 0.87), progesterone receptor–positive (adjusted HR = 0.61, 95% CI = 0.41 to 0.91), and genomic low-risk tumors (adjusted HR = 0.47, 95% CI = 0.26 to 0.85) but only lasted beyond 10 years for genomic low-risk tumors. Postmenopausal patients showed long-term benefit for all good-prognosis markers including low-grade (adjusted HR = 0.55, 95% CI = 0.41 to 0.73), lymph node–negative (adjusted HR = 0.44, 95% CI = 0.30 to 0.64), progesterone receptor–positive (adjusted HR = 0.60, 95% CI = 0.44 to 0.80), Ki-67 low (adjusted HR = 0.51, 95% CI = 0.38 to 0.68), and genomic low-risk tumors (adjusted HR = 0.53, 95% CI = 0.37 to 0.74), and regardless of tumor size (≤20 mm: adjusted HR = 0.55, 95% CI = 0.39 to 0.77; &gt;20 mm: adjusted HR = 0.64, 95% CI = 0.44 to 0.94). Premenopausal patients with no poor-prognosis tumor characteristics (clinical marker score = 0) showed early benefit and postmenopausal long-term benefit.

Conclusions
Our study suggests differential tamoxifen benefit by menopausal status. Improved long-term endocrine therapy prediction in premenopausal patients is needed and could involve molecular markers because standard tumor characteristics cannot predict benefit beyond 10 years.
Mechanically modeling chemical mechanical planarization from wafer to molecular scales: a review and discussion of future direction
Authors: Tsai Kuan-Ting Yeh and Hung-Yin 
Published: December 2024

ABSTRACT
The chemical mechanical planarization (CMP) process plays an increasingly important role in integrated circuit (IC) manufacturing. To understand the mechanism broadly, we review different scales of models describing the removal phenomenon and predicting the material removal rate (MRR). At the wafer scale, there is the empirical Preston equation and its extensions incorporating different mechanical and chemical factors. Toward feature and particle scales, we introduce several models postulating the material removal mechanism and their experimental verification. Finally, we mention several mechanical models on the molecular scale and propose that at the moment they lack generality and do not give us further useable, quantifiable insight into the CMP phenomenon. We conclude with how we may, and should, achieve finding this mechanical model on a molecular scale.
Does a religious universalism haunt secular religious education?
Authors: Lewin David 
Published: December 2024

Abstract
Contemporary theories of non-confessional religious education (RE) imagine the subject as inclusive and non-indoctrinatory. Any latent confessional tendencies towards universalism—encouraging or promoting a singular religious vision—have been exorcised within secular, liberal education systems. But can universalism be so easily avoided? In this article, I argue that some forms of universalism are unjustified, while others are educationally inevitable. The argument acknowledges that failures to distinguish between different forms of universalism lead to confusion about the purposes and justification of RE, and contribute to the poor status of the subject in schools within England and Wales. Knowing when, how, and why universalism operates educationally can help to improve all kinds of education, particularly RE. This article is part of a suite of articles, titled ‘Universal Individuals’, which explore the relations and tensions between forms of universalism (political, civic, philosophical) and individualism.
Medicines safety information from regulators in clinical practice guidelines: a mixed-method case study
Authors: Andersen Armin , Møllebæk Mathias , Almarsdóttir Anna Birna 
Published: December 2024

Abstract

Objectives
The role of Danish clinical practice guidelines in making the health care sector aware of and act in accordance with medicines safety information from regulators, has not been extensively studied. The objectives of this study were 1) to describe the extent to which information from additional risk minimization measures is included in Danish clinical practice guidelines and 2) to explore guideline developers’ attitudes towards including additional risk minimization measures in Danish clinical practice guidelines.

Methods
The study focused on five therapeutic areas and combined quantitative document analyses of 91 Danish clinical practice guidelines and qualitative semi-structured interviews with 14 key informants expected to have knowledge about the guideline development in Denmark.

Key findings
The average inclusion rate of clinical actions from additional risk minimization measures in Danish clinical practice guideline is low (3.5%), and guideline developers have a low willingness to include information originating from additional risk minimization measures in the guidelines. Guideline developers typically claim to have sufficient access to new risk information on medicinal products via other sources, especially direct and targeted messages.

