bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver metastasis affects progression pattern during immune checkpoint inhibitors monotherapy in gastric cancer
Authors: Motoo Iori , Ando Takayuki , Hamashima Takeru , Kajiura Shinya , Sakumura Miho , Ueda Yuko , Murayama Aiko , Ogawa Kohei , Tsukada Kenichiro , Ueda Akira , Suzuki Nobuhiro , Nakada Naokatsu , Nakashima Koji , Hosokawa Ayumu , Yasuda Ichiro 
Published: September 2023

IntroductionThe efficacy of immune checkpoint inhibitors (ICIs) is heterogeneous at each metastatic site, and tumor progression pattern is associated with survival; however, it remains unclear in gastric cancer (GC). Therefore, we aimed to clarify the progression pattern in response to ICIs in patients with GC, and we analyzed its mechanism focusing on the intratumoral immune cells.MethodsPatients who received ICIs were retrospectively classified into non-systemic and systemic progression groups based on their radiological assessments. Moreover, the best percentage change in target lesions from each organ was compared.ResultsAmong 148 patients, the non-systemic progression group showed a significant improvement in overall survival (OS) compared with the systemic progression group (median, 5.6 months vs. 3.3 months; HR, 0.53; 95%CI, 0.32–0.89; p = 0.012). Poor performance status (HR, 1.73, 95%CI, 1.00–2.87) and systemic progression (HR, 3.09, 95%CI, 1.95–4.82) were associated with OS. Of all metastatic sites, the liver showed the poorest percentage change, and liver metastasis (OR, 2.99, 95%CI, 1.04–8.58) was associated with systemic progression. Hence, intratumoral CD8+ T-cell density was lower in patients with liver metastasis than in those without liver metastasis after ICIs, although the density of CD4+ T-cells (Th1, Th17, and Treg) and CD163+ cells (TAM) were not significantly different.ConclusionThe new progression pattern was associated with OS in GC. Liver metastasis may be a predictive factor of systemic progression during ICIs by regulating intratumoral CD8+ T-cells.
Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term comparison of outcomes
Authors: Eoh Kyung Jin , Kim Tae-Joong , Park Jeong-Yeol , Kim Hee Seung , Paek Jiheum , Kim Young Tae 
Published: September 2023

ObjectiveThere is a lack of multi-institutional large-volume and long-term follow-up data on comparisons between robot-assisted surgery and conventional laparoscopic surgery. This study compared the surgical and long-term survival outcomes between patients who underwent robot-assisted or conventional laparoscopic surgery for endometrial cancer.MethodsWe retrospectively reviewed the data of patients from five large academic institutions who underwent either robot-assisted or conventional laparoscopic surgery for the treatment of endometrial cancer between 2012 and 2017, ensuring at least 5 years of potential follow-up. Intra- and postoperative outcomes, long-term disease-free survival, and overall survival were compared.ResultsThe study cohort included 1,003 unselected patients: 551 and 452 patients received conventional laparoscopic and robot-assisted surgery, respectively. The median follow-up duration was 57 months. Postoperative complications were significantly less likely to occur in the robot-assisted surgery group compared to the laparoscopic surgery group (7.74% vs. 13.79%, P = 0.002), primarily limited to minor complications. There were no significant differences in survival: 5-year disease-free survival was 91.2% versus 90.0% (P = 0.628) and overall survival was 97.9% versus 96.8% (P = 0.285) in the robot-assisted and laparoscopic surgery cohorts, respectively. Cox proportional hazard regression models demonstrated that the mode of surgery was not associated with disease-free survival (hazard ratio, 0.897; confidence interval, 0.563–1.429) or overall survival (hazard ratio, 0.791; confidence interval, 0.330–1.895) after adjusting for confounding factors.ConclusionRobot-assisted surgery for endometrial cancer demonstrates comparable long-term survival outcomes and a reduced incidence of postoperative minor complications when compared to conventional laparoscopic surgery.
HPV16 E7 oncoprotein test as a triage strategy for HPV16-positive women in cervical cancer screening: long-term follow-up outcome
Authors: Wang Xinmei , Shuai Guangnan , Xu Junhui , Liu Meihua , Zhao Jianguo , Zhang Na , Zhang Wenwen , Qu Pengpeng 
Published: September 2023

