bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nab-paclitaxel plus S-1 followed by gemcitabine-oxaliplatin as first-line alternating sequential treatment of pancreatic ductal adenocarcinoma
Authors: Li Zhiwei , Fan Xiaona , Jiang Dan , Li Qingwei , Liu Chao , Wang Dan , Li Na , Li Hengzhen , Chen Zhuo , Tang Hongzhen , Lou Changjie , Xu Haitao , Zhan Chao , Dong Yuandi , Ma Zhigang , Wang Guangyu , Zhang Chunhui , Lu Haibo , Zheng Tongsen , Zhang Yanqiao 
Published: September 2024

Abstract

Background
Alternating sequential administration of drugs may be a promising approach to overcome chemotherapy resistance in advanced pancreatic ductal adenocarcinoma (PDAC).

Methods
This study was an open-label, single-arm, and prospective trial included patients with untreated advanced PDAC. They received 2 cycles of NS regimen (nab-paclitaxel:125 mg/m2, intravenously injected on days 1 and 8, plus S-1:40-60 mg, orally twice per day for 1-14 days) followed by 2 cycles of GemOx regimen (gemcitabine, intravenously injected on days 1 and 8, and oxaliplatin: 130 mg/m2, intravenously injected on day 1). The primary efficacy endpoint was a progression-free survival rate at 6 months (PFSR-6m). The secondary efficacy endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Specific mRNA transcripts were used to explore survival associated genes.

Results
Forty-two patients received a minimum of one treatment cycle, and of these, 30 patients completed one alternating treatment consisting of 4 cycles. The PFSR-6m was 71% (95% CI = 58%-87%). The median PFS and OS were 6.53 months (95% CI = 6.03-8.43) and 11.4 months (95% CI = 9.8-14.4), respectively. Common grades 3-4 hematological AEs included neutropenia 30.9%, leukopenia 26.2%, anemia 2.4%, and thrombocytopenia in 11.9%. Patients with OS &gt; 10 months showed high expression of HLA-DQA2 while melanoma-associated antigen genes (MAGE) were notably upregulated in patients with OS &lt; 10 months.

Conclusion
The alternating sequential administration of the NS and GemOx regimens may be a novel approach for first-line chemotherapy in patients with advanced PDAC requiring further study (ClinicalTrials.gov Identifier: ChiCTR1900024867).
Table-mounted Versus Self-retaining Retraction
Authors: Zavras Athan G. , Vucicevic Rajko S. , Federico Vincent P. , Nolte Michael T. , Sayari Arash J. , Shepard Nicholas A. , Colman Matthew W. 
Published: September 2024

Study Design:
Retrospective study.

Objective:
To determine whether there are significant differences in postoperative dysphagia when using table-mounted versus self-retaining retractor tools.

Summary of Background Data:
Retraction of prevertebral structures during anterior cervical spine surgery (ACSS) is commonly associated with postoperative dysphagia or dysphonia. Retractors commonly used include nonfixed self-retaining retraction devices or fixed table-mounted retractor arms. However, there is a paucity of literature regarding differences in dysphagia between retractor types.

Methods:
Patients who underwent ACSS and adhered to a minimum of 6-month follow-up were retrospectively evaluated. Patient-reported outcomes (PROs) were compared between table-mounted and self-retaining retractor groups at the preoperative and final postoperative time points, including the SWAL-QOL survey for dysphagia. Categorical dysphagia was assessed using previously defined values for the minimum clinically important difference (MCID).

Results:
Overall, 117 and 75 patients received self-retaining or table-mounted retraction. Average follow-up was significantly longer in the self-retaining cohort (14.8±15.0 mo) than in the table-mounted group (9.4±7.8, P=0.005). No differences were detected in swallowing function (P=0.918) or operative time (P=0.436), although 3-level procedures were significantly shortened with table-mounted retraction (P=0.005). Multivariate analysis trended toward worse swallow function with increased operative levels (P=0.072) and increased retraction time (P=0.054), although the retractor used did not predict swallowing function (P=0.759). However, categorical rates of postoperative dysphagia were lower with table-mounted retraction (13.3% vs. 27.4%, P=0.033).

