bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishment of Prognostic Nomogram for Male Breast Cancer Patients: A Surveillance, Epidemiology and End Results Database Analysis
Authors: Ma Zhongjing , Xu Mengyao , Zhang Jingjiao , Li Jia , Fang Fengqi 
Published: August 2024

Background Male breast cancer (MBC) represents a rare subtype of breast cancer, with limited prognostic factor studies available. The purpose of this research was to develop a unique nomogram for predicting MBC patient overall survival (OS) and breast cancer-specific survival (BCSS). Methods From 2010 to 2020, clinical characteristics of male breast cancer patients were obtained from the Surveillance, Epidemiology and End Results (SEER) database. Following univariate and multivariate analyses, nomograms for OS and BCSS were created. Kaplan-Meier plots were further generated to illustrate the relationship between independent risk variables and survival. The nomogram’s ability to discriminate was measured by employing the area under a time-dependent receiver operating characteristic curve (AUC) and calibration curves. Additionally, when the nomogram was used to direct clinical practice, we also used decision curve analysis (DCA) to evaluate the clinical usefulness and net clinical benefits. Results A total of 2143 patients were included in this research. Univariate and multivariate analysis showed that age, grade, surgery, chemotherapy status, brain metastasis status, subtype, marital status, race, and AJCC-T, AJCC-N, and AJCC-M stages were significantly correlated with OS. Lung metastasis, age, marital status, grade, surgery, and AJCC-T, AJCC-N, and AJCC-M stages were significantly correlated with BCSS. By comprising these variables, a predictive nomogram was constructed in the SEER cohort. Then, it could be validated well in the validation cohort by receiver operating characteristics (ROCs) curve and calibration plot. Furthermore, the nomogram demonstrated better decision curve analysis (DCA) results, indicating the ability to forecast survival probability with greater accuracy. Conclusion We created and validated a unique nomogram that can assist clinicians in identifying MBC patients at high risk and forecasting their OS/BCSS.
Construction of a 12-Gene Prognostic Risk Model and Tumor Immune Microenvironment Analysis Based on the Clear Cell Renal Cell Carcinoma Model
Authors: Wang Shuo , Yu Ziyi , Cao Yudong , Du Peng , Ma Jinchao , Ji Yongpeng , Yang Xiao , Zhao Qiang , Hong Baoan , Yang Yong , Hai Yanru , Li Junhui , Mao Yufeng , Wu Shuangxiu 
Published: August 2024

Objectives Accurate survival predictions and early interventional therapy are crucial for people with clear cell renal cell carcinoma (ccRCC). Methods In this retrospective study, we identified differentially expressed immune-related (DE-IRGs) and oncogenic (DE-OGs) genes from The Cancer Genome Atlas (TCGA) dataset to construct a prognostic risk model using univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. We compared the immunogenomic characterization between the high- and low-risk patients in the TCGA and the PUCH cohort, including the immune cell infiltration level, immune score, immune checkpoint, and T-effector cell- and interferon (IFN)-γ-related gene expression. Results A prognostic risk model was constructed based on 9 DE-IRGs and 3 DE-OGs and validated in the training and testing TCGA datasets. The high-risk group exhibited significantly poor overall survival compared with the low-risk group in the training ( P < 0.0001), testing ( P = 0.016), and total ( P < 0.0001) datasets. The prognostic risk model provided accurate predictive value for ccRCC prognosis in all datasets. Decision curve analysis revealed that the nomogram showed the best net benefit for the 1-, 3-, and 5-year risk predictions. Immunogenomic analyses of the TCGA and PUCH cohorts showed higher immune cell infiltration levels, immune scores, immune checkpoint, and T-effector cell- and IFN-γ-related cytotoxic gene expression in the high-risk group than in the low-risk group. Conclusion The 12-gene prognostic risk model can reliably predict overall survival outcomes and is strongly associated with the tumor immune microenvironment of ccRCC.
Sjogren's syndrome due to immune checkpoint inhibitors (ICIs): Insights from a single-institution series and systematic review of the literature
Authors: Soliman Abram , Hassan Ruba , Codreanu Ion , Plaxe Steven C , Dasanu Constantin A 
Published: August 2024

