bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remote feedback in endovascular simulation training: a mixed-methods study
Authors: Roche Adam F. , Moneley Daragh , Lawler Tim , Boyle Emily , Gosi Greg , O’Callaghan Adrian , Cahir Caitriona , O’Keeffe Dara , Condron Claire M. 
Published: June 2024

Abstract
Background
There is an increasing need to increase simulation-based learning opportunities for vascular surgery residents in endovascular skills training. This study aims to explore the effectiveness of remote expert instructional feedback of endovascular simulation-based education, as a means of increasing training opportunities in this area for vascular surgery residents.

Methods
A mixed-methods study design was adopted. Twelve vascular surgery residents from Ireland were tasked with completing two endovascular renal artery procedures: one with in-person expert feedback and the other with remote instruction. Participants ranged in experience levels from second year to final year of residency. Following the training activities, interviews and a questionnaire were employed to gather information on the usefulness of remote feedback.

Results
There was no significant difference reported by participants using a post-event validated questionnaire between remote and in-person feedback. During the interviews, participants expressed mixed feelings about the presence of the educator while practicing, but they eventually saw no limiting factors to their practice when the trainer provided remote feedback. When receiving performance feedback remotely, clear communication and a shared knowledge of the task development are critical to success.

Conclusions
We believe these findings can inform the design and development of remote learning and assessment of endovascular skills training and ultimately provide increased opportunities for more skills practice for vascular surgical residents.
New insights into the DNA extraction and PCR amplification of minute ascomycetes in the genus Laboulbenia (Pezizomycotina, Laboulbeniales)
Authors: Van Caenegem Warre , Haelewaters Danny 
Published: June 2024

AbstractMolecular studies of fungi within the order Laboulbeniales (Ascomycota, Pezizomycotina) have been hampered for years because of their minute size, inability to grow in axenic culture, and lack of reliable and cost-efficient DNA extraction protocols. In particular, the genus Laboulbenia is notorious for low success with DNA extraction and polymerase chain reaction (PCR) amplification. This is attributed to the presence of melanin, a molecule known to inhibit PCR, in the cells. We evaluated the efficacy of a standard single cell-based DNA extraction protocol by halving the recommended amount of reagents to reduce the cost per extraction and adding bovine serum albumin (BSA) during the multiple displacement amplification step to reverse the effect of melanin. A total of 196 extractions were made, 111 of which were successful. We found that halving the reagents used in the single cell-based extraction kit did not significantly affect the probability of successful DNA extraction. Using the halved protocol reduces cost and resource consumption. Moreover, there was no significant difference in the probability of successfully extracting DNA based on whether BSA was added or not, suggesting that the amount of melanin present in cells of the thallus has no major inhibitory effect on PCR. We generated 277 sequences from five loci, but amplification of the internal transcribed spacer region, the mitochondrial small subunit rDNA, and protein-coding genes remains challenging. The probability of successfully extracting DNA from Laboulbeniales was also impacted by specimen storage methods, with material preserved in > 95% ethanol yielding higher success rates compared to material stored in 70% ethanol and dried material. We emphasize the importance of proper preservation of material and propose the design of Laboulbeniales-specific primers to overcome the problems of primer mismatches and contaminants. Our new insights apply not only to the genus Laboulbenia; Laboulbeniales generally are understudied, and the vast majority of species remain unsequenced. New and approachable molecular developments will benefit the study of Laboulbeniales, helping to elucidate the true diversity and evolutionary relationships of these peculiar microfungi.
Clinical efficacy of two different doses of rituximab as a treatment option in adult patients with chronic immune thrombocytopenia
Authors: El-Saied Dina G. , Dwidar Amany M. , Abdelaty Mona Mahrous 
Published: June 2024

Abstract
Background
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder with a high incidence of chronicity among adults. Rituximab is recommended as a treatment option for chronic ITP with the best long-term effect compared with other therapies. However, the optimal dose of rituximab remains unclear. We retrospectively compared the response rate, incidence of relapse, and other clinical outcomes in 34 chronic ITP patients who received rituximab in different doses. Patients were divided into two groups according to rituximab dose (the low-dose group, 100 mg/week for 4 weeks, and the standard-dose group, 375 mg/m2 weekly for 4 weeks).

