bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of protein-energy malnutrition and in-hospital clinical outcomes among patients with colorectal cancer hospitalized for gastrointestinal bleeding: A nationwide analysis.
Authors: Elom Hilary , Verinumbe Tarfa , Obomanu Elvis , Jones Colton , Mayo Ryan 
Published: June 2024

e15531 Background: Patients with colorectal cancer (CRC) commonly present with gastrointestinal (GI) bleeding and are at risk of developing protein-energy malnutrition (PEM) either due to effects of therapeutic interventions (chemotherapy, immunotherapy, radiation) or primary disease on appetite and caloric intake. There are several existing studies on CRC and gastrointestinal hemorrhage, however the impact of concurrent PEM on in-hospital outcomes for patients with CRC admitted for GI bleeding is unclear. Our study aims to assess the association of PEM and clinical outcomes among patients with CRC hospitalized for GI bleeding. Methods: We analyzed data from the 2020 National Inpatient Survey on patients with CRC who were admitted with GI bleeding. To determine our study sample, we used International Classification of Diseases, 10th Revision (ICD10) codes for CRC (C18.X, C19 and C20), and GI bleeding (K92.2 and K62.5). The primary exposure was a comorbid diagnosis of PEM (defined based on the ICD 10 codes E40 – E46). The clinical outcomes assessed in this study were all-cause mortality, sepsis, septic shock and length of stay in the hospital. A multivariate logistic regression was used to assess the association of comorbid PEM with all-cause mortality and sepsis. A cox proportional hazard regression was used to investigate the association between the PEM and time to discharge. Covariates adjusted for in our final analyses included age, sex, insurance status and number of comorbidities present on the patients record at discharge. Results: Of the 2223 patients with CRC who were admitted for GI bleeding, 55% were male, 64% were White and mean age was 63 years (SD 14.2). A quarter (23%) had comorbid PEM, 14.6% had sepsis and 5.4% had septic shock. About 6.5% died during hospitalization and the mean length of hospital stay was 7.8 days. Comorbid PEM was significantly associated with a two-fold increase in the risk of all-cause in-hospital mortality (aOR 2.05; 95% CI: 1.41 – 3.98), sepsis (aOR 2.33; 95% CI: 1.78 – 3.05) and septic shock (aOR 2.0; 95% CI:1.35 – 3.09). Additionally, compared to patients without PEM, those with concomitant PEM had a lower discharge rate (HR 0.71, 95%CI: 0.64-0.78). Conclusions: Our study demonstrated that comorbid PEM in patients with CRC hospitalized for GI bleeding is associated with increased risk of all-cause in-hospital mortality, sepsis, septic shock and prolonged length of stay. The findings from this study highlight the need for nutritional considerations when managing patients with CRC and GI bleeding to prevent adverse health outcomes and potentially improve survival among these patients.
Prognostic implications of distal resection margin length in rectal cancer proctectomy: A retrospective analysis.
Authors: Li Ming , Wang Xiaodong , Niu Pengfei , Yang Yong , Chen Jiajia , Xu Jingxuan , Cheng Yu , Wang Yanzhao , Zhang Chang 
Published: June 2024

