bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leiomyosarcoma of vascular origin: lessons learned from misdiagnosis
Authors: Ayyad Mohamed Salah , Elbellasy Mahmoud Fawzy , Hassan Amany , Gad Mona 
Published: August 2024

Abstract
Background
Leiomyosarcoma (LMS) of vascular origin is a rare entity of soft tissue sarcomas. Although they arise mostly from retroperitoneal major vascular structures, some encountered cases may arise from the smaller vascular structures of the thigh as the femoral vein. Due to their origin from the vascular structures, they represent a diagnostic challenge as they may be misdiagnosed as deep vein thrombosis (DVT).

Case presentation
We present a case of a 45-year-old woman with left femoral and iliac vein LMS that was previously described in the vascular ultrasound (US) report as extensive DVT involving the femoral and external iliac veins. The patient did not improve after receiving the prescribed anticoagulants. Seven months later, the patient underwent computerized tomography (CT) with contrast, revealing a soft tissue mass in the anatomical site of the left common femoral and external iliac veins. The patient underwent both US-guided tru-cut biopsy and incisional biopsy from the iliac lymph nodes which revealed leiomyosarcoma.

Materials and methods
The patient underwent both vascular ultrasound and magnetic resonance imaging of the pelvis and the left thigh at the time of the first presentation. Seven months later, she underwent contrast-enhanced CT of the abdomen and pelvis.

Outcome
The patient was referred to the oncology department to receive the appropriate chemotherapy protocol as the tumor was inoperable.

Conclusions
Although leiomyosarcoma of vascular origin is a rare entity of neoplasms, it is usually underestimated. A high index of suspicion would help the clinician to suspect such a neoplasm and save time for early diagnosis and management. Special caution should be taken for patients with venous thrombosis not improving on anticoagulants. When there is suspicion, other modalities such as computerized tomography and magnetic resonance imaging help confirm the diagnosis.
Comparison of directly and indirectly estimated entrance skin dose (ESD) for diagnostic radiation qualities (RQR, RQA and RQT) using water phantom and shadowfree diagnostic chamber (SFD)
Authors: Haider Umar Hussain , Hussain Babar , Shaheen Wajeeha , Rehman Shakeel Ur 
Published: August 2024

Abstract
Background
The aim of this study was to find the entrance skin dose (ESD) for diagnostic radiation qualities RQRs, RQAs and RQTs given in IAEA technical report series No. 457 using direct and indirect methods of measurement. Measurements were done for 5 × 5, 10 × 10, 15 × 15, 20 × 20 and 25 × 25 cm2 field sizes and 70, 80, 90 and 100 cm source to surface distance (SSD) using shadow-free diagnostic (SFD) chamber and water phantom having dimension 30 × 30 × 30 cm3. ESD direct measurements were done by placing SFD chamber on the surface of water phantom, while in the case of indirect measurements, air kerma values were obtained.

Results
ESD values for different selected radiation qualities RQR2, RQR5, RQR8, RQR10, RQA2, RQA5, RQA8, RQA10, RQT8, RQT9 and RQT10 were found to be in the range of 0.0045–5.11 mGy per examination.

Conclusions
Results obtained were found to be comparable with ESD values published in the literature. The obtained results in this research would help in establishing the national diagnostic reference levels (DRLs) which would help in the optimization of diagnostic imaging procedures. It would also help the radiographers to optimize field sizes and SSDs in order to reduce dose to the patients thereby ensuring good radiological practices, and this would reduce the stochastic risk to the patients caused by the ionizing radiations.
BRAF-induced EHF Expression Affects TERT in Aggressive Papillary Thyroid Cancer
Authors: Xu Yiyi , Gao Jiwei , Wang Na , Zedenius Jan , Nilsson Inga-Lena , Lui Weng-Onn , Xu Dawei , Juhlin C Christofer , Larsson Catharina , Mu Ninni 
Published: August 2024

Abstract

Context
BRAFV600E and TERT promoter mutations in papillary thyroid carcinoma (PTC) have a synergistic effect on prognosis. This effect is believed to arise from MAPK activation triggered by BRAFV600E, leading to the upregulation of ETS transcription factors that bind to the mutant TERT promoter.

