bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of preoperative immunotherapy alone followed by surgery in the treatment of advanced gastric cancer with MSI-H/dMMR or EBV-positive
Authors: Lei Xiaokang , Wang Yinkui , Shan Fei , Li Shuangxi , Jia Yongning , Miao Rulin , Xue Kan , Li Zhemin , Ji Jiafu , Li Ziyu 
Published: June 2023

Background:
At present, there is no consensus on whether preoperative immunotherapy (PIT) without chemotherapy followed by surgery could benefit patients with advanced gastric cancer (AGC). Here, we report a six-case series study to describe the safety and efficacy of PIT plus gastrectomy in patients with AGC.

Methods:
This study involved six patients with AGC who received PIT and surgery at our center between January 2019 and July 2021. Demographic characteristics, preoperative gastroscope biopsy pathology, surgical tissue pathology, radicalness of tumor resection, surgical safety, and recovery parameters were reported.

Results:
Six patients, including four patients with Epstein-Barr virus (EBV)-positive gastric cancer (GC) and two patients with microsatellite instability-high (MSI-H)/expression deficiency of mismatch repair (dMMR) protein GC, were enrolled in this study. Four patients experienced immunotherapy-related adverse events (irAEs), without severe adverse events (SAEs). Five patients underwent R0 resection, and one patient underwent palliative gastrectomy due to liver and hilar lymph node metastasis. Pathologic responses from the surgical tissue were observed in all patients, including two pathological complete response (pCR). No operative complications or postoperative deaths occurred. Three patients (50%) experienced mild or moderate postoperative complications without severe postoperative complications. All six patients eventually recovered and were discharged.

Conclusion:
This study indicated that PIT was effective and tolerant in some patients with MSI-H/dMMR and/or EBV-positive AGC. PIT followed by gastrectomy might be an alternative treatment option for these selected patients.
Value of Using a Structured Improvement Approach: A Dedicated Education Unit Exemplar
Authors: Polancich Shea , Byrd Elizabeth , Miltner Rebecca S. , Eagerton Greg , Talley Michele , Moneyham Linda , Stewart Jill , White-Williams Connie 
Published: June 2023

ABSTRACT
Using a structured approach to improvement that integrates methodological frameworks and commonly used improvement tools and techniques allows an improvement team to systematically implement and evaluate an intervention. Authors from one academic medical center will describe our four-step structured improvement approach in the design of a dedicated education unit (DEU) pilot to potentially meet a critical post-COVID-19 workforce need. Using our structured improvement approach, we successfully piloted a DEU with a unit-based clinical educator and 16 nursing students over 26 clinical days and received 13 preintervention surveys from participants. Although the DEU pilot was small with limited data, the structured improvement approach resulted in an organized and systematic way of designing, implementing, and evaluating improvement.
Role of 18F-FDG PET/CT in the diagnosis of benign vs. malignant tumor thrombus
Authors: Sarswat Sulochana , Khan Dikhra , Sagar Sambit , Kumar Rakesh 
Published: June 2023

Purpose
Hypercoagulable state is a complication of various infections, and inflammatory processes and is a common scenario in cancer patients also. Timely diagnosis and treatment are essential to reduce further complications in such patients. The present study aimed to assess the role of FDG PET/CT in the diagnosis of benign vs. malignant tumor thrombus and to determine cut-off SUVmax to differentiate them.

Patients and methods
We retrospectively reviewed all FDG PET/CT scans of patients done in our department from January 2017 to March 2022. All scans were reviewed by two experienced nuclear medicine physicians. A total of 135 patients who had venous or arterial thrombus in FDG PET/CT scans were included. All the FDG PET/CT scans of 135 patients were analyzed for primary tumor site and/or site of thrombus. Additional clinical data were collected for patients with benign conditions in the form of ESR and CRP if available and doubtful cases were followed up by HPE reports and/or CEMRI. The SUV max of the primary tumor(in cancer patients), thrombus, and background (aorta) were calculated.

