bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function
Authors: Chesli Shokoufeh Roshan , Bostani Khalesi Zahra , Chenari Sara Shirzad 
Published: June 2024

Abstract
Background
Sexual function plays a very important role in the sexual health of people, and the determination of their related factors reflects the importance of paying attention to sexual function in the cultural context.

Objective
The present study aimed to the role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function.

Methods
In this descriptive-analytical cross-sectional study, 592 married women of reproductive age referring to comprehensive health centers in Rasht city (North of Iran) and eligible for the inclusion criteria were selected by cluster random sampling. The data collection tools were demographic information form, Halbert’s Sexual Rights Questionnaires, Women’s Sexual Self-Esteem (short form), Halbert’s Sexual Desire, and Female Sexual Function Index. Data analysis was done with descriptive and inferential statistical tests at a significant level (p < 0.05).

Results
The mean and standard deviation of sexual assertiveness, sexual desire, and sexual self-esteem scores were 56.79 ± 18.24, 49.12 ± 26.04, and 98.52 ± 6.11, respectively. Sexual assertiveness (p < 0.01, r = 0.13), sexual desire (p < 0.001, r = 0.178), sexual self-esteem (p < 0.01, r = 0.34) of the participants with the total score, and all areas of female sexual function had a significant positive correlation.

Conclusion
Based on the findings, there is a direct and statistically significant relationship between sexual assertiveness, sexual desire, the adaptability of sexual self-esteem, and family income with sexual function in participants. However, the unemployment of the spouse had a negative effect on the female sexual function.
A post-hoc analysis of outcomes of patients with acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) who received oral azacitidine (Oral-AZA) maintenance therapy in the QUAZAR AML-001 study.
Authors: Voso Maria Teresa , De Botton Stéphane , Pfeilstöcker Michael , Figuera Alvarez Angela , Wang Kefeng , L. See Wendy , Ugidos Guerrero Manuel , Lopes de Menezes Daniel , Petrlik Erica , Prebet Thomas , Roboz Gail J. 
Published: June 2024

6522 Background: AML-MRC represents 25%–34% of all AML cases, and patients with this AML subtype generally have poor outcomes. In this subanalysis of the QUAZAR AML-001study, we report outcomes of patients with AML-MRC who received Oral-AZA vs placebo (PBO). Methods: QUAZAR AML-001 was a phase 3 study of Oral-AZA maintenance therapy in patients with AML in first remission after intensive chemotherapy who were not eligible for hematopoietic stem cell transplantation (HSCT). Patients ≥ 55 years of age with AML and intermediate- or poor-risk cytogenetics received Oral-AZA 300 mg or PBO QD for 14 d per 28-d cycles. In this analysis, WHO 2008 criteria were used to identify patients with secondary AML and/or patients with AML-MRC (both groups are referred to as AML-MRC in this analysis). Data on mutational profiles at diagnosis were not available. Overall survival (OS) from time of randomization to time of death from any cause after censoring for HSCT, and relapse-free survival (RFS) from time of randomization, were calculated using the Kaplan–Meier method. Duration of measurable residual disease (MRD) negativity achieved on treatment was calculated from the first MRD-negative assessment. Results: Overall, 101/472 patients had AML-MRC; 56/238 (23.5%) patients in the Oral-AZA arm and 45/234 (19.2%) patients in the PBO arm. Karyotype/cytogenetics data at diagnosis were available for 87/101 (86.1%) patients with AML-MRC and 331/371 (89.2%) patients with non-AML-MRC. A greater proportion of AML-MRC than non-AML-MRC patients had poor-risk cytogenetics (20/101 [19.8%] vs 46/371 [12.4%]), del(5q) (10/87 [11.5%] vs 9/331 [2.7%]), and monosomy 7/del(7q) (9/87 [10.3%] vs 14/331 [4.2%]). Median OS did not significantly differ in patients with AML-MRC vs non-AML-MRC in either treatment arm (Oral-AZA: 19.9 mo vs 25.1 mo, P = 0.2694; PBO: 14.8 mo vs 14.9 mo, P = 0.2099). In both treatment arms, the median RFS was inferior for patients with AML-MRC vs non-AML-MRC (Oral-AZA 7.5 mo vs 10.5 mo, P = 0.0430; PBO: 3.7 mo vs 4.9 mo, P = 0.0109). Oral-AZA significantly prolonged median OS and RFS, and the duration of MRD negativity for patients with AML-MRC compared with PBO (Table). Conclusions: Oral-AZA significantly improved OS and RFS compared with PBO for patients with AML-MRC indicating that Oral-AZA maintenance is an effective treatment option for these patients with particularly poor prognosis. Clinical trial information: NCT01757535 . [Table: see text]
Evaluation of the toxicity and outcomes of the combination of midostaurin and CLAG-M in patients with FLT3-mutated acute myeloid leukemia (AML): A multi-center retrospective analysis.
Authors: Chen Ashley Wen , Baek Grace Tonghwa , Palmer Shannon , Rasmussen Jack , Bubalo Joseph S. , Namburi Swathi , Schwarz Tenley , Tsomo Tenzin , Cohen Jonathan , Russell Kathryn , Shaw Carole , Othus Megan , Halpern Anna B. 
Published: June 2024

