bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health care utilization and costs for frail vs nonfrail patients with diffuse large B-cell lymphoma
Authors: Vijenthira Abi , Calzavara Andrew , Nagamuthu Chenthila , Kaliwal Yosuf , Liu Ning , Blunt Danielle , Alibhai Shabbir , Prica Anca , Cheung Matthew C. , Mozessohn Lee 
Published: July 2024

Abstract
Half of older patients with diffuse large B-cell lymphoma (DLBCL) receiving curative-intent treatment are frail. Understanding the differences in health care utilization including costs between frail and nonfrail patients can inform appropriate models of care. A retrospective cohort study was conducted using population-based data in Ontario, Canada. Patients aged ≥66 years with DLBCL who received frontline curative-intent chemoimmunotherapy between 2006 and 2017 were included. Frailty was defined using a cumulative deficit–based frailty index. Health care utilization and costs were grouped into 5 phases: (1) 90 days preceding first treatment; (2) early treatment (0 to +90 days after starting treatment); (3) late treatment (+91 to +180 days); (4) follow-up (+181 to –181 days before death); and (5) end of life (last 180 days before death). Costs were standardized to 30-day intervals (2019 Canadian dollars). A total of 5527 patients were included (median age, 75 years; 48% female). A total of 2699 patients (49%) were classified as frail. The median costs for frail vs nonfrail patients per 30 days based on phase of care were (1) $5683 vs $2586 ; (2) $13 090 vs $11 256; (3) $5734 vs $4883; (4) $1138 vs $686; and (5) $11 413 vs $9089; statistically significant in all phases. In multivariable modeling, frail patients had higher rates of emergency department visits and hospitalizations and increased costs than nonfrail patients through all phases except end-of-life phase. During end-of-life phase, a substantial portion of patients (n = 2569 [84%]) required admission to hospital; 684 (27%) required intensive care unit admission. Future work could assess whether certain hospitalizations are preventable, particularly for patients identified as frail.
Health risk assessment of potentially toxic elements in the riparian zone of the Sava River (southeastern Europe): effects of high and low water events
Authors: Jonjev Milica , Miletić Zorana , Pavlović Dragana , Matić Marija , Čakmak Dragan , Mitrović Miroslava , Pavlović Pavle 
Published: July 2024

AbstractThis study evaluated the source apportionment and level of contamination with potential toxic elements (PTEs)—As, Cd, Cr, Cu, Ni, Pb and Zn—in a riparian zone of the Sava River by calculating the Enrichment Factor (EF) and the Geo-Accumulation Index (Igeo). The study analysed the non-carcinogenic and carcinogenic health risks to both adults and children in the local population. Soil and sediment samples collected during high and low water events from 12 sites along 945 km of the river were screened. Elevated soil contents of As, Cr, Cu, Ni, and Zn were observed along the middle and lower stretches from Županja (ZUP) to Belgrade (BEO), and an elevated Cu content was detected in the upper stretch Čatež (CAT), highlighting these elements as a potential risk for the human population. Elevated As, Cd Cr, Ni, and Zn levels in the sediment were also detected, with the Ni content three times higher than the Permissible Exposure Limit (PEL) values, indicating high contamination. The study established that As, Cr, and Ni primarily originate from geological sources; Cu, Pb, and Zn are predominantly from anthropogenic sources; and Cd originates from both geological and anthropogenic sources. Although the EF and Igeo varied along the entire river stretch, they were significantly higher for most elements in the lower stretch, indicating intensive anthropogenic contamination and potential health risks. The carcinogenic and non-carcinogenic risks associated with soils and sediments during high and low water events did not imply a potential risk for adults. However, As, Cd, Cr, and Pb potentially pose the greatest non-carcinogenic risk for children in both high and low water events, with ingestion as the main route of exposure. According to our findings, the elevated concentrations of As, Cd, Cr, and Pb in the Sava River basin (SRB) pose a significant potential health risk to the local population based on several factors: the high levels of these elements, their potential contamination risk as determined by the EF and Igeo, and their bioavailability and solubility. Although the cumulative Total Hazard Index (THI) and Total Carcinogenic Risk (TCR) values are low, particularly in the lower stretch of the Sava River, these elements still present a high potential health threat.
Investigation of gyrA and parC mutations and the prevalence of plasmid-mediated quinolone resistance genes in Klebsiella pneumoniae clinical isolates
Authors: Rezaei Sepideh , Tajbakhsh Saeed , Naeimi Behrouz , Yousefi Forough 
Published: July 2024

