bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy, safety, and cost-effectiveness of triple therapy in preventing relapse in rheumatoid arthritis: A randomized controlled trial (ESCoRT study)
Authors: Zhao Juan , Zhou Wei , Wu Yangfeng , Yan Xiaoyan , Yang Li , Zhang Zhuoli 
Published: December 2022

Abstract

Background:
Biological agents, such as tumor necrosis factor inhibitors (TNFi), have been widely used in rheumatoid arthritis (RA) patients and greatly improved goal achievement. The aim of this study was to investigate whether conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) combination was better in reducing relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi plus MTX in RA patients who achieved low disease activity (LDA) with TNFi and MTX therapy.

Methods:
RA patients who failed to csDMARDs received an induction therapy of MTX plus TNFi for maximally 12 weeks. Those achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups: (A) adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks; (B) maintaining TNFi and MTX for 60 weeks; and (C) maintaining TNFi and MTX for the first 12 weeks and then discontinuing TNFi for the following 48 weeks. The primary outcome was relapse.

Results:
A total of 117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized, with 24, 21, and 22 patients in groups A, B, and C, respectively. The relapse rates of groups A and B during the entire 60 weeks were comparable [10/22 (45.5%) vs. 7/20 (35.0%), χ2 = 0.475, P = 0.491], however, significantly lower than that of group C [10/22 (45.5%) vs. 17/20 (85.0%), χ2 = 5.517, P = 0.019; 7/20 (35.0%) vs. 17/20 (85.0%), χ2 = 11.035, P = 0.004, respectively]. Taking RMB 100,000 Yuan as the threshold of willingness to pay, compared to MTX monotherapy (group C), both TNFi maintenance and triple csDMARDs therapies were cost-effective, but triple csDMARDs therapy was better.

Conclusion:
For RA patients who have achieved LDA with TNFi and MTX, csDMARDs triple therapy was a cost-effective option in favor of reducing relapse.

Trial registration:
ClinicalTrials.gov, NCT02320630.
Treatments for resectable esophageal cancer: from traditional systemic therapy to immunotherapy
Authors: Yan Yan , Feng Xijia , Li Chengqiang , Lerut Toni , Li Hecheng 
Published: December 2022

Abstract
Esophageal cancer (EC) has a high incidence and poor prognosis. The two major histological types, squamous cell carcinoma and adenocarcinoma, differ in their epidemiology and treatment options. Patients with locally advanced EC benefit from multimodal therapy concepts including neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy, and perioperative chemotherapy. Currently, immunotherapy for the solid tumor is a hot spot. Treatment with adjuvant immune checkpoint inhibitors (ICIs) is the first immunotherapy for resectable EC listed in the latest National Comprehensive Cancer Network Guidelines for the Esophageal and Esophagogastric Junction Cancers. Recent clinical trials have established ICIs for three treatment models of resectable EC. Their short-term results demonstrated ideal efficacy and tolerable toxicity, though some concerns remain. This review summarizes the novel data on the ICIs for resectable EC and lists the registered related clinical trials. Hopefully, this review can provide a reference for ongoing research on the treatment options for resectable EC.
A qualitative exploration of the perspectives of international medical students residing in university hostels amid COVID-19 pandemic lockdown
Authors: Khadka Sitaram , Usman Muhammad , Saleem Mohammad , Ali Moshin , Rasheed Huma , Giri Santoshi , Gupta Ravi Prasad , Bajgain Yogesh , Shahi Janak 
Published: December 2022

Background:
The coronavirus disease 2019 (COVID-19) pandemic has portentously frightened the existence of life globally. The lockdown approach was adopted as a containment strategy as the disease itself has manifested severe social, economic, and psychiatric implications. This study was conducted to explore the perception and preparedness of international medical students residing in university hostels amid the COVID-19 pandemic lockdown.

Methods:
A total of 11 international medical students were selected through the purposive sampling technique and interviewed face-to-face through the semi-structured interview guide. All the interviews were audio-taped, transcribed verbatim, and then analyzed for thematic content by standard content analysis framework.

Results:
The 5 major themes were yielded: familiarity with COVID-19, perceptions and attitudes toward COVID-19, preparedness for safety against COVID-19, barriers to lifestyle, and psychological perspectives. Adequate knowledge regarding the overview of COVID-19; preventive approaches such as social distancing, use of masks, gloves, and sanitizers; and compliance with the lockdown measures were reported by the respondents. The pertinent issue raised by the respondents was the disturbance in normal routine due to distortion in social life and isolation.

