bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes From Real‐World Data on Intraoperative Electronic Radiotherapy for the Treatment of Early‐Stage Breast Cancer: Long‐Term Recurrence and Survival Outcomes From a Single Center
Authors: De la Mata Dolores , Santiago-Concha Bernardino Gabriel , Bargalló-Rocha Juan Enrique , Robles-Vidal Carlos Daniel , Gómez-Pue Daniella , Castorena-Rojí Gerardo , Hinojosa-Gómez José , Flores-Vázquez Fabiola , Blake-Cerda Mónika , Enriquez-Barrera Mario , Maffuz-Aziz Antonio 
Published: November 2024

Purpose: This study is aimed at investigating the 10‐year outcomes of intraoperative radiotherapy (IORT) in Mexican women with early breast cancer (EBC) treated at the Centro Medico ABC, Mexico City.Methods: A cohort study included women with early‐stage invasive ductal carcinoma aged ≥ 45 years without prior oncologic treatment, tumor size ≤ 3.5 cm, cN0M0, positive hormone receptors, margins ≥ 2 mm, negative sentinel lymph nodes, and no extensive lymphovascular invasion. IORT was administered at 20 Gy for 20–30 min after a lumpectomy. Follow‐up extended over 10 years and included clinical examinations every 6 months for the first 18 months, followed by annual mammograms and conventional examinations. Patients out of the criteria were excluded from this study because they were referred for additional surgery and/or whole‐breast radiation therapy.Results: The study involved 238 patients with an average age of 61.1 years. The mean tumor size was 12 mm, and the percentages of lymphatic invasion, positive hormone receptors, and HER2/neu overexpression were 12.6%, 90.8%, and 2.1%, respectively. The median follow‐up was 66.6 months (range: 1–126 months), and the overall survival and mastectomy‐free rate reached 95.7% and 90%, respectively. Thirteen patients showed side effects; four recurrences were recorded, of which 50% were out‐field relapses. The 5‐year Kaplan–Meier probability of local relapses, mastectomy‐free, and overall survival reached 97.5%, 100%, and 98%, respectively.Conclusions: This is the first 10‐year report about the effect of IORT on Mexican women with EBC in the early stages. Strict adherence to the selection criteria in this study resulted in low rates of side effects, mortality, and local recurrences, demonstrating that IORT is an effective treatment alternative for patients with EBC. Studies with a longer follow‐up period should be performed, as recurrences can occur in the long term.
Eculizumab Versus Rituximab for Refractory Antiacetylcholine Receptor Antibody‐Positive Generalized Myasthenia Gravis: A Single‐Center Experience
Authors: Durmus Hacer , Çakar Arman , Parman Yesim Gülşen 
Published: November 2024

Background: Rituximab (RTX) and eculizumab (ECU) are treatment options for refractory myasthenia gravis (MG), but comparative clinical data derived from real‐world experience are limited. Here, we describe the baseline characteristics, treatment, and safety outcomes of patients with antiacetylcholine receptor antibody‐positive (AChR+) generalized myasthenia gravis (gMG) treated with ECU and/or RTX in our clinic.Methods: Patients with refractory AChR+ gMG who received ECU or/and RTX treatment for more than 1 year at the Department of Neurology, Istanbul Faculty of Medicine were included in this observational study. After obtaining written patient consent, data were collected retrospectively from medical records.Results: Twelve patients treated with ECU and 25 patients treated with RTX were included in the analysis. Groups were comparable with regard to demographic and clinical characteristics, including age at onset of MG, disease duration, and history of thymoma. ECU was associated with significantly better outcomes compared with RTX, as measured by decreases in the mean MG activities of daily living score at 1 (p = 0.024), 3 (p < 0.001), 6 (p < 0.001), and 12 (p < 0.001) months of treatment; steroid‐sparing effect after 1 year of treatment (decrease in mean [standard deviation] daily prednisolone dose of −21.8 mg [13.5] vs. −6.6 mg [9.4] with RTX; p < 0.001); and need for rescue treatment and number of myasthenic crisis episodes during treatment (p < 0.001). No new safety signals were observed with either treatment.Conclusion: Our data provide real‐world evidence supporting ECU over RTX to treat patients with refractory AChR+ gMG.
A Screen-and-Treat Strategy for Eradication of Helicobacter pylori among Patients with Family History of Gastric Cancer in a Diverse US Population
Authors: Zia Mona , Park Steven , Chen Qiaoling , Luong Tiffany Q. , Lustigova Eva , Jeon Christie Y. , Chen Wansu , Wu Bechien U. 
Published: November 2024

Abstract

Background:
Screening and eradication of Helicobacter pylori reduce the risk of gastric cancer in patients with a family history. We assessed patient perspectives on H. pylori screening and treatment within a diverse regional US population.