Abstract
Background
The emergence of fluoroquinolone resistance in clinical isolates of Klebsiella pneumoniae is a growing concern. To investigate the mechanisms behind this resistance, we studied a total of 215 K. pneumoniae isolates from hospitals in Bushehr province, Iran, collected between 2017 and 2019. Antimicrobial susceptibility test for fluoroquinolones was determined. The presence of plasmid mediated quinolone resistance (PMQR) and mutations in quinolone resistance-determining region (QRDR) of gyrA and parC genes in ciprofloxacin-resistant K. pneumoniae isolates were identified by PCR and sequencing.

Results
Out of 215 K. pneumoniae isolates, 40 were resistant to ciprofloxacin as determined by E-test method. PCR analysis revealed that among these ciprofloxacin-resistant isolates, 13 (32.5%), 7 (17.5%), 40 (100%), and 25 (62.5%) isolates harbored qnrB, qnrS, oqxA and aac(6’)-Ib-cr genes, respectively. Mutation analysis of gyrA and parC genes showed that 35 (87.5%) and 34 (85%) of the ciprofloxacin-resistant isolates had mutations in these genes, respectively. The most frequent mutations were observed in codon 83 of gyrA and codon 80 of parC gene. Single gyrA substitution, Ser83→ Ile and Asp87→Gly, and double substitutions, Ser83→Phe plus Asp87→Ala, Ser83→Tyr plus Asp87→Ala, Ser83→Ile plus Asp87→Tyr, Ser83→Phe plus Asp87→Asn and Ser83→Ile plus Asp87→Gly were detected. In addition, Ser80→Ile and Glu84→Lys single substitution were found in parC gene.

Conclusions
Our results indicated that 90% of isolates have at least one mutation in QRDR of gyrA orparC genes, thus the frequency of mutations was very significant and alarming in our region.
Immunological profiling for short-term predictive analysis in PD-1/PD-L1 therapy for lung cancer
Authors: Wang Yun , Chen Rujia , Guo Zhenzhou , Wei Wei , Wang Ting , Ouyang Renren , Yuan Xu , Xing Yutong , Wang Feng , Wu Shiji , Hou Hongyan 
Published: July 2024

Abstract
Background
Immune checkpoint inhibitors, such as anti-programmed cell death-1 (PD-1) and PD-1 ligand-1 (PD-L1) antibodies, have achieved breakthrough results in improving long-term survival rates in lung cancer. Although high levels of PD-L1 expression and tumor mutational burden have emerged as pivotal biomarkers, not all patients derive lasting benefits, and resistance to immune checkpoint blockade remains a prevalent issue. Comprehending the immunological intricacies of lung cancer is crucial for uncovering the mechanisms that govern responses and resistance to immunomodulatory treatments. This study aimed to explore the potential of peripheral immune markers in predicting treatment efficiency among lung cancer patients undergoing PD-1/PD-L1 checkpoint inhibitors.

Methods
This study enrolled 71 lung cancer patients undergoing PD-1/PD-L1 inhibitor therapy and 20 healthy controls. Immune cell subsets (CD4 + T cells, CD8 + T cells, B cells, NK cells, and NKT cells), phenotypic analysis of T cells and B cells, and PMA/Ionomycin-stimulated lymphocyte function assay were conducted.

Results
Lung cancer patients exhibited significant alterations in immune cell subsets, notably an increased percentage of Treg cells. Post-treatment, there were substantial increases in absolute numbers of CD3 + T cells, CD8 + T cells, and NKT cells, along with heightened HLA-DR expression on CD3 + T and CD8 + T cells. Comparison between complete remission and non-complete remission (NCR) groups showed higher Treg cell percentages and HLA-DR + CD4 + T cells in the NCR group.