e15605 Background: Proctectomy remains pivotal in rectal cancer treatment for 70% of patients, even post-neoadjuvant therapy. The determination of an appropriate distal resection margin (DRM) in proctectomy for rectal cancer is critical for achieving both curative resection and organ preservation. However, the prognostic impact of DRM length, especially measured before the shrinkage caused by fixation in pathology, remains unclear. Methods: This retrospective study include 224 stage II-III rectal cancer patients who underwent proctectomy between 2015 and 2020. Patient demographics, tumor characteristics, and follow-up data (median: 44.4 months) were collected. The lengths of mesorectal and rectal DRM were both measured on fresh specimens before pathological processing. A specific metric, (rectal DRM - mesorectum DRM)/rectal DRM > 10%, identified patients with shorter mesorectal DRMs, denoted as the "MS group". Results: Out of 224 patients, 68 (30.4%) had a rectal DRM ≤1 cm, and 156 (69.6%) > 1 cm. There were no significant differences between the groups in terms of gender, use of neoadjuvant therapy, or high-risk factors like extramural venous and perineural invasion. The local recurrence (LR), disease-specific survival (DSS) and overall survival (OS) rates did not differ significantly between groups, with P = 0.66, 0.082, 0.054, respectively. Cox univariate analysis identified pT, pN, gender, and CEA level as significant factors for OS and DSS, while DRM group was not (p = 0.06). A 5-year OS predictive model (AUC = 0.864) indicated DRM's insignificant impact on OS, validated against SEER and TCGA databases. Further analysis in 182 Dixon surgery cases revealed no significant OS or DSS differences between patients with mesorectal DRM < 1cm and those with > 1cm. Notably, 23.6% (43/182) belonged to the MS group with shorter mesorectal DRM, showing significantly inferior OS (P = 0.026) and DSS (P = 0.000265) compared to the ML group. Conclusions: In this study, while a 1 cm DRM in mesorectal and rectal regions is validated as safe for rectal cancer proctectomy, our findings indicate this is not an absolute measure of oncological safety. Patients with a mesorectal DRM shorter than the rectal DRM had inferior outcomes, suggesting the need for a more nuanced approach. Thus, a comprehensive DRM evaluation, beyond a fixed length threshold, is essential to improve surgical outcomes and patient prognosis.
MIRACLE1: Phase II study of radiotherapy followed by CapeOx and tirelizumab as first-line treatment in MSS rectal cancer with synchronous resectable liver/lung metastases.
Authors: Shan Zezhi , Zhou Menglong , Ye Zilan , He Weijing , Yang Yufei , Luo Dakui , Xia Fan , Shen Lijun , Chen Yikuan , Zhou Changming , Li Qingguo , Zhang Zhen , Li Xinxiang 
Published: June 2024

TPS3631 Background: Rectal cancer (RC) with synchronous resectable liver/lung metastases is commonly treated with surgery combined with systemic chemotherapy or local therapies. Prognosis remains poor. Microsatellite stable (MSS) are characterized by an immunosuppressive microenvironment and a low response rate to immunotherapy. Chemotherapy and Radiotherapy have been reported to potentially promote immunotherapy response. MIRACLE1 will investigate the safety and efficacy of Short-course radiotherapy (SCRT) combined with CapeOx and tirelizumab in MSS metastatic RC. Methods: We designed a single-arm, multicenter, phase II trial in MSS RC. MSS status is determined by normal immunohistochemical nuclear expression of all the mismatch repair genes MSH2, MSH6, MLH1 and PMS2. Additional inclusion criteria include RC with a distance of ≤ 10 cm from the anus by MRI evaluation and single or multiple measurable metastases in the liver and/or lungs (RECIST version 1.1) evaluated as resectable after MDT discussion. Exclusion criteria include patients with distant metastasis to parts other than the liver and lungs, including the brain, bone, ovary, peritoneum, and multiple retroperitoneal lymph node metastases.Patients are treated with radiotherapy including 25 Gy/5 fractions short-course hypofractionated radiotherapy (HFRT) for primary lesions and HFRT or stereotactic body radiotherapy (SBRT) for metastatic lesions. Afterward, six cycles of chemoimmunotherapy consisting of CapeOX and tislelizumab will be administered. Tislelizumab is administered intravenously (200 mg) along with each cycle of chemotherapy. Efficacy evaluations are conducted after the third and sixth cycles of chemoimmunotherapy and include radiological and serological evaluations. According to the efficacy evaluation results, a watch-and-wait nonoperative approach or surgical resection is performed. After surgery, postoperative treatment is to be determined by the investigators. Tislelizumab is to be maintained until one year after surgery. The primary endpoint of this study is the 1-year no-evidence of disease (NED) rate. The secondary endpoints include objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and acute toxicity related to immunotherapy. 52 patients will be enrolled to ensure 47 evaluable. The design has 80% power to detected improvement in NED rate from 60 to 77% with significance level of 0.05. The first patient was recruited on 27th March 2023. To date, 15 patients have been enrolled. Full accrual is anticipated by late 2024. Correlative studies include genomic characterization of baseline tumors, assessment of immune infiltration of tumor microenvironment and serial circulating cell-free DNA and immune biomarkers. Clinical trial information: NCT05359393 .
STELLAR-303: A randomized phase 3 study of zanzalintinib (XL092) plus atezolizumab versus regorafenib in previously treated metastatic colorectal cancer.
Authors: Saeed Anwaar , Tabernero Josep , Wang Guan , Ma Xia , Smith Robina , Hecht J. Randolph 
Published: June 2024