Methods:
Between July 2022 and August 2022, we conducted a cross-sectional study among patients with ≥1 first-degree relative(s) with gastric cancer. Eligible patients were between 18 and 75 years of age without history of H. pylori infection or gastric cancer. A survey assessed interest in testing and willingness to complete treatment for H. pylori. Interested patients were offered H. pylori testing and treatment. We examined interest and effectiveness of treatment by race and ethnicity.

Results:
We identified 15,255 eligible patients, and 1,500 patients were randomly selected for the survey; 280 (19%) patients, including two relatives not initially invited but asked to participate, responded following outreach. Respondents were 65% male and averaged 57 years (SD = 13) with 36% Hispanic, 36% non-Hispanic White, 15% Asian/Pacific Islander, and 9% non-Hispanic Black. Overall, 223 (80%) were interested in H. pylori screening; of these, 89% would take antibiotics as prescribed. Willingness to screen was consistent across racial and ethnic groups. Among 223 respondents interested in screening, 128 (57%) completed testing with 15 screen-detected cases; all 15 completed treatment, and 11 had confirmed eradication.

Conclusions:
Patients with family history of gastric cancer had a high level of interest in H. pylori screening and successful eradication when detected.

Impact:
A screen-and-treat strategy for H. pylori may be considered for patients with family history of gastric cancer.
Abstract 4138498: Sex Differences in Plasma Acylcarnitines in Patients with STEMI undergoing Primary PCI
Authors: Namkoong Jenny , Stamenkovic Aleksandra , Surendran Arun , Ravandi Amir 
Published: November 2024

Background:
Rapid coronary reperfusion using primary PCI is the corner stone therapy for patients presenting with STEMI that restores blood flow and limits infarct size. But paradoxically, the reperfusion process itself can induce additional myocardial injury. Females have increased rates of cardiovascular death compared with males following MI, and it is unclear whether this is related to differences in presentation or reperfusion injury. Given these differences, we aim to better understand the sex differences in the lipidome shift post PCI.

METHODS&RESULTS:
126 patients(97 males, 29 females) undergoing PCI for STEMI in a tertiary centre underwent venous blood sampling and semi-targeted Liquid Chromatography Tandem Mass Spectrometry(LC/MS/MS) to determine 291 lipid species. Samples were taken pre-PCI(T0), and 2 hours post PCI(T1) with successful reperfusion.

Each lipid class and species were compared between males and females at each time point using statistical analysis, to determine the similarities and differences in plasma lipidome shifts in ACS between sexes.
Whilst most lipid classes decrease following reperfusion in STEMI (T0 vs T1), Acylcarnitines increase (20%, adjusted p=0.003) in both sexes. There is a clear sex difference with a greater increase in females (39% increase, adjusted p=0.03), as compared with males (13% increase, adjusted p=0.048). In both sexes this is primarily driven by OctadecanoylCarnitine (C8), which is a medium-chained acylcarnitine.
Notably, there was no significant difference in C8 between the sexes in the control group, nor the pre-PCI group(adjusted p=0.48, at T0). At T0, total free fatty acids(FFA) and total phosphatidylinositol were significantly elevated in females compared with males(adjusted p=0.012, p=0.018 respectively).

Conclusion:
Our analysis suggests there are differences in lipidomics shift between males and females in response to myocardial reperfusion. The higher levels of circulating FFA in ischemic females pre-PCI(T0), followed by a parallel increase of acylcarnitine with reperfusion(T0vsT1), suggest differences between the sexes in myocardial metabolic response to reperfusion injury. C8 has been associated with elevated risk of cardiovascular death in stable CAD, but its clinical impact during reperfusion is still unknown. Detailed understanding of sex specific lipidomics shifts during reperfusion injury will allow us to better understand the mechanistic differences in clinical outcome between males and females.
Abstract 4138529: Acute Coronary Syndrome in a Patient with Situs Inversus Totalis
Authors: Balani Prachi , Sharma Nitish , Ray Ayita , Sarraf Rahul , Roumia Mazen , Angelis Dimitrios 
Published: November 2024

INTRODUCTION:
Situs inversus totalis (SIT) occurs in 1 in 8000 births. 0.04% of cases involve ACS, posing a clinical challenge. We present a case of NSTE-ACS in a patient with SIT, where a universal diagnostic catheter was used to engage the coronary arteries.

