bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting the Survival of Metastatic Breast Cancer Patients Treated With Cdk 4/6 Inhibitors
Authors: Isleyen¹ Zehra Sucuoglu , Muglu² Harun , Topcu³ Zeynep Alaca , Besiroglu³ Mehmet , Yasin¹ Ayse Irem , Topcu¹ Atakan , Simsek¹ Melih , Seker¹ Mesut , Turk¹ Haci Mehmet 
Published: October 2024

Abstract

Objective
We aim to determine the efficacy, and the factors associated with the effectiveness of first-line CDK4/6i (ribociclib or palbociclib) in HR-positive, HER2-negative MBC patients.
Material and method
This is a retrospective, cross-sectional, and descriptive study. Ninety patients with metastatic breast cancer receiving CDK 4/6i from three different oncology clinics were included in the study.
Results
Of the patients, 56 (62.2%) had received ribociclib, and 34 (37.8%) palbociclib. There was no significant difference between the groups regarding age, gender, comorbidities, ECOG performance status, and menopausal status (p>0.05). The cut-off values for ER, PR, and Ki-67 levels were determined by ROC curve analysis. It was found as 80% for ER level, 50% for PR level, and 30% for Ki-67 level. PFS was significantly longer in patients with ER-level greater than 80% and Ki-67 expression less than 30% in multivariate analysis. Among the patients included in our study, the median PFS was 22.41 months in the patients with only a Ki-67 level of 30% and above, while the median PFS was 17.24 months in the patients with only an ER level of 80% and below. In the patients with a combined ER of 80% or less, and a Ki-67 of 30% or more, the median PFS was 12.42 months (p<0.001).
Conclusion
This study demonstrated that CDK4/6i therapies had longer PFS in patients with ER levels greater than 80% and Ki-67 expression less than 30%. It is essential to determine which patient group benefits more from first-line CDK4/6is.
PAX5 expression and its diagnostic utility in gastroenteropancreatic neuroendocrine neoplasm
Authors: Wang Kun , Liu Xiaoying , Zhao Jie , Li Yanchun , Chen Zhihong 
Published: October 2024

Abstract

Background: Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) are common tumors of the digestive system. Although their histological diagnosis is usually straight forward, their differential diagnosis between neuroendocrine tumors G3(NETs G3) and neuroendocrine carcinomas (NECs) may be challenging at times. Because they have the similar immunophenotypes and morphology in a small cases. The previously reported revealed PAX5 expression in poorly differentiated neuroendocrine carcinoma of the gastrointestinal and pancreatobiliary tract, small cell carcinoma of lung and merkel cell carcinoma. However, above study only focused on poorly differentiated neuroendocrine carcinoma, cases of NET G1, G2 and G3 were not included.
Aims and Methods: The objective of this study is to assess the expressed and diagnostic value of PAX5 in the GEP-NENs. Immunohistochemical(IHC) analysis for PAX5 was carried out in a large cohort of GEP-NENs comprising 39 GEP-NECs and 62 GEP-NETs.
Results: Using a semi-quantitative scoring method, PAX5 was expressed in 30 out of 39 GEP-NECs (77%), with 27 out of 39 cases (69%) showing positivity in ≥10% of cells. Especially in GEP-NECs with a high proliferative index, there were more PAX5-positive cells. None of cases of GEP-NET G1 and G2 expressed PAX5. Only 2/12 cases GEP-NET G3(17%) was positive for PAX5, with showing PAX5 positivity in 1-10%% of cells and 10-50%, respectively. The difference in PAX5 expression between GEP-NETs and GEP-NECs was obviously statistically significant(3% vs. 76%, P<0.001).
Conclusions: PAX5 can be used as a complementary diagnostic immunohistochemical marker for GEP-NECs. Additionally, PAX5 can be considered in cases when it is difficult to distinguish between GEP-NECs and GEP-NET G3.
Predicting severe radiation pneumonitis in patients with locally- advanced non-small cell lung cancer after thoracic radiotherapy: Development and internal validation of a nomogram based on the clinical, hematological and dose–volume histogram parameters
Authors: Zhang Ying , Yan Yu-Jie , Zhou Shi-Hong , Wu Lei-Lei , Yuan Xiao-Shuai , Hu Min , Kang Jing-Jing , Jiang Chen-Xue , Zhu Yao-Yao , Yang Shuang-Yan , Zhao Rui-Feng , Hu Jian , Hu Min-Ren , Liu Hui , Liu Liang , Zhao Lan , Xu Ya-Ping 
Published: October 2024

