bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting nodal metastasis progression of oral tongue cancer using a hidden Markov model in MRI
Authors: Gang Qiangqiang , Feng Jie , Kauczor Hans-Ulrich , Zhang Ke 
Published: June 2024

ObjectivesThe presence of occult nodal metastases in patients with oral tongue squamous cell carcinomas (OTSCCs) has implications for treatment. More than 30% of patients will have occult nodal metastases, yet a considerable number of patients undergo unnecessary invasive neck dissection to confirm nodal status. In this work, we propose a probabilistic model for lymphatic metastatic spread that can quantify the risk of microscopic involvement at the lymph node level (LNL) given the location of macroscopic metastases and the tumor stage using the MRI method.Materials and methodsA total of 108 patients of OTSCCs were included in the study. A hidden Markov model (HMM) was used to compute the probabilities of transitions between states over time based on MRI. Learning of the transition probabilities was performed via Markov chain Monte Carlo sampling and was based on a dataset of OTSCC patients for whom involvement of individual LNLs was reported.ResultsOur model found that the most common involvement was that of level I and level II, corresponding to a high probability of 𝑝b1 = 0.39 ± 0.05, 𝑝b2 = 0.53 ± 0.09; lymph node level I had metastasis, and the probability of metastasis in lymph node II was high (93.79%); lymph node level II had metastasis, and the probability of metastasis in lymph node III was small (7.88%). Lymph nodes progress faster in the early stage and slower in the late stage.ConclusionAn HMM can produce an algorithm that is able to predict nodal metastasis evolution in patients with OTSCCs by analyzing the macroscopic metastases observed in the upstream levels, and tumor category.
The prognostic and predictive value of homologous recombination deficiency status in patients with advanced stage epithelial ovarian carcinoma after first-line platinum-based chemotherapy
Authors: Xu Yiqing , Chen Yi-Ju Amy , Wu Yunhong , Saverimuthu Angela , Jadhav Archana , Bhuiyan Rehana , Sandler Jason , Yio Jiang , Kumar Vivek 
Published: June 2024

ObjectiveHomologous recombination (HR) comprises series of interrelated pathways that repair double-stranded DNA breaks and inter-strand crosslinks. It provides support for DNA replication to recover stalled or broken replication forks. Compared with homologous recombination proficiency (HRP), cancers with homologous recombination deficiency (HRD) are more likely to undergo cell death when treated with DNA-damaging agents, such as platinum agents, and have better disease control.MethodsPatients diagnosed with stage III/IV ovarian cancer, early stages with recurrence, who received adjuvant chemotherapy after debulking surgery, and who also had known HR status were eligible.ResultsForty-four patients were included, with 21 in the HRD group (including 8 with germline mutations) and 23 in the HRP group. The HRD group was composed predominantly of serous carcinoma (95.2%), while mucinous (n=3) and clear cell (n=1) cases were all found in the HRP group. Stage III/IV disease was 66.7% and 91.3% in HRD and HRP groups, respectively (p=0.064). Patients who were optimally debulked to no residual disease was 90.0% and 72.7% (p=0.243), respectively. Late line use of PARP inhibitors was 33.3% and 17.4% (p=0.303). Median PFS was 22.5 months (95% CI, 18.5 - 66.6) and 21.5 months (95% CI, 18.3-39.5) (p=0.49) in HRD and HRP respectively. Median platinum free interval (PFI) was 15.8 months (95% CI 12.4-60.4) and 15.9 months (95% CI 8.3-34.1) (p=0.24), respectively. Median OS was 88.2 months (95% CI 71.2-NA) and 49.7 months (95% CI 35.1-NA) (p=0.21). The PFS of the patients with germline BRCA mutations (n=5) was 54.3 months (95% CI 23.1-NA) and 21.5 months (95% CI 18.3-39.5) in the HRP group (p=0.095); the PFI difference was 47.7 months (95% CI 17.6-NA) in the BRCA mutation group, and 15.9 months (95% CI 12.4-60.4) in HRP, showing statistical significance (p=0.039); while the median OS was NA and 49.7 months (95% CI 35.1-NA) respectively (p=0.051). When adding two additional patients with somatic BRCA mutations to the germline BRCA mutation carriers, the median OS is NA (95% CI 73, NA) versus 49.7 months (95% CI 35.1, NA) for HRP (p=0.045).ConclusionsHRD status was not associated with longer PFS or PFI in advanced ovarian cancer who received first line adjuvant platinum-based chemotherapy. Its role as a prognostic marker for overall survival is suggested, particularly in the subgroup with germline and somatic BRCA mutations.
Development of prognostic signatures and risk index related to lipid metabolism in ccRCC
Authors: Chen Wenbo , Zhao Zhenyu , Zhou Hao , Dong Shuang , Li Xiaoyu , Hu Sheng , Zhong Shan , Chen Ke 
Published: June 2024

