bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge and practice toward menstrual hygiene management and associated factors among visual impaired adolescent girls: a case of two selected institutions in Rwanda
Authors: Ishimwe Bazakare Marie Laetitia , Ngabo Rwabufigiri Bernard , Munyanshongore Cyprien 
Published: December 2024

Background: Menstruation is a universal and normal phenomenon during the reproductive age of females; adolescence is an essential period where females are preparing and adjusting themselves to manage their menstrual bleeding safely and cleanly. Menstrual hygiene management (MHM) is an issue that is insufficiently acknowledged and has not received adequate attention among visually impaired adolescent girls (VIAGs). Objectives: The purpose of this study was to determine the knowledge and practice of MHM and associated factors among VIAGs of selected institutions in Rwanda. Design: This study consisted of a cross-sectional study design using a quantitative approach. Methods: A cross-sectional study was conducted in April and May 2021 on 92 VIAGs. They were recruited from educational institutions in two Provinces in Rwanda. Voluntary participation and confidentiality were assured. Socioeconomic and demographic data, menstruation, and menstrual hygiene questionnaires were used to obtain the required information. Statistical Packages for the Social Sciences (SPSS) for Windows version 25 was used. Descriptive statistics, Chi-square test, and logistic regressions were used for data analysis. Results: The study reached 92 respondents. The majority of the respondents, 67.4% had a poor level of menstruation and menstrual hygiene knowledge while only 32.6% had a good level of menstruation and menstrual hygiene knowledge. Also, it is confirmed that the majority of respondents, 52.1% had a good level of practice, while 47.8% had a poor level of menstrual hygiene practice. The multivariable analysis revealed that factors associated with the menstrual hygiene practice were as follows: the mother’s education (odds ratio (OR): 5.979; 95% CI: [1.700–21.032]; p value: 0.005) and level of knowledge of menstruation and menstrual hygiene (OR: 0.132; 95% CI: [0.028–0.622]; p value: 0.010). Conclusion: The knowledge and practice of MHM among VIAGs were poor. Recommendations included the need for mothers to assist their daughters in improving learning and practice of menstrual hygiene, as well as the integration of MHM into school curricula. Further research is suggested to better understand MHM among Rwandan adolescent girls, both visually impaired and non-blind.
Multi-Omics Reveal Immune Microenvironment Alterations in Multiple Myeloma and Its Precursor Stages
Authors: Cheng Yan , Sun Fumou , Alapat Daisy V. , Wanchai Visanu , Mery David E. , Siegel Eric , Xu Hongwei , Johnson Sarah K. , Guo Wancheng , Bailey Clyde , Ashby Cody , Bauer Michael Anton , Al Hadidi Samer , Schinke Carolina , Thanendrarajan Sharmilan , Zangari Maurizio , van Rhee Frits , Tricot Guido , Shaughnessy, Jr John D , Zhan Fenghuang 
Published: December 2024

Introduction: Tumor immune microenvironmental alterations occur early in multiple myeloma (MM) development. Deep molecular characterization of the immune profiles and their crosstalk with tumor cells in MM and its precursor conditions is needed to advance treatment development and discover safe and efficient strategies to prevent disease progression. In this study, we aim to systematically characterize the tumor immune microenvironment (TME) and the tumor-immune interactions from precursor stages, i.e., monoclonal gammopathy of undetermined significance (MGUS) and smoldering MM (SMM), to newly diagnosed MM, comparing these to healthy donors.
Methods: Most current studies rely on BM aspirates, which often get contaminated by peripheral blood and lose mature granulocytes during processing. To address this limitation, we evaluated the BM cell content using a whole BM gene expression-based computational technique, CIBERSORT, and investigated the correlation of immune cell proportions with patient outcome after 5-20 years of follow-up. We also analyzed BM immune cell functional marker expression using mass cytometry in a large cohort of patients and examined BM immune cell gene expression in paired stable or progressive MM precursor conditions and MM samples using single-cell RNA sequencing (sc-RNA seq).
