bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helical Tomotherapy and Melphalan As the Conditioning Regimen in Autologous Stem Cell Transplantation for Multiple Myeloma with Extramedullary Plasmacytoma: A Single Center Clinical Research
Authors: Liu Pan , Wang Qian , Zhou Fuling 
Published: December 2023

Background
Multiple myeloma(MM) is the second hematologic malignancy. Extramedullary myeloma indicates a poorer prognosis and survival. High dose Melphalan is the most widely used conditioning regimen. Helical tomotherapy(TOMO) is one of the most advanced intensity-modulated conformal radiotherapy technologies. We applied the combination of TOMO and Melphalan as the conditioning regimen in MM patients, and analyzed its efficacy and safety.
Methods
Clinical data were collected and compared between TOMO combined with melphalan group and non-TOMO group. SPSS V.25.0 was used for statistical analysis.
Results
Two methods were not significant difference by statistics analysis. The complete response rate of 100d in non-TOMO group significantly decreased compared to 1 month after transplantation (P=0.001). The 1-year PFS rate in the TOMO group was 86%, while non-TOMO group was 91%. There was no myeloma related death in the two groups within one year. TOMO group showed earlier enter platelet count below 20x109/L (P=0.003) and granulocyte deficiency (P=0.000). In terms of platelet implantation time,TOMO group was superior in platelet implantation time (P=0.041). No atrial fibrillation, heart failure, hepatic small vein occlusion, or transplant related death occurred during the transplantation period.
Conclusion: The combination of TOMO and reduced dose Melphalan conditioning regimen is clinically feasible in terms of safety and efficacy evaluation. This scheme could improve the long-term survival of MM patients with extramedullary plasmacytoma.
High Prevalence of MYD88 and CD79B Mutations and PD-L1 Alterations in Bone Marrow Large B Cell Lymphoma Associated with Hemophagocytic Lymphohistiocytosis
Authors: Shi Wenyu , Miao Yi , Shi Yu , Zhu Huayuan , Li Jianyong 
Published: December 2023

Introduction: Bone marrow large B cell lymphoma associated with hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a highly aggressive clinical course. Until now, the molecular genomics of bone marrow large B cell lymphoma associated with HLH remains undetermined.
Methods: Cases of bone marrow large B cell lymphoma with HLH were included. The inclusion criteria were as follows: (1) diagnosis of large B cell lymphoma presenting initially in the bone marrow; (2) no overt lymph node involvement or tumor formation; (3) fulfillment of five or more of the eight HLH-2004 diagnostic criteria. (4) cases with available samples. Genomic DNA was extracted from bone marrow cells or the plasma. A panel comprising 475 hematological malignancy-related genes were used for targeted gene sequencing. The prepared library was sequenced using Illumina HiSeq 4000. Molecular classification was predicted by using the LymphGen algorithm.
Results: A total of 23 cases were included. The median age was 63. 71.4% of patients were the non-GCB subtype (10/14) based on the Hans algorithm and 50% (9/18) of cases showed CD5 expression. Somatic mutations were identified in all the cases. The most common disrupted genes were PIM1 (12/23, 52.2%), PD-L1 (9/23, 39.1%), MYD88 (8/23, 34.8%), BCL6 (6/23, 26.1%), CD79B (6/23, 26.1%), IRF4 (6/23, 26.1%) and TET2 (6/23, 26.1%) (Figure 1). For nine cases with PD-L1 aberrations, seven cases had PD-L1 structural variants (SVs) and one case showed PD-L1 amplification (Figure 2). All the six cases with BCL6 aberrations showed BCL6 SVs (Figure 2). For six cases with BCL6 SVs, four cases showed immunoglobulin heavy chain ( IGH)- BCL6 translocations and two cases harbored IKZF1- BCL6 translocations. Regarding molecular classification, eight cases (34.8%) were classified as the MCD subtype, two cases the BN2 subtype, two cases the ST2 subtype, and two cases the composite subtype.
Conclusion: To the best of our knowledge, this is the first study exploring the molecular genetics of bone marrow large B cell lymphoma with HLH. Our study suggesting bone marrow large B cell lymphoma with HLH showed frequent MYD88/CD79B and PD-L1 alterations. Our study provided clues for the pathogenesis of bone marrow large B cell lymphoma with HLH and identified potential druggable targets for future clinical trials.
Comparison of Therapeutic Effects between Young Haploidentical Donors and Elderly HLA-Matched Relative Donors for AML Patients Who Undergoing Allogeneic Hematopoietic Stem Cell Transplantation with Conditioning Regime Including ATG
Authors: Zhang Haixiao , Jiang Erlie 
Published: December 2023