BackgroundClear cell renal cell carcinoma (ccRCC) is a metabolic disorder characterized by abnormal lipid accumulation in the cytoplasm. Lipid metabolism-related genes may have important clinical significance for prognosis prediction and individualized treatment.MethodsWe collected bulk and single-cell transcriptomic data of ccRCC and normal samples to identify key lipid metabolism-related prognostic signatures. qPCR was used to confirm the expression of signatures in cancer cell lines. Based on the identified signatures, we developed a lipid metabolism risk score (LMRS) as a risk index. We explored the potential application value of prognostic signatures and LMRS in precise treatment from multiple perspectives.ResultsThrough comprehensive analysis, we identified five lipid metabolism-related prognostic signatures (ACADM, ACAT1, ECHS1, HPGD, DGKZ). We developed a risk index LMRS, which was significantly associated with poor prognosis in patients. There was a significant correlation between LMRS and the infiltration levels of multiple immune cells. Patients with high LMRS may be more likely to respond to immunotherapy. The different LMRS groups were suitable for different anticancer drug treatment regimens.ConclusionPrognostic signatures and LMRS we developed may be applied to the risk assessment of ccRCC patients, which may have potential guiding significance in the diagnosis and precise treatment of ccRCC patients.
Complete elimination of hyperleukocytosis risk in AML through early high-quality disease remission
Authors: Lyu Guoqing , Lyu Wenting 
Published: June 2024

BackgroundAcute myeloid leukemia (AML) with hyperleukocytosis (HL) is a severe medical emergency associated with high mortality rates and poor prognosis. Prompt and urgent treatment is crucial to address this medical emergency. This study aims to elucidate appropriate diagnostic thresholds for HL and investigate underlying mechanisms and potential targeted therapies.MethodsX-tile software was employed to analyze white blood cell (WBC) count thresholds in AML patients using data from TCGA and TARGET AML databases. METASCAPE and Gene Set Enrichment Analysis (GSEA) were conducted to explore the molecular mechanisms underlying HL in AML. Potential molecular targeted drugs were identified using the CELLMINER platform.ResultsAnalysis revealed that a WBC count threshold of 75×109/L, rather than the conventional 100×109/L, is more appropriate for diagnosing HL in adult AML patients. This revised threshold could aid clinicians in identifying a greater number of patients requiring immediate intervention. Significant correlations were observed between HL and specific mutations, including NPM1, FLT3, and DNMT3A. For pediatric AML patients, the HL threshold was determined to be 165×109/L. Achieving complete remission (CR) or deeper levels of remission significantly reduces the risks associated with HL. The reduction in risk can lead to survival outcomes for HL patients that are comparable to those of non-hyperleukocytosis patients. Differential gene expression analysis indicated that downregulation of cell adhesion molecules is implicated in HL pathogenesis. Potential targeted therapies for AML with HL include Bcl2 inhibitors and histone deacetylase inhibitors. Clinical observations demonstrated that the addition of Bcl2 inhibitors, such as Venetoclax, to standard therapy results in a rapid reduction in WBC counts, thereby reducing tumor burden and providing prompt symptom relief. Combining these targeted drugs with conventional therapies appears promising in mitigating risks associated with HL.ConclusionsLower diagnostic thresholds for HL in AML, identifies critical genetic correlations, and highlights effective molecular targeted therapies. Proactive early treatment is crucial for achieving deep remission and reducing HL risk. Future therapeutic strategies should consider integrating molecular targeted drugs with conventional therapies to improve outcomes for patients facing this high-risk hematological emergency.
The impact of an immersive digital therapeutic tool on experimental pain: a pilot randomized within-subject experiment with an active control condition
Authors: Diallo Sanoussy , Marchand Serge , Dumais Alexandre , Potvin Stéphane 
Published: June 2024