6523 Background: FLT3-mutated AML is associated with poor outcomes. Addition of midostaurin (multi-targeted kinase inhibitor) to standard “7+3” with cytarabine and daunorubicin significantly prolongs overall and event-free survival for these patients (Stone 2017). At the University of Washington/Fred Hutchinson Cancer Center (UW/FHCC), the standard regimen for newly diagnosed (ND) and relapsed/refractory (r/r) AML is cladribine, high-dose cytarabine, GCSF, and mitoxantrone (CLAG-M); midostaurin is added if FLT3-mutated (Halpern 2018). There is currently no peer-reviewed literature to support this combination for these patients. The purpose of this study is to evaluate the safety and efficacy of the combination of midostaurin with CLAG-M in FLT3-mutated AML patients and compare the toxicity profile to midostaurin plus 7+3. Methods: This is a retrospective multi-center review conducted at three major cancer centers. Through pharmacy records and/or an institutional AML database, we identified adults with FLT3-mutated AML undergoing (re)induction chemotherapy who received either CLAG-M (UW/FHCC, Swedish) or 7+3 (OHSU, Swedish). The primary outcome was toxicity profile of the combination as measured by rate of adverse events ([AE], CTCAE Version 5.0). Secondary outcomes included disease response per ELN2017 AML working group criteria and 28-day mortality (TRM) (Döhner 2017). Patients treated on a clinical trial and in whom midostaurin was started > 30 days after day 1 of chemotherapy were excluded. Rates of AEs were compared using Fisher’s exact test. Results: Eighty patients treated between 10/2022-12/2023 were included; 35 patients received CLAG-M, and 44 patients 7+3. Baseline characteristics were similar across all institutions, with most patients having adverse or intermediate risk disease. AE rates were similar between the two cohorts, (Table 1) except diarrhea and bleeding events were more common in the 7+3 vs. CLAG-M cohort (p = 0.004 and p = 0.037, respectively). The rate of complete remission (CR) plus CR with incomplete blood count recovery (CRi) did not significantly differ between the two cohorts: CLAG-M, 86% versus 7+3, 70% for 7+3 (p =0.11). No TRM occurred. Conclusions: The toxicity profile of CLAG-M combined with midostaurin is comparable to the combination of 7+3 with midostaurin, and induces high remissions rates in adults with FLT3-mutated AML. [Table: see text]
Trajectories of patient-reported outcomes after prolonged stays for hematopoietic cell transplant.
Authors: Gao Lucy , DeFilipp Zachariah Michael , Chen Yi-Bin Albert , Lee Stephanie , LeBlanc Thomas William , Amonoo Hermioni L. , El-Jawahri Areej , Newcomb Richard 
Published: June 2024

