bluuebunny/crossref_metadata_2025_split huggingface dataset:
Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis
Authors: Molano-Franco Daniel , Arevalo-Rodriguez Ingrid , Muriel Alfonso , del Campo-Albendea Laura , Fernández-García Silvia , Alvarez-Méndez Ana , Simancas-Racines Daniel , Viteri Andres , Sanchez Guillermo , Fernandez-Felix Borja , Lopez-Alcalde Jesus , Solà Ivan , Osorio Dimelza , Khan Khalid Saeed , Nuvials Xavier , Ferrer Ricard , Zamora Javier ,   the SEPSIS-BIOMARKERS Collaborators, Estupiñan Alvaro , Franco Luis , Cardenas Jorge , Robayo Ivan , Villabon Mario , Gomez Mario , Stalling Elena , Alvarez Noelia 
Published: August 2023

Abstract
Background
Numerous biomarkers have been proposed for diagnosis, therapeutic, and prognosis in sepsis. Previous evaluations of the value of biomarkers for predicting mortality due to this life-threatening condition fail to address the complexity of this condition and the risk of bias associated with prognostic studies. We evaluate the predictive performance of four of these biomarkers in the prognosis of mortality through a methodologically sound evaluation.

Methods
We conducted a systematic review a systematic review and meta-analysis to determine, in critically ill adults with sepsis, whether procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin (sCD14) are independent prognostic factors for mortality. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to March 2023. Only Phase-2 confirmatory prognostic factor studies among critically ill septic adults were included. Random effects meta-analyses pooled the prognostic association estimates.

Results
We included 60 studies (15,681 patients) with 99 biomarker assessments. Quality of the statistical analysis and reporting domains using the QUIPS tool showed high risk of bias in > 60% assessments. The biomarker measurement as a continuous variable in models adjusted by key covariates (age and severity score) for predicting mortality at 28–30 days showed a null or near to null association for basal PCT (pooled OR = 0.99, 95% CI = 0.99–1.003), CRP (OR = 1.01, 95% CI = 0.87 to 1.17), and IL-6 (OR = 1.02, 95% CI = 1.01–1.03) and sCD14 (pooled HR = 1.003, 95% CI = 1.000 to 1.006). Additional meta-analyses accounting for other prognostic covariates had similarly null findings.

Conclusion
Baseline, isolated measurement of PCT, CRP, IL-6, and sCD14 has not been shown to help predict mortality in critically ill patients with sepsis. The role of these biomarkers should be evaluated in new studies where the patient selection would be standardized and the measurement of biomarker results.

Trial registration
PROSPERO (CRD42019128790).
Blastic plasmacytoid dendritic cell neoplasm: challenges in diagnosis and treatment with potential of venetoclax as an alternative to vincristine in high-risk patients—a case report
Authors: Syed Naveed , Jaber Waed Mohammad , Elkonaissi Islam Samir , Mirza Imran , Damlaj Moussab 
Published: August 2023

Abstract
Background
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and challenging cancer for diagnosis and treatment. Accurate diagnosis plays a crucial role guiding appropriate treatment, typically involving high-intensity lymphoblastic leukemia regimens which typically include vincristine. However, the use of vincristine may be particularly limited in patients with pre-existing neuropathy or individuals at high risk of developing it. Here, we present a case of BPDCN that was initially diagnosed as marginal zone lymphoma (MZL) and subsequently as non-specific T-cell lymphoma, thus highlights the importance of accurate diagnosis and modified treatment.

