bluuebunny/crossref_metadata_2025_split huggingface dataset:
Boundary Between FDA Approved and Non-Approved Anticancer Drugs in Survival Benefit: A Meta-analysis
Authors: Ishizuka Koji , Ono Shunsuke 
Published: October 2024

Abstract

Survival benefit is a fundamental property of anticancer drugs for cancer patients. However, the survival benefits observed in registrational trials broadly ranged from significant to marginal, even for US Food and Drug Administration (FDA)-approved drugs. This study explores the boundary of survival benefits between FDA-approved and non-approved drugs. We screened 3,463 phase 3 investigational studies initiated from January 1990 to January 2021 with survival measurement on ClinicalTrial.gov and identified 208 randomized controlled registrational trials for anticancer drugs with overall survival (OS) measurement. Among 208 studies, 79 (38%) were conducted for FDA-approved, and 129 (62%) were for FDA-non-approved drugs. The pooled mean risk reduction of death across FDA-approved drugs was 29% (Hazard ratio (HR) 0.71), whereas FDA-non-approved drugs exhibited only a 6% risk reduction in OS (HR 0.94). The probability of FDA approval showed a sharp sensitivity to the HR for OS in the logistic regression model. A boundary was observed ranging from 0.74 to 0.86 in the HR for OS, with a 50% probability of FDA approval at HR 0.80. Our findings delineate the required survival benefits for new anticancer drugs based on the clinical and regulatory outcomes over 20 years.
Quantitative Physiologic MRI Combined with Feature Engineering for Developing Machine Learning Based Prediction Models in Distinguishing Glioblastomas from Single Brain Metastases
Authors: Hosseini Seyyed Ali , Servaes Stijn , Hall Brandon , Bhaduri Sourav , Rajan Archith , Rosa-Neto Pedro , Brem Steven , Mohan Suyash , Chawla Sanjeev 
Published: October 2024

Abstract

Background
Accurate and early distinction of glioblastomas (GBMs) from single brain metastases (BMs) provide a window of opportunity for reframing treatment strategies enabling optimal and timely therapeutic interventions. We sought to leverage physiologically sensitive parameters derived from diffusion tensor imaging (DTI), and dynamic susceptibility contrast (DSC)-perfusion weighted imaging (PWI) along with machine-learning based methods to distinguish GBMs from single BMs.
Methods
Patients with histopathology confirmed GBMs (n = 62) and BMs (n = 26) and exhibiting contrast enhancing regions (CERs) underwent 3T anatomical imaging, DTI and DSC-PWI. Median values of mean diffusivity (MD), fractional anisotropy, linear, planar and spheric anisotropic coefficients, minimum MD, and maximum relative cerebral blood volume values were measured from CERs. Data normalization and scaling were performed. In the next step, most relevant features were extracted (non-interacted features), which were subsequently used to generate a set of new, innovative, high-order features (interacted features) using a feature engineering method. Finally, 10 machine-learning classifiers were employed in distinguishing GBMs and BMs. Cross-validation and receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic performance.
Results
Random forest classifier with ANOVA F-value feature selection algorithm using both interacted and non-interacted features provided the best diagnostic performance in distinguishing GBMs from BMs with a classification accuracy of 87.8%, area under the ROC curve of 92.67%, a sensitivity of 73.64%, and a specificity of 97.5%.
Conclusion
Machine learning based approach involving combined use of interacted and non-interacted physiologic MRI parameters shows promise to differentiate between glioblastoma and brain metastasis with high accuracy.
Impact of Telemedicine through Social Media: A Study of Topics in User Comments on Twitter
Authors: Martín Mario Sierra , Chen Fang-Wei , Urbistondo Pilar Alarcón 
Published: October 2024