Objectives
To explore the role of ETS factors in relation to clinical features, BRAFV600E, and TERT promoter mutations in PTC.

Design
Transcriptomic data for 28 ETS factors were analyzed in the PTC cohort of The Cancer Genome Atlas (n = 399) and subsequently validated in a local cohort (n = 93). In vitro experiments were performed to investigate the regulatory role in relation to BRAFV600E and TERT expression.

Results
The Cancer Genome Atlas identified ETS1, ERG, FLI1, GABPA, EHF, ETV6, and SPDEF as differentially expressed genes between stages I + II and III + IV. In both cohorts, EHF was consistently associated with adverse clinical features, BRAFV600E and TERT promoter mutation/expression. Notably, in BRAFV600E mutated PTC, high EHF expression was associated with shorter disease-free survival. Cases harboring concurrent BRAFV600E, TERT promoter mutations, and high EHF expression exhibited the shortest disease-free survival. In cells harboring concurrent BRAFV600E and TERT promoter mutation, overexpression of EHF significantly increased TERT expression, whereas knockdown or pharmacological inhibition of BRAF significantly decreased both EHF and TERT expression. In addition, chromatin immunoprecipitation and quantitative PCR analysis suggested a potential binding of EHF in TERT promoter mutant cells but not in TERT promoter wild-type cells.

Conclusion
The ETS transcription factor EHF is associated with poor prognosis in PTC. This is potentially mediated by BRAF-induced upregulation of EHF, which in turn increases TERT expression in TERT promoter mutated cells.
Correlation of Morphological Appearance of Peritoneal Lesions at Laparotomy and Disease at Pathological Assessment in Patients Undergoing Cytoreductive Surgery for Peritoneal Malignancy: Results of Phase I of the PRECINCT Study in 707 Patients
Authors: Bhatt Aditi , Villeneuve Laurent , Sardi Armando , Souadka Amine , Buseck Alison , Moran Brendan J. , Khannousi Basma El , de Pedro Carlos Gonzalez , Baratti Dario , Biacchi Danielle , Morris David , Labow Daniel , Levine Edward A. , Mohamed Faheez , Adeleke Gbadebo , Goswami Gaurav , Bonnefoy Isabelle , Perry Katherine Cummins , Votanopoulos Konstantinos I. , Parikh Loma , Deraco Marcello , Alyami Mohammad , Cohen Noah , Benzerdjeb Nazim , Shah Nehal , Bahaoui Nezha El , Khajoueinejad Nazanin , Rousset Pascal , Shen Perry , Barat Shoma , Stanford Sophia , Khouchoua Selma , Troob Samantha , Shaikh Sakina , Sarpel Umut , Gushchin Vadim , Samuel Vasanth Mark , Kepenekian Vahan , Sammartino Paolo , Glehen Olivier 
Published: August 2024

Abstract
Background
The PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumors) is a prospective, multicenter, observational study. This report from phase I of PRECINCT outlines variations in recording the surgical peritoneal cancer index (sPCI) at experienced peritoneal malignancy centers and the incidence of pathologically confirmed disease in morphologically different peritoneal lesions (PL).

Methods
The sPCI was recorded in a prespecified format that included the morphological appearance of PL. Six prespecified morphological terms were provided. The surgical and pathological findings were compared.

Results
From September 2020 to December 2021, 707 patients were enrolled at 10 centers. The morphological details are routinely recorded at two centers, structure bearing the largest nodule, and exact size of the largest tumor deposit in each region at four centers each. The most common morphological terms used were normal peritoneum in 3091 (45.3%), tumor nodules in 2607 (38.2%) and confluent disease in 786 (11.5%) regions. The incidence of pathologically confirmed disease was significantly higher in ‘tumor nodules’ with a lesion score of 2/3 compared with a lesion score of 1 (63.1% vs. 31.5%; p < 0.001). In patients receiving neoadjuvant chemotherapy, the incidence of pathologically confirmed disease did not differ significantly from those undergoing upfront surgery [751 (47.7%) and 532 (51.4%) respectively; p = 0.069].