Results: By integrating results from CIBERSORT, mass cytometry, and sc-RNA seq, we demonstrate an altered balance of innate and adaptive immunity persisting from MGUS to MM. Specifically, the proportion of neutrophils decreasing in the tumor microenvironment (TME), predicts SMM progression and MM outcomes. HLA-DR is reduced in CD16+ monocytes and plasmacytoid dendritic cells. Myeloid dendritic cells are also decreased, and their expression of stress and immune-response genes is inhibited in MM and its precursor stages. We find that NK cells and CD8 T cells show common features with a shift from GZMK+ to GZMB+ cytotoxic phenotype in the TME compared to normal BM and this is accompanied by increased expressions of inhibitory markers TIM3 and TIGIT. Finally, we show that patient-specific GZMB+ CD8 T cell subtypes demonstrate limited changes in paired precursor and MM samples despite the increased numbers and heterogeneity of MM subclones in overt MM.
Conclusion: Overall, these results provide a comprehensive immune landscape of MM and its precursor stages. Enhancing neutrophil and NK cell cytotoxicity, tumor antigen presentation, and CD8 T cell versatility in precursor stages may prevent MM progression.
Acute Erythroid Leukemia Clinicopathologic Determinants of Survival: Analysis of a Pooled Database
Authors: Haddad Philip A , Vutukuri Sireesha , Gupta Ankita 
Published: December 2024

Background
Acute erythroid leukemia (AEL), a rare and aggressive subtype of acute myeloid leukemia (AML), is characterized by the predominant proliferation of immature erythroid precursors in the bone marrow and peripheral blood. Representing less than 5% of AML cases, AEL poses significant diagnostic and therapeutic challenges due to its atypical clinical presentation and the lack of standardized treatment protocols. AEL's prognosis remains poor. The determinants of survival outcomes in this disease are not very well defined. Therefore, we conducted this pooled real-world database analysis to identify the prognostic factors, clinicopathological characteristics, and therapeutic strategies that influence survival in this rare disease.
Methods
To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, prognostic factors, and survival, we compiled a pooled database of cases that satisfy the diagnostic criteria for AEL. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS).
Results
A total of 169 patients with confirmed AEL were identified. The median age was 62. There was a male preponderance with M:F of 2.7. The median duration of symptoms before diagnosis was 5.5 months. Constitutional symptoms and splenomegaly were present in 67% and 10% of the cases, respectively. The median OS of the cohort was 3 months. While majority of the cases were de novo AEL (65%), some cases developed in the context of hematologic malignancies (14%), solid cancers (2%), and MDS/MPN (18%). Patients older than 65 had worse median OS (2 vs. 4 months, p=0.0001). Those who presented with &gt;80% erythroblasts also had worse OS (2 vs 4 months, p=0.004). However, de novo AEL was associated with better OS (4 vs 2.8 months, p=0.003). Sex, levels of WBC, Hgb, and Platelets, IHC/Immunophenotype, and presence of constitutional symptoms did not impact OS. Compared to no treatment, chemotherapy and stem cell transplant had incrementally superior OS (1 vs. 3 vs. 9 months, p=0.0001). Those who received intensive AML regimens also had better OS (p=0.005). Furthermore, patients who achieved CR as their best response also had a superior median OS (9 vs. 2.6 months, p&lt;0.0001).
Conclusion
This study presents updated clinicopathologic data from a large, pooled cohort of patients with AEL. It identifies age, % marrow erythroblasts, intensity of therapy, and quality of response to treatment as critical determinants of OS.
The Role of Intensive Chemotherapy and Radiotherapy in Plasmablastic Lymphoma: Optimizing Survival Outcomes
Authors: Haddad Philip A , Lerner Jaren , Gupta Ankita , Gupta Supriya 
Published: December 2024

Background: Plasmablastic Lymphoma (PBL), a rare and aggressive subtype of non-Hodgkin's lymphoma, often arises in immunosuppressed patients, including those with HIV or undergoing immunosuppressive treatments. Due to its rarity, a standardized approach to its management has been elusive. Our study evaluated the effectiveness of intensive chemotherapy and radiotherapy on survival outcomes in patients with PBL.