Introduction Careful adverse event assessment and management are important when prescribing immune checkpoint inhibitors (ICIs) to cancer patients. Iatrogenic Sjogren's syndrome is a relatively rare immune-related adverse event (irAEs) that affects the moisture-producing glands. Methods We describe a series of four patients who developed Sjogren's syndrome while being treated with ICIs at a community cancer center in Southern California, USA (1/1/2017–12/31/2023). Patient, drug and disease-related data were collected by retrospective chart review. A systematic search of the PubMed database was performed to identify similar cases in the literature (1/1/2016–12/31//2023). Results Of 224 cancer patients at our center treated with ICIs, four (1.8%) developed iatrogenic Sjogren's syndrome. All of our patients were male; three received PD-1 inhibitors (nivolumab, pembrolizumab) and one received the PD-L1 inhibitor atezolizumab. The median time to development of Sjogren's syndrome was 24 weeks (range, 8–36 weeks); dry mouth symptoms were more prominent than dry eye symptoms. None of the patients had elevated SS-A, SS-B or antinuclear antibodies. One patient developed multiple tooth cavities and had several extractions, due to severe xerostomia. Management of all patients was primarily symptomatic. Two cases were irreversible; one was reversible and the 4th case is undermined as he is still on ICI therapy. Our systematic review of the literature identified 80 cases in five articles. Incidence of xerostomia was twice of that of xerophthalmia. The male/female ratio was 1.5:1. SS-A, SS-B, or antinuclear antibodies were found in only 9% of patients. Steroids were reported to have had only a limited role in management. Conclusions The incidence of Sjogren's syndrome due to ICIs in our center was 1.8%. Details of clinical course and management in these patients are presented. Caring for patients with ICI-related Sjogren's syndrome is facilitated by a multidisciplinary effort including oncologists, otolaryngologists, dentists, ophthalmologists and rheumatologists. Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment, and improving outcomes.
20-Year trends in the social participation of the oldest old
Authors: Augustsson Erika , Fors Stefan , Rehnberg Johan , Lennartsson Carin , Agahi Neda 
Published: August 2024

Aims: To investigate 20-year trends in social participation among the oldest old (77+ years) in Sweden and assess the extent to which changes in educational attainment and functional abilities explain these trends. Methods: Seven waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) spanning 2002–2021 were used with a repeated cross-sectional design. To analyse the association between time and social participation we employed the Karlson–Holm–Breen method of decomposition. The study focused on informal social participation (contact with friends and family), leisure participation (public or semi-public gatherings), and formal participation (organisational engagement and study circle attendance). Results: Both leisure and informal participation peaked in 2014 and declined in 2021, influenced by the COVID-19 pandemic, whereas formal participation showed a slight increase in 2021. Total participation increased at least until 2011. Overall, older adults have increased their levels of social participation in recent decades, disregarding the influence of the pandemic. Decomposition analysis revealed that population-level changes in educational attainment and functional abilities explained a substantial portion of the observed trends. Conclusions: As the proportion of older adults continues to rise, it becomes increasingly important to understand the developments and drivers of behavioural change in the older population. As more people are socially active, there may be increasing differences between those participating and those not – which could lead to increased inequalities. The observed trend in increasing participation, influenced by changes in education and health, emphasises the importance of fostering age-friendly environments and addressing potential social inequalities among older adults.
Association Between red Cell Distribution Width/Albumin Ratio and Diabetic Lower Extremity Ulcers (DLEU) among US Outpatients in the NHANES: A Retrospective Cross-Sectional Study
Authors: Huang Dali , Wang Kang , Deng Ting , Yang Ting , Cao Jinmin 
Published: August 2024