Conclusions
The sPCI was recorded with heterogeneity at different centers. The incidence of pathologically confirmed disease was 49.2% in ‘tumor nodules’. Frozen section could be used more liberally for these lesions to aid clinical decisions. A large-scale study involving pictorial depiction of different morphological appearances and correlation with pathological findings is indicated.
Integrated device for polarization-independent electro-optic modulation using a splitter-rotator structure
Authors: Pan Wanle , Chen Heming , Hu Yuchen 
Published: August 2024

An integrated device for polarization-independent electro-optic (EO) modulation based on photonic crystal is proposed. It primarily consists of three components: a polarization splitter-rotator (PSR), a combiner, and a graphene EO modulator. In the PSR, the TE0 modes and TM0 modes achieve polarization splitting and mode conversion. Subsequently, the two TE0 modes pass through the combiner to merge into a single beam. Finally, the TE0 modes enter the modulator for EO modulation. The performance parameters of the integrated device are computed and analyzed using the three-dimensional finite-difference time-domain method. The results reveal that the integrated device achieves a polarization extinction ratio of 23 dB, an insertion loss of 0.3 dB, and an extinction ratio of 21.1 dB. The modulator has a driving voltage of 3.56 V and a modulation speed of 33 GHz. The integrated device is well-suited for application in large-capacity optical communication systems.
Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation
Authors: Karlsson Jan , Hammarström Erik , Fogelkvist Maria , Lundqvist Lars-Olov 
Published: August 2024

Objective
The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation.

Methods
Stroke patients aged 18–66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation.

Results
The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument’s psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach’s alpha and McDonald’s omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms.

Conclusions
HADS showed a stable two-factor structure over the rehabilitation period. Patients’ perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18–66 years.
Peripheral Arterial Disease prevalence and risk factors in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort
Authors: Adams O. Peter , Galusha Deron , Martinez-Brockman Josefa L. , Morris Euclid H. , Hassan Saria , Maharaj Rohan G. , Nazario Cruz M. , Nunez Maxine , Nunez-Smith Marcella 
Published: August 2024

Introduction
Peripheral arterial disease (PAD) indicates generalised atherosclerotic disease but is often asymptomatic. The prevalence and potential risk factors of PAD were studied in ECHORN cohort study participants.

Methods
Representative samples of community-dwelling people ≥40 years of age residing in Barbados, Puerto Rico, Trinidad, and the USVI were recruited. The survey included questions on diabetes, hypertension, heart disease and smoking status. Body Mass Index, HbA1c, blood glucose and lipids were determined. Ankle brachial index (ABI) was evaluated in one leg. An oscillometric device measured arm and leg systolic BP simultaneously. ABI classifications were PAD ≤0.90, borderline 0.91 to 0.99, normal 1.00 to 1.40, and non-compressible >0.40. Multivariable logistic regression tested associations of potential risk factors with PAD.

Results
Of 2772 participants (mean age 57.3, 65.2% female), 35.8% were overweight, 38.1% obese, 32.4% had diabetes, 60% hypertension, and 15.4% reported heart. ABI prevalence (95% CI) by category was PAD 4.4% (3.6%, 5.1%), borderline 5.2% (4.4%, 6.1%), normal 87.0% (85.8%, 88.3%) and noncompressible 3.4% (2.7%, 4.0%). Female sex (OR 1.72, 95% CI 1.07 to 2.77), diabetes (OR 2.23, 95% CI 1.47 to 3.4), heart disease history (OR 1.74, 95% CI 1.07 to 2.83) and less than high school education vs having a university degree (OR 2.49, 95% CI 1.19 to 5.22) were independently associated with PAD.