Case presentation
A 49-year-old Arab man with a medical history of diabetes, peripheral neuropathy, hypertension, and depression presented with widespread, painless multiple skin lesions. After undergoing a biopsy at another institution, the patient was initially diagnosed with MZL, and received two cycles of bendamustine and rituximab. However, the disease relapsed and was later diagnosed with non-specific T-cell lymphoma, which proved refractory to a single cycle of CHOP chemotherapy. The patient was subsequently referred to our centre, where a comprehensive evaluation revealed BPDCN with a unique finding on bone marrow exam: signet ring plasmacytoid dendritic cells. Due to the patient's pre-existing neuropathy and previous treatment, we administered the Hyper-CVAD regimen with a 50% reduction in vincristine dosage, which resulted in an excellent response. During the second part of cycle one, when new skin lesions started appearing, venetoclax was added to the treatment regimen. Subsequently, we discontinued vincristine due to worsening neuropathic pain and neuropathy-related weakness. Venetoclax was continued in cycle two and led to a complete response. The patient achieved a disease-free state for the first time in disease course, maintaining it for a period of over six weeks before experiencing a relapse.

Conclusions
Accurate diagnosis is crucial for guiding appropriate treatment. Our case highlights the challenges associated with diagnosis and treatment, as well as the potential of venetoclax as an alternative to vincristine, particularly in patients with pre-existing neuropathy or those at a high risk of developing it. Further research is needed to evaluate the effectiveness of BCL2 inhibitors as a replacement for essential drugs and its potential as a bridging therapy until patients can undergo a stem cell transplant.
Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty
Authors: Mekkawy Kevin L. , Zhang Bo , Wenzel Alyssa , Harris Andrew B. , Khanuja Harpal S. , Sterling Robert S. , Hegde Vishal , Oni Julius K. 
Published: August 2023

Abstract
Introduction
Early postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty.

Methods
A prospective observational study of primary, elective unilateral total knee arthroplasty cases was conducted at our academic tertiary care medical center from January 2021 to September 2021. Preoperative variables were extracted from institutional electronic medical records. Postoperatively, patients utilized a knee pain map to identify the two locations with the most significant pain and rated it using the visual analog scale (VAS). The data were collected on day 0, at 2 weeks, 2 months, and 6 months after operation.

Results
This study included 112 patients, with 6% of patients having no pain at postoperative day 0, 22% at 2 weeks, 46% at 2 months, and 86% at 6 months after operation. In those who reported pain, the VAS score (mean ± standard deviation) was 5.8 ± 2.4 on postoperative day 0 and decreased at each follow-up time point (5.4 ± 2.3 at 2 weeks, 3.9 ± 2.2 at 2 months, and 3.8 ± 2.7 at 6 months). The majority of patients were able to identify distinct loci of pain. The most common early pain loci were patellae, thigh, and medial joint line, and this distribution dissipated by 6 months.

Conclusion
At 2 postoperative weeks, pain was primarily at the medial joint, and at 6 months postoperatively, pain was more likely to be at the lateral joint. No relationship was found between pain at six months and pain scores or location at postoperative day 0 or 2 weeks. Understanding the distribution and progression of knee pain following total knee arthroplasty may benefit patient education and targeted interventions.

Level of Evidence
Level II, prospective observational study
Survival of putative Lacticaseibacillus paracasei C1I12 after supplementation of marang (Artocarpus odoratissimus) juice
Authors: Calumba Kriza Faye A. , Demerey Carmina M. , Villame Rovi Gem E. , Palangga Zarryn D. , Tagubase Jackie Lou J. 
Published: August 2023

AbstractThe demand for non-dairy functional beverages is increasing. Marang (Artocarpus odoratissimus) is an underutilized fruit in the Philippines. This study aimed to assess the survival of putative Lacticaseibacillus paracasei C1I12 strain previously isolated from Nypa fruticans after supplementation of marang juice. At the end of 30 days of storage at 4 ºC, the viable cell count was significantly higher in the supplemented marang juice (8.17 log CFU/mL) compared to the raw marang juice (5.07 log CFU/mL) (P < 0.05). Cell counts in the juice with putative L. paracasei C1I12 were 7 log CFU/mL after 180 min in simulated gastric and intestinal fluids. Aerobic bacteria and coliforms were not detected in assessing the initial microbiological quality of the raw marang juice. The pH was 3.38 and 3.84 for the juice with putative L. paracasei C1I12 and the raw marang juice, respectively, while the total soluble solids reached 10.58°Brix and 14.00°Brix, respectively. This study shows that inoculation with the C1I12 strain ensured high cell counts in the marang juice after in vitro digestion. This is the first study demonstrating the potential of putative L. paracasei C1I12 in the production of a non-dairy marang beverage which can be further explored for functional food and probiotic applications.
Graphical Abstract
Preoperative CT-based radiomics for diagnosing muscle invasion of bladder cancer
Authors: Ren Jingyi , Gu Hongmei , Zhang Ni , Chen Wang 
Published: August 2023

