bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extra pulmonary versus pulmonary presentation of COVID-19 patients: comparative study
Authors: Esmaeel Hend M. , Mohamed Hamdy S. , Khalaf Asmaa R. , Mahmoud Hamza A. , Gadallah Doaa 
Published: November 2023

Abstract
Background
The respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality.

Aim
This study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined.

Methods
In this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19.

Result
This study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group.

Conclusion
Atypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility.
A comprehensive review on thermal management of electronic devices
Authors: Dhumal Amol R. , Kulkarni Atul P. , Ambhore Nitin H. 
Published: November 2023

AbstractIn the field of electronics thermal management (TM), there has already been a lot of work done to create cooling options that guarantee steady-state performance. However, electronic devices (EDs) are progressively utilized in applications that involve time-varying workloads. Therefore, the TM systems could dissipate the heat generated by EDs; however, there seemed to be a necessity for a design that would contain temperature rise within an acceptable range for limiting hot spots and managing thermal transients induced by higher-frequency operating cycles. Heat dissipation issues become more significant when miniaturization in electronics increases. More effective TM often results in enhanced reliability as well as a longer life expectancy for devices. Hence, this paper explicates the TM of EDs, the comparison of cooling methods, the comparison of convections for TM on EDs, the heat source (HS) mounted on the substrate board, and optimization techniques to optimize the size and position of HSs mounted on the substrate board. This paper also analyzes the TM technologies on different EDs from 2014 to 2023 and the comparison of the thermal conductance of EDs with two types of phase change materials (PCMs) and pin-fin heat pipes (HPs).
Contrast echocardiography: a practical guideline from the British Society of Echocardiography
Authors: Hampson Reinette , Senior Roxy , Ring Liam , Robinson Shaun , Augustine Daniel X. , Becher Harald , Anderson Natasha , Willis James , Chandrasekaran Badrinathan , Kardos Attila , Siva Anjana , Leeson Paul , Rana Bushra S. , Chahal Navtej , Oxborough David 
Published: November 2023

AbstractUltrasound contrast agents (UCAs) have a well-established role in clinical cardiology. Contrast echocardiography has evolved into a routine technique through the establishment of contrast protocols, an excellent safety profile, and clinical guidelines which highlight the incremental prognostic utility of contrast enhanced echocardiography. This document aims to provide practical guidance on the safe and effective use of contrast; reviews the role of individual staff groups; and training requirements to facilitate its routine use in the echocardiography laboratory.
Successful surgical treatment for primary cardiac angiosarcoma: a case report
Authors: Suehiro Yasuo , Kajiyama Tetsuya , Satoh Ayaka , Uemura Hisashi , Nakagawa Takaya , Matsue Hajime , Satoh Hisashi , Takase Naoto , Doi Hiroshi 
Published: November 2023

Abstract
Background
Primary cardiac angiosarcomas are extremely rare and their prognosis is poor. Surgical resection is the first-line treatment; however, no clear standard of care has been clearly established because of the rarity of these tumors.

Case presentation
A 61-year-old man who had presented with dyspnea on exertion was referred to our hospital. Contrast-enhanced computed tomography revealed massive pericardial effusion and a 40-mm enhanced mass adherent to the anterior wall of the right atrium and involving the right coronary artery. Having diagnosed the mass as a cardiac tumor, we resected the mass under the guidance of epi-cardiac echocardiography guidance, which showed continuity between the tumor and the right atrium, reconstructed the right atrial free wall with a bovine pericardial patch, and performed coronary artery bypass grafting to the right coronary artery using the great saphenous vein. The right atrial wall was resected with adequate tumor-free margin. On the right ventricular side, we resected the right atrial wall 1 cm from the tumor, 2 cm from the atrioventricular groove. Because hemodynamic deterioration occurred after aortic declamping, intra-aortic balloon pumping and veno-arterial extracorporeal membrane oxygenation were instituted. Postoperatively, circulatory support devices were removed safely, and the patient was discharged on the 25th postoperative day. Histopathological examination of the surgical specimens resulted in a diagnosis of angiosarcoma, with positive surgical margins. Chemotherapy and radiotherapy (69 Gy in 30 fractions) were therefore initiated after discharge. To date, the patient has been alive and well with no recurrence of tumor for 4 years and 10 months since surgery.