Conclusions
Testing one leg only would underestimate PAD prevalence. Increasing the ABI cutoff for identifying PAD to <1.0 when using oscillometric devices is suggested by some studies but would more than double the estimated prevalence. Guidelines need to address this issue. Female sex and lower educational attainment are important considerations when screening. While diabetes and a history of heart disease were confirmed as risk factors, the lack of association of increasing age and cigarette smoking with PAD was unexpected.
The impact of telemonitoring on correct drug use, complications and quality of life among patients with multiple myeloma (ITUMM): A study protocol for an open-label, parallel-group, randomized controlled trial
Authors: Eijsink Job F. H. , Geerts Paul A. F. , Kamminga Karin , Edens Mireille A. , Boersma Cornelis , Postma Maarten J. , Maring Jan Gerard , ter Horst Peter G. J. 
Published: August 2024

Introduction
Multiple myeloma (MM) is the second most common hematologic malignancy. MM is associated with significant morbidity due to its end-organ destruction and is a disease of the older population. Although survival rates for MM have improved over the last decade, due to an increase in treatment options, the disease remains incurable. Expensive (oral) agents are widely used in MM patients; however, tools for supporting patients in complex treatment regimens are scarce. To investigate if a tool will support MM patients and healthcare professionals, the MM e-coach was developed and tested. The aim of this study is to study the impact of telemonitoring on adherence, complications and quality of life in patients with MM (ITUMM study).

Methods
A two-arm open-label parallel-group randomized controlled trial will be conducted between March 2021 and June 2024 to compare the telemonitoring (MM e-coach) with standard MM care. This study aimed to recruit 150 patients with recently diagnosed multiple myeloma (RDMM), starting first or second line of treatment. Blinded primary outcome is adherence by pill count after start of treatment at 1–3 months. Secondary outcomes are patient reported outcomes: GFI, EQ-5D-5L, EORTC-QLQ-C30, SDM-Q-9, MARS-5, single item questions, PREMs, adverse events, OS and PFS. Patient reported outcomes were developed and integrated in the e-coach MM to regularly measure digitized outcomes of MM patients from time of RDMM until 12 months post-diagnosis. Online measurements will be performed at baseline (0), 3, 6, 9 and 12 months.

Ethics and dissemination
Ethics approval has been granted by the Ethics Committee of the Isala klinieken in The Netherlands (No. 201111) at 25 February 2021. Study results will be disseminated to the relevant healthcare communities by publication in peer-reviewed journals, and at scientific and clinical conferences.

Study registration number
ClinicalTrials.gov number: NCT05964270 and ABR number: NL75771.075.20.
Immunologic, virologic and drug resistance outcomes in an HIV-infected prospective cohort on treatment in South Africa
Authors: Ogola Bixa , Matume Nontokozo D. , Tebit Denis M. , Mavhandu-Ramarumo Lufuno G. , Bessong Pascal Obong 
Published: August 2024

Background
In September 2016, South Africa introduced the Universal Test and Treat (UTT) programme to manage HIV infection. However, the development of drug resistance and sustaining viral suppression are challenges to the success of treatment programmes. This prospective observational study describes virologic, immunologic, and drug resistance profiles in a test and treat cohort in north-eastern South Africa.

Methods
Five hundred and thirty-four HIV-1 positive antiretroviral naïve adults entering treatment programmes were enrolled between January 2016 and February 2018. Trends in CD4+ cell count, viral load, and drug resistance by examination of deep sequences were assessed at baseline and every three months, for 24 months.

Results
Seventy-five percent were late initiators into ART (that is baseline CD4+ cell counts < 500 cells/microliter) and 16% were early initiators into ART and baseline CD4 was not available for 9%. Eleven percent (12/104) achieved immunological response after 6 months, 39.4% (41 /104) after 12 months, and 97.5% (101/104) after 24 months. Seventy-one percent (381/534) had baseline viral loads >1000 RNA copies/ml. Nine percent (22/246) achieved viral suppression after 3 months, 50% (122/246) after 6 months and 73.6% (181/246) after 12 months. A slower viral suppression was observed for males than females (p value = 0.012). A total of 45.6% (52/114) individuals had at least one drug resistance mutation (DRM) detected at >20% threshold in any of the time points, and the number increased to 55% (63/114) when minor variants were accounted for. Forty-eight percent (14/29) had drug resistance mutations at >5% threshold as early as 3 months into treatment.