BackgroundColposcopy is recommended once human papillomavirus (HPV)16/18 infection is detected. However, not all HPV16/18-positive women will necessarily develop cervical lesions. Therefore, this study aimed to investigate the application of quantitative HPV16 E7 oncoprotein detection as a cervical cancer screening method for more efficient screening while minimizing unnecessary colposcopy.MethodsE7 oncoprotein (HPV16) was quantitatively detected in cervical exfoliated cells of HPV16-positive women. The levels of HPV16 E7 oncoprotein in different degrees of cervical lesions were compared, and the optimal cut-off value for identifying HSIL+ was determined by receiver operating characteristic (ROC) curve analysis. With a pathological diagnosis as the gold standard, the sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Kappa value were calculated to verify the diagnostic value of the method. Women diagnosed with low-grade squamous intraepithelial lesions (LSIL) and normal women were followed up for 5 years to evaluate the predictive value of HPV16 E7 protein for disease progression/persistent infection.ResultsThe expression level of HPV16 E7 oncoprotein was positively correlated with the degree of the cervical lesion (r = 0.589, P &lt; 0.01). The area under the ROC curve (AUC) was 0.817 (confidence interval: 0.729–0.904). The cut-off value of E7 oncoprotein for identifying HSIL+ was 8.68 ng/ml. The SEN, SPE, PPV, NPV, and Kappa values of HPV16 E7 oncoprotein for the identification of HSIL+ were 87.1%,70.0%, 87.1%, 70.0%, and 0.571, respectively, which were higher than those of ThinPrep cytology test (TCT). The SEN, SPE, PPV, and NPV of HPV16 E7 oncoprotein in predicting disease progression/persistent infection were 93.75%, 91.30%, 88.24%, and 95.45%, respectively.ConclusionThe quantitative detection of HPV 16 E7 oncoprotein can not only accurately screen cervical lesions but also achieve efficient colposcopy referral. Additionally, HPV16 E7 oncoprotein can accurately predict the progression of cervical lesions and persistent HPV infection.
Comparison of mortality and short-term outcomes between classic, intubation-surfactant-extubation, and less invasive surfactant administration methods of surfactant replacement therapy
Authors: Kim Seung Yeon , Lim Jiseun , Shim Gyu-Hong 
Published: September 2023

BackgroundIntubation-Surfactant-Extubation (InSurE) and less invasive surfactant administration (LISA) are alternative surfactant replacement therapy methods for reducing the complications associated with invasive mechanical ventilation. This study aimed to compare the Classic, InSurE, and LISA methods in Very-Low-Birth-Weight infants (VLBWIs) in South Korea.MethodsThe Korean Neonatal Network (KNN) enrolled VLBWIs born between January 1, 2019 and December 31, 2020. They were analyzed retrospectively to compare the duration of respiratory support, length of hospitalization, mortality, and short-term outcomes of the three groups.ResultsThe duration of invasive ventilator support was shorter in the following order: InSurE (3.99 ± 11.93 days), LISA (8.78 ± 29.32 days), and the Classic group (22.36 ± 29.94 days) (p = 0.014, p &lt; 0.01) and InSurE had the shortest hospitalization (64.91 ± 24.07 days, p &lt; 0.05) although the results couldn't adjust for confounding factor because of irregular distribution. InSurE had the lower risk of intraventricular hemorrhage (IVH) grade II–IV [odds ratio (OR) 0.524 [95% confidence interval (CI): 0.287–0.956], p = 0.035] than in the Classic group. Mortality was lower in the InSurE [OR 0.377 (95% CI: 0.146–0.978), p = 0.045] and LISA [OR 0.296 (95% CI: 0.102–0.862), p = 0.026] groups than in the Classic group. There was a reduced risk of moderate to severe bronchopulmonary dysplasia (BPD) [OR 0.691 (95% CI: 0.479–0.998, p = 0.049), OR 0.544 (95% CI: 0.355–0.831, p = 0.005), respectively], pulmonary hypertension [OR 0.350 (95% CI: 0.150–0.817, p = 0.015), OR 0.276 (95% CI: 0.107–0.713, p = 0.008), respectively], periventricular leukomalacia (PVL) [OR 0.382 (95% CI: 0.187–0.780, p = 0.008), OR 0.246 (95% CI: 0.096–0.627, p = 0.003), respectively], and patent ductus arteriosus (PDA) with treatment [OR 0.628 (95% CI: 0.454–0.868, p = 0.005), OR 0.467 (95% CI: 0.313–0.696, p &lt; 0.001) respectively] in the InSurE and LISA groups compared to the Classic group.ConclusionInSurE showed the lowest duration of invasive ventilator support, length of hospitalization. InSurE and LISA exhibited reduced mortality and decreased risks of moderate to severe BPD, pulmonary hypertension, PVL, and PDA with treatment compared to the Classic group.
Approach to machine learning for extraction of real-world data variables from electronic health records
Authors: Adamson Blythe , Waskom Michael , Blarre Auriane , Kelly Jonathan , Krismer Konstantin , Nemeth Sheila , Gippetti James , Ritten John , Harrison Katherine , Ho George , Linzmayer Robin , Bansal Tarun , Wilkinson Samuel , Amster Guy , Estola Evan , Benedum Corey M. , Fidyk Erin , Estévez Melissa , Shapiro Will , Cohen Aaron B. 
Published: September 2023