Abstract

Background The use of new technologies has transformed society, affecting communication, information seeking and ways of working. Telemedicine, as a remote health practice through ICTs, has grown exponentially, especially after the pandemic.
Objective This qualitative study aims to explore users' perceptions and concerns about telemedicine through comments posted on Twitter by users, identifying primary, secondary and residual themes.
Methods Natural Language Processing (NLP) and Machine Learning techniques, specifically the Latent Dirichlet Allocation (LDA) model, were used to analyse 156,633 comments extracted from Twitter related to telemedicine topics.
Results The study revealed several issues to be addressed. Data was collected using keywords such as "teleconsultation" and "telemedicine". We can see that the most frequent words in the comments include words such as "health", "service", "doctor" and "patient". The themes identified were grouped into four dimensions: general information, benefits sought, specific information and professional issues. The results showed that 60.1% of the comments focused on generic telemedicine topics, ease of use and service information. Twitter queries were observed to be public and general in nature, focusing on benefits and accessibility, while disease or treatment specific topics were less frequent.
Conclusions The results provide information for the proper development and study of telemedicine through social networks. Twitter is a platform mainly used for general telemedicine queries, with convenience and accessibility as the main benefits mentioned. The results suggest that online telemedicine interactions are complex and offer valuable insights for improving telemedicine communication strategies. Future research could explore the use of hashtags and analyse differences in interaction patterns according to user profile, providing a deeper understanding of audiences' behaviour on social networks. These findings underline the importance of considering audience preferences to improve the effectiveness of telemedicine communications.
Effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients: a clinical, randomized, controlled study
Authors: Wang Xing , Ju Xia , Duan Jinjuan , Shu Teng , Xu Siqi , Wang Shengbin 
Published: October 2024

Abstract

Purpose
To observe the effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients.
Methods
Ninety patients undergoing elective laparoscopic abdominal surgery, aged 65 ~ 87 years, American society of anesthesiologists (ASA) physical status II or III, were randomly allocated into three groups: propofol group (group P), etomidate group (group E) and etomidate combined with propofol group (group EP), 30 patients in each group. Group P received 2.5 mg/kg propofol for anesthesia induction, followed by 6 ~ 8 mg·kg− 1·h− 1 propofol to maintain anesthesia. Group E received 0.3 mg/kg etomidate for anesthesia induction, followed by 0.4 ~ 0.7 mg·kg− 1·h− 1 etomidate to maintain anesthesia. Group EP received 0.2 mg/kg etomidate combined with 1 mg/kg propofol for anesthesia induction, followed by 0.2 ~ 0.4 mg·kg− 1·h− 1 etomidate combined with 4 ~ 6 mg·kg− 1·h− 1 propofol to maintain anesthesia. The incidence of postoperative pulmonary complications (PPCs) was recorded as the primary indicator. Secondary indicators included mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (T0), after tracheal intubation (T1), 30min after anesthesia induction (T2), and at the end of surgery (T3), the levels of IL-6 and TNF-α before anesthesia induction (T0), at the end of surgery (T3), and 24 hours after surgery (T4), awakening time, time to tracheal extubation, postoperative nausea and vomiting (PONV) and quality of recovery-15 (QoR-15) scale scores 1 day before and after surgery.
Results
The incidence of PPCs in group EP and group E was significantly lower than that in group P (P < 0.05). Compare with T0, the MAP and HR at T2 and T3 were more stable in group EP (P < 0.05). The levels of IL-6 and TNF-α in groups EP and E were lower than those in group P at T3 and T4 (P < 0.05). Compared with group E, the incidence of PONV was significantly lower in group EP and group P (P < 0.05). The QoR-15 scale scores in group EP were higher than that in group P and group E (P < 0.05).
Conclusion
Combination of etomidate and propofol for anesthesia can reduce the incidence of PPCs, alleviate inflammatory response, achieved better hemodynamic stability, reduce the incidence of PONV and improve the postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery.
Trial registration
ChiCTR2200065117.
Cost-Effectiveness Analysis of Second Intravenous Immunoglobulin Infusion versus Infliximab for Treating IVIG-resistant Kawasaki Disease Patients
Authors: Johnson Jada M. , Simpson Kit N. , Simpson Annie N. , Tremoulet Adriana H. , Burns Jane C. 
Published: October 2024