Results
Females represented 72.2% and 56.3% of patients in the low dose and the standard dose groups, respectively. The overall response in all patients was 88.2%. By the end of the second month of treatment, 77.8% achieved partial remission and 11.1% achieved complete remission in the low-dose group versus 68.8% and 18.8% in the standard-dose group. Similar incidence of sustained complete response after 6 months of treatment, 83.3% after low dose rituximab and 81.2% after the standard dose (p = 1.000). The incidence of relapse was similar between both groups.

Conclusion
Our findings demonstrate that both regimens had no statistically significant differences in overall response, relapse rate, and time to reach response. The low dose of rituximab is comparable to the standard high dose in efficacy and safety for the treatment of chronic ITP patients and can be a good option in centers with limited resources.
Impact of JAK2 allele burden on MF outcome in the era of ruxolitinib.
Authors: Braish Julie , Bose Prithviraj , Pemmaraju Naveen , Pierce Sherry , Sasaki Koji , Estrov Zeev , Patel Keyur P. , Kantarjian Hagop M. , Masarova Lucia 
Published: June 2024

6514 Background: Myelodepleted myelofibrosis (MF), characterized bycytopenias, lower JAK2V617F allele burden (JAK2%) and shorter benefit from JAKi ruxolitinib (RUX), has worse survival (OS) compared to myeloproliferative MF. Lower JAK2% and inferior OS is more typical for primary MF (PMF) vs MF from essential thrombocythemia or polycythemia vera (PPV/PET-MF). We sought to investigate the impact of JAK2% (</≥ 50%), cytopenias and the use of RUX in outcome of PMF/PPV-PET-MF patients from our center. Methods: 601 medical charts of JAK2 mutated patients with MF (known JAK2%) were retrospectively reviewed. We divided patients based on the absence (-) or presence (+) of cytopenias (hemoglobin < 10 g/dL or platelets < 100 x10^9/L) and leukocytosis (WBC ≥ 25 x10^9/L) into: Gr1 = (-)/(-) [absence of both]; Gr2 = (-)/(+) [proliferative]; Gr3 = (+)/(-) [cytopenic]; Gr4 = (+)/(+) [cytopenic and proliferative]) and evaluated OS per JAK2 </≥ 50% and PMF vs PPV/PET-MF. We assessed the tolerance of RUX ≥3 years. We used descriptive statistics, Kaplan-Meier curve with log-rank test and regression analysis for demographics, estimation of OS and its comparison. OS was censored at the time of stem cell transplantation. Results: Median age of the entire cohort was 75 years (64% males). Patients with JAK2 <50%, more likely PMF, had more anemia and thrombocytopenia, higher blasts, less leukocytosis, and smaller splenomegaly. JAK2 </≥ 50% did not discriminate OS of the entire group, PMF or PPV/PET-MF (median OS of ~ 45 months for each; only PPV/PET-MF with 64 months). OS of Gr1-4 according to JAK2 </≥ 50% and PMF/ PPV/PET-MF and combined OS of patients with comparable outcome (A-D) are shown in the table. The final groups with distinct outcomes included: A+B) non-cytopenic PET/PPV-MF and PMF irrespectively of proliferation and JAK2% - with one exception of non-cytopenic, proliferative PMF with JAK2 ≥50% - had median OS of 70 months (range, 54-86); D) cytopenic and proliferative PMF with any JAK2% and PPV/PET-MF with JAK2 < 50% of median OS 19 months (range, 13-25), and C) the rest of the cytopenic patients and non-cytopenic, proliferative PMF with JAK2 ≥50% with a median OS of 36 months (range, 32-42). Among the 3 final groups, similar proportion of patients were exposed to RUX during their follow-up: 36% (A+B), 31% (B) and 28% (C), respectively (p =0.13). The most patients in (A+B) group were able to tolerate RUX for ≥3 years (p =0.036). All patients had improved OS with RUX (data to be presented). Conclusions: Cytopenias and/or proliferation, rather than JAK2 </≥50%, define the outcome of PMF and PPV/PET-MF patients. [Table: see text]
Achievement of therapeutic levels using dose-reduced peg-asparaginase in adult patients with acute lymphoblastic leukemia.
Authors: Goldberg Leah Ann , Kapadia Anjani , Palmer Andrew , Shah Syed Abdul Mannan , Rahmani Youshanlouei Hamed , DuVall Adam , Stock Wendy , Dworkin Emily , Patel Anand Ashwin 
Published: June 2024