Conclusions:
There was no significant difference observed in long-term swallowing dysfunction between patients who underwent ACSS with self-retaining and table-mounted retractors, although the rate of dysphagia was lower with table-mounted retraction. In addition, the greater number of operated levels per case in the table-mounted group at a similar time suggests improved efficiency.
Cardiovascular death risk in patients with solid tumors: a population-based study in the United States
Authors: Gao Shuaijie , Zhu Hao , Chang Xinyu , Cao Xiting , Wang Zhenwei , Chu Xiaoxuan , Zhang Lu , Wang Xinhua , Lu Jie 
Published: September 2024

Background
Previous studies have focused on the risk of cardiovascular disease (CVD)-specific death in hematological cancers and in some single anatomical tumor sites, there remains a paucity of data on systematic analyses in solid tumors.

Objective
The objective of this study is to evaluate the distribution, risk, and trends of CVD-specific death in patients with solid tumors.

Methods
A total of 2 679 293 patients with solid tumors diagnosed between 1975 and 2019 were screened from the Surveillance, Epidemiology and End Results (SEER) program across 15 anatomical sites. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were used to describe the intensity of CVD-specific death, competing risk regression models were used to assess the risk of CVD-specific death, and restricted cubic spline analyses were employed to investigate the potential linear or nonlinear relationship between age and CVD death.

Results
CVD-specific death in patients with solid tumors accounted for 48.95% of non-cancer deaths. Compared with the general population, patients with solid tumors had higher SMR and AER of CVD death (SMR: 1.15; AER: 21.12), heart disease-related death (SMR: 1.13; AER: 13.96), and cerebrovascular disease-related death (SMR: 1.20; AER: 4.85). Additionally, the SMR exhibited a decreasing trend with increasing time to diagnosis. Furthermore, a nonlinear relationship was observed between age and CVD-specific death in patients with solid tumors of different systems.

Conclusion
CVD-specific death accounted for a large proportion of the cause of non-cancer deaths. Patients with solid tumors exhibit an elevated risk of CVD-specific death. Screening for CVD death and optimizing risk management in patients with solid tumors throughout anticancer treatment may be beneficial in preventing CVD death.
Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam
Authors: PHAM Thi Thu Huong , WU Chia-Yi , LEE Ming-Been , NGUYEN Van Tuan , PHAM Thi Thu Hien , DANG Thanh Tung , VU Son Tung , NGUYEN Thi Son 
Published: September 2024

ABSTRACT

Background
Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression.

Purpose
This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge.

Methods
A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model.

Results
Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants.

Conclusions/Implication for Practice
Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.
A case of multiples liver metastases from a grade 2 brain meningioma: a rare entity with comprehensive literature review
Authors: Borni Mehdi , Kammoun Brahim , Taallah Marouen , Mzid Yosra , Boudawara Ons , Boudawara Mohamed Zaher 
Published: September 2024

Introduction and importance:
Meningiomas are primary benign extra-axial central nervous system neoplasms that originate in meningothelial cells. Extra-neurological metastases are quite rare and occur in 0.1% of cases. The main metastatic sites are usually the lungs, bones, pleura, mediastinum and lymph nodes. Hepatic locations are quite rare and account for ~3% of all extracranial metastases. The dissemination route is still a subject of debate. Suggested routes of dissemination include the venous system, lymph nodes, or even cerebrospinal fluid. The treatment is based on complete surgical excision or on radiosurgery and adjuvant radiotherapy in case of subtotal resection.

Case presentation:
The authors present the following clinical case of a 31-year-old healthy male patient with surgical history of meningioma excisions, who presents, 3 years later, evidence of liver masses on tomography and confirmed diagnosis of liver metastases from brain meningioma after biopsy with favorable outcomes after chemotherapy.