6553 Background: Patients hospitalized for hematopoietic cell transplantation (HCT) may have prolonged length of stay (PLOS). The longitudinal effect of PLOS in this population on quality of life (QOL) and psychological distress is unknown. Methods: We conducted secondary analyses of data from three prospective studies of patients undergoing HCT (2011-2022) at three academic centers. We defined PLOS as ≥30 days for allogeneic and ≥21 days for autologous HCT from date of admission. We collected patient-reported outcomes (PROs) for QOL, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms at baseline, 2 weeks, 3 and 6 months post-HCT. We used multivariate logistic regression to assess the effect of change in PROs from baseline to week 2 on PLOS adjusting for age, transplant type, donor, and diagnosis. We then fit linear mixed effects models to characterize the trajectory of PROs by PLOS over time. Results: 593 patients (mean age 56 years) were included, the majority of whom were male (57%), white (82%), and underwent allogeneic HCT (52%). The most common diagnosis was acute leukemia (28%). Patients with PLOS (26%) were younger (57 [range 18-78 yrs], 53 [19-75 yrs], p = 0.002), had acute leukemia (26%, 34%, p = 0.001), received myeloablative conditioning (21%, 41%, p < 0.001), and underwent allogeneic HCT (50%, 60%, p < 0.001). At baseline, patients with PLOS had lower QOL (108, 102, p = 0.001) and more depression symptoms (4.4, 5.3, p = 0.02). There was no difference in baseline anxiety or PTSD symptoms. An increase in depression symptoms from baseline to week 2 was associated with greater odds of PLOS (adjusted OR = 1.08, p = 0.04). The table depicts longitudinal differences in PROs by PLOS. Compared to those without PLOS, patients with PLOS reported lower QOL (time*PLOS interaction, ∆ = -6.6, SE = 2.1, p = 0.001) and greater increase in depression symptoms (time*PLOS interaction, ∆ = 1.9, SE = 0.6, p < 0.001) at week 2. Lower QOL in those with PLOS persisted through 6 months (Table). PLOS was associated with more re-admissions (0.8, 1.1, p = 0.02) and mortality (9%, 19%, p = 0.001) within 1 year of HCT. No difference was seen in rate of relapse and severe acute or chronic graft- versus-host disease. Conclusions: Patients with PLOS experienced worse QOL and increased psychological distress. Increase in depression symptoms from admission to week 2 may be an early indicator of PLOS and supports mental health screening during the index HCT hospitalization. Patients with PLOS may benefit from enhanced supportive care during and after HCT.[Table: see text]
Comparison of the efficacy of immunotherapy at different time points during the perioperative period for stage II-III NSCLC.
Authors: Zhang Yajuan , Jia Xiaohui , Liu Mengjie , Ni Yunfeng , Dang Chengxue , Liu Jia , Mao Ziyang , Li Yanlin , Fu Xiaolan , Guo Hui 
Published: June 2024

e20009 Background: The application of immune checkpoint inhibitors (ICIs) in early-stage lung cancer is fraught with unresolved issues, and there are no clinical studies directly comparing the efficacy of ICIs used in neoadjuvant, adjuvant, and neoadjuvant followed by adjuvant therapy across different perioperative time points in non-small cell lung cancer (NSCLC). Consequently, the optimal timing for immunotherapy in surgically resectable NSCLC remains uncertain. Methods: This study encompassed 536 patients with stage II-III NSCLC, diagnosed and treated across multiple centers from January 2019 to December 2022. Clinical data for all patients ultimately included in the study were retrospectively collected. The primary endpoints evaluated were event-free survival (EFS)/disease-free survival (DFS) and overall survival (OS) . Secondary endpoints included pathological complete response (pCR) and major pathological response (MPR). Propensity score matching was utilized to mitigate confounding factors, comparing the efficacy of ICIs across different treatment modalities and time dimensions during the perioperative period of lung cancer. Results: The integration of neoadjuvant ICIs with chemotherapy was observed to significantly enhance pCR ( p < 0.001), MPR ( p < 0.001), EFS ( p = 0.002), and OS ( p < 0.001) in comparison to neoadjuvant chemotherapy alone. Similarly, the combination of adjuvant ICIs with chemotherapy markedly improved DFS ( p = 0.034) and OS ( p = 0.021) relative to adjuvant chemotherapy alone. Building on these insights, we further delineated the efficacy of ICIs across distinct temporal dimensions within the perioperative interval, categorizing patients into three groups: neoadjuvant ICIs plus chemotherapy, adjuvant ICIs plus chemotherapy, and a sequential regimen of neoadjuvant followed by adjuvant ICIs plus chemotherapy. The analysis revealed no significant differences in DFS and OS among the three patient groups for stage II NSCLC. In contrast, for stage III NSCLC, both neoadjuvant ( p = 0.015) and sequential treatment approaches ( p = 0.047) demonstrated significantly improved DFS outcomes compared to the adjuvant protocol, with no substantial statistical difference noted between the neoadjuvant and sequential treatments ( p = 0.274). Furthermore, the sequential regimen outperformed the adjuvant strategy in OS ( p = 0.020). However, when comparing the neoadjuvant strategy with either the adjuvant ( p = 0.054) or sequential approaches ( p = 0.717), there were no statistically significant variances detected. Conclusions: For individuals with resectable stage III NSCLC, perioperative administration of neoadjuvant and sequential adjuvant ICIs appears to confer enhanced survival advantages. Future efforts should focus on refining treatment strategies for early-stage NSCLC, aiming to deliver enhanced survival benefits to patients.
Single-cell landscape of the immune microenvironment of leptomeningeal metastases in non-small cell lung cancer treated with pemetrexed sheath injection.
Authors: Xu Yiquan 
Published: June 2024

