bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing patient (pt) care through pt-focused resources to prevent and manage hand-foot skin reaction (HFSR).
Authors: Patel Meera , Patel Arti , Silva Ana Cinthia Gonçalves , Merchant Pooja S. , Dayaram Yaswant K. 
Published: June 2024

e24144 Background: Research has shown that pts and caregivers (non-HCPs) seek medical and disease-related information more than once a month, and this has accelerated due to the COVID-19 pandemic. However, they find it difficult to understand the information they receive and thus, can be misinformed. By understanding the use of fair-balanced medical information (MI) resources by non-HCPs, pharmaceutical companies can develop scientifically accurate yet pt-friendly resources to meet their needs (Goettner, 2022; Rai, 2022). Upon reviewing the unsolicited oncology inquiries received by our MI department, approximately 25% of inquiries were from non-HCPs seeking information. Over the past 3 years, non-HCPs have submitted almost 10,000 inquiries regarding our oncology products, in which 191 inquiries were specifically regarding HFSR and regorafenib and sorafenib. Historically, our MI department responded to non-HCP inquiries by sharing the product label information. However, we identified an unmet need for trustworthy, comprehensive, and accurate pt resources in plain language. Methods: A full literature review was performed, and the relevant data were summarized in plain language for pts. Both HCPs and pts participated in developing the global pt resource on the prevention and management of HFSR for regorafenib and sorafenib. The seven-page interactive brochure was written in 4th to 6th grade reading level which included images and graphics to enhance the understanding of data, easy navigation to the content of interest, and glossary to define key terms. Furthermore, these materials were translated for pts who participated in the regorafenib and sorafenib Patient Support Program in Brazil to further educate and support pts who have started therapy. Results: As of June 2023, the global pt medical resource has been deployed 28 times in Brazil, delivering key information to non-HCPs on their disease and treatment while emphasizing its practical utility and addressing health literacy challenges. We collected feedback from pts who utilized the translated material, and they described it to be “informative” and “helpful” since it empowered them to effectively navigate and address HFSR-associated discomforts during their treatment journey. The feedback has also been utilized to further enhance the resource’s feasibility. Conclusions: The pt feedback on the brochures showcases the value of pt-focused approach in oncology and the positive impact of collective efforts across all stakeholders including pts, pharmaceutical MI departments and pt programs. Furthermore, it demonstrates how MI can bridge the gap between pt insights and clinical knowledge by addressing their needs and providing practical and trustworthy tools. Not only does this initiative enhance pt understanding but also empowers pts to take a more active role in their treatment and fosters shared-decision making.
Immune checkpoint inhibitors (ICI): From cancer killers to electrolyte disruptors.
Authors: Sampat Parth J. , Desai Devashish , Shahnawaz Myera , Ghelani Ghanshyam H. , Kallem Mansi , Ramovic-Zobic Merima 
Published: June 2024

