bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advance care planning in oncology: a scoping review and some recommendations
Authors: Libert Yves , Choucroun Lisa , Razavi Darius , Merckaert Isabelle 
Published: May 2023

Purpose of review
Cancer patients’ communication with their relatives and healthcare professionals (HCPs) is essential for advance care planning (ACP). The purpose of this scoping review was to synthesize recent research findings about factors enabling cancer patients’, their relatives’, and physicians’ communication about ACP, and to propose recommendations for future ACP implementation in cancer care.

Recent findings
This review confirmed the importance of aspects of the cancer care context (i.e., culture) as ACP uptake-predisposing and -enabling factors. It highlighted the difficulty of determining who should initiate ACP discussion, with which patients and at what time-points. It also highlighted a lack of consideration for socioemotional processes in the study of ACP uptake despite evidence that cancer patients’, relatives’ and physicians’ discomforts that arise from communication about end-of-life and the wish to safeguard each other are main obstacles to ACP implementation.

Summary
Based on these recent findings, we propose an ACP communication model, developed with the consideration of factors reported to influence ACP uptake and communication in healthcare, and integrating socioemotional processes. The testing of the model may yield suggestions for innovative interventions that can support communication about ACP and promote a better uptake in clinical practice.
New targeted treatments for advanced sarcomas
Authors: Li Chia-Chen , Chen Tom Wei-Wu 
Published: May 2023

Purpose of review
The purpose of this review is to provide the rationale and results behind recent clinical trials regarding molecular-targeted agents for advanced sarcomas.

Recent findings
Tazemetostat, a first-in-class EZH2 inhibitor, was approved to treat advanced epithelioid sarcoma. In synovial sarcoma, the interaction between pathognomonic SS18-SSX fusion protein and the BAF complex has brought insight in using BRD9 inhibitors as a treatment based on synthetic lethality. MDM2 overexpression is an important mechanism to suppress p53 function, and MDM2 gene amplification is pathognomonic in well differentiated and dedifferentiated liposarcoma. Two MDM2 inhibitors, milademetan and BI907828, have both reached the optimal dosing and have shown promising efficacy in MDM2-amplified liposarcoma. Late-stage pivotal studies are ongoing for both of these MDM2 inhibitors. The co-amplification of CDK4 and MDM2 in liposarcoma also provided a rationale for CDK4/6 inhibitors as a potential therapy. Selinexor, an exportin-1 inhibitor, has shown single-agent activity in dedifferentiated liposarcoma and action in gastrointestinal stromal tumour in combination with imatinib. Lastly, a new formulation of mTOR inhibitor, nab-sirolimus, was recently approved for perivascular epithelioid cell tumour (PEComa).

Summary
Molecular-guided precision medicine holds a bright future in bringing more active treatments for advanced sarcoma patients.
Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts After Cannabis Legalization
Authors: Marshall Allison , Fai Caitlin , Han John , Yule Amy M. , Jangi Sushrut 
Published: May 2023

Goals:
We described the demographics, inpatient utilization, and cost of services among patients hospitalized for putative cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts.

Background:
As the recreational use of cannabis has been widely legalized nationally, the resulting shifts in clinical presentation, health care utilization, and estimated costs of CHS hospitalizations remain unclear in the postlegalization era.

Study:
We performed a retrospective cohort study among patients admitted to a large urban hospital between 2012 and 2021, before and after the date of cannabis legalization in Massachusetts (Dec 15, 2016). We examined the demographic and clinical characteristics of patients admitted for putative CHS, the utilization of hospital services, and estimated inpatient costs pre and postlegalization.

Results:
We identified a significant increase in putative CHS hospitalizations pre and post-cannabis legalization in Massachusetts (0.1% vs 0.02% of total admissions per time period, P < 0.05). Across 72 CHS hospitalizations, patient demographics were similar pre and postlegalization. Hospital resource utilization increased postlegalization, with increased length of stay (3 d vs 1 d, P < 0.005), and need for antiemetics (P < 0.05). Multivariate linear regression confirmed that postlegalization admissions were independently associated with increased length of stay (Β = 5.35, P < 0.05). The mean cost of hospitalization was significantly higher postlegalization ($18,714 vs $7460, P < 0.0005), even after adjusting for medical inflation ($18,714 vs $8520, P < 0.001) with intravenous fluid administration and endoscopy costs increased (P < 0.05). On multivariate linear regression, hospitalization for putative CHS during postlegalization predicted increased costs (Β = 10,131.25, P < 0.05).