e20026 Background: The incidence of leptomeningeal metastasis (LM) is increasing in non-small cell lung cancer (NSCLC) and pemetrexed injection is an important treatment for LM. Here, we used single-cell RNA sequencing (scRNA-seq) to define the immune landscape of LM in NSCLC treated with pemetrexed sheath injection. Methods: scRNA-seq was utilized on 27 cerebrospinal fluid (CSF) samples from 20 patients, including 7 pairs of pre- and post-treatment samples. Detailed immune landscapes were mapped, and key results were confirmed by flow cytometry and IHC. Biomarkers for the efficacy of pemetrexed sheath injection was analyzed. Results: The LM microenvironment was characterized by macrophages and cancer cells with decreased significantly after pemetrexed injection. The cancer cells in LM was highly expressed CEACAM6, SFTPB and NAPSA, and chemokines liked CXCL16 in macrophages decreased significantly after receiving pemetrexed sheath treatment than pre- treatment, which was validated by flow cytometry and IHC. In the signal pathway enrichment analysis, significant changes of metabolism and cell cycle genes occurred before and after pemetrexed injection. Moreover, the analysis of tumor cells and immune cells interaction showed that CSF1-CSF1R, AREG/HBEGF-EGFR, FD1-Intergrin_a2B1_complex, CCL5-CCR1, CD55_ADGRE play a key role in tumor cells recruiting monocytes and inhibiting macrophages. Gene set based on the efficacy of pemetrexed sheath injection was enriched, including C15orf48, CCL5, DUSP6, FLNA, TXNIP, TNNT1, was confirmed associating with increased overall survival. Conclusions: Our study characterizes the immune cell landscape of LM from NSCLC, and provided the biomarkers for the efficacy of pemetrexed injection.
Clinical and genomic characteristics of multiple primary lung cancers with germline mutations.
Authors: Yang Yingshun , Li Mingwei , Ma Xiaoxue , Wang Shuai , Pei Guotian , Qin Jiayue , Liu Jun , Huang Yuqing 
Published: June 2024

e20054 Background: The number of multiple primary lung cancer (MPLC) patients has rapidly increased in recent years. However, germline mutations and information regarding the etiology of MPLC is very rare. In this study, we sought to determine the prevalence and clinical significance of germline pathogenic/likely pathogenic (P/LP) variants in patients with MPLC. Methods: A total of 111 MPLC patients undergoing radical surgery were enrolled in this study and 625 patients with single-focus lung cancer (SFLC) were analyzed as a control. Tumor and blood lymphocyte DNA from patients were sequenced using next-generation sequencing (NGS) platform interrogating up to 808 cancer-associated genes. Interpretation of sequence variations was classified according to the American College of Medical Genetics and Genomics guidelines. Results: A total of 15 germline P/LP mutations in 12.6% (14/111) of MPLC patients were observed, including one patient with 2 germline alterations; of these, 9 patients (64.3%) had germline mutations in DNA-damage repair (DDR) pathway genes in which the most commonly genes were WRN (14.3%, 2/14) and BRCA1/2 (14.3%, 2/14), followed by RAD50 and MSH3. Similarly, 68 germline mutations were identified in 67 (10.7%)SFLCs, and 54 (79.4%) mutation genes were DDR genes including RAD50 (10.4%, 7/67) showed the highest frequency. The somatic mutations of EGFR (59.5% vs. 48.5%) were enriched in P/LP alterations carriers, while TP53 (12.4% vs. 4.8%) was more common in MPLC patients without P/LP alterations. Besides, lower BRAF and MET mutation frequency were observed in SPLC with germline alterations (p < 0.05), compared to those who did not. MPLC were more likely to be patients with family history of cancers (32.4% vs. 25.0%, p = 0.099) than SFLC, while the proportion of patients with family history of cancers found no significant difference between P/LP and non-P/LP groups. MPLC patients with germline P/LP variances were diagnosed at younger age ( < 40 years old) compared to non-carriers. For MPLC, the ratio of males is not associated with P/LP variations. However, significantly higher proportion of germline P/LP mutations was detected in males in SFLC (61.2% vs. 48.4%, p = 0.048). Patients with a history of smoking were significantly less enriched in MPLC (p = 0.030) compared to SPLC but were independent of whether harbored germline mutations. Conclusions: Taken together, ur results show that in the first large Chinese cohort of MPLC, 12.6% of patients carry germline variants. In addition, a more detailed analysis of the spectrum of germline mutations and clinical characteristics of MPLC may provide clues for the oncology treatment strategy and cancer prevention for MPLC.
Evaluating progression-free survival of EGFR exon 20ins in patients with advanced non-small lung cancer receiving EGFR inhibitors: A real-world data study.
Authors: Kabbaha Suad , Dempsey Sarah Carder , Thorlund Kristian 
Published: June 2024