CASE PRESENTATION:
51-year-old Caucasian male with situs inversus totalis presented with worsening right-sided chest&right arm pain after shoveling snow. Initial examination was benign, but the EKG showed features of dextrocardia with T wave inversions in V2-V6. Laboratory results showed elevated CKMB (119.2)&up-trending troponin T 1.260 ng/ml. He was started on a Heparin drip and 81 mg of Aspirin with a plan for urgent cardiac catheterization.

A coronary angiogram from the right radial with a 6 French Tiger Radial Catheter in the right anterior projection (RAO) 30 degrees showed minor luminal irregularities in the RCA, and 90% stenosis in the LAD. RCA was enganged anticlockwise and LCA clockwise.
A 6 French XB 3.5 guide catheter was used to engage the LCA system, and the mid-LAD was stented. DAPT including Aspirin and Ticagrelor, was initiated. A TTE showed an EF of 25-30% with severe anterior, apical, and septal wall hypokinesis. The patient was discharged home with GDMT for coronary artery disease.

DISCUSSION:
CAD in dextrocardia can be challenging, requiring reversed limb and precordial leads and a right-sided ECG to show the extent of MI. Failure to recognize dextrocardia can lead to underestimating or missing MI. Typical findings include global negativity in lead I, positively deflected QRS in aVR, negative P-wave in lead II, reverse R-wave progression in precordial leads, and right-axis deviation. Our patient's EKG revealed polarity reversal in leads I and aVL, QS and rS patterns in precordial leads, and positive polarity in aVR, suggesting dextrocardia with T wave inversions, prompting further workup.

Engaging the coronary arteries is challenging. We used a Tiger radial catheter with a reverse torque technique: anticlockwise for the RCA and clockwise for the LCA. Both arteries were engaged in the right anterior oblique view at 30 degrees. The cranial and caudal angulation remained the same, but the standard left anterior oblique view was switched with the right anterior oblique view and vice versa. The double inversion technique is useful during interventions when dealing with unfamiliar anatomy. It is not well-established whether dextrocardia is a risk factor for myocardial infarction.
Abstract 4138555: The ApoB/LDL-C Ratio Predicts Cardiovascular Events in Coronary Artery Disease Patients Independently of Type 2 Diabetes Status
Authors: Larcher Barbara , Plattner Thomas , Mader Arthur , Vonbank Alexander , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H 
Published: November 2024

A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL-C ratio and the presence of T2DM are mutually independent predictors of cardiovascular events is unclear and is addressed in the present study.
We enrolled a large high-risk cohort of 1200 patients with coronary artery disease. T2DM was diagnosed according to current ADA guidelines. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.5±4.9 years.
At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=422) than in subjects who did not have T2DM (0.81±0.18 vs. 0.74±0.15 p<0.001). During follow-up, 662 patients suffered cardiovascular events. The Apo B/LDL-C ratio predicted cardiovascular events in univariate analysis (HR=1.11 [1.03-1.20] p= 0.006), and the event rate was higher in patients with than in those without T2DM (62.2% vs. 52.3%; p=0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted cardiovascular events in a mutually independent manner, with standardized adjusted HRs of 1.11 [1.03-1.20]; p=0.008 and 1.39 [1.18- 1.64]; p<0.001, respectively.
We conclude that in subjects with coronary artery disease the ApoB/LDL-C and T2DM are mutually independent predictors of cardiovascular events.
Abstract 4139610: A Curious Complete Heart Block with Carfilzomib
Authors: Shah Mohammed , Rahman Naveed , Al-Mohamad Talal , Batra Sejal , Vyas Apurva 
Published: November 2024