Conclusions:
In the postlegalization era of cannabis in Massachusetts, we found increased putative CHS hospitalizations, with a concomitant increased length of hospital stay and total cost per hospitalization. As cannabis use increases, the recognition and costs of its deleterious effects are necessary to incorporate into future clinical practice strategies and health policy.
Feasibility of Accelerated Prostate Diffusion-Weighted Imaging on 0.55 T MRI Enabled With Random Matrix Theory Denoising
Authors: Lemberskiy Gregory , Chandarana Hersh , Bruno Mary , Ginocchio Luke A. , Huang Chenchan , Tong Angela , Keerthivasan Mahesh Bharath , Fieremans Els , Novikov Dmitry S. 
Published: May 2023

Introduction
Prostate cancer diffusion weighted imaging (DWI) MRI is typically performed at high-field strength (3.0 T) in order to overcome low signal-to-noise ratio (SNR). In this study, we demonstrate the feasibility of prostate DWI at low field enabled by random matrix theory (RMT)-based denoising, relying on the MP-PCA algorithm applied during image reconstruction from multiple coils.

Methods
Twenty-one volunteers and 2 prostate cancer patients were imaged with a 6-channel pelvic surface array coil and an 18-channel spine array on a prototype 0.55 T system created by ramping down a commercial magnetic resonance imaging system (1.5 T MAGNETOM Aera Siemens Healthcare) with 45 mT/m gradients and 200 T/m/s slew rate. Diffusion-weighted images were acquired with 4 non-collinear directions, for which b = 50 s/mm2 was used with 8 averages and b = 1000 s/mm2 with 40 averages; 2 extra b = 50 s/mm2 were used as part of the dynamic field correction. Standard and RMT-based reconstructions were applied on DWI over different ranges of averages. Accuracy/precision was evaluated using the apparent diffusion coefficient (ADC), and image quality was evaluated over 5 separate reconstructions by 3 radiologists with a 5-point Likert scale. For the 2 patients, we compare image quality and lesion visibility of the RMT reconstruction versus the standard one on 0.55 T and on clinical 3.0 T.

Results
The RMT-based reconstruction in this study reduces the noise floor by a factor of 5.8, thereby alleviating the bias on prostate ADC. Moreover, the precision of the ADC in prostate tissue after RMT increases over a range of 30%–130%, with the increase in both signal-to-noise ratio and precision being more prominent for a low number of averages. Raters found that the images were consistently of moderate to good overall quality (3–4 on the Likert scale). Moreover, they determined that b = 1000 s/mm2 images from a 1:55-minute scan with the RMT-based reconstruction were on par with the corresponding images from a 14:20-minute scan with standard reconstruction. Prostate cancer was visible on ADC and calculated b = 1500 images even with the abbreviated 1:55-minute scan reconstructed with RMT.

Conclusions
Prostate imaging using DWI is feasible at low field and can be performed more rapidly with noninferior image quality compared with standard reconstruction.
Prediction of Bone Marrow Biopsy Results From MRI in Multiple Myeloma Patients Using Deep Learning and Radiomics
Authors: Wennmann Markus , Ming Wenlong , Bauer Fabian , Chmelik Jiri , Klein André , Uhlenbrock Charlotte , Grözinger Martin , Kahl Kim-Celine , Nonnenmacher Tobias , Debic Manuel , Hielscher Thomas , Thierjung Heidi , Rotkopf Lukas T. , Stanczyk Nikolas , Sauer Sandra , Jauch Anna , Götz Michael , Kurz Felix T. , Schlamp Kai , Horger Marius , Afat Saif , Besemer Britta , Hoffmann Martin , Hoffend Johannes , Kraemer Doris , Graeven Ullrich , Ringelstein Adrian , Bonekamp David , Kleesiek Jens , Floca Ralf O. , Hillengass Jens , Mai Elias K. , Weinhold Niels , Weber Tim F. , Goldschmidt Hartmut , Schlemmer Heinz-Peter , Maier-Hein Klaus , Delorme Stefan , Neher Peter 
Published: May 2023