Conclusions
The findings confirm previous studies highlighting the paramount role of direct and targeted messages as opposed to guidelines when disseminating medicinal risk information to clinicians. The findings provide a new in-depth understanding of attitudes towards various types of medicinal risk information in clinical practice and guidelines and give rise to future studies assessing clinicians’ access to, awareness of, compliance with, and unmet needs regarding any medicinal risk information.
Infections and Antibiotic Resistance in Malawian Children Under Five-Years Old Hospitalized With Severe Acute Malnutrition
Authors: Vonasek Bryan J , Nyirongo Mwawi , Kondwani Alexander , Kamvaunamwali Tiwonge , Ng’oma Doris , Ciccone Emily J , Kaphatika James , Tepeka Amazing-Grace , Kumwenda Mercy , Eickhoff Jens , Garcia-Prats Anthony J , Mvalo Tisungane 
Published: December 2024

Abstract
This prospective cohort study from Malawi updates our understanding of the burden of bacterial infections and drug resistance in children &lt;5 years hospitalized with severe acute malnutrition. Urinary tract infection was diagnosed in 20% and bacteremia in 10%. Resistance to first- and second-line antibiotics occurred in &gt;1/3 of the bacteria isolated.
(025) IMPLANTABLE NEUROSTIMULATOR FOR ERECTILE FUNCTION TREATMENT ON SPINAL CORD INJURED PATIENTS – EARLY RESULTS
Authors: Glina S , Seligra Lopes L , Neves Neto O , Lessa P , Glina F , Juliano R , Cintra C , Rios L 
Published: December 2024

Abstract

Introduction
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, many men present with erectile dysfunction (ED). Recently, an implantable neurostimulator (CaverSTIM) has been developed to deliver electrostimulation to the cavernosal nerves. This is a first-in-human investigation to evaluate CaverSTIM safety, tolerability, and effectiveness in patients with SCI.

Objective
The purpose of this study is to assess in a limited number of SCI patients the long-term safety and tolerability of CaverSTIM, as a method for enhancing penile erection in the treatment of ED.

Methods
Men with stable SCI, which occurred at least 1 year prior to study enrolment with IIEF-15 score of the erectile function domain (sum of questions 1, 2, 3, 4, 5 and 15) equal to or less than 25 points and responsive to PDE-5 inhibitors were recruited. CaverSTIM was implanted by extraperitoneal video laparoscopy procedure. After stabilizing the pneumoperitoneum, the ventral prostatic fat was removed and the puboprostatic ligaments will be identified. The endopelvic fascia will be carefully dissected, bilaterally, to expose the neurovascular bundles and the paddles of the device were inserted with the electrodes facing the neurovascular bundle and an intraoperative stimulation will be performed to optimize paddle positioning prior to fixation. The implantable pulse generator was implanted subcutaneously in the lower abdomen. Patients were followed for 6 months. Erectile function of all participants was assessed at 44, 90 and 180 days after surgery, using the IIEF questionnaire.

Results
In this ongoing investigation, 5 patients have been successfully implanted with CaverSTIM. No serious adverse event has been observed and the device was well tolerated. Functional data with IIEF 6 at 44 days post-operative has been collected from 4 patients until now as shown in Fig. 1.

Conclusions
CaverSTIM implantation in SCI patients seems to be safe and well tolerated. Early results indicate Caverstim shows promise in improvement of the erectile function of those patients.

Disclosure
Yes, this is sponsored by industry/sponsor: Comphya.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Comphya.
(034) ARTIFICIAL INTELLIGENCE (AI) AS AN AID FOR ADULT MEN WITH LOWER URINARY SYMPTOM (LUTS)
Authors: Wang EY , Malmström P 
Published: December 2024

Abstract

Introduction
Lower Urinary Symptom (LUTS) are very common among adult men, but they rarely seek medical help, and these issues are not prioritized in healthcare, leading to long wait times to visit a doctor. The potential of AI as an aid has received considerable attention, and a number of apps have started being used in the interaction between patients and healthcare providers. For women with urinary incontinence, there is now an AI applications (APP) reported to give good results. However, for men, there is no available app. Our hypothesis in this study is that AI algorithms applied to self-generated data can provide recommendations that men can follow during the often long wait for a doctor’s visit. We believe that the APP can be used as a complement to a medical examination and thus serve as decision support for healthcare providers in primary care.

Objective
The purpose of our project is to investigate whether it is possible to partially replace a visit to the health center for men with LUTS by the help of digital medical history and AI-generated individualized recommendations. Furthermore, the collected data can serve as decision support for healthcare providers in outpatient care.

Methods
Our project is divided into four phases: Phase 1: A retrospective database was established based on data collected during routine doctor’s visits. From this, an algorithm is developed using AI. Phase 2: A prospective database is established with data on patients managed in primary care. The aim is to validate the previously developed algorithm. When patients visit a doctor, they are asked if they want to participate in a study where their information is anonymized and used in the database. Phase 3: The goal is to investigate whether the mobile application can be useful during a doctor’s visit. Phase 4: The value of the app will be evaluated in a randomized study.

Results
Phase 1: An app with questions that mimic a standardized medical interview has been developed. Phase 2: 150 men over 50 years old with urinary problems will be recommended to fill out the IPSS (symptom questionnaire), a fluid diary and perform urine flow measurements at home. We now have results from the first evaluable 50 patients. It seems relatively few receive treatment at the first visit. Less than half received the same treatment recommendation at the first visit that the AI algorithm would have suggested. Phase 3 and Phase 4: on going.