6530 Background: Peg-asparaginase (PEG) doses range from 2000-2500 IU/m2 in pediatric-inspired regimens for acute lymphoblastic leukemia (ALL). Pediatric PEG dosing in adolescents and young adults (AYAs) has resulted in improved outcomes, but PEG-associated toxicities increase with age and often limit its use. Therapeutic dosing is determined by asparagine (ASP) depletion for 14 days after dose; L-asparaginase levels can act as a surrogate marker of ASP depletion. We previously showed dose reduced PEG (defined as <2000 IU/m2) results in high rates of therapeutic L-asparaginase 7 days post PEG (Derman et al, Leuk Lymphoma 2020). Here we describe prolonged duration of ASP depletion and comparable toxicities after dose reduced PEG in adults with ALL. Methods: Patients ≥18 years with ALL or lymphoblastic lymphoma (LBL) who received PEG from 1/1/2008 to 9/28/2023 were identified for retrospective chart review. Those with ≥1 PEG trough level (defined as 10-20 days after dose) were included. The primary endpoint was therapeutic PEG levels (≥0.1IU/mL L-asparaginase) at 7 and 14 days post administration, with secondary endpoint being induction grade 3+ toxicities (CTCAE v.5.0). Results: 49 patients met inclusion criteria, of which 48 received PEG during induction. Median age was 34.7 (range 18-66), 67% were male and 53% had B-cell ALL. 17 (35%) received an induction dose ≤ 500 IU/m2, 22 (46%) received 501 to ≤1000 IU/m2 and 9 (19%) received >1000 IU/m2. Induction median dose was 1000 IU/m2. Among those with PEG trough levels, 79% were therapeutic after induction; of note, 4 patients were transitioned from PEG to Erwinia asparaginase due to silent inactivation. During induction, 23 (48%) patients had ≥1 grade 3+toxicity, including 5 (10%) with hepatotoxicity, 1 (2%) with pancreatitis, and 2 (4%) with a thrombotic event. There was no statistical relationship between dose level and toxicities (p=.8). Conclusions: This study demonstrates durability of therapeutic L-asparaginase levels and ASP depletion that persists 14 days despite dose reduction. There were decreased rates of hepatotoxicity and comparable rates of pancreatitis and thrombotic events compared to rates reported in CALBG 10403 (C10403) (Stock et al, Blood 2019), which utilized standard pediatric dosing. In addition, our cohort’s median age was significantly older than those treated on C10403. This suggests PEG dose reduction may offer similar therapeutic ASP depletion with comparable or reduced toxicities. Dose reduction should be studied prospectively in AYAs with ALL. [Table: see text]
Outcomes of patients with bone marrow fibrosis in de novo and secondary acute myeloid leukemia.
Authors: Urrutia Samuel , Kantarjian Hagop M. , Ravandi-Kashani Farhad , Jabbour Elias , Kanagal-Shamanna Rashmi , Loghavi Sanam , Patel Keyur P. , Montalban-Bravo Guillermo , Short Nicholas James , Daver Naval Guastad , Borthakur Gautam , Dinardo Courtney Denton , Kadia Tapan M. , Masarova Lucia , Bose Prithviraj , Pemmaraju Naveen , Garcia-Manero Guillermo , Sasaki Koji 
Published: June 2024