Abstract
Background
The primary objective of the research was to develop a method using radiomics-based computed tomography (CT) to predict muscle invasion in bladder cancer (BCa) before surgery.

Methods
A total of 269 patients with bladder cancer were divided into two groups; training group (n = 188 cases) and validation group (n = 81 cases). Radiomics characteristics were determined by analyzing the CT images of each patient. The least absolute shrinkage and selection operator (LASSO) technique was used for developing a radiomics signature. Furthermore, logistic regression (LR), the support vector machine (SVM), decision tree (DT), and Artificial Neural Network (ANN) models were applied to differentiate between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Their performance was determined using the area under the receiver operating characteristic curve (AUC-ROC). In addition, accuracy, specificity, and sensitivity evaluations were also conducted.

Results
The radiomics signature was found to be successful in its prediction. A total of 1036 radiomics features were found in the 269 patients, and out of those, 16 were selected as the best predictors of radiomics features. The results revealed that the ANN classifier had the best performance, with a validation set accuracy of 0.950.

Conclusions
The current work used machine learning and radiomics techniques to successfully construct a prediction model for muscle invasion in bladder cancer. The ANN model produced significant outcomes that may be used in clinical diagnosis or therapy.
Recurrent aneurysm 11 years after thoracoabdominal aortic replacement due to recanalization of intercostal arteries of the wrapping native aorta in Marfan syndrome: a case report
Authors: Tanaka Shun , Yamauchi Haruo , Minegishi Sachito , Ono Minoru 
Published: August 2023

Abstract
Background
Persistent blood flow is common in aortic aneurysms following endovascular repair. However, the recanalization of thrombosed intercostal arteries after open aortic repair is rare. We report a case of aortic aneurysm recurrence 11 years after thoracoabdominal aortic replacement resulting from recanalization of the intercostal arteries like a type II endoleak in a patient with Marfan syndrome.

Case presentation
A 50-year-old woman with Marfan syndrome presented with left-sided back pain after meals. She underwent abdominal aortic replacement at 35 years of age, distal aortic arch and thoracoabdominal aortic replacement for type B chronic aortic dissection at 38 years of age, and aortic root to the remnant arch replacement with a mechanical valve conduit for type A acute aortic dissection at 43 years of age, which resulted in complete replacement of the entire aorta with prosthetic grafts. The patient has been taking warfarin since then. The prothrombin time-international normalized ratio levels were controlled almost within the range of 1.5–2.5 during the follow-up period, but it was elevated up to 3.4 at 1 month before she felt back pain and kept high at 4.2 on admission. Enhanced computed tomography (CT) revealed an aneurysm between the descending graft and the remaining native aortic wall, compressing the esophagus. However, there were no abnormal findings on the CT performed 10 months prior to admission. Surgery revealed that the orifices of the intercostal arteries were patent with backflow. We closed the patent intercostal arteries using nonabsorbable sutures. The patient’s postoperative course was uneventful, and the CT performed 1 year later showed no aneurysmal recurrence.