Objective Diabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States. Methods A retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index. Results The study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% ( n = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19∼3.61), 2.92 (95% CI = 1.63∼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, P = .028). Conclusion These results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.
Fate assessment of the ectatic common iliac artery using flared limb during endovascular aneurysm repair
Authors: Kim Choshin , Park Yang-Jin , Park Joon-Kee , Kim Young-Wook , Kim Dong-Ik , Yang Shin-Seok , Park Taek Kyu , Choi Seung-Hyuk 
Published: August 2024

Objectives This study aimed to evaluate the outcomes and anatomical predictors of the complications of flared limb (FL) use for ectatic common iliac arteries accompanied by abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR). Methods In this single-center retrospective study, we reviewed data from 391 patients (638 limbs) treated between 2005 and 2020. The cohort was divided into two groups. The standard limbs (SLs, n = 403) included stent graft (SG) of <20 mm in diameter and the FLs ( n = 235) included stent graft of ≥20 mm in diameter. Complications within 30 days were investigated as the short-term outcome. Limb events during follow-up including type Ib endoleak (EL), type IIIa EL, and limb occlusion were compared between SLs and FLs using log-rank test. Results Early results indicated that the FL group had a significantly higher incidence of intraoperative type Ib EL at 5.1% (12), than 1.7% (7) in the SLs ( p = .016). For 19 patients in whom intraoperative type Ib EL was discovered, SG extension alone or internal iliac artery embolization was all performed before completing the procedure. Overall, we noted one case of type Ib EL and two cases of limb events in each group at 30 days. Over a median follow-up of 39 months, 31 (4.9%) events (17 type Ib EL, 2 type IIIa EL, and 12 limb events), 13 (5.5%) in FLs and 18 (4.5%) in SLs ( p = .984), were observed. The FLs had significantly higher rates of aortic sac enlargement, with 46 (19.6%) cases for FLs and 36 (8.9%) for SLs ( p < .001). The Kaplan–Meier analysis revealed significant differences at 5 years in SLs versus FLs for freedom from type Ib EL (96.6% vs 82.4%, respectively; p < .001) and no difference in freedom from limb events (94.7% vs 84.5%, respectively; p = .519). Furthermore, no difference was observed for overall survival and aneurysm-related mortality. Conclusions Although an FL for EVAR is used to treat dilated iliac arteries, there is an increased risk of intraoperative and late type Ib EL and aortic sac enlargement. Long-term close follow-up is mandatory, especially in the patients who undergo EVAR using FLs.
Understanding how nurses can effectively utilise social media for increasing public involvement, recruitment and impact dissemination of Clinical Research Trials
Authors: Jackson Jessica Eve , Moreton Joshua , Barnett Nicola , Hurst Matthew 
Published: August 2024

Background: The methodologies for clinical research trials are evolving to greater usage of social media platforms, providing opportunities to incorporate smart technologies in their delivery. Research Nurses should consider how they can utilise platforms for public engagement in trials. Aim: To explore the experiences of social media platforms and clinical research trials in a healthy population group, to gain insight into how clinical researchers can utilise these platforms professionally and ethically. Methods: Using a critical realist qualitative focus group design with template analysis, we recruited 16 healthy members of the public aged 18–75 years. The data expands upon their thoughts and behaviours regarding social media platforms with their understanding of clinical research. Results: Three main themes along with their specific subthemes (1) Design: Patient and Public Involvement (Subtheme: Understanding of clinical research, Diversity of social media users), (2) Implementation: Recruitment to active studies, (Subtheme: Motivators for volunteering, Trustworthy), (3) Dissemination: Impact and Awareness of Results, (Subtheme: Information overload, Motivations for users to share information). Conclusions: This study has highlighted the need to consider the way different population groups use social media platforms and the information they share when looking to engage them in clinical research trials.
The First 100 Children Treated in a Newly Established Pediatric Vertigo Center
Authors: Alnoury Mohammed K. , Salameh Samer , Ostrovska Aleksandra , Gurberg Joshua 
Published: August 2024