Discussion
This case study suggests the usefulness of multimodality treatment comprising surgical resection and adjuvant therapy, for cardiac angiosarcoma.
Blinatumomab for First-Line Treatment of Children and Young Persons With B-ALL
Authors: Hodder Angus , Mishra Avijeet K. , Enshaei Amir , Baird Susan , Bhuller Kaljit , Elbeshlawi Ismail , Bonney Denise , Clesham Katherine , Cummins Michelle , Vedi Aditi , Gibson Brenda , George Lindsay , Ingham Danielle , Jigoulina Galina , Lancaster Donna , Lindsay Katherine , Madni Majid , Malone Andrea , Mitchell Bethany , Moppett John , Motwani Jayashree , Moorman Anthony V. , Patrick Katharine , Samrin Lamia , Tewari Sanjay , Thakur Indu , O'Connor David , Samarasinghe Sujith , Vora Ajay 
Published: November 2023

PURPOSE We tested whether blinatumomab (Blina) is effective as a toxicity-sparing alternative to first-line intensive chemotherapy in children and young persons (CYP) with B-ALL who were chemotherapy-intolerant or chemotherapy-resistant. METHODS Data were collected for consecutive CYP (age 1-24 years) with Philadelphia chromosome–positive or Philadelphia chromosome–negative B-ALL who received Blina as first-line therapy. Blina was given as replacement for postremission intensive chemotherapy to patients with chemotherapy intolerance or resistance. Blina responders received further chemotherapy (Blin-CT) or first remission hematopoietic stem-cell transplant (Blin-HSCT) if indicated. Event-free survival (EFS) and overall survival (OS) of the Blin-CT group were compared with those of matched controls treated with standard chemotherapy in the UKALL 2003 trial. Events were defined as death, relapse, or secondary cancer. RESULTS From February 2018 to February 2023, 105 patients were treated, of whom 85 were in the Blin-CT group and 20 were in the Blin-HSCT group. A majority of Blin-CT patients received Blina for chemotherapy intolerance (70 of 85, 82%), and the group had a higher-risk profile than unselected patients with B-ALL. Blina was well tolerated with only one patient having a grade 3/4–related toxicity event, and of the 60 patients who were minimal residual disease–positive pre-Blina, 58 of 60 (97%) responded. At a median follow-up of 22 months, the 2-year outcomes of the 80 matched Blin-CT group patients were similar to those of 192 controls (EFS, 95% [95% CI, 85 to 98] v 90% [95% CI, 65 to 93] and OS, 97% [95% CI, 86 to 99] v 94% [95% CI, 89 to 96]). Of the 20 in the HSCT group, three died because of transplant complications and two relapsed. CONCLUSION Blina is safe and effective in first-line treatment of chemotherapy-intolerant CYP with ALL.
Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma
Authors: Federico Massimo , Fortpied Catherine , Stepanishyna Yana , Gotti Manuel , van der Maazen Richard , Cristinelli Caterina , Re Alessandro , Plattel Wouter , Lazarovici Julien , Merli Francesco , Specht Lena , Schiano de Colella Jean-Marc , Hutchings Martin , Versari Annibale , Edeline Véronique , Stamatoulas Aspasia , Girinsky Theodore , Ricardi Umberto , Aleman Berthe , Meulemans Bart , Tonino Sanne , Raemaekers John , André Marc 
Published: November 2023