e24146 Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. Cancer patients, especially lung cancer (LCa), are at an increased risk of developing electrolyte imbalance due to several etiologies such as poor nutrition, paraneoplastic syndromes, etc. It is vital to address electrolyte disturbances with the use of ICIs. Objective: The study aims to understand the relationship between ICIs and electrolyte disturbance in LCa patients. Methods: TrinetX, a global federated research network, provides a dataset of electronic medical records from different healthcare organizations (HCOs), was utilized. Initial query was made to isolate patients with LCa stages 2-4. The 2 groups were based on the presence or absence of IO (atezolizumab, durvalumab, pembrolizumab, nivolumab, ipilimumab). Further, propensity score matching (PSM) was carried out to match age, sex, race, chronic kidney disease, diarrhea. Compare outcome analytic function was utilized to map the co-relation with electrolyte imbalance. Results: 41,818 patients were identified, out of which 12.37% (n = 5172) patients received immunotherapy at some point in their cancer treatment. There was no statistical difference in age (65.9 ± 10.3 vs 65.9 ± 11.3, p = 0.8608) as well as gender in both groups. Caucasians (69% vs 66% for Causians (p < 0.0001)) were the predominant race in both groups and were more likely to receive immunotherapy compared to African Americans (12% vs 14% in AA (p = 0.0004)). Diarrhea (30% vs 9%, p < 0.0001) and Chronic kidney disease (CKD) (18% vs 8%, p < 0.0001) were predominantly seen in IO group. Prior to matching, hypomagnesemia (HypoMg) (10.47% vs 5.85%, p < 0.0001), hypocalcemia(HypoCa) (3.36% vs 2.03%, p < 0.0001), hypokalemia (HypoK) (16.91% vs 11.02%, p < 0.0001), hyperkalemia (HyperK) (7.69% vs 4.88%, p < 0.0001), hyponatremia (HypoNa) (16.82% vs 10.66%, p < 0.0001) and hypercalcemia (HyperCa) (5.26% vs 3.05%, p < 0.0001) were seen higher in IO group while hypermagnesemia (HyperMg) (2.04% vs 2.62%, p = 0.0150) was more seen in the non IO group, with no significant difference in hypernatremia (HyperNa) (2.34% vs 1.95%, p = 0.0634). After PSM, HypoMg (10.48% vs 7.01%, p < 0.0001), HypoK (16.92% vs 12.64%, p < 0.0001), HyperK (7.69% vs 6.26%, p = 0.0060), HypoNa (16.80% vs 11.56%, p < 0.0001) and HyperCa (5.26% vs 3.06%, p < 0.0001) were seen more in IO group, while HyperMg (2.04% vs 2.67%, p = 0.0399) was higher in non IO and there was no significant difference for HypoCa (3.36% vs 2.77, p = 0.0829) and HyperNa (2.34% vs 1.89%, p = 0.1135). Conclusions: Our study demonstrated that there is correlation between ICI use and electrolyte imbalance. Providers should be vigilant about the potential electrolyte abnormalities when treating patients with ICI therapy.
Safety and efficacy of interleukin-6 blockade for immune-related adverse events: A systematic review and meta-analysis.
Authors: Vilbert Maysa , Koch Hein Erica C. , Madeira Thiago , Michelon Isabella , N. Priantti Jonathan , Lobo Matheus , Dacoregio Maria Inez , Castro Caio , Cavalcante Ludimila , Wu Chia-Yun , Rouhani Sherin Juliet , Merkin Ross D , Sullivan Ryan J. , Reynolds Kerry Lynn 
Published: June 2024

e24149 Background: Interleukin-6 blockade (IL-6) - tocilizumab and sarilumab - have shown promising results for steroid-refractory immune-related adverse events (irAEs) in cancer patients treated with immune-checkpoint inhibitors (ICI). However, the ideal scenario for IL-6 therapy use is not well established. Hence, we conducted a systematic review and meta-analysis to investigate the safety and efficacy of IL-6 blockade for patients with ICI-associated irAEs. Methods: PubMed, Embase, and Cochrane databases were searched for studies including at least five patients with ICI-associated irAEs treated with IL-6 blockade. The main outcomes were safety and efficacy, measured as clinical improvement (resolution or improvement of irAEs or steroid taper to < 10mg daily), C-reactive protein (CRP) level changes, and elevated IL-6 levels. Analyses using random-effects model were done in R Software. Heterogeneity was assessed using I2. Results: Eight studies with 202 patients were included: 1 clinical trial, 3 multicenter, and 4 single-center observational studies. The median age was 63 years (30-81), and 59% were male. Melanoma was the predominant tumor type (n = 78, 38.6%), followed by lung (n = 67, 33%), renal cell carcinoma (n = 21, 10%), bladder cancer (n = 12, 6%), and others. Monotherapy with ICI, targeting PD-1, PD-L1, or CTLA-4, was given to 77% of patients, while 23% had combination ICI therapy. Follow-up ranged from 6 to 23 months. Most patients received prior steroids (85%) or steroid-sparing immunosuppression (24%). Pooled analysis of all patients showed an overall clinical improvement rate of 87.9% (95%CI 78.7 to 95.1, I2= 44%). Clinical improvement with IL-6 blockade was significantly higher in patients with cytokine release syndrome (CRS, 100%) and rheumatic irAEs (88%) compared to other irAEs (p < 0.01, Table 1). At the time of irAEs, the median CRP level was 109.3 (11.5 to 233), which decreased to 17 (1 to 60) after IL-6 blockade. The frequency of baseline elevated IL-6 level was 90.6% (95%CI 68 to 100, I2= 80%). Grade 3 or 4 IL-6-related adverse events were reported in 11% (17/151) of patients and included neutropenia (n = 6), increased liver transaminase levels (n = 4), and gastrointestinal perforation (n = 2). Conclusions: This systematic review and meta-analysis provides evidence for the use of IL-6 blockade for steroid-treating refractory irAEs associated with ICI. The vast majority of patients with steroid-refractory CRS and rheumatic irAEs were successfully treated with anti-IL6 therapy.[Table: see text]
Cardiac Dysfunction Among Breast Cancer Survivors: Role of Cardiotoxic Therapy and Cardiovascular Risk Factors
Authors: Bostany Geoffrey , Chen Yanjun , Francisco Liton , Dai Chen , Meng Qingrui , Sparks Jessica , Sessions Min , Nabell Lisle , Stringer-Reasor Erica , Khoury Katia , Lenneman Carrie , Keene Kimberly , Armenian Saro , Landier Wendy , Bhatia Smita 
Published: June 2024