Background Correctly diagnosing dizziness in children is essential for appropriate management; nevertheless, healthcare professionals face challenges due to children’s limited ability to describe their symptoms and their cooperation during physical examination. The objective of this study is to describe the first 100 patients seen at a newly established pediatric vertigo center. Methods This is a retrospective review of a consecutive series of 100 patients seen at our pediatric vertigo clinic in a tertiary referral center from August 2019 until June 2022. Comprehensive clinical data were collected. The diagnoses were established by 2 pediatric otolaryngologists based on validated diagnostic criteria. Trends in diagnosis, investigation, and treatment of these patients were analyzed. Results A total of 100 children were included in the study. Vestibular migraine was the most common diagnosis (20%) followed by benign paroxysmal vertigo of childhood (14%). Eleven patients had combined pathologies. Fifteen out of 70 children (21%) had abnormal audiograms, 30 out of 48 children (62.5%) had abnormal vestibular testing, and 6 out of 31 (19%) patients had abnormal imaging. Fifty-one children received medical treatment, 23 received vestibular physiotherapy, and 9 patients had particle repositioning maneuvers; moreover, 17 of these patients received multimodal treatment. Conclusions Our analysis suggests that imaging and audiology testing have relatively low yield in the assessment of pediatric vertigo. On the other hand, vestibular testing detected a high proportion of abnormalities, such as saccadic pursuit, vertical nystagmus, central positional nystagmus, and abnormal directional preponderance, particularly associated with vestibular migraine. Given the complexity of diagnosing vertigo in children, it is critical to establish multidisciplinary specialized centers capable of providing accurate diagnosis and treatment for these children.
Discovery of α-Glucosidase/Acetylcholinesterase Inhibitors from a Traditional Herbal Prescription of Qi-Li-Qiang-Xin Capsule by Time-Based Fractionation and Enzymatic Activity Assay
Authors: Song Hui-Peng , Zhao Ming-Yue , Xu Zhi-Li , Zhang Jia-Nuo , Wang Wen-Yu , Ding Zi-Xuan , Wang Ying , Zhan Li-Bin , Chen Xi , Li Ruo-Nan , Chen Yue-Hua 
Published: August 2024

Objectives The aim is to discover α-glucosidase/acetylcholinesterase inhibitors as lead compounds from a traditional herbal prescription of Qi-Li-Qiang-Xin capsule (QLQX). Methods A novel strategy combining time-based fractionation, LC-QTOF-MS, enzymatic activity assay, molecular docking and component-target association analysis was performed to discover α-glucosidase/acetylcholinesterase inhibitors from QLQX. Time-based fractionation combined with enzymatic activity assay was used to find the distribution period of active compounds in the herbal prescription. LC-QTOF-MS was used to analyze the structure of active compounds. Molecular docking was applied to explore the interaction between active compounds and targets. Results According to time-based fractionation, the active components of QLQX for acetylcholinesterase were primarily concentrated in the highly polar region, whereas the active components for α-glucosidase were predominantly found in the moderately polar area. A total of 33 compounds were identified by comparing with chemical reference substances. Dihydrotanshinone Ⅰ (16.98 µM), hydroxysafflor yellow A (84.57 µM), salvianolic acid A (76.62 µM) and cryptotanshinone (112.68 µM) were identified as acetylcholinesterase inhibitors from QLQX. Similarly, rosmarinic acid (62.29 µM), isochlorogenic acid A (17.95 µM), 4,5-dicaffeoylquinic acid (117.93 µM), danshensu (207.88 µM), salvianolic acid A (1.31 µM), 3,4-dicaffeoylquinic acid (91.71 µM), formononetin (67.26 µM), ginsenoside Rd (3.43 µM), ginsenoside Rb1 (26.37 µM) and ginsenoside F1 (18.79 µM) were discovered as α-glucosidase inhibitors. Notably, salvianolic acid A inhibited both acetylcholinesterase and α-glucosidase. The results of molecular docking indicated that hydrogen bonds, hydrophobic interactions and Pi-Pi T-shaped interactions were crucial for inhibiting acetylcholinesterase. Meanwhile, hydrogen bonds, hydrophobic interactions and Pi-Pi stacked interactions were significant in suppressing α-glucosidase. Conclusion QLQX contains numerous acetylcholinesterase and α-glucosidase inhibitors, demonstrating its potential therapeutic benefits for Alzheimer's disease and diabetes.
Implementing a rapid cord compression Magnetic Resonance Imaging protocol in the emergency department: Lessons learned
Authors: Mishra Shruti , Srinivasan Ashok , Kelsey Lauren , Bojicic Katherine , Masotti Maria , Chen Qiaochu , Hoeffner Ellen , Kronick Steven , Gomez-Hassan Diana 
Published: August 2024