Abstract

Objective
Intravenous immunoglobulin (IVIG) is a known effective treatment to reduce the incidence of coronary artery aneurysms in Kawasaki disease (KD) patients. However, there has been an increase in IVIG-resistant patients and a lack of clinical trial data to determine the best second treatment. The Kawasaki Disease Comparative Effectiveness (KIDCARE) trial was a randomized trial comparing infliximab to a second IVIG infusion. Data from the trial were used for a cost-effectiveness analysis.
Methods
We developed a decision tree to estimate total costs and outcomes and calculated cost-effectiveness ratios for both treatment pathways. Cost and resource use was estimated from IBM MarketScan Commercial Database, US Bureau Labor of Statistics, IBM Micromedex Redbook and relevant peer-reviewed sources. Outcomes were measured using fever free days based on the KIDCARE study results. We addressed uncertainty using a one-way sensitivity analysis.
Results
Infliximab was the less costly treatment pathway in children with IVIG-resistant KD compared to a second dose of IVIG. The second IVIG treatment pathway cost $1,809 per additional fever free day while the infliximab treatment pathway cost $1,289 per additional fever free day. The incremental cost-effective ratio (ICER) was -$11,812 and was most sensitive to patient weight due to weight-based dosing but infliximab remained cost-effective.
Conclusions
Infliximab was the dominant economic treatment choice compared to a second dose of IVIG under a range of assumptions for both treatment patterns. This study suggests that clinicians could consider this when choosing treatment for IVIG-resistant KD patients.
Recurrence patterns in patients with low-grade intermediate-risk non-muscle invasive bladder cancer eligible for active surveillance
Authors: Zaurito Paolo , Scilipoti Pietro , Longoni Mattia , de Angelis Mario , Re Chiara , Quarta Leonardo , Tremolada Giovanni , Burgio Giusy , Pellegrino Francesco , Rosiello Giuseppe , Necchi Andrea , Colombo Renzo , Gandaglia Giorgio , Salonia Andrea , Montorsi Francesco , Briganti Alberto , Moschini Marco 
Published: October 2024

Abstract

Objective
The intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) prognostic group is heterogeneous. Growing evidence supports the role of active surveillance (AS) for patients with low-risk NMIBC, however, no clear data exists considering IR-NMIBC.
Methods
We retrospectively evaluated 174 LG IR-NMIBC patients who underwent transurethral resection of bladder tumor (TURBT) from 2012 to 2023 at a tertiary referral center and fulfilled the inclusion criteria for enrollment in AS protocols at the index TURBT (≤ 5 suspicious lesions, no macrohematuria, negative urine cytology, lesions ≤ 1cm). Patients were then stratified according to the International Bladder Cancer Group (IBCG) risk factors: frequent recurrence, early recurrence, previous instillation, and multifocality. Kaplan Meier plots and multivariable Cox regression analysis (MVA) were used to assess the risk of any and high-grade (HG) recurrence according to the number of risk factors.
Results
Overall, 168 (97%) patients had a TaLG disease. After a median follow-up of 36 months (IQR 20–54), 75 (43%) and 32 (18%) patients experienced any- and HG recurrence, respectively. The 3-year RFS was 86% [95% Confidence Interval (CI), 76–98%] for patients with 0, 76% (95% CI, 68–84%) for those with 1–2, and 54% (95% CI, 34–84%) for those with ≥ 3 risk factors. The 3-year HG-RFS was > 90% for patients with 0 and 1–2 risk factors, compared to 76% (95% CI, 58–99%) of those with ≥ 3 risk factors. At MVA, the presence of ≥ 3 risk factors was associated with a higher risk of recurrence [hazard ratio: 4.74, 95% CI: 1.75–12.8, p = 0.002].
Conclusion
Among patients with LG IR-NMIBC eligible for AS, those with more than 2 IBCG risk factors may not be suitable candidates due to a higher risk of HG recurrence. Randomized controlled trials with standardized AS protocols are necessary to validate these findings and optimize patient selection for AS in LG IR-NMIBC.
The Hidden Cost of Illness: Exploring the Relationship Between Seasonal Respiratory Illness, Self-Efficacy, and Academic Achievement of Undergraduate Science Students
Authors: White Jenna , Todd Amy M. 
Published: October 2024