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. The primary analysis of the Early positron emission tomography (ePET) Response–Adapted Treatment in localized Hodgkin Lymphoma H10 Trial demonstrated that in ePET-negative patients, the risk of relapse increased when involved-node radiotherapy (INRT) was omitted and that in ePET-positive patients, switching from doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) to bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc) significantly improved 5-year progression-free survival (PFS). Here, we report the final results of a preplanned analysis at a 10-year follow-up. In the favorable (F) ePET-negative group, the 10-year PFS rates were 98.8% versus 85.4% (hazard ratio [HR], 13.2; 95% CI, 3.1 to 55.8; P value for noninferiority = .9735; difference test P < .0001) in favor of ABVD + INRT; in the unfavorable (U) ePET-negative group, the 10-year PFS rates were 91.4% and 86.5% (HR, 1.52; 95% CI, 0.84 to 2.75; P value for noninferiority = .8577; difference test P = .1628). In ePET-positive patients, the difference in terms of PFS between standard ABVD and intensified BEACOPPesc was no longer statistically significant (HR, 0.67; 95% CI, 0.37 to 1.20; P = .1777). In conclusion, the present long-term analysis confirms that in ePET-negative patients, the omission of INRT is associated with lower 10-year PFS. Instead, in ePET-positive patients, no significant difference between standard and experimental arms emerged although intensification with BEACOPPesc was safe, with no increase in late adverse events, namely, second malignancies.
Publicly Funded Cancer Care: Are Adjuvant Therapies Prioritized Over Treatment of Metastatic Cancer? The Israeli Experience
Authors: Hammerman Ariel , Azran Carmil , Topol Yael , Landsberger Daniel , Liebermann Nicky , Siegelmann-Danieli Nava 
Published: November 2023

PURPOSE
In Israel, a public committee advises which new medications should be reimbursed subject to an annual budget allocation. The committee considers clinical trial outcomes, professional societies' preferences, projected budget impacts, and other social and ethical aspects. The Israeli oncologists' society places a strong emphasis on prioritizing adjuvant therapies because of their potential to advance cure. In 2023, several novel adjuvant therapies were suggested for national funding. Our objective was to ascertain whether Israeli decision makers have embraced the practice of prioritizing budgets for therapies with curative intent over late-disease therapy.

METHODS
We collected data on all proposed cancer therapies for the 2023 update: indications, treatment settings, European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) score, and whether accepted for reimbursement. The rates of acceptance were compared between drugs in curative and noncurative settings. Data were extracted from the official Israeli Ministry of Health publications and ESMO-MCBS website.

RESULTS
Seven of the eight proposed therapies with curative intent received reimbursement approval (88%), in contrast to 11 of the 55 therapies for advanced/metastatic stages (20%). Among all advanced disease therapies with a high ESMO-MCBS score of 4, only four of 16 (25%) secured reimbursement approval.

CONCLUSION
Our analysis revealed that during the 2023 reimbursement deliberations, Israeli policymakers embraced the prioritization of potentially curative therapies over treatments for incurable cancers, including several interventions that have demonstrated significant improvements in overall survival and/or quality of life. Introducing objective cost-effectiveness measures as a guiding framework for comparing competing medications may offer some resolution to this complex challenge.
Polycystic Ovary Syndrome Physiologic Pathways Implicated Through Clustering of Genetic Loci
Authors: Stamou Maria I , Smith Kirk T , Kim Hyunkyung , Balasubramanian Ravikumar , Gray Kathryn J , Udler Miriam S 
Published: November 2023

Abstract

Context
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, with disease loci identified from genome-wide association studies (GWAS) having largely unknown relationships to disease pathogenesis.

Objective
This work aimed to group PCOS GWAS loci into genetic clusters associated with disease pathophysiology.

Methods
Cluster analysis was performed for 60 PCOS-associated genetic variants and 49 traits using GWAS summary statistics. Cluster-specific PCOS partitioned polygenic scores (pPS) were generated and tested for association with clinical phenotypes in the Mass General Brigham Biobank (MGBB, N = 62 252). Associations with clinical outcomes (type 2 diabetes [T2D], coronary artery disease [CAD], and female reproductive traits) were assessed using both GWAS-based pPS (DIAMANTE, N = 898,130, CARDIOGRAM/UKBB, N = 547 261) and individual-level pPS in MGBB.