Background: As artificial intelligence (AI) continues to advance with breakthroughs in natural language processing (NLP) and machine learning (ML), such as the development of models like OpenAI’s ChatGPT, new opportunities are emerging for efficient curation of electronic health records (EHR) into real-world data (RWD) for evidence generation in oncology. Our objective is to describe the research and development of industry methods to promote transparency and explainability.Methods: We applied NLP with ML techniques to train, validate, and test the extraction of information from unstructured documents (e.g., clinician notes, radiology reports, lab reports, etc.) to output a set of structured variables required for RWD analysis. This research used a nationwide electronic health record (EHR)-derived database. Models were selected based on performance. Variables curated with an approach using ML extraction are those where the value is determined solely based on an ML model (i.e. not confirmed by abstraction), which identifies key information from visit notes and documents. These models do not predict future events or infer missing information.Results: We developed an approach using NLP and ML for extraction of clinically meaningful information from unstructured EHR documents and found high performance of output variables compared with variables curated by manually abstracted data. These extraction methods resulted in research-ready variables including initial cancer diagnosis with date, advanced/metastatic diagnosis with date, disease stage, histology, smoking status, surgery status with date, biomarker test results with dates, and oral treatments with dates.Conclusion: NLP and ML enable the extraction of retrospective clinical data in EHR with speed and scalability to help researchers learn from the experience of every person with cancer.
Aerobic exercise improves sleep in U. S. active duty service members following brief treatment for posttraumatic stress disorder symptoms
Authors: Young-McCaughan Stacey , Straud Casey L. , Bumstead Susannah , Pruiksma Kristi E. , Taylor Daniel J. , Jacoby Vanessa M. , Yarvis Jeffrey S. , Peterson Alan L. 
Published: September 2023

IntroductionPhysical exercise is a lifestyle intervention that can positively impact aspects of physical and psychological health. There is a growing body of evidence suggesting that physical exercise, sleep, and PTSD are interrelated. This study investigated possible relationships. Three research questions were posed: (1) Did randomization to an aerobic exercise intervention reduce insomnia more than being randomized to an intervention without exercise, (2) Did change in sleep predict change in PTSD symptoms, and (3) Did change in sleep impact the relationship between exercise and PTSD symptom reductions?MethodsData were collected from 69 treatment-seeking active duty service members with PTSD symptoms randomized into one of four conditions; two conditions included aerobic exercise, and two conditions did not include exercise. Participants in the exercise groups exercised five times per week keeping their heart rate &gt; 60% of their heart rate reserve for 20–25 min.ResultsAt baseline, 58% of participants reported moderate or severe insomnia. PTSD symptom severity decreased following treatment for all groups (p &lt; 0.001). Participants randomized to exercise reported greater reductions in insomnia compared to those in the no exercise group (p = 0.47). However, change in insomnia did not predict change in PTSD symptoms nor did it significantly impact the relationship between exercise and PTSD symptom reductions.DiscussionAdding exercise to evidence-based treatments for PTSD could reduce sleep disturbance, a characteristic of PTSD not directly addressed with behavioral therapies. A better understanding of exercise as a lifestyle intervention that can reduce PTSD symptoms and insomnia is warranted.
Exploring the risk of glycemic variability in non-diabetic depressive individuals: a cross-sectional GlyDep pilot study
Authors: Mishra Shivang , Singh Anurag Kumar , Rajotiya Sumit , Singh Pratima , Raj Preeti , Bareth Hemant , Singh Mahaveer , Jagawat Tushar , Nathiya Deepak , Tomar Balvir Singh 
Published: September 2023