Objective: Donor selection is one of the issues faced in allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aims to compare the impact of young haploidentical donors and elderly matched relative donors on the outcomes of AML patients undergoing allo-HSCT with conditioning regime including ATG, providing reference for donor selection.
Methods: A retrospective analysis was conducted on 708 AML patients who underwent allo-HSCT at our hospital from 2014 to 2021. Among them, 354 patients were included in this study, with 289 patients receiving haploidentical transplantation from donors under the age of 50 (haplo group) and 65 patients receiving fully matched sibling transplantation from donors over the age of 50 (MSD group). Clinical characteristics and transplantation outcomes of both groups of patients and donors were compared.
Results: Among the 354 AML-MRC patients, there were 178 males and 176 females, with a median age of 41 (18~56) years. The median follow-up time was 35 (95% CI 30~49) months, and the median overall survival (OS) was 78 (95% CI 23~) months. The 3-year OS rate was 63.1% (95% CI 45.6%~81.4%), the 3-year event-free survival (EFS) rate was 59.0% (95% CI 40.8%~66.1%), the cumulative incidence of relapse (CIR) was 26.8% (95% CI 16.6%~30.0%), and the transplantation-related mortality (TRM) was 22.7% (95% CI 13.2%~33.8%). There were no statistically significant baseline differences between the haplo group and MSD group. The 3-year OS rates for haplo group vs. MSD group were 0.660 (95% CI 0.597-0.731) vs. 0.670 (95% CI 0.558-0.806) (p=0.7), the 3-year EFS rates were 0.620 (95% CI 0.543-0.720) vs. 0.570 (95% CI 0.458-0.656) (p=0.6), and the TRM rates were 0.165 (95% CI 0.121-0.282) vs. 0.134 (95% CI 0.062-0.234) (p=0.6). The CIR rates were 0.199 (95% CI 0.147-0.250) vs. 0.275 (95% CI 0.165-0.397) (p=0.196), and the cumulative incidence of grade II-IV aGVHD was 0.288 (0.237-0.342) vs. 0.309 (95% 0.200-0.424) (P=0.891). The incidence of cGVHD was 0.140 (0.099-0.188) vs. 0.250 (95% 0.147-0.367) (p=0.032).
Conclusion: For AML patients undergoing allo-HSCT with conditioning regime including ATG, compared to elderly fully matched donors, young haploidentical donors may reduce the occurrence of post-transplant cGHVD.
Bone Marrow Cellularity at Diagnosis Predicts Outcomes of Patients with Myelodysplastic Syndrome with Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Ahn Seo-Yeon , Kim Mihee , Song Ga-Young , Jung Sung-Hoon , Ahn Jae-Sook , Yang Deok-Hwan , Lee Je-Jung , Kim Hyeoung-Joon 
Published: December 2023