ObjectivesIn multiple myeloma and its precursor stages, plasma cell infiltration (PCI) and cytogenetic aberrations are important for staging, risk stratification, and response assessment. However, invasive bone marrow (BM) biopsies cannot be performed frequently and multifocally to assess the spatially heterogenous tumor tissue. Therefore, the goal of this study was to establish an automated framework to predict local BM biopsy results from magnetic resonance imaging (MRI).Materials and MethodsThis retrospective multicentric study used data from center 1 for algorithm training and internal testing, and data from center 2 to 8 for external testing. An nnU-Net was trained for automated segmentation of pelvic BM from T1-weighted whole-body MRI. Radiomics features were extracted from these segmentations, and random forest models were trained to predict PCI and the presence or absence of cytogenetic aberrations. Pearson correlation coefficient and the area under the receiver operating characteristic were used to evaluate the prediction performance for PCI and cytogenetic aberrations, respectively.ResultsA total of 672 MRIs from 512 patients (median age, 61 years; interquartile range, 53–67 years; 307 men) from 8 centers and 370 corresponding BM biopsies were included. The predicted PCI from the best model was significantly correlated (P≤ 0.01) to the actual PCI from biopsy in all internal and external test sets (internal test set:r= 0.71 [0.51, 0.83]; center 2, high-quality test set:r= 0.45 [0.12, 0.69]; center 2, other test set:r= 0.30 [0.07, 0.49]; multicenter test set:r= 0.57 [0.30, 0.76]). The areas under the receiver operating characteristic of the prediction models for the different cytogenetic aberrations ranged from 0.57 to 0.76 for the internal test set, but no model generalized well to all 3 external test sets.ConclusionsThe automated image analysis framework established in this study allows for noninvasive prediction of a surrogate parameter for PCI, which is significantly correlated to the actual PCI from BM biopsy.
Relative Change in Donor-Derived Cell-free DNA is Superior to Absolute Values for Diagnosis of Acute Lung Allograft Dysfunction
Authors: Trindade Anil J. , Chapin Kaitlyn C. , Gray Jennifer N. , Furuya Yuka , Mullican Amy , Hoy Haley , Demarest Caitlin T. , Robbins Ivan M. , Bacchetta Matthew , Erasmus David B. , Shaver Ciara M. 
Published: May 2023

Background.
Donor-derived cell-free DNA (dd-cfDNA%) is a biomarker of early acute lung allograft dysfunction (ALAD), with a value of ≥1.0% indicating injury. Whether dd-cfDNA% is a useful biomarker in patients >2 y posttransplant is unknown. Our group previously demonstrated that median dd-cfDNA% in lung recipients ≥2 y posttransplant without ALAD was 0.45%. In that cohort, biologic variability of dd-cfDNA% was estimated by a reference change value (RCV) of 73%, suggesting that change exceeding 73% may be pathologic. In this study, we aimed to determine whether dd-cfDNA% variability or absolute thresholds are optimal for detecting ALAD.

Methods.
We prospectively measured plasma dd-cfDNA% every 3 to 4 mo in patients ≥2 y post–lung transplant. ALAD was defined as infection, acute cellular rejection, possible antibody-mediated rejection, or change in forced expiratory volume in 1 s >10%, and was adjudicated retrospectively. We analyzed area under the curve for RCV and absolute dd-cfDNA% and reported performance of RCV ≥73% versus absolute value >1% for discriminating ALAD.

Results.
Seventy-one patients had ≥2 baseline measurements of dd-cfDNA%; 30 developed ALAD. RCV of dd-cfDNA% at ALAD had a greater area under the receiver operator characteristic curve than absolute dd-cfDNA% values (0.87 versus 0.69, P = 0.018). Test characteristics of RCV >73% for ALAD diagnosis were sensitivity 87%, specificity 78%, positive predictive value 74%, and negative predictive value 89%. In contrast, dd-cfDNA% ≥1% had sensitivity 50%, specificity 78%, positive predictive value 63%, and negative predictive value 68%.