Abstract

Purpose
Severe radiation pneumonitis (grade≥3 RP) remains an important dose-limiting toxicity after thoracic radiotherapy (RT). This study aimed to investigate risk factors for severe RP in patients with locally-advanced non-small cell lung cancer (NSCLC) after thoracic RT, develop a prediction model to identify high-risk groups and investigate impact of severe RP on overall survival (OS).
Methods
We retrospectively collected clinical, hematological and dosimetric factors from 351 stage-Ⅲ NSCLC patients after thoracic RT between 2018 and 2022. The primary endpoint was development of severe RP. The secondary endpoint was OS. Logistic regression and least absolute shrinkage and selection operator (LASSO) regression analysis were used to identify risk factors of severe RP. Nomogram was generated based on multivariate regression coefficients. Area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA) were conducted to validate the model. After a long-term follow-up, OS of patients with RP vs. non-RP and mild RP vs. severe RP groups was analyzed by Kaplan‒Meier method.
Results
ILD (p<0.001), percentage of contralateral lung volume receiving≥5Gy (contraV5) (P=0.013), percentage of ipsilateral lung volume receiving≥20Gy (ipsiV20)(P=0.039), pre-RT derived neutrophil lymphocyte ratio (dNLR) (P=0.015) and post-RT systemic inflammation response index (SIRI) (p=0.001) were showed to be independent predictors of severe RP and were included in the nomogram. ROC curves revealed the AUC of the nomogram was 0.782. Calibration curves showed favorable consistency, and DCA showed satisfactory positive net benefits of the model. Median follow-up time was 19.8 months (1.4-52.9 months), and cases who developed severe RP showed shorter OS than those developed mild RP (P=0.027).
Conclusion
We identified that ILD, contraV5(>11%), ipsiV20(>45%), pre-RT dNLR (>1.9) and post-RT SIRI (>3.4) could predict severe RP among patients with locally-advanced NSCLC receiving thoracic RT. Combining these indicators, a nomogram was first built and validated, showing its potential value in clinical practice.
Prediction of Delivery Mode in Primiparous Women Based on Clinical and Intrapartum Ultrasound Parameters
Authors: Huang Chunxia , Chen Yu 'e , Zhang Yuxia , Lin Weiru , Guo Qiuling , Cai Zhundun , Lyu Gourong 
Published: October 2024

Abstract

Objective: To monitor intrapartum ultrasound in primiparous women entering the first stage of labor and construct a model to predict the delivery mode for these women.
Materials and Methods: A total of 203 full-term singleton primiparous women admitted to our hospital for vaginal delivery between February 2022 to November 2023 were included. Initially, cervical dilation and fetal presentation were assessed by midwives through vaginal examination. Subsequently, ultrasound monitoring of the labor progress was conducted, with both assessments conducted blindly. Measurements were performed according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines, including abdominal assessment of fetal presentation and transperineal measurements of the angle of progression (AOP), head-perineum distance (HPD),progression distance (PD), and midline angle (MLA). Three measurements were performed for each parameter, and the average values were calculated. The participants were divided into a vaginal delivery group (163 cases) and a cesarean section group (40 cases) based on the delivery outcome. Clinical and ultrasound parameters were analyzed to determine differences between the two groups. Multiple logistic regression analysis was conducted to identify the independent influencing factors, and a nomogram was constructed. The robustness of the model was assessed and its clinical effectiveness was evaluated,which was then externally validated.
Results: (1) Maternal height, weight, gestational age, estimated fetal weight (EFW), maternal gestational diabetes, and maternal preeclampsia showed no statistical differences (P > 0.05), whereas epidural analgesia, fetal presentation, AOP, MLA, HPD, and PD exhibited significant differences (P < 0.05). (2) Multiple logistic regression analysis revealed that epidural analgesia, fetal presentation, AOP, and HPD were independent factors influencing vaginal delivery. The constructed nomogram exhibited a sensitivity of 74.2%, a specificity of 77.5%, and an area under the curve (AUC) of 0.808 (95% confidence interval: 0.729-0.886). (3) The nomogram prediction model was externally validated,and the constructed nomogram exhibited a sensitivity of 78.3%, a specificity of 80.0%, and an area under the curve (AUC) of 0.839 (95% confidence interval: 0.717-0.961).
Conclusion: Epidural analgesia, fetal presentation, AOP, and HPD were identified as independent factors influencing vaginal delivery in primiparous women. The nomogram model based on clinical and intrapartum ultrasound parameters demonstrated robustness and effectiveness, providing a valuable tool for predicting delivery mode.
The Endobiota-estrobolome Study in Reproductive aged Women with Ovarian Endometriosis
Authors: Hu Chia-Yu , Pai Angel Hsin-Yu , Wang Yi-Wen , Lu Pei-Chen , Wu Hsien-Ming , Huang Hong-Yuan 
Published: October 2024