Conclusion:
The findings from this study lighten the people’s perspectives that help the government to prepare public health strategies based on population-focused approaches. The present study demonstrates the respondents’ opinion on COVID-19 management through personal hygiene, social distancing, and complying with the lockdown measures. Furthermore, it demands the adoption of timely and evidence-based teaching-learning techniques for students’ engagement which ensures mental health and self-motivation as well.
A novel professional automated auscultatory blood pressure monitor with visual display of Korotkoff sounds: InBody BPBIO480KV validation according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard
Authors: Ntineri Angeliki , Theodosiadi Aikaterini , Menti Ariadni , Kyriakoulis Konstantinos G. , Ntousopoulos Vasileios , Kollias Anastasios , Stergiou George S. 
Published: December 2022

Objective:
A novel automated auscultatory upper arm-cuff blood pressure (BP) monitor (InBody BPBIO480KV) for office use was developed. An electronic stethoscope embedded in the device cuff records the Korotkoff sounds, which are audible to the user and graphically displayed during cuff deflation. Automated BP measurements are provided, while allowing the user to assess the Korotkoff sounds. The device accuracy was tested using the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) and its Amendment 1.2020-01.

Methods:
Participants were recruited to fulfil the age, sex, BP, arm circumference and cuff distribution criteria of the Universal Standard in general population using the same arm sequential measurement method. Three cuffs of the test device were used for arm circumference 23–28, 28–35 and 33–42 cm.

Results:
Data from 85 individuals were analysed [mean age 57.3 ± 15.0 (SD) years, 53 men, arm circumference 23–42 cm]. For validation of criterion 1, the mean ± SD of the differences between the test device and reference BP readings (N = 255) was 0.3 ± 5.5/0.6 ± 4.7 mmHg (systolic/diastolic; threshold ≤5 ± 8 mmHg). For criterion 2, the SD of the averaged BP differences per individual (N = 85) was 3.76/3.61 mmHg (systolic/diastolic; threshold ≤6.95/6.91 mmHg).

Conclusion:
The InBody BPBIO480KV device for office use, which provides automated auscultatory measurements while reproducing and displaying the Korotkoff sounds, comfortably fulfilled the AAMI/ESH/ISO Universal Standard requirements in general population and can be recommended for clinical use. The assessment of Korotkoff sounds by healthcare professionals for evaluating the quality of automated measurements requires further evaluation.
Overcoming Challenges to HIV Medical Care-seeking and Treatment Among Data-to-Care Program Clients in Baton Rouge and New Orleans, Louisiana
Authors: Carey James W. , Roland Katherine B. , Bessler Patricia A. , Tesfaye Casey Langer , Randall Laura A. , Frew Paula M. 
Published: December 2022

Abstract
Data to Care (D2C) uses US public health surveillance data to identify persons with diagnosed HIV who are not receiving adequate medical care. These persons are linked to care and ancillary social services through personalized outreach. We conducted semistructured interviews with 36 adults with HIV in Louisiana who were engaged for the first time or reengaged back into HIV care through D2C efforts. Before D2C program staff contact, nearly 40% were not contemplating HIV care. Program clients cited barriers to HIV care, including difficulties with appointment scheduling and transportation, health care service and drug costs, low motivation, and competing non-HIV health needs. Thirty-four of the 36 clients said that D2C staff helped them overcome these barriers. Clients also described psychosocial support from D2C staff. After receiving D2C program assistance, more than 90% of clients reported consistently receiving HIV medical care and taking medications. Our findings suggest that D2C staff successfully identified client needs and provided tailored assistance.
Whole-body single photon emission computed tomography/computed tomography for assessment of oncological bone disease – is an extended field of view (from vertex to toes) of clinical value?
Authors: Komber Hend , Redman Stewart , Graham Richard , Anane-Adusei Sarah , Little David 
Published: December 2022

Objectives
Whole-body single photon emission computed tomography/computed tomography (WB-SPECT/CT) is useful for diagnosing bone metastases. When performed on a dual-headed gamma camera, this may cover from clavicles to proximal femurs due to time constraints. In contrast, the novel 360o cadmium-zinc-telluride scanner can perform WB-SPECT/CT (from vertex to toes) in approximately 20 min. The aim was to assess the prevalence of additional findings above the clavicles and below the lesser trochanters and the prevalence of incidental findings in the CT component.