Conclusion
The study findings suggest potential predictive roles for immune cell subsets and phenotypes, particularly Treg cells, HLA-DR + CD4 + T cells, and naïve CD4 + T cells, in evaluating short-term PD-1/PD-L1 therapy efficacy for lung cancer patients. These insights offer valuable prospects for personalized treatment strategies and underscore the importance of immune profiling in lung cancer immunotherapy.
Combination of neoadjuvant and adjuvant chemotherapy with FOLFOX compared with adjuvant chemotherapy in management of locally advanced rectal cancers: a randomized trial of a promising therapeutic approach
Authors: Biniaz Mandana , Moradi Arash , Basit Manouchehr Ghorbanpour , Pashaki Abdol-Azim Seddighi , Dehghan Arash , Mohammadian Kamal 
Published: July 2024

Abstract
Background
Colorectal cancer (CRC) is a significant malignancy with widespread implications. Despite progress in surgical interventions for rectal cancer, improvements in overall prognosis remain disproportionate. Standard preoperative chemoradiation, while established as the standard treatment for the majority of rectal cancers, exhibits limited effectiveness in enhancing disease-free survival (DFS) and mitigating distant metastases, particularly in cases of locally advanced rectal cancer (LARC).

Methods
This randomised clinical trial assessed 286 patients with LARC in two paralleled groups. Group A underwent six courses of neoadjuvant MFOLFOX chemotherapy, chemoradiation, surgery, and six adjuvant chemotherapy cycles. Group B received concurrent chemoradiation, surgery, and twelve adjuvant chemotherapy cycles. Patient evaluations were achieved at multiple stages of treatment and follow-up.

Results
Group A had significantly lower local recurrence (11.64%) than Group B (21.74%, P = 0.025). The distant metastasis rate in Group A (8.90%) was lower than in Group B (20.29%) but was not significant (p = 0.143). More patients in Group A experienced downstaging (80.82% vs. 60.87%, p < 0.001). Specifically, 72.60% demonstrated downstaging of tumour invasion and 54.79% downstaging of lymph node involvement, compared to 57.25% and 41.30% in Group B (p = 0.009 and p = 0.025, respectively) as well as higher pCR rate (26.03% vs. 15.25%, p = 0.030) and three-year DFS rate (82.19% vs. 71.01%, p = 0.035) in group A compare to group B.

Conclusion
This innovative strategy for LARC showed promising results with lower local recurrence and higher rates of downstaging and pCR. Treatment side effects were similar in both groups but less frequent in Group A. Anaemia was the most common haematological side effect (A: 58%, B: 68%), and peripheral sensory neuropathy was the most common non-haematological complication (A: 63%, B: 64%). These findings suggest this regimen could be a valuable therapeutic approach for LARC.

Trial Registration
This trial was registered on 2023–12-08 within the IRCT.IR database under the number IRCT20210308050628N1.
The effect of adding physician recommendation in digitally-enabled outreach for COVID-19 vaccination in socially/economically disadvantaged populations
Authors: Sumar Kamal , Blue Lisa , Fatahi Gina , Sumar Mehek , Alvarez Stephanie , Cons Pedro , Valencia Nathalie , Williams Zachary , Bhatti Atiq , Parthasarathy Sairam , Doubeni Chyke A. 
Published: July 2024

Abstract
Introduction
People from backgrounds that are economically/socially disadvantaged experienced disproportionately high COVID-19 death rates and had lower vaccination rates. Effective outreach strategies for increasing vaccine uptake during the pandemic are not fully known. Among patients receiving care at a Federally Qualified Health Center, we tested whether community engaged digitally-enabled outreach from a trusted clinician messenger increased COVID vaccine uptake.

Study design, setting, and participants
A 3-parallel-arm randomized controlled trial with a hybrid effectiveness-implementation design was conducted among patients ≥ 18 years old on study enrollment during 2021 with 1,650 assigned in 3:10:20 ratio; 2,328 were later selected for two subsequent implementation rounds.

Interventions
From April 13 to June 10, 2021, patients were proactively sent a text-messaging invitation to make an appointment for vaccination as part of the routine practice with a link to frequently asked questions (Arm 1, n = 150) with added personalized clinician recommendation alone (Arm 2, n = 500) or with enabled 2-way SMS messaging feature (Arm 3, n = 1,000). Further implementation used messaging addressing vaccine hesitancy (n = 1,323) or adverse reactions to vaccines (n = 1,005).

Main outcomes and measures
The primary outcome was the completion of the first SARS-Cov-2 vaccine dose determined at 14, 30 and 90 days after outreach.