Methods: We conducted a comprehensive analysis using a pooled database, encompassing demographic data, molecular characteristics, and treatment responses of a retrospective cohort with confirmed PBL cases. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the survival impacts of various treatments.
Results: The study cohort comprised 300 confirmed PBL cases with a median age of 49. It predominantly consisted of males (M:F ratio of 2.7). Approximately 51% were diagnosed at advanced stages (III/IV), and 62% had an immunocompromised status, 47% due to HIV. Analysis showed a median overall survival (OS) and disease-free survival (DFS) of 25 and 15 months, respectively. Significant factors influencing OS included bone marrow, liver, lung/pleura, and upper GI tract involvements; all were associated with poorer outcomes. Conversely, early-stage &lt;2 disease (p&lt;0.0001), head and neck involvement (p=0.0001), and attaining CR (p&lt;0.0001) were linked to better survival. Compared to no treatment, chemotherapy (CT) and stem cell transplant had incrementally better OS (2 vs. 27 vs. NR months, p&lt;0.0001). Patients who underwent frontline intensive chemotherapy (ICT) had a superior OS compared to those treated with CHOP-like or myeloma protocols in decreasing order (p&lt;0.0001). ICI survival benefit persisted when analyzed by early vs. advanced stages (p=0.0009). Radiotherapy (RT) improved OS when added to intensive and non-intensive CT (p=0.03). However, upon further analysis, RT benefits were restricted to those with early stages (I&II) H&N PBL (NR vs. 27mo; p=0.0008).
Conclusion: Our findings support an aggressive chemotherapy approach in managing Plasmablastic Lymphoma with the addition of radiotherapy in H&N early-stage disease. This approach maximizes survival and highlights the importance of tailored treatment strategies based on disease stage and location.
Impact of Protein Energy Malnutrition on Hospitalized Patients with Multiple Myeloma: A United States Population-Based Cohort Study
Authors: Syal Arshi , Arya Yajur , Casipit Bruce Adrian , Dourado Claudia , Leighton John Charles 
Published: December 2024

Background
Multiple myeloma poses a significant burden to the society and the healthcare system. With newer advances in therapeutics and prolonged survival, these patients are predisposed to multiple co-morbidities, including cancer-related cachexia, systemic inflammation, and adverse effects of therapy, often leading to varying degrees of protein-energy malnutrition (PEM). PEM can further complicate the clinical picture, leading to an inability to tolerate therapy & propagation of this vicious cycle. Thus, the impact of PEM on outcomes among patients with multiple myeloma needs further exploration.
Methods
We utilized the 2020 National Inpatient Sample (NIS) Database to conduct this retrospective cohort study. We identified patients with multiple myeloma and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with multiple myeloma based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p-value of &lt;0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charges among hospitalized patients with multiple myeloma.
Results
We identified a total of 19025 hospitalized patients with multiple myeloma, of which 12.50% (2380/19025) had co-morbid PEM. The overall in-hospital mortality among patients with multiple myeloma was 4.33% (825/19025). Among those with concomitant PEM, the mortality rate was significantly higher at 9.24% (220/2380, p&lt;0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.53; 95% (confidence interval [CI] 1.70-3.76; p&lt;0.001), longer LOS (coefficient 3.78; CI 2.29-5.27; p&lt;0.001), higher total hospitalization charge ($59042; CI $28467-$89617; p&lt;0.001), and increased need for mechanical ventilation (adjusted OR 2.92; CI 1.78-4.79; p&lt;0.001).
Conclusion
Our analysis demonstrated that PEM was widely prevalent in patients with multiple myeloma. It was associated with worse outcomes, including significantly increased in-hospital mortality, longer LOS, total cost of healthcare utilization, as well as increased need for mechanical ventilation. Efforts should be made to promote nutritional assessment and screening mechanisms to include early nutritional support as indicated. Prospective studies with larger sample sizes are warranted to better understand these associations.