Conclusions
As far as we know, this study will be the first to evaluate the possibilities of improving the health of adult men using digital medical history and AI-based advice. In addition to better quality of life, it can also lead to reduced strain on healthcare by saving medical visits and improving the management of such visits through pre-answered questionnaires.

Disclosure
No.
(040) ASSOCIATION BETWEEN STROKE AND ERECTILE DYSFUNCTION: RESULTS FROM A CROSS-SECTIONAL STUDY AND MENDELIAN RANDOMIZATION ANALYSIS
Authors: Dilixiati D , Kadier K , Zhang W , Lu J , Aisihaer M , Azhati B , Rexiati M 
Published: December 2024

Abstract

Introduction
The relationship between stroke and erectile dysfunction (ED) remains insufficiently understood. This investigation seeks to elucidate the connection between the stroke and ED.

Objective
This investigation seeks to elucidate the connection between the stroke and ED.

Methods
This study encompassed both cross-sectional analysis and Mendelian randomization(MR) investigations. The cross-sectional study enrolled 4110 male participants selected from the National Health and Nutrition Examination Survey (NHANES) database spanning 2001-2002, representing a total population of 87 355 061 males in the United States. Genetic variants associated with stroke as well as its subtypes and ED were identified through genome-wide association studies (GWAS). MR analysis was utilized to investigate the distinct causal relationships between stroke and its subtypes with ED. Various tests were conducted to assess both heterogeneity and pleiotropy within these associations.

Results
In the cross-sectional study, the prevalence of ED among individuals with stroke was found to be 67.72% (95% CI, 55.76-79.68). The multivariate model’s findings reveal a positive correlation between stroke and an elevated prevalence of ED in the US population (OR 2.45; 95% CI, 1.24-4.86; P &lt; 0.001). In the MR study, the results from the inverse variance weighted (IVW) analysis demonstrate a significant association between stroke and an increased risk of ED, with an OR of 1.282 (95% CI, 1.052–1.562).

Conclusions
Our study delineates a substantial correlation between stroke and ED, as evidenced by a cross-sectional analysis encompassing a representative sample from the United States population. Moreover, the results derived from the MR study provide compelling evidence of a causal link between stroke and ED.

Disclosure
No.
(065) ASSOCIATION BETWEEN LEVATOR ANI MUSCLE AVULSION INJURY AND SEXUAL FUNCTION IN PAROUS WOMEN
Authors: Morin M , Dumoulin C , Kruger J , Tu LM , Mayrand M , Dubois M , Girard I , Wong V 
Published: December 2024

Abstract

Introduction
Childbirth is a major risk factor for levator ani muscle (LAM) trauma. In 21%-36% of women, stretching of the LAM leads to an avulsion injury, which is the detachment of the LAM from its insertion points on the pubic symphysis. LAM avulsion injury has been found to be significantly associated with important consequences such as higher rates and greater severity of stress urinary incontinence and pelvic organ prolapse. However, little is known about the impact of this obstetrical injury on sexual function.

Objective
This study aimed to examine the association between LAM avulsion injury and sexual function in parous women.

Methods
This multicenter prospective study involved 322 primiparous and multiparous women aged 18 to 45 years. Participants underwent a 3D/4D transperineal assessment, ≥ 3-month after delivery with a physiotherapist experienced in assessing LAM injury. The avulsion diagnosis was confirmed by two offline reviewers blinded to the patient’s clinical data following a validated protocol. A third reviewer was involved in case of discrepancy. Sexual function was measured with the Female Sexual Function Index (FSFI) questionnaire. Multiple linear regressions were computed to examine the association between avulsion injury and sexual function while controlling for potentially confounding variables (maternal age, time since last childbirth, stage of perineal tears 0-4, use of hormonal contraception, breastfeeding, urinary incontinence assessed with the International Consultation Incontinence Questionnaire – Urinary Incontinence (ICIQ-IU-SF), and pelvic organ prolapse evaluated with the Pelvic Organ Prolapse Symptom Score (POPSS).

Results
Of the 322 women who completed the study, 194 had an intact LAM, 77 had a unilateral avulsion, and 51 had a bilateral avulsion. Participants had a median parity of 2 (IQR 2-3) as well as a median of 4.4 (IQR 1.7-9.4) years since last childbirth. Avulsion was significantly associated with lower sexual function (β = -0.143, p = 0.011) as measured by the FSFI total score. Further analyses of the FSFI domains revealed that avulsion was also significantly associated with lower arousal (β = -0.160, p = 0.004), decreased lubrication (β = -0.128, p = 0.023) and lower orgasm (β = -0.146, p = 0.010).