TPS3634 Background: Metastatic colorectal cancer (mCRC) has seen increased rates in overall survival (OS) as novel targeted agents have become available. Unfortunately, the median OS is still less than 2 years, and the 5-year survival rate is only about 16%. This underscores an unmet need in this population that necessitates finding therapeutic options to enhance treatment outcomes. As monotherapy, immune checkpoint inhibitors (ICIs) have shown limited efficacy in non–microsatellite instability-high (non–MSI-H) mCRC, which represents a majority of mCRC cases. However, addition of tyrosine kinase inhibitors (TKIs) to ICIs has demonstrated encouraging efficacy in mCRC, particularly in patients without liver metastases (LM). Clinical data suggest synergy whereby TKIs may increase sensitivity to ICIs by promoting an immune-permissive tumor microenvironment. Zanzalintinib is a novel TKI targeting VEGFR, MET, and the TAM kinases (TYRO3, AXL, MER), which are involved in tumor angiogenesis, metastasis, and immunosuppression. In a phase 1 study, zanzalintinib in combination with atezolizumab (an anti–PD-L1 ICI) showed antitumor activity and a manageable safety profile across multiple tumor types, including mCRC. The present study, STELLAR-303, was designed to evaluate the efficacy and safety of zanzalintinib + atezolizumab in patients with non–MSI-H mCRC. Methods: STELLAR-303 (NCT05425940) is a global, randomized, open-label, phase 3 study. Patients must be aged ≥18 years and have non–MSI-H/non-mismatch repair deficient disease, with documented RAS status by tissue-based analysis, measurable disease per RECIST v1.1, and ECOG performance status of 0–1. Patients must have had intolerance to, or radiographic progression during/after, standard-of-care treatments for mCRC. Patients previously treated with regorafenib, trifluridine/tipiracil, or PD-L1/PD-1 ICIs are excluded. Patients with or without active LM at baseline are eligible; those with definitively treated LM (including surgical resection, microwave/radiofrequency ablation, or stereotactic body radiation therapy, but not yttrium-90 or chemoembolization alone) are considered to have non-active LM if treated ≥6 months before enrollment with no evidence of radiologic progression on subsequent imaging. Patients are randomized 1:1 to receive either zanzalintinib + atezolizumab, or regorafenib alone. Planned enrollment is 874 patients, and the number of patients with/without LM will be capped to ensure relevance to the real-world mCRC population. The primary endpoint is OS in patients without LM, while OS in all randomized patients is the key secondary endpoint. A hierarchical testing strategy will be employed for primary and key secondary endpoints. Safety will also be assessed. STELLAR-303 enrollment is ongoing in the US, Europe, and Asia-Pacific region. Clinical trial information: NCT05425940 .
“It was very nice to be in a room where everyone had ADD—that’s kind of VIP”: Exploring clients’ perceptions of group CBT for ADHD inattentive presentation
Authors: Strålin Elinor Eskilsson , Sunnhed Rikard , Thorell Lisa B. , Lundgren Tobias , Bölte Sven , Bohman Benjamin 
Published: June 2024

Objectives
This qualitative study explored the perceptions of adult clients participating in a new psychological treatment for attention-deficit/hyperactivity disorder inattentive presentation (ADHD-I, also called “attention deficit disorder”, ADD). The study aimed to explore (i) what aspects of treatment the participants found to be helpful, and (ii) if there were areas that ought to be developed to make the protocol more useful to clients with ADHD-I.

Methods
Participants were recruited from treatment groups following the protocol of cognitive-behavioral therapy for ADHD-I (CADDI), at three psychiatric outpatient units in Stockholm, Sweden. Individual semi-structured interviews, lasting on average 44,6 minutes, were conducted with 14 adults after the completion of CADDI. Interviews explored participants’ perceptions of CADDI, its usefulness, and asked for suggestions for improvement. Interviews were conducted by independent interviewers and were transcribed verbatim. The text was analyzed using reflexive thematic analysis.

Results
The analysis generated three themes: “Factors of importance for change”, with the subthemes; the group, therapeutic components, structure of treatment, and motivation,”Gains in treatment”, with the subthemes; insight and understanding, increased attention, and planning and acting, and “Challenges with ADHD-I and remaining needs”, with the subthemes; ADHD as a lifelong condition, maintaining gains in treatment, and wish for further support.