Clinical discussion:
The overall incidence of extra-neurological metastases of meningiomas remains low. The vast majority of these metastases concern those of high grade, namely WHO grade 2 and 3 as it was reported in our case. Hepatic metastases remain quite rare and account for ~3% of all extracranial locations. Due to these characteristics of having low recurrence and its rare frequency of metastasis to extracranial sites, the authors, through their case, will dig into the literature to dissect this rare entity.

Conclusion:
In the report of liver lesions, the first differential diagnosis in mind should be metastatic lesions, if there is a prior clinical history of primary tumors.
Prediction of hospitalization time probability for COVID-19 patients with statistical and machine learning methods using blood parameters
Authors: Motarjem Kiomars , Behzadifard Mahin , Ramazi Shahin , Tabatabaei Seyed A. H. 
Published: September 2024

Objectives:
Coronavirus disease 2019 (COVID-19) may induce life-threatening complications and lead to death in the patients.

Method:
The aim of this study was to describe a predictive model for the disease outcome (length of hospitalization and mortality) by using blood parameters results at the admission time of 201 patients with positive RT-PCR test for the infection. Variables including; age, sex, comorbidity risk factors, the length of hospitalization, and 25 blood parameters results at the time of admission were considered.

Results:
After analyzing the data, it was observed that several factors, such as hypocalcemia, hyponatremia, red blood cell microcytosis, monocytopenia, thrombocytosis, comorbidity risk factors (diabetes, dialysis, cardiovascular diseases, and hypertension), and age over 50 years had a significant impact on the length of hospitalization and mortality of the patients (P<0.05).

Conclusion:
Based on the data analysis, the authors found that the proportional hazard assumption was not established. Therefore, the authors opted to use the accelerated failure time model for our analysis. Among the various models considered, the log-normal model provided the best fit. Considering the analysis of laboratory results at the time of admission, the authors propose that thrombocytosis, red blood cell microcytosis, monocytopenia, hypocalcemia, hyponatremia, comorbidity factors, and age over 50 years can serve as predictive markers for estimating hospitalization length and mortality. These findings suggest that these factors may play a significant role in predicting patient outcomes.
The effect of median household income on the prognosis of lung adenocarcinoma: A SEER analysis
Authors: Wang Ruina , Lai Xiaofan , Huang Binying , Ning Xiaohua , Zhang Tingting 
Published: September 2024

Background:
Lung cancer is the main cause of death related to malignant tumors. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine–Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significantly how socio-economic status influences initial treatment decisions and survival outcomes in patients with lung adenocarcinoma.

Objective:
The aim of this study was to identify the predictors of lung adenocarcinoma.

Methods:
The U.S. Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with lung adenocarcinoma between 2000 and 2018. Seventeen thousand four hundred forty-one patients with lung adenocarcinoma were subdivided in four socio-economic tertiles, based on median household income. Cox regression modeling explored the relationship between race, surgery, grading, and median household income on survival outcomes. The study also assessed patient demographic characteristics, age at diagnosis, and surgical interventions.

Results:
Among 17 441 patients with primary lung adenocarcinoma, the age distribution was as follows: less than 45 years (n=202, 1.16%), between 45 and 54 years (n=1121, 6.43%), 55 and 64 years (n=4252, 24.38%), 65 and 74 years (n=6357, 36.45%), 75 and 84 years (n=4426, 25.38%), and more than 84 years (n=1083, 6.2%). The adjusted hazard ratio (aHR) with 95% CI for ages 65–74 years, 75–84 years, and older than or equal to 85 years were 0.25 (0.11,1.29), 0.40 (0.11,1.50), and 0.72 (0.11,2.05), respectively. Multifactorial Cox regression indicated that the aHR for tumor metastasis was 0.93 (0.03, 2.54), and for patients who did not undergo surgery, it was 1.46 (0.03, 4.31). Grade IV patients exhibited the lowest survival rate [0.66(0.11, 1.93)]. A notable correlation existed between median household income and survival, with distinctly lower survival rates observed in low-income groups.