Results
Four PCOS genetic clusters were identified with top loci indicated as following: (i) cluster 1/obesity/insulin resistance (FTO); (ii) cluster 2/hormonal/menstrual cycle changes (FSHB); (iii) cluster 3/blood markers/inflammation (ATXN2/SH2B3); (iv) cluster 4/metabolic changes (MAF, SLC38A11). Cluster pPS were associated with distinct clinical traits: Cluster 1 with increased body mass index (P = 6.6 × 10−29); cluster 2 with increased age of menarche (P = 1.5 × 10−4); cluster 3 with multiple decreased blood markers, including mean platelet volume (P = 3.1 ×10−5); and cluster 4 with increased alkaline phosphatase (P = .007). PCOS genetic clusters GWAS-pPSs were also associated with disease outcomes: cluster 1 pPS with increased T2D (odds ratio [OR] 1.07; P = 7.3 × 10−50), with replication in MGBB all participants (OR 1.09, P = 2.7 × 10−7) and females only (OR 1.11, 4.8 × 10−5).

Conclusion
Distinct genetic backgrounds in individuals with PCOS may underlie clinical heterogeneity and disease outcomes.
Cardiovascular Risk Markers in Adults With Adrenal Incidentaloma and Mild Autonomous Cortisol Secretion
Authors: Chen Angela X , Radhakutty Anjana , Drake Sophie M , Kiu Andrew , Thompson Campbell H , Burt Morton G 
Published: November 2023

Abstract

Context
Many adrenal adenomas exhibit mild autonomous cortisol secretion (MACS). Although MACS is associated with increased cardiovascular mortality, the underlying mechanisms are not fully defined.

Objective
To investigate mechanisms that may link MACS and cardiovascular mortality in adults with adrenal adenoma.

Design
Cross-sectional study.

Patients
Twenty adults with adrenal adenoma and MACS and 20 controls with nonfunctioning adrenal adenoma.

Methods
Reactive hyperemia index (RHI) was measured by peripheral artery tonometry and 24-hour ambulatory blood pressure monitoring (24h AMBP) was performed. Indices of insulin secretion and sensitivity were estimated by measuring glucose and insulin fasting and following a mixed meal.

Main outcome measure
The primary outcome was the difference in RHI between participants with MACS vs nonfunctioning adrenal adenoma.

Results
The average cortisol after 1-mg dexamethasone and urinary free cortisol were higher in patients with MACS. There was no significant difference in fasting RHI (2.0 [interquartile range (IQR) 1.6-2.4] vs 2.0 [IQR 1.7-2.2, P = .72), but postprandial RHI was higher in patients with MACS (2.2 [1.8-2.7] vs 1.8 [1.5-2.2], P = .04). 24-hour ambulatory blood pressure monitoring and Matsuda index were not significantly different in the groups. Fasting glucose and glucose area under the curve after the mixed meal were higher and insulinogenic index was lower in participants with MACS.

Conclusion
Adults with adrenal adenoma and MACS do not have fasting endothelial dysfunction and postprandial endothelial function may be better. These patients have fasting and postprandial hyperglycemia with lower insulin secretion, which may underlie the association between MACS and increased cardiovascular mortality.
Risk and Incidence of Endocrine Immune-Related Adverse Effects Under Checkpoint Inhibitor Mono- or Combination Therapy in Solid Tumors: A Meta-Analysis of Randomized Controlled Trials
Authors: Vardarli Irfan , Tan Susanne , Brandenburg Tim , Weidemann Frank , Görges Rainer , Herrmann Ken , Führer Dagmar 
Published: November 2023

Abstract

Context
Few meta-analyses on incidence of endocrine immune-related adverse effects (eirAEs) have been published and many trials have been published since.

Objective
We performed a comprehensive meta-analysis with updated literature to assess risk and incidence of eirAEs of any grade and grade 3 to 5 by immune checkpoint inhibitor (ICI) monotherapy or combination therapy in solid tumors.