Conclusions
Participants emphasized the importance of the group setting as a facilitator of therapeutic effects of increased understanding and self-acceptance. Further, they considered the practice of mindfulness to enhance attention and awareness of thoughts, feelings, and activities and considered the structure of treatment as supporting the work in therapy. These findings support the value of the group setting and confirm the usefulness of CADDI. However, participants were concerned about how to maintain gains of treatment after its termination and suggested follow-up sessions to improve the CADDI protocol.

Trial registration
Preregistered at Clinical Trials: NCT05037903.
Offensive language detection in low resource languages: A use case of Persian language
Authors: Mozafari Marzieh , Mnassri Khouloud , Farahbakhsh Reza , Crespi Noel 
Published: June 2024

THIS ARTICLE USES WORDS OR LANGUAGE THAT IS CONSIDERED PROFANE, VULGAR, OR OFFENSIVE BY SOME READERS.
Different types of abusive content such as offensive language, hate speech, aggression, etc. have become prevalent in social media and many efforts have been dedicated to automatically detect this phenomenon in different resource-rich languages such as English. This is mainly due to the comparative lack of annotated data related to offensive language in low-resource languages, especially the ones spoken in Asian countries. To reduce the vulnerability among social media users from these regions, it is crucial to address the problem of offensive language in such low-resource languages. Hence, we present a new corpus of Persian offensive language consisting of 6,000 out of 520,000 randomly sampled micro-blog posts from X (Twitter) to deal with offensive language detection in Persian as a low-resource language in this area. We introduce a method for creating the corpus and annotating it according to the annotation practices of recent efforts for some benchmark datasets in other languages which results in categorizing offensive language and the target of offense as well. We perform extensive experiments with three classifiers in different levels of annotation with a number of classical Machine Learning (ML), Deep learning (DL), and transformer-based neural networks including monolingual and multilingual pre-trained language models. Furthermore, we propose an ensemble model integrating the aforementioned models to boost the performance of our offensive language detection task. Initial results on single models indicate that SVM trained on character or word n-grams are the best performing models accompanying monolingual transformer-based pre-trained language model ParsBERT in identifying offensive vs non-offensive content, targeted vs untargeted offense, and offensive towards individual or group. In addition, the stacking ensemble model outperforms the single models by a substantial margin, obtaining 5% respective macro F1-score improvement for three levels of annotation.
Understanding migraine in Saudi society: An assessment of public knowledge and attitudes: A cross-sectional study
Authors: Alshehri Fahad S. , Ashour Ahmed M. , Alharbi Adnan S. , Hakami Alqassem Y. , Alorfi Nasser M. 
Published: June 2024

Objective
This study aims to assess the knowledge and perceptions of the public toward migraine in Saudi Arabia.

Methods
This cross-sectional survey assessed the knowledge and perceptions of migraine among Saudi Arabian individuals. The study was conducted over three months in 2023 (1st of June 2023 to 31st of August 2023) using a prevalidated online questionnaire divided into four sections.

Results
A total of 1,975 adults aged between 18 and 64 completed the web-based survey. Of these, over half were male (n = 1,268; 64.2%). The main causes of migraine identified by the participants were genetic disease (n = 540, 27.3%), followed by physical disease (n = 341, 17.3%), head trauma (n = 274, 13.9%), and psychiatric disease (n = 157, 7.9%). The main symptoms identified by the participants were photophobia (21%), followed by inability to control urine (14.1%), vomiting and nausea (13.8%), and vision loss (8.3%). The majority of the participants in this study had a good knowledge of migraines, while 49% had poor knowledge. The migraine knowledge score was significantly associated with the participants’ gender (p = 0.002), age (p = 0.0001), educational level (p = 0.001), employment status (p = 0.001), monthly income (p = 0.0001), region (p = 0.0001), and history of migraine (p = 0.0001).

Conclusion
Although one-third of the participants exhibiting good knowledge, deficiencies existed in certain clinical aspects, emphasizing the need for targeted educational interventions to enhance public awareness and understanding of migraines.
The efficacy and safety of different Janus kinase inhibitors as monotherapy in rheumatoid arthritis: A Bayesian network meta-analysis
Authors: Qu Bingjia , Zhao Feng , Song Ying , Zhao Junyi , Yao Yuxin , Chen Yulan , Liao Ruobing , Fu Lingyu 
Published: June 2024

Objective
This study aims to evaluate the efficacy and safety of JAK inhibitors in the treatment of patients with RA.