Clinical Characteristic Outcomes and Mortality Among Cancer and Non-Cancer Patients Presented with Incidental Pulmonary Embolism
Authors: Chai-Adisaksopha Chatree , Chaiwong Warawut , Niprapan Piangrawee , Tantiworawit Adisak , Bumroonkit Chaiwat 
Published: December 2024

Introduction: Cancer patients are at risk of developing venous thromboembolism, which includes pulmonary embolism (PE) and deep vein thrombosis. Advances in multidetector computed tomography (CT) scanners have led to increased detection of PE. However, the natural course of incidental PE, particularly in cancer patients, remains controversial. The objectives of this study were to determine characteristics of PE and mortality among patients with and without cancer.
Methods: This retrospective cohort study was conducted at a tertiary medical center in Thailand. Patients aged 15 or older who were diagnosed with PE between 2011 and 2020, identified by the International Classification of Diseases, 10th Revision codes, were included in this study. Electronic medical records were reviewed to confirm the diagnosis of PE, which was defined as radiological evidence of PE by CT with contrast or V/Q scan. Patients were classified into two groups: the incidental PE (iPE) group and the suspected PE (sPE) group. Incidental PE was defined as cases where patients underwent CT without a specific request to investigate PE. The primary outcome was 30-day mortality.
Results: A total of 736 patients with acute PE were included in the study, with 281 classified as iPE and 455 as sPE. The mean age was 58.8 ± 14.3 years in the iPE group and 57.5 ± 16.2 years in the sPE group. Active cancer was more common in the iPE group compared to the sPE group (70.8% versus 46.6%, P&lt;0.001). Patients in the sPE group were more likely to exhibit PE-related symptoms, including dyspnea (P&lt;0.001), chest pain (P&lt;0.001), tachycardia (P&lt;0.001), tachypnea (P&lt;0.001), shock (P&lt;0.001), and oxygen saturation &lt;90% (P&lt;0.001). The sPESI score identified 84.9% of patients in the iPE group as high-risk and 94.0% in the sPE group. There was no significant difference in the risk of 30-day mortality between the iPE and sPE groups (odds ratio [OR] 0.73, 95% CI 0.52-1.04, P=0.08). However, subgroup analysis revealed that cancer patients with iPE had lower 30-day mortality compared to those in the sPE group (OR 0.40, 95% CI 0.26-0.61, P&lt;0.001). There were no significant differences in 30-day mortality among non-cancer patients with iPE versus sPE (OR 1.31, 95% CI 0.66-2.59, P=0.44). Multivariable analysis showed that cancer patients with PE who had dyspnea (hazard ratio [HR] 1.92, 95% CI 1.13-3.37, P=0.016), tachycardia (HR 1.66, 95% CI 1.13-2.45, P=0.01), oxygen saturation &lt;90% (HR 1.67, 95% CI 1.06-2.65), and ECOG performance status &gt;1 (HR 1.98, 95% CI 1.22-3.21) were associated with a significantly increased risk of death.
Conclusions: Although the overall mortality rate of patients with iPE was not significantly different from those with sPE, patients with active cancer had a higher risk of 30-day mortality, particularly if they exhibited symptoms related to PE.
Health Related Quality of Life (HrQoL) in Patients with Bleeding Disorder of Unknown Cause (BDUC)
Authors: Monard Amaury , Tegels Sanne , Merry Inge , Derikx Floor , Henskens Yvonne , Beckers Erik AM , Moenen Floor CJI 
Published: December 2024

Background: Patients with an increased bleeding tendency without any abnormalities in laboratory hemostasis tests are classified as having a bleeding disorder of unknown cause (BDUC). Data on health related quality of life (HrQoL) in BDUC patients and other patients with an increased bleeding tendency are scarce. The aim of this study was to investigate HrQoL in patients with BDUC and by extension in other patients with an increased bleeding tendency.
Methods: 237 patients from the prospective Predictors of Bleeding Evaluation in Adult Hematologic Patients with Bleeding Tendencies cohort (ProBe-AHP study), in which patients with an increased bleeding tendency are included, were invited to complete the 36-item Short Form Health Survey (RAND-36). This questionnaire consists of 36 questions within eight subcategories including physical functioning, energy, emotional wellbeing, social functioning, pain, general health and role limitations due to physical health or emotional problems. These subcategories can be combined into the physical component summary (PCS) and the mental component summary (MCS). Scores range from 0-100, with 0 being the lowest HrQoL and 100 the highest. The ProBe-AHP study population consists of patients with an established bleeding disorder (BD), patients with BDUC and patients with no bleeding disorder (NBD). Data from a Dutch RAND-36 population survey were used as a reference (general population).