Conclusion
The UNAIDS target of 95% viral suppression in individuals under treatment was not observed after 12 months of treatment, and this was less successful for males. Adherence and drug resistance monitoring could be beneficial for individuals harbouring resistant viruses early into treatment.
The effectiveness of live music in reducing anxiety and depression among patients undergoing haemodialysis. A randomised controlled pilot study
Authors: Soliva Miriam Serrano , Carrascosa López Conrado , Rico Salvador Inmaculada , Ramón Rafael Ortiz , Coca Javier Villalón , Maset Rafael García , Testal Alicia García 
Published: August 2024

Background
Anxiety and depression are highly prevalent disorders among individuals undergoing chronic haemodialysis. For patients with kidney disease, the haemodialysis process often exacerbates these conditions. This study aims to investigate the effects of listening to live classical music on anxiety and depression scales during haemodialysis sessions.

Methods
A randomised clinical trial was conducted with a group of patients who listened to live classical music during haemodialysis sessions, while the control group received treatment as usual. Anxiety and depression levels were assessed at baseline and after 4 weeks of listening to live music. The study comprised 90 patients.

Results
The results demonstrated a significant decrease in anxiety and depression among the intervention group, who listened to music, compared to the control group, who did not receive this intervention. Specifically, the intervention group, presented a decrease in score on the anxiety scale of -5.35 (p < 0.001) points on average and a decrease in score on the depression scale of -5.88 (p < 0.001) points on average, while in the control group the levels worsened with the progression of time.

Conclusion
It is concluded that listening to live classical music during haemodialysis sessions reduces anxiety and depression levels in HD patients. This conclusion adds value to listening to live music in the hospital context, specifically in this case, in haemodialysis rooms.
Severe acute malnutrition among children under the age of 5 years
Authors: Chama Gift C. , Siame Lukundo , Kapoma Chanda , Hamooya Benson M. , Masenga Sepiso K. 
Published: August 2024

Background
Severe acute malnutrition (SAM) poses a significant threat to child health globally, particularly in low- and middle-income countries. Zambia, like many Sub-Saharan African nations, faces high rates of child malnutrition, with SAM contributing significantly to under-five mortality. Therefore, this study aimed to determine the prevalence and factors associated with SAM.

Methods
This retrospective cross-sectional study was conducted at Livingstone University Teaching Hospital in Zambia (LUTH). SAM was defined according to the World Health Organization (WHO) criteria as either weight-for-height less than -3 standard deviations, mid-upper arm circumference (MUAC) less than 115 mm, or presence of bilateral pitting edema in children between 6 months and 5 years old who were attended to between 2020 and 2022. Data abstraction from pediatric patient records was conducted between August 2023 and January 2024. The records without the age and outcome variable were excluded. A total of 429 participants between 6 months and 5 years old were included, with demographic, clinical, and hematological parameters analyzed. Univariable and multivariable logistic regression were employed to investigate factors associated with SAM.

Results
Overall, 429 medical records were included in the study and the prevalence of SAM was 27.0% (n = 116). Age group 6–24 months (Adjusted Odds Ratio [AOR]: 11.60; 95% Confidence Interval [CI]: 3.34–40.89, p<0.001), living with HIV (AOR:3.90; 95% CI: 1.14–13.70, p = 0.034), Tuberculosis (TB) (AOR:22.30, 95% CI: 4.53, 110.3, p < 0.001), comorbidities (AOR: 2.50; 95% CI 1.13, 5.88, p = 0.024) and platelet count (AOR: 1.00; 95% CI 1.00, 1.00, p = 0.027) were positively associated with SAM.

Conclusions
This study found a high prevalence of SAM, exceeding the WHO target of reducing SAM to 5% by 2025. SAM was associated with younger age (6–24 months), HIV infection, TB, comorbidities and platelet count. Therefore, there is need to enhance strategies aimed at reducing SAM among young children, children living with HIV, TB and comorbidities, particularly by intensive treatment, continuing and strengthening nutrition services.