Carfilizomib is a proteasome inhibitor used in the treatment of multiple myeloma. The incidence of arrhythmias according to one pooled analysis was 13.3%, mostly linked to mild supraventricular arrhythmias. We present a case of carfilzomib-induced complete heart block (CHB).
A 66-year-old male with a history of restrictive lung disease on 2 liters (L) oxygen, moderate aortic stenosis and multiple myeloma presented with shortness of breath and mild chest discomfort that started earlier that day. His most recent chemotherapy with carfilzomib, cyclophosphamide, and dexamethasone was 3 days prior to arrival. Oxygen requirements increased to 15L. Laboratory findings showed elevated high sensitivity troponins (600s), elevated brain natriuretic peptide (800), creatinine of 1.86 above baseline of 0.9. Chest x-ray revealed pulmonary edema. Initial electrocardiogram (EKG 1) showed 2nd degree, type 1 atrioventricular block, which was new compared to a prior EKG. Subsequent EKGs showed alternating bundle branch blocks with LBBB and RBBB (EKG 2) that progressed to eventual complete heart block (EKG 3). Echocardiogram revealed an ejection fraction of 55-59% without wall motion abnormalities and unchanged valve pathologies.
The patient was treated for acute heart failure with diuretics and fluid restriction. Cardiac catheterization was deferred as he did not have classic anginal symptoms. Oncology recommended discontinuation of carfilzomib. Electrophysiology recommended implantation of a permanent pacemaker (PPM) due to persistent complete heart block, which he successfully underwent, improving his symptoms.
The general arrhythmogenic effects of carfilzomib are established, however there is limited data on the specific types of arrhythmias. This case suggests that carfilzomib can result in CHB. Additional monitoring or early discontinuation of carfilzomib should be considered to prevent severe conduction abnormalities resulting in morbidity and potential mortality. Further research is necessary to elucidate underlying mechanisms and risk factors associated with carfilzomib-induced conduction abnormalities and whether they resolve with discontinuation of the medication.
Abstract 4139822: Adipocyte TRPM7 promotes aortic dissection by accelerating SMC phenotype switching
Authors: Wang Mi , Gao Min 
Published: November 2024

Background:
Aortic dissection (AD) is a life-threatening condition with high mortality. It initiates from an acute intimal tear, which allows a large amount of blood to penetrate into media, leading to the formation of intramural hematoma or false lumen. Digging into and unravelling the pathogenesis of AD will aid in exploring novel therapeutics for AD.

The major characteristics of AD is degeneration of aortic wall architecture. Particularly, the phenotypic switching of VSMCs and enhanced tissue inflammation are pivotal steps of AD progression. Studies have shown that upregulation of Trpm7 triggers the phenotypic switching of VSMCs.
Perivascular adipose tissue (PVAT) harbors mature adipocytes that regulate vascular function physiologically and pathologically. Inflammatory cytokines secreted from PVAT promotes VSMC phenotypic switching.
This study aims to explore whether the adipocyte TRPM7-mediated Ca2+ could uncouple Bip-IRE1a and perturb the inhibition of Bip on IRE1a, inducing PCG1a mRNA decay and inflammatory cytokines secretion, thus promoting VSMC phenotypic switching and the development of AD.

Methods:
Mouse breeding. Trpm7fl/fl mice were cross-bred with Ap2-Cre mice to generate adipocyte-specific Trpm7 KO mice.

Mouse genotyping. Genomic DNA was extracted from the mouse tail for PCR to validate the genotype of mice.
Establishment of BAPN-induced TAD mouse model. 3-week-old mice was administered with BAPN intragastrically (1g/kg/day) for 4 weeks.
H&E staining. Different segments of mouse aorta were subjected to H&E staining to examine the lesions.
EVG staining. Different segments of mouse aorta were subjected to EVG staining to examine the aortic wall architecture.
Real-time quantitative PCR (qPCR). The expression level of inflammatory genes and VSMC contractile genes, including IL1b, TNF-a, Acta2, Cnn1, Tagln, S100A4, as well as Trpm7 were assessed by qPCR.

Results:
Adipocyte-specific Trpm7 KO mice (Trpm7fl/fl ; Ap2-Cre ) were successfully generated and each genotype was validated by PCR.

BAPN-induced TAD mouse model was successfully established. The mortality rate reached to 50-80%.
Adipocyte-specific deletion of Trpm7 hindered inflammation and the development of TAD effectively.
Trpm7 inhibitors FTY720 hindered the progress of TAD significantly.

Conclusion:
Adipocyte-specific deletion of Trpm7, as well as Trpm7 blockers FTY720 markedly ameliorates TAD, suggesting that Trpm7 enhances TAD progression.
Abstract 4140247: Place and Race in Cardiovascular Outcomes among Prostate Cancer Patients in Georgia: a 20-year Geospatial Analysis
Authors: Nain Priyanshu , Kulkarni Neel , Rupji Manali , Hyma Kunhiraman Harikrishnan , Datta Biplab , Patel Vraj , Jiang Stephanie , Stabellini Nickolas , Weintraub Neal , Mandawat Anant , Cantu Stephanie , ward kevin , Switchenko Jeffrey , Patel Sagar , Guha Avirup 
Published: November 2024

Background:
Men with prostate cancer (PC) frequently die of cardiovascular disease (CVD). Rurality has shown to increase adverse outcomes in PC men. 26% of Georgians live outside Urban centers and 120/159 counties of Georgia (GA) are considered rural.

Aim:
To identify CVD mortality (CVDm) risk factors in GA public health districts (PHD) and map the racial differences in CVDm across PHDs.