Abstract

Background
The human body harbors greater than 10 trillion symbiotic, microbial cells that contribute to our bodily functions. Emerging evidences suggest that dysbiosis, especially of the gut or urogenital system, may induce various pathological conditions or altered estrobolome and associate with certain estrogen-dependent diseases like endometriosis. The present case-control study analyzed the enzymatic expressions, bacterial compositions, and variations of estrogen metabolites in fecal, vaginal, and urinary samples of patients with or without ovarian endometriosis.
Methods
A total of 38 women of reproductive age, 24 with pathologically-proven ovarian endometriosis and 14 without (control), were analyzed. Recruited patients provided stool, urine, and vaginal samples before undergoing surgeries for ovarian endometriosis or other benign ovarian tumors. Gut enzymatic assays of β-glucuronidase and β-glucosidase were conducted using an ELISA spectrophotometer. Advanced liquid chromatography and mass spectrometry analyzed estrogen and 14 estrogen metabolites in stool, urine, and vaginal samples. Gut and vaginal microbiota were detected with 16S ribosomal-RNA gene sequencing and further classified with Institute of Genome Sciences bioinformatics pipeline. Analyses for species composition, diversity, and abundance were compared between the ovarian endometriosis and control groups. Statistical significance was determined using t-tests and Wilcoxon tests (p < 0.05).
Results
While similar gut β-glucuronidase activities, microbial diversity, and abundance were observed in the fecal samples of both groups, the gut microbiota of the control group showed higher prevalence of Rothia genus whereas genera such as Megamonas, [Eubacterium] coprostanoligenes_group, Allisonella, Ruminiclostridium_5, [Eubacterium] hallii_group, and Negativibacillus were significantly more abundant in the ovarian endometriosis group. Meanwhile, besides statistically lower folds of 4-methoxyestrone (p = 0.046), 2-methoxyestrone (p = 0.043), and 2-hydroxyestrone-3-methyl ether (p = 0.006), vaginal samples of patients with endometriosis also revealed significantly lower bacterial abundance, diversity, richness, and evenness.
Conclusions
While the current findings did not demonstrate obvious dysbiosis in patients with ovarian endometriosis, variations in certain genera and families of bacteria between the two groups could indicate altered estrogen metabolism or disturbed urogenital and gastrointestinal microbiota.
Improving cervical cancer screening participation by introducing HPV vaginal self-sampling to women living with HIV in Denmark – a cross-sectional study
Authors: Svensgaard Siri Nana Halling , Tranberg Mette , Andersen Berit , Petersen Lone Kjeld , Storgaard Merete , Jespersen Sanne 
Published: October 2024