BackgroundPain is a complex and multifaced sensory and emotional experience. Virtual reality (VR) has shown promise in reducing experimental pain and chronic pain. This study examines an immersive VR environment initially designed for endometriosis patients, which demonstrated short-term analgesic effects. The research aims to determine the impact of the VR environment on experimental pain intensity and unpleasantness both during and after VR exposure (3D with binaural beats), while using an active control condition (2D with no binaural beats). Additionally, a secondary objective of the study was to identify the psychological and psychophysical factors that predict the analgesic effects of the immersive digital therapeutic tool.MethodsThe study involved twenty-one healthy individuals and used a within-subject design, comparing a VR treatment with an active control condition. Continuous heat stimulation was applied to the left forearm with a Peltier thermode. Pain ratings were collected for immediate and short-term effects.ResultsIn both the VR and Control conditions, there were no significant differences in pain intensity before, during, and after exposure. However, during VR exposure, there was a significant decrease in pain unpleasantness as compared to before exposure (p &lt; 0.001), with a 27.2% pain reduction. In the Control condition, there were no significant differences in pain unpleasantness during and after exposure. Furthermore, no psychological and psychophysical factors predicted the analgesic effects.DiscussionThe study investigated how a VR environment affected experimentally induced pain in healthy volunteers. It showed that VR reduced pain unpleasantness during exposure but had no lasting impact. The VR environment mainly influenced the emotional aspect of pain, possibly due to its inclusion of binaural beats and natural stimuli. The study suggests that the VR environment should be tested in chronic pain population with high distress levels.
Registration number (clinicaltrials.gov)NCT06130267.
Evaluation of time to sputum smear conversion and its association with treatment outcomes among drug-resistant tuberculosis patients: a retrospective record-reviewing study
Authors: Alzarea Abdulaziz Ibrahim , Saifullah Amna , Khan Yusra Habib , Alanazi Adullah Salah , Alatawi Ahmed D. , Algarni Majed Ahmed , Almalki Ziyad Saeed , Alahmari Abdullah K. , Alhassan Hassan H. , Mallhi Tauqeer Hussain 
Published: June 2024

Background: This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases.Methods: The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants.Results: Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5 years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97 kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion (p &lt; 0.001, aOR = 5.817, and 95% CI = 3.703–9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855–0.907, and p &lt; 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion (p &lt; 0.001, aOR = 7.446, and 95% CI = 4.869–11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835–0.889, and p &lt; 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877–0.927, and p &lt; 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes.Conclusions: Within 2 months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.
The influence of parents’ education anxiety on children’s learning anxiety: the mediating role of parenting style and the moderating effect of extracurricular tutoring
Authors: Yin Xia , Zhang HePing , Chen Meng 
Published: June 2024

IntroductionThis study investigates the intricate relationship between parents’ education anxiety and children’s learning anxiety, examining the mediating role of parenting style and the moderating effect of extracurricular tutoring.MethodsUtilizing data from the “Survey of Parents and Students in Primary and Secondary Schools,” the study employs stratified sampling (n = 3,298) and various psychological scales to measure education anxiety, parenting styles, and extracurricular tutoring.ResultsThis study reveals that parents’ education anxiety significantly influences children’s learning anxiety, with a notable positive correlation (r = 0.301**). Parenting styles particularly rejection and overprotection style increase this anxiety, while emotional warmth style decreases it. Academic tutoring serves as a moderator, reducing the impact of parental anxiety on children’s learning anxiety (β = −0.033, p &lt; 0.05).DiscussionThe study underscores the importance of addressing internal family dynamics to alleviate education anxiety. It advocates for a balanced approach to tutoring, emphasizing the benefits of arts and sports activities in reducing learning anxiety. Parents should be encouraged to adopt emotionally warm parenting styles and to engage their children in a variety of extracurricular activities.
Postpartum acute stress disorder symptoms, social support, and quality of couple’s relationship associations with childbirth PTSD
Authors: Handelzalts Jonathan E. , Kalfon-Hakhmigari Maor , Raichin Adi , Peled Yoav 
Published: June 2024

BackgroundWe aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple’s relationship quality at 8–12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables.MethodsParticipants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1–4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8–12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS).ResultsIn partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p &lt;.001) and the total score (β = .29, p &lt;.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple’s relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms.ConclusionOur study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple’s relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.
The effect of the stress autism mate app on perceived stress, coping, and resilience in adults with autism: a single-case experimental design
Authors: Hoeberichts Kirsten , Roke Yvette , Niks Irene , van Harten Peter N. 
Published: June 2024