PURPOSE
Cardiac dysfunction is the leading cause of mortality among 10-year breast cancer survivors. Limited information regarding long-term risks of cardiac dysfunction after cardiotoxic therapy (anthracyclines, trastuzumab/pertuzumab, radiation) has precluded development of surveillance guidelines for the survivors.

METHODS
Patients with breast cancer who completed cardiotoxic therapy underwent echocardiographic screening every 2 years. New-onset cardiac dysfunction was defined as left ventricular ejection fraction (LVEF) <50% after cardiotoxic therapy initiation and included early- and late-onset cardiac dysfunction.

RESULTS

We evaluated 2,808 echocardiograms in 829 breast cancer survivors; the median age at breast cancer diagnosis was 54.2 years (range, 20.3-86.3); the median follow-up was 8.6 years (1.8-39.8); 39.7% received anthracyclines, 16% received trastuzumab/pertuzumab, 6.2% received both anthracyclines and trastuzumab/pertuzumab, and 38.1% received radiation alone. The cumulative incidence of cardiac dysfunction increased from 1.8% at 2 years to 15.3% at 15 years from cardiotoxic therapy initiation. Multivariable Cox regression analysis identified the following risk factors: non-Hispanic Black race (hazard ratio [HR], 2.15 [95% CI], 1.37 to 3.38), cardiotoxic therapies (anthracyclines: HR, 2.35 [95% CI, 1.25 to 4.4]; anthracyclines and trastuzumab/pertuzumab: HR, 3.92 [95% CI, 1.74 to 8.85]; reference: left breast radiation alone), selective estrogen receptor modulators (HR, 2.0 [95% CI, 1.2 to 3.33]), and precancer hypertension (HR, 3.16 [95% CI, 1.63 to 6.1]). Late-onset cardiac dysfunction was most prevalent among anthracycline- and radiation-exposed patients; early-onset cardiac dysfunction was most prevalent among patients exposed to anthracyclines and trastuzumab/pertuzumab; equal prevalence of both early- and late-onset cardiac dysfunction was observed in trastuzumab-/pertuzumab-exposed patients. Adjusted longitudinal analyses revealed an annual decline in LVEF by 0.29% (
P
= .009) over 20 years from breast cancer diagnosis.