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only known curative therapy for myelodysplastic syndromes (MDS). The decision of allo-HSCT depends on prognostic scoring models such as revised international prognostic scoring system (IPSS-R) which include cytogenetic abnormalities, cytopenia, and % of bone marrow (BM) blasts. Recently, the prognostic role of genomic profile in MDS patients is arising. However, it is hard to conduct the next generation sequencing to all MDS patients in the real-world. Therefore, we aimed to evaluate the prognostic impact of BM cellularity at diagnosis as a new clinical prognostic factor of MDS with allo-HSCT.
A total of 122 patients with MDS patients who underwent allo-HSCT between July 2009 to August 2022 in single center were analyzed retrospectively. Overall survival (OS) was analyzed using the Kaplan-Meier survival curves according to the BM cellularity at diagnosis. The potential prognostic parameters were evaluated for OS by uni-and multivariate cox-regression analysis.
All patients were eligible for allo-HSCT and median age of 61.5 years (range: 19-71). Median follow-up duration was 36.9 (IQR 17.6-72.4) months. The 3-year and 5-year OS were 60.1% (95% CI 51.6-69.0) and 52.5% (95% CI 42.8-61.3), respectively. IPSS-R risk group was classified as very low (6, 4.9%), low (15, 12.2%), intermediate (40, 32.8%), high (37, 30.3%) and very high (24, 19.7%). Seventeen patients (13.9%) had complex karyotype at diagnosis. Seventy-seven patients (63.1%) were treated with hypomethylating agents before allo-HSCT. Most patients (70, 57.4%) had less than 5% BM blasts at allo-HSCT. The majority (74, 60.7%) received reduced intensity conditioning.
OS significantly differed between patients with hypercellular BM and normo- to hypocellular BM at diagnosis by the log-rank test ( P &lt;0.001) (Figure 1). In multivariate analysis for OS, complex karyotype at diagnosis ( P&lt;0.001; HR 6.00; 95% CI 3.08-11.66), age ( P=0.04; HR 1.03; 95% CI 1.00-1.06) and hypercellular BM at diagnosis ( P=0.005; HR 2.16; 95% CI 1.26-3.72) were associated with worse outcome (Table 1).
In this study, we demonstrated the BM hypercellularity at diagnosis independently predicts the inferior outcome of MDS patients with allo-HSCT. Although further validation with a larger cohort would be needed, it could be helpful to decide the treatment strategy of transplantation eligible MDS patients.
Analysis of GATA transcription factors and their expression patterns under abiotic stress in grapevine (Vitis vinifera L.)
Authors: Zhang Xiuming , Ma Jiahui , Yang Shijin , Yao Wenkong , Zhang Ningbo , Hao Xinyi , Xu Weirong 
Published: December 2023

Abstract
Background
GATA transcription factors are type IV zinc-finger proteins that play key roles in plant growth and responses to environmental stimuli. Although these proteins have been studied in model plants, the related studies of GATA gene family under abiotic stresses are rarely reported in grapevine (Vitis vinifera L.).

Results
In the current study, a total of 23 VviGATA genes were identified in grapevine and classified into four groups (I, II, III, and IV), based on phylogenetic analysis. The proteins in the same group exhibited similar exon–intron structures and conserved motifs and were found to be unevenly distributed among the thirteen grapevine chromosomes. Accordingly, it is likely that segmental and tandem duplication events contributed to the expansion of the VviGATA gene family. Analysis of cis-acting regulatory elements in their promoters suggested that VviGATA genes respond to light and are influenced by multiple hormones and stresses. Organ/tissue expression profiles showed tissue specificity for most of the VviGATA genes, and five were preferentially upregulated in different fruit developmental stages, while others were strongly induced by drought, salt and cold stress treatments. Heterologously expressed VamGATA5a, VamGATA8b, VamGATA24a, VamGATA24c and VamGATA24d from cold-resistant V. amurensis ‘Shuangyou’ showed nuclear localization and transcriptional activity was shown for VamGATA5a, VamGATA8b and VamGATA24d.

Conclusions
The results of this study provide useful information for GATA gene function analysis and aid in the understanding of stress responses in grapevine for future molecular breeding initiatives.
Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study
Authors: Jiang Wencai , Zeng Xu , Zhou Xinyu , Liao Ou , Ju Feng , Zhao Zhifu , Zhang Xianjie 
Published: December 2023

Abstract
Background
Laparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the benefits of magnesium sulfate intravenous infusion during the perioperative period post-laparoscopic surgery are yet lacking.

Methods
A total of 88 gastrointestinal cancer male patients scheduled for laparoscopic radical resection were randomly divided into two groups: normal saline (control) and magnesium. In the magnesium group, a 40 mg/kg loading dose of intravenous magnesium sulfate was administered for 10 min just after the induction of anesthesia, followed by continuous intravenous infusion of 15 mg/kg/h magnesium sulfate until the end of the surgery; the control group was administered the same dose of normal saline. Subsequently, 2 μg/kg sufentanil was continuously infused intravenously by a postoperative patient-controlled intravenous analgesia (PCIA) device. The primary outcome was the incidence of CRBD at 0 h after the surgery. The secondary outcomes included incidence of CRBD at 1, 2, and 6 h postsurgery, the severity of CRBD at 0, 1, 2, and 6 h postsurgery. Remifentanil requirement during surgery, sufentanil requirement within 24 h postsurgery, the postoperative numerical rating scale (NRS) score at 48 h after the surgery, magnesium-related side effects and rescue medication (morphine) requirement were also assessed.