Methods
Retrospective study of 117 WB-SPECT/CT scans for oncological bone assessment over a 4-month-period. Scan analysis was performed by two independent experienced radionuclide radiologists.

Results
The male:female ratio was 71:46 and the mean patient age was 68 years. The primary malignancies were predominantly prostate 65/117 (55.6%) and breast 40/117 (34.2%). There were additional findings of malignancy above the clavicles in 16/116 scans (13.8%) and below the lesser trochanters in 16/117 scans (13.7%). Two cases in the ‘above the clavicles’ group were suspected solitary metastases, whereas four cases in the ‘below lesser trochanters’ group were bone metastases at risk of pathological fracture. Incidental findings of clinical significance included suspected new malignancy in 11/117 (9.4%).

Conclusion
A WB-SPECT/CT (from vertex to toes) oncological bone protocol is useful for the detection of additional findings of clinical significance above the clavicles and below the lesser trochanters. Reviewing and reporting the CT findings in SPECT/CT is important.
Mucosal Microbiota Associated With Eosinophilic Esophagitis and Eosinophilic Gastritis
Authors: Furuta Glenn T. , Fillon Sophie A. , Williamson Kayla M. , Robertson Charles E. , Stevens Mark J. , Aceves Seema S. , Arva Nicoleta C. , Chehade Mirna , Collins Margaret H. , Davis Carla M. , Dellon Evan S. , Falk Gary W. , Gonsalves Nirmala , Gupta Sandeep K. , Hirano Ikuo , Khoury Paneez , Leung John , Martin Lisa J. , Menard‐Katcher Paul , Mukkada Vincent A. , Peterson Kathryn , Spergel Jonathan M. , Wechsler Joshua B. , Yang Guang‐Yu , Rothenberg Marc E. , Harris J. Kirk 
Published: December 2022

Objective:The aim of the study was to determine the mucosal microbiota associated with eosinophilic esophagitis (EoE) and eosinophilic gastritis (EoG) in a geographically diverse cohort of patients compared to controls.Methods:We conducted a prospective study of individuals with eosinophilic gastrointestinal disease (EGID) in the Consortium of Eosinophilic Gastrointestinal Disease Researchers, including pediatric and adult tertiary care centers. Eligible individuals had clinical data, mucosal biopsies, and stool collected. Total bacterial load was determined from mucosal biopsy samples by quantitative polymerase chain reaction (PCR). Community composition was determined by small subunit rRNA gene amplicons.Results:One hundred thirty‐nine mucosal biopsies were evaluated corresponding to 93 EoE, 17 EoG, and 29 control specimens (18 esophageal) from 10 sites across the United States. Dominant community members across disease activity differed significantly. When comparing EoE and EoG with controls, the dominant taxa in individuals with EGIDs was increased (Streptococcus in esophagus; Prevotella in stomach). Specific taxa were associated with active disease for both EoE (Streptococcus, Gemella) and EoG (Leptotrichia), although highly individualized communities likely impacted statistical testing. Alpha diversity metrics were similar across groups, but with high variability among individuals. Stool analyses did not correlate with bacterial communities found in mucosal biopsy samples and was similar in patients and controls.Conclusions:Dominant community members (Streptococcus for EoE, Prevotella for EoG) were different in the mucosal biopsies but not stool of individuals with EGIDs compared to controls; taxa associated with EGIDs were highly variable across individuals. Further study is needed to determine if therapeutic interventions contribute to the observed community differences.
Accuracy of Nodule Volume and Airway Wall Thickness Measurement Using Low-Dose Chest CT on a Photon-Counting Detector CT Scanner
Authors: Dunning Chelsea A.S. , Marsh Jeffrey F. , Winfree Timothy , Rajendran Kishore , Leng Shuai , Levin David L. , Johnson Tucker F. , Fletcher Joel G. , McCollough Cynthia H. , Yu Lifeng 
Published: December 2022

Objectives
A comparison of high-resolution photon-counting detector computed tomography (PCD-CT) versus energy-integrating detector (EID) CT via a phantom study using low-dose chest CT to evaluate nodule volume and airway wall thickness quantification.