Results: A total of 97/237 RAND-36 questionnaires were completed and returned. From the 97 returned questionnaires, 20% (n=19) were filled in by NBD patients, 34% (n=33) by BDUC patients and 46% (n=45) by BD patients. The median PCS score and the median MCS score was not statistically significant different between these three groups (Median PCS score [IQR]: NBD (84 [66-93], BDUC (61 [35-90]) and BD (72 [34-88]), median MCS score [IQR]: NBD (79 [53-87]), BDUC (75 [51-86]) and BD (68 [41-82]). Compared to the general population, BDUC patients had a statistically significant decreased score on the role limitations in physical health, energy, social functioning, pain and general health subcategories.
Conclusion: HrQoL is impaired in BDUC and BD compared to the general population. No statistically significant difference in RAND-36 score was found between NBD, BDUC and BD patients in the ProBE-AHP cohort. These results suggest that HRQoL-related issues should be an integral part of the personalized management of BDUC and BD patients.
Identifying Gut Microbiota and Immune Host Factors Associated with Bleeding Risk in Children with Immune Thrombocytopenic Purpura
Authors: Saini Shelly , Koh Andrew Y. , Zia Ayesha 
Published: December 2024

Background:
Immune thrombocytopenia (ITP) may cause clinically significant bleeding episodes that can adversely affect a patient's quality of life. The gut microbiome plays a critical role in host immune system education and response in both healthy and diseased states. Previous studies comparing microbial taxa and cytokine levels in ITP patients have focused on differences between healthy controls and ITP participants. The role of the microbiome and cytokine levels in bleeding risk among ITP patients remains unclear.
Methods:
In our prospective cohort study, we analyzed stool and blood samples from 30 pediatric ITP participants at platelet levels ≤30,000/uL at time of diagnosis. Participants were divided into two groups, mild or moderate-severe bleeding phenotype, using the Buchanan-Adix bleeding score with mild participants having a score ≤3a and moderate-severe with a score ≥3b. Microbiome data was obtained using 16S rRNA gene sequencing on stool samples and cytokine profiling was obtained using Luminex assays on blood samples. Microbial diversity, microbial abundance, and cytokine levels were then compared between participants with mild and moderate-severe bleeding phenotype.
Results:
Of the 30 participants, the median age was 5.5 years (IQR 2-9.5). 11 (36.7%) were diagnosed with mild phenotype and 19 (63%) with moderate-severe bleeding phenotype. The median platelet count in the moderate-severe group was 4,000/uL (IQR 4-6) and in the mild group 6,000/uL (IQR 4-15) with no difference found between the two groups (p&gt;0.05). The gut microbiota taxa that were significantly enriched in moderate-severe versus mild bleeders included the bacterial families Erysipelotrichaseae (LDA score 3.75), Ruminococaceae (LDA score 3.16), and Oscillospiraceae (LDA score 2.81), as assessed by LEfSe. Mild phenotype had increased Megamonas (LDA score 4.33) and Fusobacterium (LDA score 3.65) taxa compared to moderate-severe. Systemic cytokine profiling revealed a significant increase in IL-1ar in the moderate-severe group compared to those with mild phenotype (p=0.0447) with a significant positive correlation seen between Ruminococcus gut microbiota and IL-1ar cytokine levels (p=0.0865).
Conclusion:
Pediatric patients with acute ITP and a moderate-severe bleeding phenotype are enriched in the anti-inflammatory bacteria Ruminococcus and cytokine IL-1ra, while those with a mild phenotype have higher relative amounts of pro-inflammatory bacteria Megamonas and Fusobacterium. These findings suggest that gut microbiota modulates bleeding risk in pediatric ITP. This study provides novel insight into the altered composition of gut microbiota and cytokines in ITP patients with variable bleeding phenotype at similar platelet counts.