6538 Background: The outcomes of patients with de novo acute myeloid leukemia (AML) with bone marrow fibrosis (MF) have not been systematically studied. Our objective was to define the prognosis of patients with AML and multiple degrees of bone marrow fibrosis, efficacy of therapy, and survival outcomes. Methods: We retrospectively evaluated 2302 patients diagnosed with AML at a single center from 2007 to 2023 and annotated clinicopathologic characteristics and outcomes. Results: We identified 492 (21%) with AML and MF. We found 344 (69.9%) had MF 0-1 and 148 (30.1%) had MF 2-3. Median age was 67 (IQR: 57-73). Fifty-five (11.1%) had a history of myeloproliferative neoplasm (MPN). Patients with MF 2-3 were associated with complex cytogenetics (39.2%), JAK2 mutations (25.7%), and lower incidence of IDH2(16.9%) or CEBPA(15.5%) mutations (Table). For patients with MF 0-1, median overall survival (mOS) was 14.2 months compared to 7.5 months for those with MF 2-3 (p<0.005). Survival in patients with MPN history was 9.4 months compared to 12.4 months in patients with de novo AML. In a multivariate analysis, MF 2-3 (HR 2.00 95%CI 1.59-2.51), non-diploid cytogenetics (HR 1.29, 95%CI 1.33-1.69), and number of co-morbidities (HR 1.26 95%CI 1.10-1.43) were prognostic for shorter mOS. Sixty-four percent were treated with low-intensity chemotherapy (LIC), 36.1% with intensive chemotherapy (IC). Complete remission (CR)/CR with incomplete count recovery (CRi) rates were 63.5% for IC vs 37.9% for LIC (p=0.007). Four-week mortality after induction was 5.8% with IC, 8.4% with LIC (p = 0.809). In patients aged 60 and older, with MF 2-3, intensive therapy did not result in improved survival (6.5 months vs 7.0 months, p = 0.19). Conclusions: Patients with AML and MF 2-3 have worse outcomes irrespective of MPN history. For patients aged 60 and above, intensive chemotherapy does not result in improved survival. [Table: see text]
Impact of protein energy malnutrition on hospitalized patients with acute myeloid and lymphoid leukemia: A United States population-based cohort study.
Authors: Syal Arshi , Arya Yajur , Casipit Bruce Adrian , Obomanu Elvis , Heller Gordon , Dourado Claudia M. , Leighton John Charles 
Published: June 2024

6548 Background: Acute leukemia poses a significant burden to the society and the healthcare system. Advances in chemotherapeutics and hematopoietic stem cell transplantation (HSCT) have increased survival in these patients. Protein energy malnutrition (PEM) frequently complicates the clinical picture in patients with cancer, however data on the impact of PEM in patients with acute myeloid and lymphoid leukemia is limited. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with acute leukemia (myeloid and lymphoid) and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with acute leukemia based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among patients with acute leukemia. Results: We identified a total of 30995 hospitalized patients with acute leukemia, of which 13.06% (4050/30995) had comorbid PEM. The overall in-hospital mortality among patients with acute leukemia was 8.95% (2775/30995). Among those with co-morbid PEM, the mortality rate was significantly higher at 12.47% (505/4050, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 1.50; 95% (confidence interval [CI], 1.18 -1.91); p=0.001), longer LOS (coefficient 10.50; CI 8.59 -12.41; p<0.001), and higher total hospitalization charge ($208,308; CI $147,516- $269,100; p<0.001). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with acute leukemia and significantly worsened outcomes including increased in-hospital mortality, LOS, and cost of healthcare utilization. A proactive approach for prevention and early management of cancer associated malnutrition is required. Further prospective multicentric studies are needed to better describe these associations.
A prospective phase II randomized clinical study of folic acid in the intervention of radiation esophagitis induced by concurrent chemoradiotherapy in lung cancer.
Authors: Zhang Hao , Zhu Yiying , Ouyang Weiwei , Su Shengfa , Ma Zhu , Li Qingsong , Yang Wengang , Chen Xiaxia , Lu Bing 
Published: June 2024