Results
A total of 135 patients (108 cancer patients and 27 with benign thrombus) were included with an age range of 3 to 86 years (median 50 years). There were 91 males and 44 females. Of 108 cancer patients, the most common cancers were hepatocellular cancer – 38 (35.18%), renal cell cancer – 28(25.92%), and carcinoma of the thyroid – 6 (5.55%). Of 108 cancer patients, 36 (33.33%) had tumor thrombosis in inferior vena cava, 31 (28.70%) in the portal vein, and 41 (37.96%) in other vessels (renal vein, jugular vein, etc.). Of 27 patients with benign conditions,13 had venous thrombi, 11 had arterial thrombus and three had atrial thrombus and the most common thrombus sites were thoraco-abdominal aorta in seven (25.92%) and right atrium in three (11.11%) patients. In the subgroup of 108 oncological patients, the mean SUV max of the primary tumors was 17.67 (range 2.1–91.0; median 10.82), thrombi were 17.61 (range 2.14–90.11; median 14.56) and background was 5.29 (range 0.29–25.00; median 3.12). Of 27 patients with benign conditions, the mean SUV max of the thrombi was 11.09 (range 1.98–31; median 8.10) and the background was 9.80 (range 1.46–24.50; median 10.20) The ESR was raised in 13 of 26 patients (mean 35.84, range 10.98–62.00, median 35.00) and CRP was raised 22 of 26 patients (mean11.46, range 3.45–24.50, median 20.40). Upon plotting the receiver operating curve, a cutoff SUV max of 12.7 with a sensitivity of 62.96% and specificity of 77.77% was produced to demarcate tumor thrombus from benign thrombus.

Conclusion
FDG PET/CT plays a significant role in the detection of thrombo-embolic disease and can differentiate benign thrombus from tumor thrombus.
A Current State Assessment on Nursing Work Activities
Authors: Perpetua Zachary , Lennon Jennifer , Shovel Judith A. , Appell Katherine E. , Patterson Leah , Martin Susan C. , Minnier Tamra E. , Sackrowitz Rachel , Zapf Rachel L. , Kip Paula L. , McLaughlin Maribeth 
Published: June 2023

Background:
Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care.

Local Problem:
Staffing challenges and nursing burnout were becoming growing concerns and success was contingent upon efficient use of existing resources.

Methods:
Direct observation current state assessment was completed on medical-surgical specialty units to better understand work activities of registered nurses (RNs) and unlicensed assistive personnel (UAPs).

Results:
RNs spent more time performing indirect care (eg, documentation) than direct patient care. Interruptions and problems consumed 17.4% and 5.6% of their time, respectively. UAPs performed more direct patient care but had a higher proportion of downtime. RNs underdelegated nonclinical tasks.

Conclusions:
Direct observation current state assessment offers a better understanding of workflow and workload inefficiencies. This information is critical to provide informed, evidence-based recommendations to develop future patient care models with more capacity to deliver high-quality care with greater efficiency and lessen nursing burden and burnout during the nursing shortage crisis.
Ruptured Appendicitis Within an Intussusception on Point-of-Care Ultrasound
Authors: Wu Amy 
Published: June 2023

Abstract
This case describes a 21-month-old girl who was transferred to our pediatric emergency department with daily fevers for 9 days and concern for intussusception on an ultrasound obtained at the outside hospital. Her examination was notable for diffuse tenderness to palpation with no rebound or guarding. Point-of-care-ultrasound (POCUS) revealed a noncompressible, target-shaped structure in the right midabdomen, which appeared to contain a dilated loop of bowel surrounded by a hypoechoic fluid collection. This was confirmed by radiology-performed ultrasound and computed tomography scan, which showed an ileocolic intussusception containing a dilated echogenic loop of bowel consistent with perforated acute appendicitis and associated abscess with surrounding inflammatory changes. To our knowledge, this is the first reported case of perforated appendicitis within an intussusception identified on POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the recognition of an atypical diagnosis of a perforated appendicitis contained within an intussusception and helping to guide further evaluation and management.
Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital.
Authors: BENAISSA ELMOSTAFA , Belouad Elmehdi , Maleb Adil , Elouennass Mostafa 
Published: June 2023