Methods:
Men ≥ 18 years with PC (2004–2018) were identified using GA Cancer Registry, with mortality data from state vital statistics and National Death Index. CVDm was identified by ICD-10 codes. A multivariable Fine and Gray model identified CVDm risk factors. Adjusted competing risk analysis included factors like PHD, race, age, T-stage, hormone therapy, and Gleason Score. Race specific 5-year CVDm rates per 100000 were calculated by multiplying county-specific standardized mortality ratios (SMRs) by the crude race-specific mortality rates of CVD and then aggregating these into PHDs. The ratio of Black vs White CVDm was calculated for each of GA's 18 PHD and mapped using R.

Results:
Of 51,262 men with PC (median age 63), 36.2% were Black, predominantly from greater Atlanta area (36%) and ~17% received hormone therapy. CVDm was noted in 4.1% of cohort. The PC cohort risk factors for CVDm are presented in Table 1.

Men with stage T2-3 PC had a lower risk of CVDm vs stage T1 PC (aHR 0.52, CI 0.36-0.75; aHR 0.47, CI 0.31 – 0.71). CVDm was significantly higher in northwest (aHR 1.72), west central (aHR 1.85), coastal (aHR 1.92), and southeast (aHR 1.90) GA vs. greater Atlanta area. CVDm was significantly higher in Black men (aHR 1.47). High Gleason scores significantly correlated with CVDm (aHR 1.48), though hormone therapy use showed no statistical difference (P=0.124)
Figure 1 shows the mapped relative racial disparity. Overall, the highest Black vs. White CVDm differences were noted in Northeast, LaGrange, and Southwest GA as well as Dekalb County in Atlanta (1.81 - 3.63).

Conclusion:
In GA, there are significant geographic and racial differences in CVDm in men with PC. Determining the reasons (i.e., insufficient access to care, inadequate CVD risk prevention) is needed to establish healthcare equity for all men with PC in GA.
Abstract 4140643: Real World Evidence on Health Care Resources Utilization and Economic Burden of Arrhythmias in Patients with Diabetes and COPD.
Authors: Russo Pierantonio , Nathan Ramaa , Pfefer Daniel , Kamdar Shilpa , Wright Brent 
Published: November 2024

Introduction:
We studied the healthcare resource utilization (HCRU) and medical costs of managing arrhythmias inT2D and COPD, and the impact of EKG screening on the rate of hospitalization and ER visits.

Hypothesis:
Arrhythmias in T2D and COPD generate high costs. Screening with EKG monitoring devices may be associated with a reduced rate of hospitalization and ER visits for arrhythmias.

Methods:
A retrospective claims analysis using the Merative MarketScan and the Symphony Integrated Dataverse databases. We identified patients > 18 years with claims for T2D or COPD or both T2D and COPD (T2D+COPD) and assigned them into groups:

Target:
patients without prior history of arrythmias, followed by arrythmias claims.

Control:
patients with either of the conditions, but without arrhythmias claims.

Target and control were matched 1:1 on demographic, year of first episode of arrhythmia, risk (ECI, DSI, Gold criteria). HCRU and medical cost drivers over 24 months were analyzed. HCRU of patients with arrythmia screened with EKG monitoring devices was compared to that of not screened patients.

Results:
Target group and control group included the same number of patients.213,226 T2D: 47,851 COPD; 31,571T2D/COPD. Atrial fibrillation was the most reported arrhythmia in the target cohort, followed by SVT.

Hospitalizations/1000/year were: 584/205 (T2D target/control); 650/311(COPD target/control); 844/402 (T2D+COPD).
The ER days/1000 /year and the 30 days readmissionfor the target patients were nearly twice as high than for the control.
Total cost of care per patient / year was significantly higher for all target patients compared to control (T2D $34,171/ $18,687; COPD $ 37,719/$25,656; T2D COPD $46,484/ $30,802). The per patient / year cost of hospitalization was higher in the target patient's vs control (T2D $28,316/$19,439; COPD $25,098/$17,906; T2D COPD $28,694/$19,352). ER cost per patient/year was 35%-50% higher in the target cohort.
Hospitalizations/1000 /month of patients screened with monitor devices was significantly lower than a 1:1 matched control cohort not using monitoring devices (T2D 64/215; COPD 69/198; 93/276). ER visits/1000/year were up to 50% lower in patients screened with monitoring devices.

Conclusions:
Arrhythmias significantly increase HCRU and total cost for T2D and COPD, particularly in patients requiring ER visits and hospitalization. Early detection with monitoring devices, could reduce the utilization of acute care and associated costs.