Conclusions
Here, we describe a rare case of recurrent aortic aneurysm long term after graft replacement due to recanalization of the intercostal arteries of the remaining aortic wall. Our findings suggest that closing all orifices of the intercostal arteries during aortic repair, regardless of backflow, could prevent delayed reopening; systemic anticoagulation after aortic replacement may be a risk factor for recanalization, and that postoperative periodic CT follow-up is essential, especially in patients receiving anticoagulant therapy.
Prospective validation of the IRSN-23 model for personalized chemotherapy and proposal of new breast cancer subtype classification.
Authors: Sota Yoshiaki , Seno Shigeto , Naoi Yasuto , Honma Keichiro , Shimoda Masafumi , Tanei Tomonori , Matsuda Hideo , Shimazu Kenzo 
Published: August 2023

10 Background: The IRSN-23 model uses DNA microarray analysis of tumor tissue to stratify patients into highly sensitive (Gp-R) or less sensitive (Gp-NR) chemotherapy groups based on immune-related gene expression. In a previous report (n=901), Gp-R showed a 39% pCR rate, while Gp-NR had 11% (P=4.98E-23; Sota, Y., et al., Annals of Oncology 25.1 (2014): 100-106). This study aimed to evaluate the reproducibility of the IRSN-23 model in prospective independent validation cohorts and investigate its clinical significance and impact on breast cancer subtype classification. Methods: Tumor tissues were obtained from 143 breast cancer patients undergoing preoperative chemotherapy at Osaka University Hospital (OUH). Patients were classified into Gp-R or Gp-NR using the IRSN-23 model, and its ability to predict pathological complete response (pCR) was assessed. Results were validated with independent public datasets (n=965; breast cancer (n=919) and rectal cancer (n=46)). Results: In the OUH prospective cohort, the pCR rate was significantly higher in the Gp-R group (29.3% (11/41)) than in the Gp-NR group (1.4% (1/71)) without trastuzumab (P=1.70E-5). In all prospective validation cohorts without anti-HER2 therapy, the pCR rate in the Gp-R group was significantly higher than in the Gp-NR group. Pooled analysis of the prospective validation set revealed higher pCR rates in the Gp-R group than in the Gp-NR group, both without (Gp-R 41.9% (104/248) vs. Gp-NR 13.6% (50/367), P=4.0E-15) and with (Gp-R 48.3% (57/118) vs. Gp-NR 35.5% (66/186), P=0.03) anti-HER2 therapy (Table). Collaborative analyses of IRSN-23 Immune Score (IS) and OncotypeDx Recurrence Score (RS) suggested the identification of a highly sensitive chemotherapy group (pCR%; IS>-25+RS>25: 21.6% vs. IS ≤ 25 + RS > 25: 2.9%, P=1.13E-04). PAM50 as an attack factor and IRSN-23 as a defense factor capture the tumor microenvironment, suggesting a new subtype classification of breast cancer. Conclusions: This study offers prospective validation of the IRSN-23 model in predicting chemotherapy efficacy, exhibiting high reproducibility. The findings indicate the IRSN-23 model is clinically valuable and propose new breast cancer subtype classification. These results hold significant implications for personalized treatment strategies.[Table: see text]
Identifying gaps and challenges faced in lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) adolescent and young adults (AYA) cancer care: A scoping review.
Authors: Thaarun Thirumeninathan , Heng E Han , Poon Eileen Yi Ling 
Published: August 2023