Introduction : Acinetobacter spp is a non-fermenting and ubiquitous Gram-negative coccobacillus, which is in recent years the leading cause of healthcare-associated infections worldwide. Our objective is to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care units.
Methods:
This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two Intensive Care Units of the Military Hospital of Instruction Mohammed V-Rabat over a 3-month period.
Results: We included 180 patients, out of which 60 had Acinetobacter baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years IQR [59.5-77]. The median length of stay in the intensive care units before infection was 8.5days IQR [5-14]. Multi-variate logistic regression analysis identified the risk factors statistically associated with Acinetobacter baumannii infection at the intensive care units level as follows: duration of invasive procedures˃ 7days(OR=1. 02), parenteral nutrition(OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin(OR=5.645), probabilistic antibiotic therapy ˃4days (OR=9.063) and neoplastic pathology(OR=5.727).
Conclusion:
Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices, and optimizing antibiotic therapy could decrease the incidence of these infections.
Algorithm Refinement in the Non-Invasive Detection of Blood Glucose via Bio-RFID™ Technology1
Authors: Klyve Dominic , Currie Kaptain , Anderson James H. , Ward Carl , Schwarz David , Shelton Barry 
Published: June 2023

AbstractDiabetes Mellitus (DM) is a highly prevalent and increasingly common disorder that can have dire health consequences if not properly managed. Managing DM involves monitoring blood glucose levels, which can be cumbersome and invasive, and adherence to this practice is poor. We present a validation for a novel sensor designed to measure blood glucose (BG) non-invasively using Radio Frequency (RF) waves. In this n=5 study, we trained a Light Gradient-Boosting Machine (lightGBM) model to predict BG values using 1,555 observations from over 130 hours of data collection from five participants, where an observation is defined as data collected from 13 Bio-RFID sensor sweeps paired with a single Dexcom G6® value. Using this model, we predicted BG in the test set with a Mean Absolute Relative Difference (MARD) of 12.7% in the normoglycemic range and 14.0% in the hyperglycemic range. Overall, 70.7% of the estimates fell within 15% of the reference value, and 79.1% fell within 20% of the reference value. While this is a small participant sample, these strong initial results indicate the efficacy of this technique, and that with further refinement and more data, there is promise to achieve a clinically relevant level of accuracy.
Quantitative CT of Normal Lung Parenchyma and Small Airways Disease Topologies are Associated With COPD Severity and Progression
Authors: Bell Alexander J. , Pal Ravi , Labaki Wassim W. , Hoff Benjamin A. , Wang Jennifer M. , Murray Susan , Kazerooni Ella A. , Galban Stefanie , Lynch David A. , Humphries Stephen M. , Martinez Fernando J. , Hatt Charles R. , Han MeiLan K. , Ram Sundaresh , Galban Craig J. 
Published: June 2023

AbstractObjectivesSmall airways disease (SAD) is a major cause of airflow obstruction in COPD patients, and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline.Materials and MethodsPRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n=8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNormand PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1decline using a machine learning model.ResultsMultivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSADand PRMNormwere independently associated with the amount of emphysema. Readouts χfSAD(β of 0.106, p<0.001) and VfSAD(β of 0.065, p=0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1decline over five years with an AUC of 0.69.ConclusionsWe demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSADand PRMNormmay show promise as an early indicator of emphysema onset and COPD progression.
Similarity and diversity of genetic architecture for complex traits between East Asian and European populations
Authors: Zhang Jinhui , Zhang Shuo , Qiao Jiahao , Wang Ting , Zeng Ping 
Published: June 2023