Background & Purpose (1) Evaluate efficacy of an abbreviated total spine protocol in triaging emergency department (ED) patients through retrospective evaluation. (2) Describe patient outcomes following implementation of a rapid cord compression protocol. Methods (1) All contrast-enhanced total spine magnetic resonance imaging studies (MRIs) performed on ED patients ( n = 75) between 10/1–12/31/2022 for evaluation of cord compression were included. Two readers with 6 and 5 years of experience blindly reviewed the abbreviated protocol (comprised of sagittal T2w and axial T2w sequences) assessing presence of cord compression or severe spinal canal stenosis. Ground truth was consensus by a neuroradiology fellow and 2 attendings. (2) The implemented rapid protocol included sagittal T1w, sagittal T2w Dixon and axial T2w images. All ED patients ( n = 85) who were imaged using the rapid protocol from 5/1–8/31/2023 were included. Patient outcomes and call-back rates were determined through chart review. Results (1) Sensitivity and specificity for severe spinal canal stenosis and/or cord compression was 1.0 and 0.92, respectively, for reader 1 and 0.78 and 0.85, respectively, for reader 2. Negative predictive value was 1.0 and 0.97 for readers 1 and 2, respectively. (2) The implemented rapid cord compression protocol resulted in 60% reduction in imaging time at 1.5T. The call-back rate for additional sequences was 7%. In patients who underwent surgery, no additional MRI images were acquired in 82% of cases (9/11). Conclusions Implementing an abbreviated non-contrast total spine protocol in the ED results in a low call-back rate with acquired MRI images proving sufficient for both triage and treatment planning in most patients.
Impact of early COVID-19 pandemic events in Singapore on clinic attendance and default rates in a hospital-based ambulatory paediatrics service
Authors: Koura Rachana , Davis Courtney 
Published: August 2024

Background While the impact of COVID-19 on health care seeking behaviour has been well documented in adult studies, little is known about the impact of COVID-19 on ambulatory paediatric care in South East Asia. Objective To analyse the impact of early COVID-19 events on weekly clinic attendance volumes and default rates in the ambulatory paediatric service of a large tertiary teaching hospital in Singapore. Methods We used independent t tests to compare the weekly aggregate clinic attendance and default rates of the different time periods of the early COVID-19 pandemic (early COVID-19, movement controls, release of movement controls). Results The total weekly clinic attendance decreased significantly and default rates increased significantly during the early COVID-19 period prior to the implementation of movement controls. During the period of movement controls, the first visit default rate remained significantly increased despite the postponement of all non-essential first visits. Post movement controls, both the first and follow up visits rebounded to pre-COVID 19 levels. The default rate for follow up visits was significantly lower than baseline in the post movement control period. Conclusions Decreased utilization of ambulatory paediatric care in Singapore in a pandemic has implications for future pandemic preparedness including both health care resource allocation and health communication.