Materials and Methods
Twelve solid and ground-glass lung nodule phantoms with 3 diameters (5 mm, 8 mm, and 10 mm) and 2 shapes (spherical and star-shaped) and 12 airway tube phantoms (wall thicknesses, 0.27–1.54 mm) were placed in an anthropomorphic chest phantom. The phantom was scanned with EID-CT and PCD-CT at 5 dose levels (CTDIvol = 0.1–0.8 mGy at Sn-100 kV, 7.35 mGy at 120 kV). All images were iteratively reconstructed using matched kernels for EID-CT and medium-sharp kernel (MK) PCD-CT and an ultra-sharp kernel (USK) PCD-CT kernel, and image noise at each dose level was quantified. Nodule volumes were measured using semiautomated segmentation software, and the accuracy was expressed as the percentage error between segmented and reference volumes. Airway wall thicknesses were measured, and the root-mean-square error across all tubes was evaluated.

Results
MK PCD-CT images had the lowest noise. At 0.1 mGy, the mean volume accuracy for the solid and ground-glass nodules was improved in USK PCD-CT (3.1% and 3.3% error) compared with MK PCD-CT (9.9% and 10.2% error) and EID-CT images (11.4% and 9.2% error), respectively. At 0.2 mGy and 0.8 mGy, the wall thickness root-mean-square error values were 0.42 mm and 0.41 mm for EID-CT, 0.54 mm and 0.49 mm for MK PCD-CT, and 0.23 mm and 0.16 mm for USK PCD-CT.

Conclusions
USK PCD-CT provided more accurate lung nodule volume and airway wall thickness quantification at lower radiation dose compared with MK PCD-CT and EID-CT.
Utility of Banff Human Organ Transplant Gene Panel in Human Kidney Transplant Biopsies
Authors: Smith Rex N. , Rosales Ivy A. , Tomaszewski Kristen T. , Mahowald Grace T. , Araujo-Medina Milagros , Acheampong Ellen , Bruce Amy , Rios Andrea , Otsuka Takuya , Tsuji Takahiro , Hotta Kiyohiko , Colvin Robert 
Published: December 2022

Background.
Microarray transcript analysis of human renal transplantation biopsies has successfully identified the many patterns of graft rejection. To evaluate an alternative, this report tests whether gene expression from the Banff Human Organ Transplant (B-HOT) probe set panel, derived from validated microarrays, can identify the relevant allograft diagnoses directly from archival human renal transplant formalin-fixed paraffin-embedded biopsies. To test this hypothesis, principal components (PCs) of gene expressions were used to identify allograft diagnoses, to classify diagnoses, and to determine whether the PC data were rich enough to identify diagnostic subtypes by clustering, which are all needed if the B-HOT panel can substitute for microarrays.

Methods.
RNA was isolated from routine, archival formalin-fixed paraffin-embedded tissue renal biopsy cores with both rejection and nonrejection diagnoses. The B-HOT panel expression of 770 genes was analyzed by PCs, which were then tested to determine their ability to identify diagnoses.

Results.
PCs of microarray gene sets identified the Banff categories of renal allograft diagnoses, modeled well the aggregate diagnoses, showing a similar correspondence with the pathologic diagnoses as microarrays. Clustering of the PCs identified diagnostic subtypes including non-chronic antibody-mediated rejection with high endothelial expression. PCs of cell types and pathways identified new mechanistic patterns including differential expression of B and plasma cells.

Conclusions.
Using PCs of gene expression from the B-Hot panel confirms the utility of the B-HOT panel to identify allograft diagnoses and is similar to microarrays. The B-HOT panel will accelerate and expand transcript analysis and will be useful for longitudinal and outcome studies.
Is Exclusion of Coronary Artery Disease in the Kidney Allocation System Preventing Optimal Longevity Matching?
Authors: Tandukar Srijan 
Published: December 2022

Background.
Coronary artery disease (CAD) in a kidney transplant candidate is an important predictor of posttransplant mortality. It is not known how the exclusion of CAD in the kidney allocation system has impacted its goal of longevity matching.

Methods.
This is an observational study on adult deceased donor kidney transplant alone recipients between December 4, 2014, and December 31, 2018, with Medicare fee for service (FFS) insurance. Patients were categorized on the basis of Kidney Donor Profile Index (KDPI), Estimated Posttransplant Survival (EPTS), and CAD. Outcomes studied were mortality, death with a functioning graft, overall graft loss, and death-censored graft loss.