AbstractBackground:Genome-wide association studies have detected a large number of single-nucleotide polymorphisms (SNPs) associated with complex traits in diverse ancestral groups. However, the trans-ethnic similarity and diversity of genetic architecture is not well understood currently.Results:By leveraging summary statistics of 37 traits from East Asian (Nmax=254,373) or European (Nmax=693,529) populations, we first evaluated the trans-ethnic genetic correlation (ρg) and found substantial evidence of shared genetic overlap underlying these traits between the two populations, withranging from 0.53 (se=0.11) for adult-onset asthma to 0.98 (se=0.17) for hemoglobin A1c. However, 88.9% of the genetic correlation estimates were significantly less than one, indicating potential heterogeneity in genetic effect across populations. We next identified common associated SNPs using the conjunction conditional false discovery rate method and observed 21.7% of trait-associated SNPs can be identified simultaneously in both populations. Among these shared associated SNPs, 20.8% showed heterogeneous influence on traits between the two ancestral populations. Moreover, we demonstrated that population-common associated SNPs often exhibited more consistent linkage disequilibrium and allele frequency pattern across ancestral groups compared to population-specific or null ones. We also revealed population-specific associated SNPs were much likely to undergo natural selection compared to population-common associated SNPs.Conclusions:Our study provides an in-depth understanding of similarity and diversity regarding genetic architecture for complex traits across diverse populations, and can assist in trans-ethnic association analysis, genetic risk prediction, and causal variant fine mapping.
Syndromic surveillance during 2022 Uganda martyrs’ commemoration
Authors: Ninsiima Mackline , Wanyana Mercy W. , Kiggundu Thomas , King Patrick , Lubwama Bernard , Migisha Richard , Bulage Lilian , Kadobera Daniel , Ario Alex Riolexus 
Published: June 2023

AbstractMass gatherings frequently include close, prolonged interactions between people, which presents opportunities for infectious disease transmission. Over 20,000 pilgrims gathered at Namugongo Catholic and Protestant shrines to commemorate 2022 Uganda Martyr’s Day. We described syndromes suggestive of key priority diseases particularly COVID–19 and viral hemorrhagic fever (VHF) among visiting pilgrims during May 25−June 5, 2022. A suspected COVID–19 case was defined as ≥2 signs or symptoms of: fever >37.50C, flu, cough, and difficulty in breathing whereas a suspected VHF case was defined as fever >37.50C and unexplained bleeding among pilgrims who visited Namugongo Catholic and Protestant shrines from May 25 to June 5, 2022. Pilgrims were sampled systematically at entrances and demarcated zonal areas to participate in the survey. Additionally, we extracted secondary data on pilgrims who sought emergency medical services from Health Management Information System registers. Descriptive analysis was conducted to identify syndromes suggestive of key priority diseases based on signs and symptoms. Among 1,350 pilgrims interviewed, 767 (57%) were female. The mean age was 37.9 (±17.9) years. Nearly all pilgrims 1,331 (98.6%) were Ugandans. A total of 236 (18%) reported ≥1 case definition symptom and 25 (2%) reported ≥2 symptoms. Twenty-two (1.6%) were suspected COVID–19 cases and three (0.2%) were suspected VHF cases from different regions of Uganda. Among 5,582 pilgrims who sought medical care from tents, 538 (9.6%) had suspected COVID–19 and one had suspected VHF. Almost one in fifty pilgrims at the 2022 Uganda Martyrs’ commemoration had at least one symptom of COVID–19 or VHF. Overall, we identified 4 Viral Hemorrhagic Fever and 560 COVID-19 suspected cases during the 2022 Uganda Martyrs’ commemoration. Intensified syndromic surveillance and planned laboratory testing capacity at mass gatherings is important for early detection of public health emergencies that could stem from such events.
Arg4810Lys Mutation inRNF213among Eastern Indian Non-MMD Ischemic Stroke Patients: A Genotype-Phenotype Correlation
Authors: Sadhukhan Dipanwita , Mitra Parama , Mishra Smriti , Roy Arunima , Podder Gargi , Ray Biman Kanti , Biswas Atanu , Hui Subhra Prakash , Banerjee Tapas Kumar , Biswas Arindam 
Published: June 2023