IntroductionThe mobile health application “Stress Autism Mate” (SAM) was designed to support adults with autism in identifying and managing daily stress. SAM measures stress four times daily, provides a daily and weekly stress overview, and provides personalised stress reduction advice. This study aimed to assess the effectiveness of SAM over four weeks in reducing perceived stress and internalised stigma, and enhancing coping self-efficacy, quality of life, and resilience among adults with autism.MethodsUsing an A1-B-A2 single-case experimental design, the effect of using SAM on adults with autism was assessed. The phases consisted of A1; treatment as usual (TAU), B; introducing SAM, and finally A2; follow-up with TAU and without the use of SAM. Each phase lasted four weeks, and data were collected via questionnaires before and after each phase. Linear mixed models were used for data analysis.ResultsResults show significant reductions in perceived stress levels, increased coping self-efficacy, and improved perceived health and psychological well-being after using SAM. Furthermore, increased resilience, and decreased internalised stigma were reported after follow-up.DiscussionIn conclusion, this study highlights SAM as a valuable tool for empowering adults with autism to reduce stress and internalised stigmaand to improve coping self-efficacy, psychological well-being, and resilience.
“Some distance between us”: a UK mixed methods study exploring experiences of remote care for eating disorders during COVID-19
Authors: Murphy-Morgan Claire , Brown Richard , Love Charlotte , Branley-Bell Dawn 
Published: June 2024

IntroductionCOVID-19 necessitated a rapid move from face-to-face services to remote care for eating disorders/eating distress (EDs). This study explores the advantages and challenges of remote care, identifying future implications for service provision. Remote care has been considered in the broadest of terms, including therapeutic care (e.g., Cognitive Behavioural Therapy, peer support, forums, one-to-one and group care options).MethodsUsing a mixed methods approach, data were collected from 211 people with lived experience of EDs (PWLE), with and without formal diagnosis. 27 participants took part in semi-structured interviews/workshops and a further 184 participants took part via an online survey. Participants reported on their ED status, the impact of the pandemic on symptoms, the benefits, and challenges of remote care (and type of support accessed), and any reasons for not accessing support. Participants were invited to make future care recommendations.ResultsED symptoms were reported as worsening during the pandemic with contributing factors including isolation, lack of routine, negative emotions, and feeling like the external situation was outside of one’s control. Remote care was positively attributed to increased flexibility and facilitation of social connection. Identified barriers to access included lack of awareness about support availability, digital access/literacy, and competing commitments. Further challenges included approaches being perceived as too clinical (e.g., ED information and support presented using clinical language and/or limited to support within medical care settings, without acknowledging the broader context of disordered eating), uncertainty around remote care quality, and concerns that remote platforms may facilitate masking of symptoms. Participants reported distress caused by online platforms where self-view is the default during video calls. They expressed a need for more holistic approaches to remote care, including: “real stories” of recovery, and hybrid (online and offline) options for greater flexibility and widening of access and choice. Participants also expressed a need for appropriate digital literacy training.DiscussionFuture recommendations emphasise user-centred holistic and hybrid approaches to ED remote support, with training to address digital literacy barriers and facilitate user control of platform functionalities (e.g., self-view). This study underscores the need for continued remote care with a focus on inclusivity and user empowerment.
The prevalence of PTSD and coping strategies among Palestinian mental health professionals during political violence and wartime
Authors: Ahmead Muna , Abu Turki Mariam , Fawadleh Louy 
Published: June 2024

BackgroundIn times of war, mental health professionals are at an increased risk of developing psychological problems, including posttraumatic stress disorder (PTSD). The effects of conflicts or wars on mental health professionals in Palestine and their coping methods of dealing with these challenges remain unknown. This study aimed to assess the prevalence of PTSD symptoms and strategies for coping among mental health professionals in Palestine, in light of the ongoing Gaza war and political violence.MethodsThe study utilized a cross-sectional research design. Self-reported questionnaires, including the PCL-5 and Brief COPE scales, were used to gather data. The relationship between the research variables and PTSD symptoms was investigated using frequencies, percentages, bivariate analysis, Pearson correlation, and Pearson’s chi-square test.ResultsA total of 514 participants were recruited, with an estimated prevalence of PTSD of 38.7%. Furthermore, the multivariate analysis revealed that having a prior history of trauma and feeling disabled or unable to deal with your patients during the current Gaza war and Israeli–Palestinian political violence increases the likelihood of developing PTSD symptoms. In addition, using venting, self-blame, and behavioral disengagement as coping strategies increases the likelihood of developing symptoms of PTSD. Moreover, using acceptance and substance use as coping strategies reduces the risk of developing PTSD symptoms.ConclusionThe findings revealed a high prevalence of PTSD symptoms among mental health professionals during wartime and political violence. As a result, mental health professionals need immediate assistance in enhancing their mental wellbeing through supervision, psychotherapy, and comprehensive and continuous training.