Abstract

Background
Seasonal respiratory illnesses (SRIs), including COVID-19, have significantly disrupted university students' academic experiences. This study examines the impact of SRIs on key academic factors such as attendance, self-efficacy, and academic performance, alongside the effectiveness of preventative behaviours like handwashing and mask-wearing.
Methods
Undergraduate students were surveyed during the Winter 2023 Semester. The survey collected data on SRIs, self-efficacy (using the General Academic Self-Efficacy scale), perceived attendance, and academic performance. SRI scores were derived from illness frequency, duration, and severity. Analyses included descriptive statistics, correlation, and multiple linear regression.
Results
Among participants, 84.5% reported experiencing SRIs, with an average of 3.8 occurrences lasting a total of 22 days. Regular handwashing correlated with lower SRI scores (β = -1.87, p = 0.05), while mask-wearing unexpectedly correlated with higher SRI scores (β = +1.79, p = 0.02). Higher SRI scores were significantly linked to lower self-efficacy (p = 0.0011) and academic performance (p < 0.0001).
Conclusions
SRIs notably affect students' academic outcomes, likely through their impact on self-efficacy, while a diminished role for attendance on academic achievement may reflect the post-pandemic shift in instructional strategies towards online access. The unexpected link between mask-wearing and higher SRI scores suggests a need for further research on specific factors relating to the efficacy of masks in university environments. Overall findings suggest that supporting students' psychological resilience and promoting regular handwashing are critical for reducing SRIs' significant impact on academic success.
How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative
Authors: Rosales-Arreola Laura Fernanda , Ayala-Galván Citlali , Villa-Aguilar Estefany , Villegas-González Analí , Soriano-Rosales Rosa E , Pérez-Guillé Beatriz , González-Zamora José Francisco , González-Ortiz Ailema 
Published: October 2024

Abstract

Background
The rising intake of ultra-processed foods (UPFs) among children and adolescents poses challenges due to the lack of precise and accessible tools to quantify such intake. This complicates understanding its effects on dietary quality and hampers the design of effective preventive interventions across diverse socioeconomic and geographic contexts. Objective: This paper aims to determine the relationship between the UPF score and dietary characteristics.
Methods
This cross-sectional study involved 353 participants aged 3 to 17. The methods included (1) a three-day food intake record; (2) an evaluation of intake across five food groups; (3) categorization of intake frequency (0, 1, 2, or up to 3 times weekly); and (4) scoring by cumulative intake. Principal component analysis and regression models were utilized to assess diet associations with UPF score.
Results
Higher UPF score groups showed increased intake of energy, fats, and sodium (p < 0.01); decreased fiber intake (p = 0.03), vegetables, fruits, and cereals (p < 0.05); higher sugar intake (p < 0.01); and reduced intake of vitamins A and C (p < 0.05). Four principal components, representing over 65% of sample variability, identified two healthy and two less healthy dietary patterns. Linear regression indicated higher fiber intake at lower UPF scores, declining with higher UPF scores.
Conclusions
The UPF score represents a useful tool for efficiently and swiftly assessing UPF intake and dietary characteristics in pediatric population.
The Economic Impact of the Multifaceted Stroke 1-2-0 Educational Campaign in China
Authors: Yuan Jing , Wang Yong , Lu Kevin Z. , Liu Yang , Liu Renyu , Zhao Jing 
Published: October 2024