Conclusion:
Older patients, especially those who did not undergo surgery and had a higher tumor grade, had significantly reduced survival. Moreover, survival rates for black patients in lower-income brackets were worse than those for white patients in the same financial category.

Implications for practice:
The quality of life of lung cancer patients is affected by low-income family.
Intestinal microbiome as a diagnostic marker of coronary artery disease: a systematic review and meta-analysis
Authors: Dean Yomna E. , Shebl Mohamed A. , Doma Mohamed , Elmezayen Rafeek W. , Loayza Pintado Jose J. , Rouzan Samah S. , Hassan Noheir Ashraf Ibrahem Fathy , Yaqout Yasmeen E. , Tokunaga Akiko , Anozie Chukwuebuka , ElKoumi Omar , Elawady Sameh S. , Mady Tamer , Nizam Sana N. , Etman Yasser , Nizam Rayees , Hazimeh Yusef , Alazmy Mohamed , Aiash Hani 
Published: September 2024

Background:
The intestinal microbiome has been recently linked to several metabolic and chronic disorders, one of which is coronary artery disease (CAD). Our study aimed to analyze the intestinal microbiome of CAD patients and assess the eligibility of dysbiosis as a diagnostic marker of CAD.

Methods:
PubMed, Scopus, Embase, and Web of Science were searched using terms, such as ‘CAD’ and ‘microbiome’. Only observational controlled studies were included. R version 4.2.2 was used for the analysis.

Results:
A significant association was found between the CAD group and increased Simpson and Shannon Indices compared with the control group (MD=0.04, 95% CI=0.03–0.05, and MD=0.11, 95% CI=0.01–0.22, respectively). Our analysis yielded a statistically significant association between the CAD group and increased Prevotella genus (MD=13.27, 95% CI=4.12–22.42, P-value=0.004), Catenibacterium genus (MD=0.09, 95% CI=0.09–0.10), Pseudomonas genus (MD=0.54, 95% CI=0.29–0.78, P-value), and Subdoligranulum (MD=−0.06, 95% CI=−0.06 to −0.06) compared with the control group. Another significant association was detected between the CAD group and decreased Bacteroides vulgatus and Bacteroides dorei (MD=−10.31, 95% CI=−14.78 to −5.84, P-value <0.00001).

Conclusion:
Dysbiosis is an acceptable diagnostic marker of CAD. Decreased B. dorei and B. vulgatus among CAD patients suggests a protective role of these bacteria. Future clinical trials are necessary to investigate the potential benefit of supplementation of these bacteria in treating or preventing CAD.
A complex case of PASH syndrome: pyoderma gangrenosum, acne, suppurative hidradenitis, and Crohn’s disease in a 36-year-old smoker
Authors: Abdul Rahman Noura , Jazmati Aya , Roumi Jamal Bakri , Darwish Israa , Kouja Doaa , Ishkhanian Silva 
Published: September 2024

Introduction and importance:
PASH syndrome, is autoinflammatory condition driven by immune system dysfunction, resulting in elevated interleukin 1 levels and subsequent production of proinflammatory cytokines and chemokines. The clinical progression of PASH typically starts with acne conglobate in adolescence, followed by hidradenitis suppurativa, and pyoderma gangrenosum. Diagnosis relies on recognizing these hallmark features, but treatment remains a challenge despite current understanding. Conventional immunosuppressive therapies have shown limited efficacy in managing PASH syndrome.

Case presentation:
The authors present a 36-year-old man with a complex combination of pyoderma gangrenosum, acne, suppurative hidradenitis, obesity, and Crohn’s disease. The patient’s symptoms began in adolescence with acne and recurrent furuncles, evolving into painful skin ulcers and fistulas over time. Histological examination confirmed the diagnosis of pyoderma gangrenosum. Despite various treatment modalities, including isotretinoin, cyclosporine, azathioprine, and adalimumab, the patient experienced only partial improvement until receiving Infliximab, which led to remarkable improvement.