Methods
An electronic search using PubMed/Medline, Embase, and the Cochrane Library was performed. Randomized controlled studies (RCTs) assessing eirAEs under ICI monotherapy or ICI combination therapy were selected. Stata software (v17) was used for statistical analyses and risk of bias was evaluated using Review Manager version 5.3.

Results
A total of 69 RCTs with 80 independent reports, involving 42 886 patients, were included in the study. Meta-analysis revealed the following pooled estimates for risk ratio and incidence, respectively: for any grade hypothyroidism 7.81 (95% CI, 5.68-10.74, P &lt; .0001) and 7.64% (95% CI, 6.23-9.17, P &lt; .0001); significantly increased also for hyperthyroidism, hypophysitis/hypopituitarism, and adrenal insufficiency; and for insulin-dependent diabetes mellitus 1.52 (95% CI, 1.07-2.18, P = .02), and 0.087% (95% CI, 0.019-0.189, P = .0006), respectively. Meta-regression showed that combination of ICIs (nivolumab plus ipilimumab; durvalumab plus tremelimumab) is an independent risk factor for any grade hypophysitis/hypopituitarism, and that ICI agent is an independent factor of risk for adrenal insufficiency, but that cancer type is not an independent risk factor for eirAEs.

Conclusion
We showed that risk, independent from cancer type, and incidence of eirAEs are substantially increased with ICI therapy. Combination of ICIs increases risk for eirAEs, especially for hypophysitis/hypopituitarism.
The United States’ Record-Low Child Poverty Rate in International and Historical Perspective: A Research Note
Authors: Parolin Zachary , Filauro Stefano 
Published: November 2023

Abstract
In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries.
Role of Concurrent Ultrasound Surveillance of Sentinel Node-Positive Node Fields in Melanoma Patients Having Routine Cross-Sectional Imaging
Authors: Gjorup Caroline A. , Woodford Rachel , Li Isabel , Carlino Matteo S. , Ch’ng Sydney , Chung David , Hsiao Edward , Lo Serigne N. , London Kevin , Long Georgina V. , Menzies Alexander M. , Nieweg Omgo E. , Pennington Thomas E. , Rtshiladze Michael A. , Saw Robyn P. M. , Scolyer Richard A. , Shannon Kerwin F. , Spillane Andrew J. , Stretch Jonathan R. , Thompson John F. , Varey Alexander H. R. , van Akkooi Alexander C. J. 
Published: November 2023

Abstract
Purpose
In sentinel node-positive (SN+ve) melanoma patients, active surveillance with regular ultrasound examination of the node field has become standard, rather than completion lymph node dissection (CLND). A proportion of these patients now receive adjuvant systemic therapy and have routine cross-sectional imaging (computed tomography [CT] or positron emission tomography [PET]/CT). The role of concurrent ultrasound (US) surveillance in these patients is unclear. The purpose of our study was to describe the modality of detection of nodal recurrence in SN+ve node fields.

Methods
SN+ve melanoma patients who did not undergo CLND treated at a single institution from January 1, 2016 to December 31, 2020 were included.

Results
A total of 225 SN+ve patients with a median follow-up of 23 months were included. Of these, 119 (53%) received adjuvant systemic therapy. Eighty (36%) developed a recurrence at any site; 24 (11%) recurred first in the SN+ve field, of which 12 (5%) were confirmed node field recurrence only at 2 months follow-up. The nodal recurrences were first detected by ultrasound in seven (3%), CT in seven (3%), and PET/CT in seven (3%) patients. All nodal recurrences evident on US were also evident on PET/CT and vice versa.

Conclusions
The high rate of recurrences outside the node field and the identification of all US-detected nodal recurrences on concurrent cross-sectional imaging modalities suggest that routine concurrent ultrasound surveillance of the node-positive field may be unnecessary for SN+ve melanoma patients having routine cross-sectional imaging.