Abstract

Background:
Cervical cancer, despite being largely preventable through vaccination and screening, continues to pose a significant global health challenge. Women living with HIV (WLWH) are at a six-fold higher risk of developing cervical cancer, primarily due to persistent infection with high risk HPV (hrHPV). While effective screening methods have the potential to reduce this risk, WLWH remain inadequately screened.
The aims of this study were fourfold: To estimate the proportion of WLWH who are not screened according to WHO guidelines; to establish the proportion of WLWH who accepted the self-sampling offer; to estimate the hrHPV DNA prevalence; and to estimate the compliance to follow-up among women with a hrHPV-positive vaginal self-sample.
Methods:
This single-centre, cross-sectional study was conducted from February to May 2022 at the Department of Infectious Diseases, Aarhus University Hospital, Central Denmark Region. Eligible women were contacted by phone and invited to participate. Participants were provided with a self-sampling kit and detailed instructions. The collected samples were analysed for hrHPV DNA. Demographic, clinical, and screening history data were obtained from medical records and the Danish Pathology Databank.
Results:
Of the 100 eligible participants, 50 (50%) accepted the offer of self-sampling, and 40 (80%) returned their samples for analysis. The prevalence of hrHPV among these women was 25%. Follow-up compliance among hrHPV-positive women was 40%. The analysis revealed that 42% of WLWH had not been screened in accordance with WHO guidelines, and 18% had never undergone screening. No significant differences were observed in demographic or clinical characteristics between participants and non-participants.
Conclusions:
Our study highlights a substantial gap in cervical cancer screening among WLWH. Although home-based hrHPV self-sampling was well-received, overall participation and compliance to follow-up HPV-screen positive were insufficient. To improve cervical cancer prevention, more personalized and clinic-based screening strategies, combined with enhanced follow-up procedures, are essential. Addressing these barriers is critical to improving health outcomes and reducing the incidence and mortality of cervical cancer among WLWH.
Trial registration:
The Central Denmark Region Committee on Health Research Ethics deemed this study as a quality improvement study on the 9th of November 2021 (request approval j.no: 204/1-10-72-274-21). Clinical trial number: Not applicable.
Surgical Training Outcomes Using a Mixed Reality Combination System
Authors: Kabuye Ernest , Bone Jennifer , Hudson Andrew , Feinberg Adam , Sangimino Mark , Cagan Jonathan , LeDuc Philip 
Published: October 2024

Abstract

A significant number of medical errors are surgical, when patients are in the operating room, and are also a prominent cause of death. Prior work introduced a Mixed Reality Combination System (MRCS) that integrates Augmented Reality (AR) technology, an inertial measurement unit (IMU) sensor, and 3D-printed, collagen-based specimens to enable realistic and versatile synthetic environments for surgical training, with the goal of alleviating this issue. The MRCS creates an iterative learning scenario that allows a user to pick up a skill set in a limited time. This paper demonstrates the advantages of the MRCS technology through human subjects studies that assess its effectiveness. Results from a controlled study show that the MRCS study participants are 25% better at task execution, reach a net zero difference in expected task outcomes in 75% of the cases, and demonstrate self-confidence in their surgical skills compared to the non-MRCS study participants. A second qualitative study with medical residents demonstrates MRCS’s proposed benefit as a training tool in a medical school curriculum. This work has the potential to benefit future surgical training and surgical planning.
Cost minimization analysis between iron saccharate and ferric carboxymaltose in the treatment of iron deficiency anemia: a real life cohort study
Authors: Braga Renan Camilo , Rabello Bianca Pimentel de Andrade Barbosa , de Almeida-Neto César , Corrêa Lorena Costa , de Oliveira Fábio Henrique Cavalcanti 
Published: October 2024

Abstract

Background Approximately 20 to 30% of the Brazilian population is anemic. Specialized hospitals tend to serve a population with a high incidence of iron deficiency anemia, routinely administering intravenous (IV) iron therapy. Ferric hydroxide sucrose (FHS) and ferric carboxymaltose (FCM) are IV iron compounds used in Brazil. Due to differences in administration time, daily dose limits, pharmacodynamics, and vial prices, it is necessary to develop an economic feasibility analysis to better allocate resources. This study aims to deepen the discussion on public health management in economically peripheral regions such as the Northeast, addressing health economics as a strategic response.Methods This is a real-world, retrospective cohort study of cost-minimization conducted at a hospital specialized in gynecology and obstetrics in Northeast Brazil. A total of 834 records of IV iron usage were evaluated from 09/13/2022 to 04/25/2024, with this sample selected for convenience. All patients underwent treatment for iron deficiency anemia with FCM or FHS. The acquisition cost per vial for FCM and FHS was $97,69 and $1,82, respectively. Among the variables computed, following economic evaluation guidelines, were vial cost, infusion cost, outpatient consultation, daily medical clinical hospitalization cost, and follow-up cost, based on the institution's actual costs and national databases.Results Of the 834 records, 644 were for FHS and 190 for FCM. A total of $37.124,69 was spent on acquiring FCM and $11.766,77 on FHS. The minimum individual cost for treating iron deficiency anemia is $257,90 for FCM and $641,07 for FHS. The cost of treating 644 patients with FHS was $412.849,08, while the estimated cost of treatment with FCM for the same 644 patients would be $166.087,60.Conclusion Treatment of iron deficiency anemia with FHS proved to be approximately 148% more expensive. The use of FCM leads to cost reductions, allowing for better allocation of public financial resources, as well as shorter hospitalization times and fewer invasive procedures.
The utility of individualized interactive 3D virtual models for improving patient and resident education in robotic partial nephrectomy
Authors: Hochberg Aaron R. , Raghavan Rajiv , Monane Rachel , Belko Sara , Lavine Isabel B. , Im Brian H. , Dispagna Mauro , Pugliese Robert , Lallas Costas D. 
Published: October 2024