Conclusions.
Relative change in dd-cfDNA% has improved test characteristics for diagnosing ALAD compared with absolute values.
PREDICTION OF MORTALITY USING GET WITH THE GUIDELINE HEART FAILIURE SCORE (GWTG-HF), ITS COMPARISON WITH APACHE 2 SCORE AND ITS CORRELATION WITH NTPRO BNP LEVELS: A STUDY AMONG PATIENTS OF ACUTE DECOMPENSATED HEART FAILURE FROM SOUTH EAST ASIAN REGION
Authors: Kumar Lalit , Mahla Himanshu , Chaturvedi Neeraj , Sharma Shashi Mohan , Bagarhatta Rajeev , Agrawal V.V. , Pathak Vijay , Meena Chandrabhan , Maheshwari Deepak , Meena Pradeep , Pachar Balbir Singh , Sharma Sohan Kumar , Gautam Dinesh , Chaudhary Sarita , Shekhawat Dhananjay , Sidhu Navdeep Singh 
Published: May 2023

AbstractObjectivesTo study Get with the guidelines heart failure Score (GWTG-HF) among patients of acute decompensated heart failure, correlate it with outcome of survival or death till 4 week of illness, compare its performance with APACHE 2 score and to Compare its results with NT PROBNP in predicting mortality amongst patient of south east Asian ethnicity.Study designprospective observational study at medical wards and ICUs in the Department of Cardiology, SMS medical college.MethodsIn this study 300 patients of acute decompensated heart failure, as per Framingham criteria were analyzed and each patient underwent a complete clinical evaluation along with calculation of GWTG HF and APACHE 2 score. All the patients had NT pro BNP test within 48 hours of admission. Patient were then followed till 4 weeks of illness for outcome of survival or death, whichever occurred earlier. GWTG HF score of the patient was then compared with APACHE 2 score and it was correlated with the outcome of patients and NT pro BNP levels.ResultsThe GWTG-HF score could predict the outcome of survival and death in ADHF patients of south east Asian ethnicity. When compared, APACHE 2 score performed better than GWTG-HF score in predicting outcome. However, GWTG-HF score was easily calculated at the bedside and was easy to use. GWTG-HF score correlated with NT-pro BNP levels with rising score having higher NT pro BNP levels.
Mapping patient interactions in psychiatric presentations to a tertiary emergency department
Authors: McCullough Michael H , Small Michael , Jayawardena Binu , Hood Sean 
Published: May 2023

AbstractReliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians are faced with the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment and referral decisions. Patient outcomes therefore depend on the reliable flow of information though networks of clinical staff and information systems. We studied information flow at a systems-level in a tertiary hospital emergency department using network models and machine learning. Data were gathered by mapping trajectories and recording clinical interactions for patients at suspected risk of suicide or self-harm. A network model constructed from the data revealed communities closely aligned with underlying clinical team structure. By analysing connectivity patterns in the network model we identified a vulnerability in the system with the potential to adversely impact information flow. We then developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams. Finally, we investigated a novel application of machine learning for distinguishing specific interactions along a patient’s trajectory which were most likely to precipitate a psychiatric referral. Together, our results demonstrate a new framework for assessing and reinforcing important information pathways that guide clinical decision processes and provide complimentary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm.
Comparing the Demographic and Health Survey’s timing-based measure of unintended pregnancy to the London Measure of Unplanned Pregnancy in Bangladesh
Authors: Khan Md Nuruzzaman , Khanam Shimlin Jahan , Harris Melissa L. 
Published: May 2023

AbstractBackgroundDemographic and Health Survey’s timing-based measure is commonly used in Low and Middle Income Countries to estimate unintended pregnancy despite its limitations, including ambivalent responses and failure to consider the partner’s intention, while LMUP, which can address these limitations, is not widely used in LMICs and is yet to be administered in Bangladesh. This study compared unintended pregnancy rates measured by the DHS timing-based measure and LMUP, as well as explored the extent of discordance between the measures and their determinants.MethodsA cross-sectional survey was conducted in four districts of Bangladesh using two-stage stratified random sampling. Data was collected from 1,200 postnatal women. The study focused on discordance in reporting pregnancy intention between DHS timing-based measure and LMUP. Multivariate logistic regression models were used to identify predictors of discordant responses in reporting pregnancy intention.ResultsThe prevalence of unintended pregnancy was found to be 24.3% through the DHS timing-based measure and 31.0% through the LMUP. Discordance in responses to pregnancy intention in the two measures was around 28%. Key predictors of discordance included older age, female last child, more than two children, poorer wealth quintile, and rural residence. Conclusions: Prevalence of unintended pregnancy in Bangladesh and other LMICs, measured by DHS timing-based measure, may grossly underestimated. This suggests that the negative effects of unintended pregnancy are even more significant than currently believed, further highlighting the need to strengthen the family planning program in Bangladesh.
Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru
Authors: Biewer Amanda , Tzelios Christine , Tintaya Karen , Roman Betsabe , Hurwitz Shelley , Yuen Courtney M. , Mitnick Carole D. , Nardell Edward , Lecca Leonid , Tierney Dylan B. , Nathavitharana Ruvandhi R. 
Published: May 2023