CONCLUSION
These findings provide evidence to support echocardiographic surveillance for several years after cardiotoxic therapy and also suggest a need to examine the efficacy of management of cardiovascular risk factors to mitigate risk.
International Hackathon as a Tool to Augment Education, Collaboration, and Innovation in Global Neurosurgery
Authors: Razak Shahaan S. , West Timothy R. , Tunsiricharoengul Sasha , Nair-Kanneganti Aparna , Perez Nicole A. , Mazurek Mercy H. , Gal Zsombor , Duvall Julia B. , Rigney Grant H. , Cerda Ivo H. , Morcos Mary M. , Keay Emma , Hernández Alejandra Silva , Lawton Michael T. , Nahed Brian V. , Quiñones-Hinojosa Alfredo 
Published: June 2024

BACKGROUND AND OBJECTIVES:
Health care providers' exposure to global surgical disparities is limited in current nursing and/or medical school curricula. For instance, global health is often associated with infectious diseases or maternal health without acknowledging the growing need for surgical care in low- and middle-income countries (LMICs). We propose an international virtual hackathon based on neurosurgical patient cases in under-resourced settings as an educational tool to bring awareness to global surgical disparities and develop relationships among trainees in different countries.

METHODS:
Participants were recruited through email listservs, a social media campaign, and prize offerings. A 3-day virtual hackathon event was administered, which included workshops, mentorship, keynote panels, and pitch presentations to judges. Participants were presented with real patient cases and directed to solve a barrier to their care. Surveys assessed participants' backgrounds and event experience. The hackathon was executed through Zoom at Harvard Innovation Lab in Boston, MA, on March 25 to 27, 2022. Participants included medical students, with additional participants from business, engineering, or current health care workers.

RESULTS:
Three hundred seven applications were submitted for 100 spots. Participants included medical students, physicians, nurses, engineers, entrepreneurs, and undergraduates representing 25 countries and 82 cities. Fifty-one participants previously met a neurosurgeon, while 39 previously met a global health expert, with no difference between LMIC and high-income countries' respondents. Teams spent an average of 2.75 hours working with mentors, and 88% of postevent respondents said the event was “very” or “extremely conducive” to networking. Projects fell into 4 categories: access, language barriers, education and training, and resources. The winning team, which was interdisciplinary and international, developed an application that analyzes patient anatomy while performing physical therapy to facilitate remote care and clinical decision-making.

CONCLUSION:
An international virtual hackathon can be an educational tool to increase innovative ideas to address surgical disparities in LMICs and establish early collaborative relationships with medical trainees from different countries.
Pleomorphic adenoma (mixed tumor) of the upper lip: A case report
Authors: Chidzonga Midion Mapfumo , Mahomva Leonard , Zambuko Blessing , Muungani Welcome 
Published: June 2024

BACKGROUND
Salivary gland tumors are relatively rare. Most minor salivary gland tumors are malignant with benign tumors accounting for 18% of the tumors. Pleomorphic adenoma (PA) is the most common salivary gland tumor. Lip PA is uncommon with 9.8% occurring in the upper lip. We are adding on the knowledge of the rare upper lip PA (benign mixed tumor).
CASE SUMMARY
We report an upper lip PA (benign mixed tumor) in a 28-year-old man. His complaint was a painless swelling on the upper lip. A painless, non-tender, well-circumscribed, slightly mobile, sessile, nodular, and rubbery (in consistency) tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip. The overlying skin was not fixed and of normal color. There was no ulceration, and palpation did not elicit pain or bleeding. There was no history of trauma. Blunt dissection was used to completely excise the nodular, whitish, and encapsulated tumor. Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion, with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells, well-formed tubules containing eosinic secretion, and nests of myoepithelial cells. A diagnosis of PA (benign mixed tumor) was confirmed.
CONCLUSION
Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.
Meningioma originating from the superior petrosal vein without dural attachment: A case report
Authors: Kim Yeong-Jin , Jung Shin , Jung Tae-Young , Moon Kyung-Sub , Kim In-Young 
Published: June 2024