Results
Of 1,650 patients in effectiveness Arms, 61% was female. Vaccination rates for Arms 1, 2, and 3, were 6% (n = 9), 5.4% (n = 27) and 3.3% (n = 33) at 14 days, and 11.5% (n = 17), 11.6% (n = 58), and 8.5% (n = 85) at 90 days, respectively, which were similar in pairwise comparisons. At 90 days, vaccination rates were similar across the two implementation rounds (3.9% vs. 3.6%) and were similar to the rate (3.3%) among patients who were not selected for intervention arms or implementation rounds (n = 8,671).

Conclusions
Digitally-enabled outreach that included SMS messaging outreach augmented with clinician recommendations did not improve COVID-19 vaccination rates.

Trial registration
This study is registered at ClinicalTrails.gov Identifier: NC-T04952376.
Illegitimate work tasks: an investigation of psychometric properties of the Swedish version of the BITS instrument and its suitability in human versus ‘non-human’ service occupations
Authors: Stengård Johanna , Leineweber Constanze , Berthelsen Hanne 
Published: July 2024

Abstract
Background
Illegitimate tasks, i.e. working tasks that are perceived as unnecessary or unreasonable, are commonly measured by the Bern Illegitimate Tasks Scale (BITS). Despite a growing research attention paid to illegitimate tasks, the Swedish version of BITS needs yet to be properly evaluated. Moreover, previous multiorganizational studies in this field have taken for granted, without really testing it, that the instrument functions invariantly in different contexts; a prerequisite for meaningful comparisons.

Methods
Two occupational groups that differs hugely—966 human services workers (teachers and registered nurses) and 750 non-’human service’ workers (construction and IT-workers) were targeted utilizing questionnaires data collected 2018 within the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. Psychometric properties, i.e., reliability, dimensionality, and measurement invariance between the occupations were examined using confirmatory factor analyses and structural equation models. Also, the associations between the two dimensions of illegitimate tasks and job satisfaction and emotional exhaustion, respectively, were tested.

Results
Good reliability was supported and two- versus one-dimensionality showed better psychometric properties. Partial scalar measurement invariance was satisfactory supported with only 25% relaxed constraints of equal intercepts between groups. Examining the two subdimensions revealed different associations with emotional exhaustion, where the associations was more substantial for unreasonable tasks. Nevertheless, the findings point to potential improvements for future investigation.

Conclusions
This study shows that the Swedish version of BITS is working satisfactory and allows for meaningful comparisons of occupational groups. Furthermore, construct validity of the two dimensions was corroborated.
Association between lipoprotein(a), fibrinogen and their combination with all-cause, cardiovascular disease and cancer-related mortality: findings from the NHANES
Authors: Wang Zhenwei , Yan Xuejiao , Fang Lijuan , Tang Junnan , Zhang Jinying 
Published: July 2024

Abstract
Background
There is evidence indicating that both lipoprotein(a) [Lp(a)] and fibrinogen (FIB) are associated with mortality, However, the impact of their combination on mortality has not been determined. Thus, the aim of this study was to examine the association between the combination of Lp(a) and FIB with all-cause and cause-specific mortality.

Methods
This prospective cohort study enrolled 4,730 participants from the third National Health and Nutrition Examination Survey. The exposure variables included Lp(a), FIB and their combination, while the outcome variables consisted of all-cause, cardiovascular disease (CVD) and cancer-related mortality. Multivariate COX regression, subgroup analysis, sensitivity analysis and restricted cubic spline (RCS) were used to investigate the association between Lp(a), FIB and their combination with all-cause, CVD and cancer-related mortality.

Results
Over a median follow-up period of 235 months, 2,668 individuals died, including 1,051 deaths attributed to CVD and 549 deaths due to cancer. Multivariate Cox regression analyses revealed independent associations between both Lp(a) and FIB with all-cause, CVD, and cancer-related mortality. Compared to participants in the 1st to 50th percentiles of both Lp(a) and FIB, those in the 90th to 100th percentiles exhibited multivariable adjusted HRs of 1.813 (95% CI: 1.419–2.317, P < 0.001), 2.147 (95% CI: 1.483–3.109, P < 0.001) and 2.355 (95% CI: 1.396, 3.973, P = 0.001) for all-cause, CVD and cancer-related mortality, respectively. Subgroup and sensitivity analyses did not substantially attenuate the association between the combination of high Lp(a) and high FIB with the risk of all-cause and CVD-related mortality. Additionally, the RCS analysis showed that the relationship between Lp(a) and the risk of all-cause and cancer-related mortality, as well as the relationship between FIB and the risk of cancer-related mortality, were linear (P for nonlinearity > 0.05). Conversely, the relationship between Lp(a) and the risk of CVD-related mortality, as well as the relationship between FIB and the risk of all-cause and CVD-related mortality, were nonlinear (P for nonlinearity < 0.05).