Abstract

Introduction:
Robotic partial nephrectomy (RAPN) requires careful planning due to high anatomical variability between patients presenting challenges during counseling on the surgery, anatomy, and risks. 3D digital modeling provides an opportunity to address this issue. Prior studies predominantly investigate the use of 3D printed models which have limitations including cost. This study seeks to assess the utility of an individualized interactive 3D virtual model for patient counseling and surgical trainee education for RAPN.
Methods:
Patient-specific virtual 3D models were derived from imaging of 32 patients to undergo RAPN at Thomas Jefferson University Hospital between October 2023 and April 2024. Patients filled out surveys pre and post model exposure to assess their understanding of their kidney, pathology, the surgery, and its risks. Surgical trainees filled out pre and post model surveys and post-operative surveys to assess the impact of the model on surgical understanding and patient counseling.
Results:
Patient understanding of their kidney, pathology, and surgery all significantly improved after viewing the model (p < 0.05) Both patients and trainees found the model to be helpful (averaging > 9 out of 10) across all assessed domains of patient counseling and education. The model was not found to be significantly associated with improved trainee confidence in anatomy and surgical planning.
Conclusion:
This study shows that an interactive 3D virtual model is a useful adjunct to patient education prior to RAPN from both the patient and provider experience and can serve as a less resource-intensive alternative to 3D printed modeling for this application.
Timely reduction of triglyceride in patients with different severity of hypertriglyceridemia-associated acute pancreatitis：secondary analysis of a multicenter, prospective cohort study
Authors: Luo Xiang , Li Xiaoling , Lai Xiaoyan , Mao Wenjian , Ke Lu , Fu Lingyan , Gao Lin , Liu Yaolu 
Published: October 2024

Abstract

Objectives
It is controversial whether rapid lowering of triglyceride (TG) levels was associated with clinical benefits in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP). Particularly, patients with different severity of disease may respond differently to TG-lowering therapy. In this study, we aimed to explore the association between timely reduction in serum TG levels and organ failure in patients with different severity of HTG-AP.
Methods
This is a secondary analysis of data from a multicenter, prospective registry recruiting HTG-AP patients (plasma TG levels > 11.3mmol/L at admission) admitted within 72 hours from the onset of symptoms. Patients were dichotomized into either target reaching (TG ≤ 5.65 mmol/L on study day 3) or not. The primary outcome was the presence of organ failure on day 14. The association between target-reaching and the primary outcome was modelled. Furthermore, subgroup analyses were conducted based on the disease severity of HTG-AP patients at enrollment (with vs. without organ failure, predicted severe vs. predicted non-severe based on APACHEII score).
Results
Overall, 413 patients were included for analysis, of whom 192 (46.5%) patients reached the target on day 3. For the overall study cohort, there was no significant difference in presence of organ failure at day 14 between patients reaching the target or not (3.1% vs. 6.8%, p = 0.091). In the subgroup of HTG-AP patients with organ failure at enrollment, compared to patients with TG > 5.65mmol/L on day 3, patients who reached the target had significantly lower presence of organ failure at day 14 (7.8% vs. 22%, p = 0.039), and the results remain unchanged after adjustment for potential confounders (p = 0.027). In the subgroup of more severe HTG-AP patients (APACHE II ≥ 8), there was also lower presence of organ failure at day 14 (5.8% vs. 17.7%, p = 0.044) and lower incidence of IPN within 60 days (1.4% vs. 11.3%, p = 0.036) in patients who reached the target.
Conclusion
Timely reduction of serum TG levels was associated with decreased presence of organ failure at day 14 in patients with more severe HTG-AP.