Conclusions
The findings of this study support the role of LAM avulsion in sexual dysfunction. LAM avulsion was associated with poorer sexual function overall and more specifically, lower arousal, lubrication, and orgasm. Given the impact of LAM avulsion on sexual function, women diagnosed with this obstetrical injury should be screened for sexual dysfunction and offered appropriate treatment and counselling. Further research is needed to explore effective interventions and support for sexual dysfunctions in women sustaining this injury.

Disclosure
No.
(067) UNCONSUMMATED MARRIAGE AMONG COUPLES COMPLAINING OF INFERTILITY
Authors: Kaabia O 
Published: December 2024

Abstract

Introduction
Unconsummated marriage (UCM) is defined as the failure at all attempts of vaginal coitus that a faithful couple, married or not, might have tried in vain, for at least 3 consecutive months of night-time cohabitation. It is a common medical and social problem facing fertility specialists in conservative communities.

Objective
This study aims to report the prevalence of unconsummated marriage among couples consulting for infertility. The secondary aim is to identify the clinical features and describe the therapeutic approaches of unconsummated marriage (UCM) among couples consulting for infertility.

Methods
This is a case series including the couples diagnosed with UCM among those initially complaining of infertility between July 2021 and June 2023 at our fertility consultation.

Results
Among the 879 couples consulting for infertility, 15 have been diagnosed with UCM, with a prevalence of 1.7%. The mean age of the husbands was 34,20 ± 9,14 years, and that of the brides was 29,64 ± 5,62 years. The average length of marriage was 15 months (range 1–45 months). The sexual dysfunctions noted were: erectile dysfunction (ED) in 5 cases, premature ejaculation in 2 cases, a low sexual desire in men in 2 cases, and vaginismus in 6 cases. The first-line treatment was based on sex education and sex therapy, associated in all cases of ED with oral drugs. After a mean follow-up of 3 months (range 1–12 months), the outcomes of treatment were: good prognosis with consummation of marriage in 13 cases, failure with persistent UCM in 2. The fertility complaint was treated independently of the UCM with intra-vaginal insemination.

Conclusions
UCM is quite frequent among the population of couples complaining of infertility in conservative societies. The best treatment is prevention based on sexual education and premarital counseling. The treatment of the sexual dysfunctions is independent of the quest for fertility.

Disclosure
No.
(076) SERUM TESTOSTERONE LEVEL AS A PREDICTOR OF ADVERSE PATHOLOGICAL OUTCOMES IN MEN WITH PROSTATE CANCER
Authors: Mulhall J , Elshafei A , Flores J 
Published: December 2024

Abstract

Introduction
Debated in the literature is the link between total testosterone (TT) levels and pathological outcomes in prostate cancer (CaP) patients, with some literature suggesting that low TT levels predict higher grade/stage cancer. We investigated the correlation between preoperative TT and the presence of unfavorable pathology (UP) in such men.

Objective
We investigated the correlation between preoperative TT and the presence of unfavorable pathology (UP) in such men.

Methods
Men with CaP treated with RP constituted the analyzed population. Men who had androgen deprivation therapy (ADT) prior to RP or within 3 months after RP were excluded from the study. Morning TT levels were measured by LCMS within 3 months of RP with low TT defined as &lt;300 ng/dl. UP was defined as any Gleason grade grouping (GGG) with extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM) and lymph node involvement (LNI) or GGG ≥4 irrespective of other pathological parameters. Variables included in the univariate model (UVA): age, comorbid conditions, pre-RP PSA, clinical T stage (cT), biopsy GGG, total MRI prostate volume (PV), and low TT. Multivariable analysis (MVA) was conducted to define independent predictors of UP using those factors found to be significant on UVA.

Results
1599 men were analyzed. Median age 63 (57, 68) years, PSA 6 (4,9) ng/ml, TT 447 (343, 575) ng/dl. Median GGG 2 (2, 3). 57% had ECE, 12% SVI, 22% PSM, 14% LNI. On UVA, older age (p &lt; 0.001), clinical stage ≥T2b (p &lt; 0.001), higher pre-RP PSA (&lt;0.001), higher biopsy GGG (p &lt; 0.001), and smaller MRI PV (p = 0.001) were significantly associated with UP while peri-operative TT (≤300 ng/dl) (p = 0.8) was not associated with UP. On MVA, higher biopsy GGG, clinical stage ≥T2b, higher pre-RP PSA, smaller PV and older age were independent predictors of UP, while peri-operative TT (≤300 ng/dl) was not associated with UP. (Table) Furthermore, we found no correlation between very low TT (≤200 ng/dl) and UP.

Conclusions
Peri-operative TT is not associated with adverse pathology in men treated by RP.

Disclosure
No.