Discussion:
PASH syndrome, a rare neutrophilic dermatosis linked to autoinflammatory conditions like Braun Flaco, is characterized by Pyoderma gangrenosum, acne, and suppurative hidradenitis. This clinical entity presents diagnostic challenges due to its unique features and association with obesity and bowel diseases, such as Crohn’s disease. Treatment options, including TNF-α blockers like Infliximab, have shown promising results in controlling cutaneous manifestations. Our case study underscores the complexity of treating PASH syndrome and highlights the importance of personalized therapeutic approaches for optimal outcomes.

Conclusion:
PASH syndrome presents significant diagnostic and treatment challenges due to its complex symptomatology and associations with conditions like Crohn’s disease. The case of a 36-year-old man demonstrates the partial efficacy of conventional therapies and highlights the promising results of infliximab. This underscores the need for personalized treatment strategies and ongoing research to improve outcomes for patients with this rare and intricate syndrome.
Unanticipated diagnosis of Swyer syndrome: a case report
Authors: Giri Kanti Prabha , Thapa Sumana , Rawat Rohit , Rouniyar Sangam 
Published: September 2024

Introduction and importance:
Swyer syndrome or complete/pure gonadal dysgenesis, a rare genetic disorder, presents with a female phenotype despite a 46, XY karyotype. The case highlights the importance of early diagnosis and management in XY females to prevent gonadal malignancy and facilitate proper growth of secondary sexual characteristics of the patient by initiating hormone replacement therapy (HRT).

Case presentation:
A 15-year-old female presented with lower abdominal pain, seeking an investigation, ultrasonography revealed the non-visualization of the uterus. Further examination with MRI revealed a hypoplastic uterus and non-visualization of ovaries. Clinical examination and diagnostic laparoscopy along with karyotype analysis confirmed the diagnosis of Swyer syndrome, prompting bilateral Salpingo-oophorectomy and initiation of HRT after the surgery. Follow-up showed improvement in the growth of the uterus and secondary sexual characteristics.

Clinical discussion:
Case discussion explores into the unique clinical findings of Swyer syndrome, emphasizing the importance of differentiating it from other disorders of sex development (DSD) like Mayer–Rokitansky–Küster–Hauser syndrome and androgen insensitivity syndrome. Genetic and hormonal aspects of the condition are also explored in relation to the patient’s presentation and management.

Conclusion:
The case highlights the significance of early diagnosis and comprehensive management of Swyer syndrome. It emphasizes the need for multidisciplinary care, including fertility counseling and psychological support, in addressing the complexities of rare genetic disorders like Swyer syndrome. The key message includes the importance of considering Swyer syndrome in cases of primary amenorrhea, the benefits of early surgical intervention, and the necessity of psychological support for patients.
A case of hypertensive crisis following administration of nonionic low molecular weight contrast in hemorrhagic stroke patient: a case report
Authors: Akkash Nour , Alshutaihi Mohamad S. 
Published: September 2024

Introduction:
Radiocontrast agents can be iodinated or noniodinated. Iodinated agents are further divided into low and high molecular weights. In recent decades, LOCM has largely replaced the use of HOCM due to safety concerns, but an increasing number of severe side effects cases have been reported.

Case presentation:
A 62-year-old woman presented with acute right hemiparesis. A CT scan revealed ICH with IVH. A contrasted CTA was ordered, during which Iohexol was administered. Shortly after the injection, she developed a hypertensive crisis. She was transferred to the ICU, intubated, and given labetalol. Repeated CT scan showed increased IVH with posterior edema. Her family declined surgical intervention. Unfortunately, she died.

Discussion:
This represents a unique adverse effect of a low molecular weight contrast agent that has been rarely reported before, particularly in pheochromocytoma patients. Nevertheless, our patient had subtle hypertension that was revealed during hospital admission but without pheochromcytoma.

Conclusion:
This case represents an unusual instance of a severe adverse. It suggests that the malignant rise in blood pressure may not be catecholamine-induced.