Results
The incidence of CRBD at 0, 1, 2, and 6 h postoperatively was lower in the magnesium group than the control group (0 h: P = 0.01; 1 h: P = 0.003; 2 h: P = 0.001; 6 h: P = 0.006). The incidence of moderate to severe CRBD was higher in the control group at postoperative 0 and 1 h (0 h: P = 0.002; 1 h: P = 0.028), remifentanil requirement during surgery were significantly lower in the magnesium group than the control group. Sufentanil requirements during the 24 h postoperative period were significantly lower in the magnesium group than the control group. The NRS score was reduced in the magnesium group compared to the control group in the early postoperative period. Magnesium-related side effects and rescue medication (morphine) did not differ significantly between the two groups.

Conclusions
Intravenous magnesium sulfate administration reduces the incidence and severity of CRBD and remifentanil requirement in male patients undergoing radical resection of gastrointestinal cancer. Also, no significant side effects were observed.

Trial registration
Chictr.org.cn ChiCTR2100053073. The study was registered on 10/11/2021.
Needs and challenges among general practitioners in the management of actinic keratosis: a qualitative study
Authors: Verhoeven Charlotte , Claessens Zilke , Lubeek Satish F.K. , Schers Henk J. 
Published: December 2023

Abstract
Background
Because of the increasing incidence of actinic keratosis (AK), optimal use of limited healthcare resources is essential. Although most patients can be managed in primary care, dermatology referrals are common. More profound knowledge of general practitioners’ (GPs) considerations might assist in enhancing AK care.

Methods
The aim of the current study was to gain insight into AK management in primary care by exploring the needs and challenges among GPs in the Netherlands. A qualitative study was conducted based on semi-structured in-depth interviews with 15 conveniently sampled Dutch GPs, focusing on the needs and challenges in AK management. A literature-informed, predefined topic list guided the interviews, which were recorded, transcribed ad verbatim, and thematically analysed using the Framework Method.

Results
All GPs reported AK to be a clinical diagnosis and most GPs indicated that most AK patients could be managed in primary care. Cryotherapy was preferred and experience with 5-FU therapy was limited. Most GPs applied cryotherapy without discussing other treatment options with patients. Reasons for dermatology referrals included an incomplete treatment response, extensive lesions, difficult-to-treat areas, and serious doubts about the diagnosis. GPs reported a need for more education, especially on 5-FU therapy. Their main challenges were dealing with diagnostic uncertainty, treating extensive lesions, managing treatment-related skin reactions, and reconciling patient misconceptions.

Conclusions
This study shows various AK management approaches among Dutch GPs with suboptimal guideline compliance due to diverse underlying barriers. It suggests that more education might contribute to a more standardised and uniform AK management and supports further transition of AK care from hospital to primary care.
Clinical impact of medication reviews for community-dwelling patients in primary healthcare
Authors: Dobszai Annika , Lenander Cecilia , Borgström Bolmsjö Beata , Wickman Katarina , Modig Sara 
Published: December 2023

Abstract
Background
A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent on the process. We aimed to evaluate medication reviews for community-dwelling patients regarding the clinical relevance of the pharmacists’ recommendations, and their implementation by general practitioners. We also wanted to investigate if the general practitioners’ tendency to act on drug-related problems was correlated to different factors of the process.

Methods
This was a cohort study, where patients in primary healthcare considered in need of a medication review were selected. Pharmacists identified drug-related problems and gave written recommendations on how to solve the problems to the general practitioner, via the medical record, and in addition in some cases via verbal communication. The clinical relevance of the recommendations was graded according to the Hatoum scale, ranging from one (adverse significance) to six (extremely significant). Descriptive statistics were used regarding the clinical relevance and the general practitioners´ tendency to act on drug-related problems. Multiple logistic regression analysis was used to examine the association between the tendency to act and different factors of the process.

Results
A total of 96.1% of the 384 assessed recommendations from the pharmacists were graded as significant or more for the patient (Hatoum grade 3 or higher). The general practitioners acted on 63.8% of the drug-related problems. Fewer recommendations per patient, as well as verbal communication in addition to written contact, significantly increased the general practitioners’ tendency to act on a drug-related problem. No significant association was seen between the tendency to act and the clinical relevance of the recommendation.