Abstract

Background
Stroke prehospital time is exceptionally long in China. The multifaceted Stroke 1-2-0 Amplifying Version Engagement (SAVE) intervention has substantially reduced onset-to-door time for patients with acute stroke in Shanghai, China. This study aimed to assess the implementation and downstream healthcare costs associated with the educational program.
Methods
Data were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from 2016 to 2019. Cost data from different years were converted into 2019 Chinese Yuan (CNY) using a 5% discount rate. We used a multivariate generalized linear model (GLM) with log-link to examine the campaign's impact on LOS and costs.
Results
The SAVE intervention was estimated to cost CNY 1,768,067 for Xinzhuang County from October 2016 to December 2019. Most costs (59.64%) were for the mass media broadcast. 2830 stroke patients met the inclusion criteria, including 490 in the pre-campaign and 2,340 in the post-campaign period. Following the multifaceted SAVE intervention, the mean (SD) LOS decreased from 9.48 (3.80) days to 8.80 (3.55) days. The mean (SD) hospitalization costs per patient dropped from ¥21950.72 (10410.74) to ¥19262.50 (12772.81) CNY (P < .01). In the GLM model, the campaign was associated with reduced LOS (Table; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P < 0.01) and hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P < 0.01).
Conclusions
Our findings suggest that the SAVE intervention generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via digital health, will need to be explored by lowering costs for personnel and mass media.
Predictability of Adult Patient Medical Emergency Condition from Triage Vital Signs and Comorbidities: A Single-Center, Observational Study
Authors: YAZICI Maral , YETER Ahmet Sefa , GENÇ Sinan , KOCA Ayça , OĞUZ Ahmet Burak , ENEYLİ Müge GÜNALP , POLAT Onur 
Published: October 2024

Abstract

Background
Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.
Methods
This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 hours, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 hours, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.
Results
A total of 10022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. The median age of patients was 46 (min-max: 18–104). Six hundred four patients presented with a MEC. 3480 (34.7%) patients had at least one comorbidity, while 5031 (50.2%) patients had at least one abnormal vital sign. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, a MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.
Conclusion
Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of a MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.
Among renal cell carcinoma subtypes, only papillary renal cell carcinoma demonstrated relevant TROP-2 positivity as a rationale for antibody-drug conjugates targeting TROP-2
Authors: Kessler Carolina , von Brandenstein Melanie , Klümper Niklas , Krausewitz Philipp , Storz Enno , Rieger Constantin , Sperber Laurenz , Paffenholz Pia , Tolkach Yuri , Nestler Tim , Wirtz Ralph , Eckstein Markus , Heidenreich Axel , Weiten Richard 
Published: October 2024

Abstract

Objective
To evaluate the expression of trophoblast cell surface antigen-2 (TROP-2), a broadly expressed antibody-drug conjugate (ADC) target, in non-clear cell renal cell carcinoma (non-ccRCC) and to conduct a proof-of-concept analysis assessing the effect of TROP-2-directed ADC Sacituzumab govitecan (SG) in RCC cell lines.
Methods
A cohort comprising a ccRCC (n=44), pRCC (n=22), chRCC (n=22), and benign tumors subcohort (n=8) including oncocytoma and angiomyolipoma, was analysed using quantitative real-time PCR, ELISA and immunohistochemical staining with evaluation of H-score. The cytotoxic efficacy of the TROP-2-targeted ADC Sacituzumab govitecan (SG) in vitro was analysed using Western Blot, FACS, and MTT assay.
Results
We observed increased TROP-2 mRNA expression levels in pRCC compared to ccRCC, chRCC and benign tumors (p<0.001). Immunohistochemical analysis revealed moderate to strong membranous TROP-2 expression in most of pRCC patients [n=20/22 with H-score ≥ 100, median H-score 265 (IQR 202.5-290)], while TROP-2 was absent or weak in patients with ccRCC and chRCC (p<0.0001). Additionally, we detected soluble TROP-2 in the serum of RCC patients, establishing a strong positive correlation with membranous TROP-2 expression (ρ=0.78, p=0.0001, R2=0.52), indicating its potential as a non-invasive biomarker for RCC. In vitro findings indicated that the efficacy of SG depended on the extent of TROP-2 expression. Notably, SG inhibited the growth of TROP-2 expressing Caki-1 cells, whereas TROP-2 negative 769-P cells were resistant to SG (p<0.01).
Conclusion
In conclusion, the substantial expression of TROP-2 in pRCC, combined with our preclinical in vitro results, provides preclinical evidence supporting the potential effectiveness of TROP-2-directed ADCs such as SG in patients with TROP-2 positive metastatic pRCC.