BACKGROUND
Meningioma in the cerebellopontine angle (CPA) without dural attachment is extremely rare. We report a unique case of meningioma derived from the superior petrosal vein without dural attachment.
CASE SUMMARY
A 44-year-old right-handed woman presented with a two-month history of headache and tinnitus. Brain magnetic resonance imaging showed a well-defined contrast-enhancing lesion in the right CPA without a dural tail sign. Tumor resection was performed using a right retro sigmoid approach. A dural attachment was not seen at the tentorium or posterior surface of the petrous pyramid. The tumor was firmly adherent to the superior petrosal vein. The origin site was cauterized and resected with the preservation of the superior petrosal vein. A diagnosis of meningothelial meningioma was made. The patient’s headache and tinnitus gradually disappeared, and a recurrence was not observed five years after the surgery.
CONCLUSION
The rare occurrence of meningioma without dural attachment makes it difficult to determine dural attachment before surgery. The absence of dural attachment makes it easy to completely resect such tumors. Vessels related to tumors should be removed carefully, considering the possible presence of tumor stem cells in the microvessels.
Effect of transcranial direct current stimulation on supernumerary phantom limb pain in spinal cord injured patient: A case report
Authors: Park Hyo-Sik , Kim Jae-Hyung 
Published: June 2024

BACKGROUND
Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report effect of transcranial direct current stimulation (tDCS) on SPL pain in a patient with cervical cord injury.
CASE SUMMARY
The subject was a 57-year-old man who was diagnosed with complete spinal cord injury (C6/C5, motor level; C5/C5, sensory level; AIS-A) approximately three months ago. After a period of 2 wk, we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA. Following that treatment, the patient experienced a decrease of SPL pain intensity and frequency, which lasted for 1 week after the end of treatment.
CONCLUSION
Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.
Brain abscess caused by Streptococcus anginosus group: Three case reports
Authors: Tan Si-Di , Li Ming-Hui 
Published: June 2024

BACKGROUND
This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by Streptococcus anginosus . We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.
CASE SUMMARY
Case 1 presented with a history of left otitis media and exhibited high fever, confusion, and vomiting as primary symptoms. Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection. Case 2 experienced dizziness for two days as the primary symptom. Postoperative pus culture suggested an intermediate streptococcal brain abscess. Case 3: Enhanced head magnetic resonance imaging (MRI) and diffusion-weighted imaging revealed occupancy of the left temporal lobe, initially suspected to be a metastatic tumor. However, a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection. The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection. All three patients demonstrated sensitivity to penicillin, ceftriaxone, vancomycin, linezolid, chloramphenicol, and levofloxacin. Successful treatment was achieved through stereotaxic puncture, drainage, and ceftriaxone administration with a six -week course of antibiotics.
CONCLUSION
Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses. Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important. This case series was in accordance with the CARE guidelines.
BLASTING BMAC: A NOVEL THERAPY TO IMPROVE HEALING IN FUSION SURGERY
Authors: Stewart S. , Darwood A. , Higgins C. , Masouros S. , Ramasamy A. 
Published: June 2024

IntroductionFusion represents an effective treatment option in patients affected by end-stage arthritis. To minimise the risk of non-union following fusion, biological preparations such as bone marrow aspirate concentrate (BMAC) are commonly used intra-operatively. Mechanotransduction represents an emerging field of research whereby physical stimuli can be used to modulate the behaviour and differentiation of cells. Blast waves (a subtype of shock waves) are one such physical stimulus. The aim of this study was to investigate whether the osteogenic potential of BMAC can be enhanced using a blast wave, and thus improve its efficacy in fusion surgery.MethodsHuman BMAC samples were obtained from three healthy patients and exposed to a single blast wave (peak overpressure= 50psi), before being placed in a suspension of mesenchymal stem cells, to represent the biological environment of the fusion site. Three test groups were used: MSC (the experimental control); MSC + BMAC; MSC + BMAC + blast wave. Calcium mineralisation assays were performed on the MSCs on Day 7 and 14 to assess for osteoblastic transformation.ResultsCalcium mineralisation on Day 7 was significantly increased in the MSC + BMAC group compared to the MSC group (mean percentage change 42.12 vs 0.0, p=0.012). The MSC + BMAC + blast wave group also demonstrated significantly increased levels compared to the MSC + BMAC group (84.56 vs. 42.14, p = 0.039). The difference in calcium mineralisation between the MSC and MSC + BMAC + blast wave groups was strongly significant (0.00 vs. 84.56, p = 0.003).ConclusionExposure of BMAC to a single blast wave enhances its osteogenic potential. This represents a potential novel way to improve healing following fusion surgery and reduce the rates of non-union.