Conclusions
The high proportion of clinically relevant recommendations from the pharmacists in this study strengthens medication reviews as an important tool for reducing drug-related problems. Verbal communication between the pharmacist and the general practitioner is important for measures to be taken. Multiple recommendations for the same patient reduced their likelihood to of being addressed by the general practitioner.
Returning-to-work after mental health-associated sick leave: a qualitative interview study exploring the experiences of general practitioners in Germany
Authors: Geipel Martina , Pelizäus Anna , Hamann Johannes 
Published: December 2023

Abstract
Background and aim
Psychiatric disorders are increasing globally. Especially when these disorders affect working people, this places a financial burden on society due to long-term sick leave, the incapacity to work and the inability to earn and pay taxes. General practitioners (GPs) are often the first health professionals to be consulted by those suffering from mental health disorders.
This study investigated the experiences of GPs regarding their patients with mental health disorders and identified factors that are important for a successful return to work.

Methods
This qualitative study used semi-structured interviews to explore the opinions of GPs (n = 12) working in Munich, Germany, or its metropolitan area. The interviews were audio-recorded, transcribed, and analyzed using the reflexive thematic analysis method.

Results
GPs think of themselves as important players in the rehabilitation process of patients with mental health disorders. In their daily routine, they face many obstacles to ensure the best treatment and outcome for their patients. They also suffer from poor collaboration with other stakeholders, such as psychiatric hospitals, therapists or employers.
They indicate that the mental health disorder of each patient is unique, including the barriers to and possibilities of a successful return to work. Additionally, the workplace appears to play a crucial role in the success rate of re-entry into work. It can exacerbate the course of mental health disorders or support recovery. Fear, shame and stigmatization of the patients are personal factors responsible for prolonged sick leave.

Conclusion
We conclude that GPs believe that they can have a major impact on the rehabilitation of patients with mental health disorders. As such, special focus should be placed on supporting them in this context.
Maternal and obstetric outcomes after Ex-Utero Intrapartum Treatment (EXIT): a single center experience
Authors: Domínguez-Moreno Marta , Chimenea Ángel , García-Díaz Lutgardo , Antiñolo Guillermo 
Published: December 2023

Abstract
Background
The Ex-utero Intrapartum Treatment (EXIT) is a procedure developed to manage a range of fetal conditions, aiming to ensure the maintenance of neonatal airway and preserving the feto-placental circulation. Its goal is to enhance the neonatal ability to successfully transition and adapt to postnatal life, thereby reducing perinatal morbidity and mortality. However, EXIT has been associated with a high risk of maternal complications. This paper provides an overview of the indications and characteristics of the EXIT procedure, as well as the obstetric outcomes and maternal complications.

Methods
A retrospective analysis was conducted on a cohort of patients undergoing EXIT at our center between January 2007 and December 2022. Maternal outcomes, including demographic information, data related to the surgical procedure, surgical complications, and postoperative complications were analyzed. To assess the severity of the surgical complications, a modified Clavien-Dindo classification was used. Comparative analysis was performed by randomly selecting a sample from elective cesarean deliveries performed at our center.

Results
A total of 34 EXIT procedures were performed. According to the modified Clavien-Dindo classification, we observed no major complications, while minor maternal complications were present in 2.94% of cases. Compared to elective cesarean deliveries (n = 350), there were no significant differences in terms of maternal complications, highlighting the similarity observed in the mean decrease in postoperative hemoglobin (1.15 g/dL in EXIT vs. 1.2 g/dL in elective cesarean deliveries, p = 0.94). In EXIT group, there was a higher rate of polyhydramnios (26.47% vs 6.59%, p < 0.001), as well as the need for amnioreduction (14.71% vs 0%, p = 0.001) and preterm delivery (32.35% vs 6.02%, p = 0.001). There were no cases of endometritis, post-procedural fever, or abruptio placentae following EXIT.

Conclusions
EXIT can be considered a safe procedure when performed under adequate conditions, including appropriate uterine access and proper anesthetic management. In our series, EXIT procedure was not associated with a higher incidence of maternal complications when compared to elective cesarean delivery.

Trial registration
Retrospectively registered.