BackgroundData on the correlation between glycemic variability and depression in nondiabetic patients remain limited. Considering the link between increased glycemic variability and cardiovascular risks, this relationship could be significant in depressed patients.MethodsIn this single-center pilot study, we utilized Flash Glucose Monitoring (Abbott Libre Pro) to study glycemic variability. The CES-D (Center for Epidemiological Studies– Depression) scale was employed to measure depression levels. Based on CES-D scores, patients were classified into two groups: those with scores ≥ 33 and those with scores &lt; 33. We analyzed various glycemic variability indices, including HBGI, CONGA, ADDR, MAGE, MAG, LI, and J-Index, employing the EasyGV version 9.0 software. SPSS (version 28) facilitated the data analysis.ResultsWe screened patients with depression visiting the department of psychiatry, FGM was inserted in eligible patients of both the groups which yielded a data of 196 patient-days (98 patient-days for CES-D ≥ 33 and 98 patient-days for CES-D &lt; 33). The glycemic variability indices CONGA (mg/dl), (76.48 ± 11.9 vs. 65.08 ± 7.12) (p = 0.048), MAGE (mg/dl) (262.50 ± 25.65 vs. 227.54 ± 17.72) (p = 0.012), MODD (mg/dl) (18.59 ± 2.77 vs. 13.14 ± 2.39) (p = 0.002), MAG(mg/dl) (92.07 ± 6.24vs. 63.86 ± 9.38) (p = &lt;0.001) were found to be significantly higher in the CES-D ≥ 33 group.ConclusionPatients with more severe depressive symptoms, as suggested by CES-D ≥ 33, had higher glycemic variability.
The healthy moms and babies app to prevent postpartum depression: analysis of user-profiles and dropout cases
Authors: Rodriguez-Muñoz María F. , Kovacheva Katina , García-López Helena S. , Le Huynh-Nhu , Ruiz Natalia , Olivares Maria Eugenia , Izquierdo Mendez Nuria , Coronado Pluvio 
Published: September 2023

IntroductionPerinatal depression affects mothers, babies and society. Preventive interventions are needed, but face barriers to access. E-health interventions could be an effective and accessible option. To date, few studies have attempted to understand the use of mobile health (m-health) applications and why they are not more widely used. This study aims to understand the demographic characteristics of enrolled participants and examine dropout patterns through the Healthy Moms and Babies app.MethodsA longitudinal study was conducted with a sample of 511 women recruited between 2020 and 2022. Data were collected from the app, including sociodemographic information, the participant’s progress through the modules of the app, and the permissions granted to use the app.ResultsOut of the 511 women who completed the initial form to initiate participation, 279 downloaded the app and completed the evaluation. Results indicated that granting permission to be notified about the module’s availability is related to an increase in the use of the first modules.ConclusionThis study shows the importance of establishing follow-ups in the use of mobile apps during the perinatal period.
Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study
Authors: Lin Wei-Quan , Lin Lin , Sun Si-Yu , Yuan Le-Xin , Sun Min-Ying , Wang Chang , Chen Jia-Min , Li Yao-Hui , Zhou Qin , Wu Di , Huang Ting-Yuan , Liang Bo-Heng , Liu Hui 
Published: September 2023

IntroductionAs a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases.MethodsA total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases.ResultsA total of 251 participants (15.41%, 95% CI: 13.98%−17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%−11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681–1.761) aged ≥80 years (1.910, 1.847–1.975), unemployed (1.226, 1.171–1.284), uninsured (1.555, 1.448–1.671), average monthly household income of 2,001–4,000 CNY (1.878, 1.827–1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383–1.475), illness within 2 weeks (1.633, 1.595–1.672), high-intensity physical activity (2.254, 2.191–2.32), sedentary (1.094, 1.070–1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870–1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705–0.737) of falls and higher risk (1.086, 1.057–1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China.ConclusionThe high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.
AI in the Loop: functionalizing fold performance disagreement to monitor automated medical image segmentation workflows
Authors: Gottlich Harrison C. , Korfiatis Panagiotis , Gregory Adriana V. , Kline Timothy L. 
Published: September 2023

IntroductionMethods that automatically flag poor performing predictions are drastically needed to safely implement machine learning workflows into clinical practice as well as to identify difficult cases during model training.MethodsDisagreement between the fivefold cross-validation sub-models was quantified using dice scores between folds and summarized as a surrogate for model confidence. The summarized Interfold Dices were compared with thresholds informed by human interobserver values to determine whether final ensemble model performance should be manually reviewed.ResultsThe method on all tasks efficiently flagged poor segmented images without consulting a reference standard. Using the median Interfold Dice for comparison, substantial dice score improvements after excluding flagged images was noted for the in-domain CT (0.85 ± 0.20 to 0.91 ± 0.08, 8/50 images flagged) and MR (0.76 ± 0.27 to 0.85 ± 0.09, 8/50 images flagged). Most impressively, there were dramatic dice score improvements in the simulated out-of-distribution task where the model was trained on a radical nephrectomy dataset with different contrast phases predicting a partial nephrectomy all cortico-medullary phase dataset (0.67 ± 0.36 to 0.89 ± 0.10, 122/300 images flagged).DiscussionComparing interfold sub-model disagreement against human interobserver values is an effective and efficient way to assess automated predictions when a reference standard is not available. This functionality provides a necessary safeguard to patient care important to safely implement automated medical image segmentation workflows.
Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned
Authors: Younan Sarah , Cardona Magnolia , Sahay Ashlyn , Willis Eileen , Ni Chroinin Danielle 
Published: September 2023

BackgroundThe importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice.MethodsWe adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus.ResultsFrom amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems.ConclusionThe pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.