e20092 Background: EGFR mutations with exon 20 insertions (Exon20ins) have emerged as a distinct subset with significant clinical implications. Their prevalence is approximately 10%. Patients with Exon20ins have fewer available treatment options compared to common EGFR mutations. We therefore aimed to evaluate progression-free survival (PFS) in advanced and recurrent non-small cell lung cancer (NSCLC) patients harboring Exon20ins and treated with EGFR inhibitors. Methods: We searched the OpenCase database for stage III-IV advanced and recurrent NSCLC patients harboring (Exon20ins) mutation and limited to patients having received at least commercially available EGFR inhibitors (including off-label use). We extracted time to progression or longest duration of follow-up for all patients as well as key baseline characteristics. We calculated median PFS (IQR) across all patients. Subgroup analysis compared the sub-populations contingent on each having data from n>9 patients: line of therapy (1st, 2nd and 3rd+, Sex, Age (<65 years vs older), and smoking status (never vs former/current). Results: The number of patients harboring Exon20ins mutation was n=93. Filtering to patients who had received EGFR inhibitors yielded a sample size of n=36 patients. Fourteen patients had data on 2 or 3 lines of treatments, thus yielding n=53 PFS data points. The median age was 56.5 years (IQR: 39.7-68) with 63.8% females, and 69.4% never-smokers (11% missing values). PFS was available for 21, 12, and 13 patients on 1st, 2nd and 3rd+ line of therapy, respectively. EGFR inhibitors were Afatinib (13), Osimertinib (12), Furmonertinib (6), Anlotinib(6), Crizotinib (3), Poziotinib(2), Almonertinib(2), Apatinib (2), Other (8). The overall median PFS was 9.0 months (IQR: 5.0 to 10.3, min-max: 1 to 38). The median PFS was similar for 1st, 2nd and 3rd+ lines of treatment at 8.13, 8.0 and 9.5 months, respectively. The median PFS for females was 9 months (IQR: 3.8 to 12, n=36) versus 6.2 months (5 to 10, n=17). Lastly, the median PFS for patients younger than 65 years was 9 months (IQR: 5.3 to 12, n=39) versus 5.6 (IQR: 2,5 to 9.4, n=15) for older patients. Subgroup comparison for smoking status was not possible due to low number of former/current smokers. Conclusions: Our exploratory analysis suggested improved PFS among female, and younger patients. No differences were observed by treatment line or treatment.
The Accuracy of the Learning-Curve Cumulative Sum Method in Assessing Brachial Plexus Block Competency
Authors: de Oliveira Filho Getúlio Rodrigues , Soares Garcia Jorge Hamilton 
Published: June 2024

BACKGROUND:
The learning-curve cumulative sum method (LC-CUSUM) and its risk-adjusted form (RA-LC-CUSUM) have been proposed as performance-monitoring methods to assess competency during the learning phase of procedural skills. However, scarce data exist about the method’s accuracy. This study aimed to compare the accuracy of LC-CUSUM forms using historical data consisting of sequences of successes and failures in brachial plexus blocks (BPBs) performed by anesthesia residents.

METHODS:
Using historical data from 1713 BPB performed by 32 anesthesia residents, individual learning curves were constructed using the LC-CUSUM and RA-LC-CUSUM methods. A multilevel logistic regression model predicted the procedure-specific risk of failure incorporated in the RA-LC-CUSUM calculations. Competency was defined as a maximum 15% cumulative failure rate and was used as the reference for determining the accuracy of both methods.

RESULTS:
According to the LC-CUSUM method, 22 residents (84.61%) attained competency after a median of 18.5 blocks (interquartile range [IQR], 14–23), while the RA-LC-CUSUM assigned competency to 20 residents (76.92%) after a median of 17.5 blocks (IQR, 14–25, P = .001). The median failure rate at reaching competency was 6.5% (4%–9.75%) under the LC-CUSUM and 6.5% (4%–9%) for the RA-LC-CUSUM method (P = .37). The sensitivity of the LC-CUSUM (85%; 95% confidence interval [CI], 71%–98%) was similar to the RA-LC-CUSUM method (77%; 95% CI, 61%–93%; P = .15). Identical specificity values were found for both methods (67%; 95% CI, 29%–100%, P = 1).

CONCLUSIONS:
The LC-CUSUM and RA-LC-CUSUM methods were associated with substantial false-positive and false-negative rates. Also, small lower limits for the 95% CIs around the accuracy measures were observed, indicating that the methods may be inaccurate for high-stakes decisions about resident competency at BPBs.