e20004 Background: To investigate the efficacy and safety of folic acid intervention in lung cancer patients with radiation esophagitis caused by concurrent chemoradiotherapy. Methods: It was a randomized, controlled, single-center clinical trial of 82 patients with stage N2~N3 lung cancer including SCLC and NSCLC were prospectively included. All patients were randomly divided into experimental and control group according to 1:1, and patients were required to receive radiation therapy for lung lesions and mediastinal metastatic lymph nodes (More than 2 cycles of chemotherapy were completed during the same period of radiotherapy or take targeted drugs at the same time, the cumulative radiation dose of chest lesions should exceed 40Gy). The experimental group took folic acid tablets 30mg/day orally at the beginning of radiotherapy until the end of radiotherapy, while the control group did not receive any drug intervention.When two groups appeared radiation esophagitis, the grading criteria for RTOG should be evaluated first, then according to the guidelines of symptomatic treatment.Esophageal toxicity was evaluated during radiotherapy, and improved RTOG and NCI-CTC ratings were performed weekly at the onset of radiation esophagitis and thereafter until 1 week after the end of radiotherapy. Results: The incidence of radiation esophagitis in the experimental group was low during the observation period, and the occurrence time of radiation esophagitis could be delayed in the experimental group, but there was no statistical significance between the two groups ( P=0.456). After folic acid intervention, the symptoms of pain and dysphagia of radiation esophagitis in the experimental group were significantly decreased, especially the RTOG grade and NCI-CTC improvement grade decreased significantly 2 weeks after the occurrence of radiation esophagitis( P=0.007, P=0.009). In the experimental group, it was found that the greater the change of hemoglobin before and after radiotherapy, the occurrence time of radiation esophagitis was about delayed, which was statistically significant(r=0.348, P=0.040).The correlation analysis of the control group showed that the change of body mass index was positively correlated with the onset time of radiation esophagitis(r=0.372, P=0.020);The lower the hemoglobin content after radiotherapy and the larger the hemoglobin difference before and after radiotherapy, the higher the highest incidence of radiation esophagitis(r= -0.454, P=0.004;r= -0.343, P=0.032). Conclusions: Oral folic acid can delay the onset of radiation esophagitis due to concurrent chemoradiotherapy and promote the recovery of radiation esophagitis to a certain extent,but can not interfere with the occurrence of radiation esophagitis.This trial is registered in Clinical Trials(NCT0529636). Clinical trial information: NCT0529636 .
Osimertinib related cardiotoxicity in patients with non-small cell lung cancer.
Authors: Mensah Samuel Akaakole , Alruwaili Waleed , Ahmad Syed , Patel Brijesh , Almubarak Mohammed 
Published: June 2024

e20011 Background: There have been cases of cardiotoxicity induced by osimertinib in patients with non-small cell lung cancer (NSCLC). Limited data exists for a comprehensive cardiotoxicity profile analysis for osimertinib in NSCLC patients. Methods: Data was retrospectively collected from electronic medical records for all patients who were started on osimertinib for NSCLC at West Virginia University Health System between 7/2016 and 1/2024. Prevalence of heart failure (HF), atrial fibrillation, and prolonged QT before and after starting osimertinib were calculated. Corrected QT interval was calculated using the Fredericia formula. QT prolongation was defined as a QTc >500 milliseconds (ms). Results: A total of 116 participants with NSCLC on osimertinib were included in the analysis with median age of 52.2 years, 69.8% female, and mean 1.52 years of follow-up. The study population was 93.1% of white race, and significant comorbidities within the overall population included hypertension (70.7%), hyperlipidemia (53.4%), tobacco use (38.8%), coronary artery disease (18.1%) and diabetes mellitus (15.5%) (Table). Out of 85 patients with no specified prior cardiac abnormalities, 29.4% developed new onset cardiac abnormalities (Table). The median QTc increased from 429 ms to 444 ms after starting osimertinib, and 8.8% of patients had QTc >500 ms. Conclusions: Osimertinib is used in NSCLC and appears to be associated with an increase in cardiac abnormalities. A direct causal relationship between osimertinib use and cardiotoxicity has not yet been established. Given the strong association between this medication exposure and the observed cardiac toxicities, use of osimertinib may entail closer cardiac monitoring of electrocardiogram and echocardiographic abnormalities. [Table: see text]