Methods
The databases CNKI, VIP, Wanfang, CBM, and PubMed, Embase, Cochrane Library and Web of Science were searched to identify relevant randomized controlled trials (RCTs), all from the time of database creation to April 2024. Screening, data extraction, and risk of bias assessment (using Review Manager-5.3 software) were independently performed by at least two authors. The network meta-analysis was conducted using R 4.1.3 software. PROSPERO registration number: CRD42022370444.

Results
Thirty-three RCTs included 15,961 patients The experimental groups involved six JAK inhibitors (filgotinib, tofacitinib, decernotinib, baricitinib, upadacitinib and peficitinib) and 12 interventions (different doses of the six JAK inhibitors), and the control group involved adalimumab (ADA) and placebo. Compared with placebo, all JAK inhibitors showed a significant increase in efficacy measures (ACR20/50/70). Compared with ADA, only tofacitinib, low-dose decernotinib, and high-dose peficitinib showed a significant increase in ACR20/50/70. Decernotinib ranked first in the SUCRA ranking of ACR20/50/70. In terms of safety indicators, only those differences between low-dose filgotinib and high-dose upadacitinib, low-dose tofacitinib and high-dose upadacitinib were statistically significant. Low-dose filgotinib ranked first in the SUCRA ranking with adverse events as safety indicators. Only the efficacy and safety of tofacitinib ranked higher among different SUCRA rankings.

Conclusion
Six JAK inhibitors have better efficacy than placebo. The superior efficacy of decernotinib and safety of low-dose filgotinib can be found in the SUCRA. However, there are no significant differences in safety between the different JAK inhibitors. Head-to-head trials, directly comparing one against each other, are required to provide more certain evidence.
Analisis Laju Filtrasi dan Morfometrik Kerang Darah (Anadara granosa) pada Budidaya Sistem Kokultur dengan Berbagai Kombinasi Biota
Authors: Kabangnga Arnold , Heriansah Heriansah , Nursida Nur Fajriani 
Published: June 2024

Keberadaan kerang dengan karakteristik filter feeder diperlukan untuk memanfaatkan limbah akuakultur yang tersuspensi di kolom air sehingga dapat direduksi. Penelitian ini, kerang darah dari empat sistem akuakultur dievaluasi untuk menentukan laju filtrasi, yaitu sistem monokultur, polikultur, kokultur IMTA non-padi, dan kokultur IMTA padi. Kerang darah, ikan nila, dan udang windu masing-masing ditebar sebanyak 20 ekor pada 90 L air payau, sedangkan kepadatan teripang adalah 10 ekor. Untuk padi, dipelihara dengan metode terapung menggunakan nampan. Selama 4 minggu, pakan diberikan 4 kali sehari sebanyak 10% dari biomassa. biota sangat menentukan keberhasilan budidaya multibiota pada sistem ko-kultur. Hasil analisis ragam menunjukkan bahwa kombinasi biota berpengaruh nyata (P<0,05) terhadap konsentrasi amoniak, nitrat, dan fosfat. Konsentrasi ketiga bahan organik di akhir penelitian pada sistem polikultur dan sistem IMTA secara signifikan lebih rendah dibandingkan pada sistem monokultur. Sementara itu, pengaruh kombinasi biota terhadap karakteristik morfometrik tidak menunjukkan pengaruh nyata (P>0,05). Laju filtrasi dan morfometrik akan efektif jika dikultur dengan spesies trofik level yang lengkap melalui sistem IMTA. The existence of mussels with filter feeder characteristics is needed to utilize aquaculture waste suspended in the water column so that it can be reduced. In this study, blood cockles from four aquaculture systems were evaluated to determine the filtration rate, namely monoculture, polyculture, non-rice IMTA coculture, and rice IMTA coculture. Blood clams, tilapia and tiger prawns were each stocked with 20 individuals in 90 L of brackish water, while the density of sea cucumbers was 10 individuals. For rice, it is maintained by the floating method using trays. For 4 weeks, the feed was given 4 times a day as much as 10% of the biomass. biota greatly determines the success of multibiota cultivation in co-culture systems. The results of the analysis of variance showed that the combination of biota had a significant effect (P<0.05) on the concentrations of ammonia, nitrate and phosphate. The concentrations of the three organic matter at the end of the study in the polyculture system and the IMTA system were significantly lower than in the monoculture system. Meanwhile, the effect of the combination of biota on the morphometric characteristics did not show a significant effect (P>0.05). Filtration rate and morphometrics will be effective if cultured with complete trophic level species through the IMTA system