Results.
Among 21 151 patients with Medicare FFS coverage for >1 y before transplant, there were 2869 and 18 282 patients with and without CAD, respectively. On Kaplan-Meier analysis, there was higher risk of mortality, death with a functioning graft, overall graft loss, and death-censored graft loss with CAD (P < 0.05 for all). Mortality was higher for CAD group within each category of KDPI and among patients with Estimated Posttransplant Survival 0% to 20% receiving kidneys with KDPI <20% (P < 0.001 for all). On Cox multivariate analysis, the hazard ratios (HRs) of mortality and graft loss were higher with CAD diagnosis without intervention (HR 1.38 [1.25-1.52] and 1.29 [1.18-1.4]), CAD with stents (HR 2.76 [1.68-4.53] and 2.36 [1.46-3.81]), and CAD with bypass surgery (HR 1.56 [1.29-1.89] and 1.39 [1.17-1.65]). Posttransplant CAD events were higher in patients with preexisting CAD (P < 0.001).

Conclusions.
The exclusion of a candidate’s history of CAD in the kidney allocation system adversely impacts its goal of optimal longevity matching.
Influence of the mutation load on the genomic composition of hybrids between outcrossing and self-fertilizing species
Authors: Fyon Fréderic , Berbel-Filho Waldir M. 
Published: December 2022

AbstractHybridization is a natural process whereby two diverging evolutionary lineages reproduce and create offspring of mixed ancestry. Differences in mating systems (e.g., self-fertilization and outcrossing) are expected to affect the direction and extent of hybridization and introgression in hybrid zones. Among other factors, selfers and outcrossers are expected to differ in their mutation loads. This has been studied both theoretically and empirically; however, conflicting predictions have been made on the effects mutation loads of parental species with different mating systems can have on the genomic composition of hybrids. Here we develop a multi-locus, selective model to study how the different mutation load built up in selfers and outcrossers as a result of selective interference and homozygosity impact the long-term genetic composition of hybrid populations. Notably, our results emphasize that genes from the parental population with lesser mutation load get rapidly over-represented in hybrid genomes, regardless of the hybrids own mating system. When recombination tends to be more important than mutation, outcrossers’ genomes tend to be of higher quality and prevail. When recombination is small, however, selfers’ genomes may reach higher quality than outcrossers’ genomes and prevail. Taken together these results provide concrete insights into one of the multiple factors influencing hybrid genome composition and introgression patterns in hybrid zones with species containing species with different mating systems.
CluSA: Clustering-based Spatial Analysis framework through Graph Neural Network for Chronic Kidney Disease Prediction using Histopathology Images
Authors: Lee Joonsang , Warner Elisa , Shaikhouni Salma , Bitzer Markus , Kretzler Matthias , Gipson Debbie , Pennathur Subramaniam , Bellovich Keith , Bhat Zeenat , Gadegbeku Crystal , Massengill Susan , Perumal Kalyani , Saha Jharna , Yang Yingbao , Luo Jinghui , Zhang Xin , Mariani Laura , Hodgin Jeffrey B. , Rao Arvind 
Published: December 2022

ABSTRACTMachine learning applied to digital pathology has been increasingly used to assess kidney function and diagnose the underlying cause of chronic kidney disease (CKD). We developed a novel computational framework, Clustering-based Spatial Analysis (CluSA), that leverages unsupervised learning to learn spatial relationships between local visual patterns in kidney tissue. This framework minimizes the need for time-consuming and impractical expert annotations. To incorporate spatial information over the clustered image patterns on the biopsy sample, we spatially encoded clustered patterns with colors and performed spatial analysis through graph neural network. A random forest classifier with various groups of features were used to predict CKD. For predicting high/low eGFR at the biopsy, we achieved a sensitivity of 0.97, specificity of 0.90, and accuracy of 0.95. AUC was 0.96. For predicting eGFR changes in one-year, we achieved a sensitivity of 0.83, specificity of 0.85, and accuracy of 0.84. AUC was 0.85. This study presents the first spatial analysis based on unsupervised machine learning algorithms. Without expert annotation, CluSA framework can not only accurately classify and predict the degree of kidney function at the biopsy and in one year, but also identify novel predictors of kidney function and renal prognosis.