ABSTRACTIntroductionRNF213mutations have been reported mostly in Moyamoya Disease (MMD) with varying frequencies across different ethnicities. However, its prevalence in non-MMD adult-onset Ischemic Stroke is still not well explored.Aims & ObjectivesThis present study thus aims to screen the most commonRNF213variant (Arg4810Lys, among East Asians) in the Eastern Indian non-MMD Ischemic Stroke patients and correlate it with long-term progression and prognosis of the patients. The subjects were analysed for this variant using PCR-RFLP and confirmed using Sanger sequencing method.Result & ConclusionWe have identified Arg4810Lys variant among eleven young-onset familial Ischemic Stroke patients in heterozygous manner. A positive correlation of the variant with positive family history (P = 0.001), earlier age-at-onset (P = 0.002), history of recurrent stroke (P = 0.015) was observed. However, the carriers showed better cognitive performances in memory (P = 0.042) and executive function (P = 0.004). Therefore, we can conclude that Arg4810Lys/RNF213- a pathogenic variant for young-onset familial Ischemic Stroke with higher incidence of recurrent events unlike in MMD cases, have no additional impact on cognition among Eastern Indians.
Data-driven hypothesis generation among inexperienced clinical researchers: A comparison of secondary data analyses with visualization (VIADS) and other tools
Authors: Jing Xia , Cimino James J. , Patel Vimla L. , Zhou Yuchun , Shubrook Jay H. , De Lacalle Sonsoles , Draghi Brooke N. , Ernst Mytchell A. , Weaver Aneesa , Sekar Shriram , Liu Chang 
Published: June 2023

AbstractObjectivesTo compare how clinical researchers generate data-driven hypotheses with a visual interactive analytic tool (VIADS, avisual interactiveanalysis tool for filtering and summarizing largedatasets coded with hierarchical terminologies) or other tools.MethodsWe recruited clinical researchers and separated them into “experienced” and “inexperienced” groups. Participants were randomly assigned to a VIADS or control group within the groups. Each participant conducted a remote 2-hour study session for hypothesis generation with the same study facilitator on the same datasets by following a think-aloud protocol. Screen activities and audio were recorded, transcribed, coded, and analyzed. Hypotheses were evaluated by seven experts on their validity, significance, and feasibility. We conducted multilevel random effect modeling for statistical tests.ResultsEighteen participants generated 227 hypotheses, of which 147 (65%) were valid. The VIADS and control groups generated a similar number of hypotheses. The VIADS group took a significantly shorter time to generate one hypothesis (e.g., among inexperienced clinical researchers, 258 seconds versus 379 seconds,p= 0.046, power = 0.437, ICC = 0.15). The VIADS group received significantly lower ratings than the control group on feasibility and the combination rating of validity, significance, and feasibility.ConclusionThe role of VIADS in hypothesis generation seems inconclusive. The VIADS group took a significantly shorter time to generate each hypothesis. However, the combined validity, significance, and feasibility ratings of their hypotheses were significantly lower. Further characterization of hypotheses, including specifics on how they might be improved, could guide future tool development.
Age classes stratified by risk and adaptive behavior during epidemics
Authors: Arthur Ronan F. , Levin May , Labrogere Alexandre , Feldman Marcus W. 
Published: June 2023

AbstractHeterogeneity in contact patterns, mortality rates, and transmissibility among and between different age classes can have significant effects on epidemic outcomes. Adaptive behavior in response to the spread of an infectious pathogen may give rise to complex epidemiological dynamics. Here we model an infectious disease in which adaptive behavior incentives, and mortality rates, can vary between three age classes. The model indicates that age-dependent variability in infection aversion can produce more complex epidemic dynamics at lower levels of pathogen transmissibility.