AbstractIntroductionTuberculosis (TB) transmission in healthcare facilities is common in high-incidence countries. Yet, the optimal approach for identifying inpatients who may have TB is unclear. We evaluated the diagnostic accuracy of qXR (Qure.ai, India) computer-aided detection (CAD) software versions 3.0 and 4.0 (v3 and v4) as a triage and screening tool within the FAST (Find cases Actively, Separate safely, and Treat effectively) transmission control strategy.MethodsWe prospectively enrolled two cohorts of patients admitted to a tertiary hospital in Lima, Peru: one group had cough or TB risk factors (triage) and the other did not report cough or TB risk factors (screening). We evaluated the sensitivity and specificity of qXR for the diagnosis of pulmonary TB using culture and Xpert as primary and secondary reference standards, including stratified analyses based on risk factors.ResultsIn the triage cohort (n=387), qXR v4 sensitivity was 0.91 (59/65, 95% CI 0.81-0.97) and specificity was 0.32 (103/322, 95% CI 0.27-0.37) using culture as reference standard. There was no difference in the area under the receiver-operating-characteristic curve (AUC) between qXR v3 and qXR v4 with either a culture or Xpert reference standard. In the screening cohort (n=191), only one patient had a positive Xpert result, but specificity in this cohort was high (>90%). A high prevalence of radiographic lung abnormalities, most notably opacities (81%), consolidation (62%), or nodules (58%), was detected by qXR on digital CXR images from the triage cohort.ConclusionsqXR had high sensitivity but low specificity as a triage in hospitalized patients with cough or TB risk factors. Screening patients without cough or risk factors in this setting had a low diagnostic yield. These findings further support the need for population and setting-specific thresholds for CAD programs.
Identification of SYT10 as a potential prognostic biomarker in esophageal cancer by comprehensive analysis of a mRNA-pseudogene/lncRNA-miRNA ceRNA network
Authors: Daneshmand-Parsa Milad , Mahmoudian-Hamedani Sharareh , Nikpour Parvaneh 
Published: May 2023

AbstractBackgroundEsophageal carcinoma (ESCA) is often diagnosed at the advanced stages, has a poor survival rate and overall is one of the deadliest cancers world-wide. Recent studies have elaborated the significance of non-coding RNAs like pseudogenes, long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in cancer progression. In this study, we constructed a four-component competing endogenous RNA (ceRNA) network in ECSA and suggested an RNA with prognostic potential.Materials and methodsExpression profiles of mRNAs, pseudogenes, lncRNAs and miRNAs were collected from The Cancer Genome Atlas (TCGA) database. A ceRNA network was constructed based on differentially-expressed RNAs. KEGG and GO functional analysis and PPI network analysis was carried out on differentially-expressed (DE) RNAs of the ceRNA network. Survival analysis was carried out on a selection of RNAs with the highest degree centrality ranks to discover potential prognostic biomarkers.ResultsA four-component ceRNA network with 529 nodes and 729 edges was constructed. The most significant GO biological process terms included signal transduction, cell adhesion and positive regulation of gene expression. The analysis of KEGG pathways showed that DEmRNAs were significantly enriched in pathways such as cytokine-cytokine receptor interaction and Cell cycle. Amongst the RNAs that were found to be associated with survival,SYT10had the highest hazard ratio and thus, proved to be a potential prognostic biomarker for ESCA.ConclusionOur study presented a four-component ceRNA network for ESCA, and identified RNA candidates that were associated with survival of ECSA. Further experimental evaluations and precise validation studies are needed for their clinical significances and roles in the progression of ESCA.