100 Background: There is a dearth of evidence related to the needs and challenges faced by LGBTQIA+AYA cancer patients and survivors. This scoping review aims to summarize the existing literature about the challenges faced, the nature and currently available services provided for LGBTQIA+ AYA cancer patients and survivors. Methods: In February 2023, a systematic keyword search was conducted on PubMed and Embase. This included the terms, “AYA”, “Adolescent and Young Adults”, “Cancer”, “LGBTQIA+”, “Sexual and Gender Minorities”, “obstacles”, “biases” and “challenges”. The studies selected were screened for further relevant cited references. Papers exploring LGBTQIA+ AYA (ages 15-49) challenges and available services were selected. Exclusion criteria included studies that lacked AYA-specific results, or did not report on challenges/difficulties faced. Included studies were then thematically analyzed according to challenges, available services and help required. Qualitative analysis was subsequently performed. Results: A total of 202 studies were identified. We excluded 185 studies based on the exclusion criteria. 17 studies were included in this review. 7 challenges, 7 help service gaps and 3 available services were identified in LGBTQIA+ AYA cancer care. Major challenges reported include LGBTQIA+ inclusive understanding of psychosocial needs, depression/anxiety, disclosure of sexual and gender minority status to Healthcare Providers (HCPs) and the recognition of partners by HCPs. Deficient services included LGBTQIA+-specific support groups and cultural competence training amongst HCPs. Frameworks are currently being developed to enhance HCP-patient relationships and improve the inclusivity of marginalized LGBTQIA+ patients in the healthcare system. However, the exact available services were unreported or not specific to this population. Conclusions: This review underlined the lack of LGBTQIA+-AYA-specific evidence regarding challenges faced by patients and survivors. While domains relating to mental health outcomes are increasingly reported in the literature, others including identity formation, financial outcomes and fertility needs continue to be underreported. There is also an absence of research on Asian populations and less developed countries. Further research is required to understand and address these specific gaps and difficulties. This is necessary to provide holistic AYA care to improve compliance, and also ensure better cancer treatment and survivorship experiences.
The use of machine learning models to predict PFS and OS outcomes from waterfall plots in randomized clinical trials (MAP-OUTCOMES).
Authors: Alshankati Khadjah , Alshibany Aisha , Toma Augustin , Lajkosz Katherine , Wang Bo , Haibe-Kains Benjamin , Siu Lillian L. 
Published: August 2023

107 Background: Depth of tumor response (DepOR) of individual patients, as visualized by waterfall plots, is an emerging short-term endpoint that may represent a surrogate for survival-based outcomes such as PFS and OS. We hypothesize that the configuration of waterfall plots in randomized trials may predict PFS/OS outcomes. Methods: A literature-based search was performed for all phase II/III randomized clinical trials published in MEDLINE from 2010 to 2022 testing molecularly targeted agents (MTA) or immunotherapy (IO). Articles reporting at least 1 waterfall plot for each treatment arm depicting maximum DepOR of target lesions with corresponding PFS/OS Kaplan-Meier plots were included. Studies are defined as positive or negative based on the achievement of a priori stated primary endpoint. Trial data collected included sample size per arm, cancer type, mechanisms of action of drug(s) tested, line of treatment, etc. Images of waterfall plots were manually extracted from publications and then processed through a semi-automatic extraction process using WebPlotDigitizer and Tesseract to produce tabular representations. Logistic regression with L2 regularization was used for modeling; hyperparameter tuning was accomplished with five-fold cross-validation on a training set compromising 80% of the data. Results: A total of 111 studies were identified: 65 (59%) phase III and 46 (41%) phase II, mean sample size per arm 317 (19-1581). Most frequent cancer type was gastrointestinal 24 (22%). MTA, IO and combinations were tested in 113 (51%), 35(16%) and 11 (5%) studies respectively. Chemotherapy and other treatment regimens were used in 63 (28%) trials. PFS was the primary endpoint in 62 (56%); 80 (75%) studies were positive. Of the 111 studies only 83 (75%) were retained for machine learning analysis, the remainder were excluded due to atypical formatting such as superimposed waterfall plots. Performance of the model was assessed on a test set which comprised 20% of the original dataset. Table below shows the classification metrics from modelling. Both PPV and NPV were ≥80%. Conclusions: MAP-OUTCOMES evaluated pan-cancer randomized studies with diverse therapeutic anticancer agents. It is a computational tool with the potential to predict survival-based outcomes from waterfall plots and may help with decisions regarding follow-on randomized studies. Further validation is ongoing. [Table: see text]