Conclusions
High levels of Lp(a) and FIB together conferred a greater risk of mortality from all-cause, CVD and cancer.
Thoracic and vertebral deformities in lung transplantation: perioperative complications and long-term prognoses
Authors: Nikkuni Etsuhiro , Hirama Takashi , Ui Masahiro , Watanabe Toshikazu , Mukai Shunta , Watanabe Tatsuaki , Watanabe Yui , Oishi Hisashi , Ebihara Satoru , Okada Yoshinori 
Published: July 2024

Abstract
Background
Lung transplantation (LTx) is a crucial therapeutic strategy for patients suffering from end-stage respiratory diseases, necessitating precise donor-recipient size matching to ensure optimal graft function. While standard allocation protocols rely on predicted lung capacity based on factors such as sex, age, and height, a subset of patients with respiratory diseases presents an additional challenge – thoracic or vertebral deformities. These deformities can complicate accurate volume predictions and may impact the success of lung transplantation.

Methods
In this retrospective cohort study of patients who underwent LTx at Tohoku University Hospital between January 2007 and April 2022, with follow-up until October 2022, the primary objective was to assess the influence of thoracic and vertebral deformities on perioperative complications, emphasizing interventions, such as volume reduction surgery. The secondary objective aimed to identify any noticeable impact on long-term prognoses in recipients with these deformities.

Results
Of 129 LTx recipients analyzed, 17.8% exhibited thoracic deformities, characterized by pectus excavatum, while 16.3% had vertebral deformities. Perioperative complications, requiring delayed chest closure, tracheostomy, and volume reduction surgery, were more prevalent in the deformity group. Thoracic deformities were notably associated with the need for volume reduction surgery. However, long-term prognoses did not differ significantly between patients with deformities and those without. Vertebral deformities did not appear to significantly impact perioperative or long-term outcomes.

Conclusions
This study highlights the prevalence of thoracic deformities in LTx recipients, correlating with increased perioperative complications, particularly the potential need for volume reduction surgery. Importantly, these deformities do not exert a significant impact on long-term prognoses. Additionally, patients with vertebral deformities, such as scoliosis and kyphosis, appear to be manageable in the context of LTx.
Application of indocyanine green-labeled fluorescence technology in laparoscopic total extra-peritoneal inguinal hernia repair surgery:a preliminary study
Authors: Zhang Qi , Xu Xiujuan , Ma Jun , Ling Xinjian , Wang Yongsheng , Zhang Yaming 
Published: July 2024

Abstract
Background
Laparoscopic Total Extra-peritoneal Inguinal Hernia Repair(TEP) presents escalated risks of surgical complications, notably bleeding, particularly in European Hernia Society (EHS) types 3 and recurrent inguinal hernia. In this study, we introduced an innovative technique using indocyanine green-labeled fluorescence laparoscopy to mitigate intraoperative complications, including bleeding and rupture of the hernial sac.

Methods
This retrospective study reviewed records of 17 patients who underwent TEP repair at Anqing Municipal Hospital between July and August 2023. Intraoperatively, fluorescence imaging was utilized to trace the pathway of the spermatic vessels and outline the boundaries of the hernia sac to facilitate a thorough dissection.

Results
The procedure was successfully completed in all 17 patients, with a median operation time of 42 min (range: 30–51 min). Median intraoperative blood loss was 5 ml (range: 3–8 ml). Complete dissection of the hernia sac was achieved in each case without any incidents of sac rupture. Hemodynamic parameters of blood flow within the spermatic artery on postoperative day 1 showed no statistically significant deviations from the preoperative values. Furthermore, during the 7-month follow-up period, there were no cases of seroma formation or hernia recurrence.

Conclusion
Our findings suggest that employing indocyanine green-labeled fluorescence technology in TEP repair significantly reduces intraoperative complications, notably bleeding and rupture of the hernial sac. This technique demonstrated a negligible impact on the hemodynamic parameters of the spermatic artery and reduced the overall surgical time.