bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of 12 First-Line Treatments for Patients With Advanced EGFR Mutated NSCLC in the United Kingdom and China
Authors: Guan Haijing , Wang Chunping , Chen Chen , Han Sheng , Zhao Zhigang 
Published: June 2022

BackgroundLung cancer is imposing significant pressure on the national health insurance system worldwide, especially under the COVID-19 pandemic. However, the cost-effectiveness of all available first-line treatments for patients with advanced epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) is still uncertain. The aim of this study was to evaluate the cost-effectiveness of 12 first-line treatments for patients with advanced EGFR mutated NSCLC from the perspective of the United Kingdom (UK) National Health Service and Chinese health care system.MethodsWe used a Markov model to estimate the cost-effectiveness of 12 treatments, including 6 EGFR tyrosine kinase inhibitors, 4 combination treatments and 2 chemotherapies. The key clinical efficacy and safety data were from a network meta-analysis. The cost and health preference were mainly collected from the literature. The most cost-effective treatment was inferred through a sequential analysis. Uncertainty was tested with one-way sensitivity analyses, scenario analyses, and probabilistic sensitivity analyses. Quality-adjusted life years (QALYs), direct medical costs, and incremental cost-effectiveness ratio (ICER) were estimated, at willingness-to-pay thresholds of £20000 to £50000 and £8000 to £24000 per QALY in the UK and China respectively.ResultsFor clinical effectiveness, osimertinib and gefitinib plus pemetrexed based chemotherapy (PbCT) yielded the highest QALYs, while two chemotherapy treatments gained the lowest QALYs. For costs, gefitinib treatment was the cheapest option in both countries (£24529 in the UK and £12961 in China). For cost-effectiveness, 4 treatments including gefitinib, gefitinib plus pemetrexed, gefitinib plus PbCT, and osimertinib formed the cost-effectiveness frontier in both countries. Gefitinib alone (70.7% and 80.0% under the threshold of £20000 and £8000 per QALY in the UK and China, respectively) and gefitinib plus PbCT (62.3% and 71.2% under the threshold of £50000 and £24000 per QALY in the UK and China, respectively) were most likely to be cost-effective compared with other first-line treatments.ConclusionsGefitinib and gefitinib plus PbCT were likely to be cost-effective for patients with advanced EGFR mutated NSCLC in both countries.
Germline Mutations in Patients With Early-Onset Prostate Cancer
Authors: Tang Tang , Tan Xintao , Wang Ze , Wang Shuo , Wang Yapeng , Xu Jing , Wei Xiajie , Zhang Dianzheng , Liu Qiuli , Jiang Jun 
Published: June 2022

ObjectiveTo investigate the inherited mutations and their association with clinical features and treatment response in young-onset prostate cancer patients.MethodTargeted gene sequencing on 139 tumor susceptibility genes was conducted with a total of 24 patients diagnosed with PCa under the age of 63 years old. Meanwhile, the related clinical information of those patients is collected and analyzed.ResultsSixty-two germline mutations in 45 genes were verified in 22 patients. BRCA2 (20.8%) and GJB2 (20.8%) were found to be the most frequently mutated, followed by CHEK2, BRCA1, PALB2, CDKN2A, HOXB13, PPM1D, and RECQL (8.3% of each, 2/24). Of note, 58.3% (14/24) patients carry germline mutations in DNA repair genes (DRGs). Four families with HRR (homologous recombination repair)-related gene mutations were described and analyzed in detail. Two patients with BRCA2 mutation responded well to the combined treatment of androgen deprivation therapy (ADT) and radiotherapy/chemotherapy.ConclusionMutations in DRGs are more prevalent in early-onset PCa with advanced clinical stages, and these patients had shorter progression-free survival. ADT Combined with either radiotherapy or chemotherapy may be effective in treating PCa caused by HRR-related gene mutations.
Impact of Limb Salvage on Prognosis of Patients Diagnosed With Extremity Bone and Soft Tissue Sarcomas
Authors: Yu Kaixu , Chen Ying , Song Kehan , Xiong Fanxiu , Tian Yahao , Guan Hanfeng , Li Feng 
Published: June 2022

BackgroundAlthough clinicians and patients with extremity bone and soft tissue (EBST) are increasingly interested in limb salvage surgery (LSS), because of the minimal damage to physical appearance and function, however, there is still a lack of large-scale population studies on whether LSS improves the prognosis of patients.PurposeThe aim of this study was to compare the survival of patients with EBST sarcomas after receiving LSS and amputation.MethodsTo conduct the population-based study, we identified 6,717 patients with a histologically diagnosed bone sarcoma and 24,378 patients with a histologically diagnosed soft tissue sarcoma from the Surveillance, Epidemiology, and End Results database. We analyzed overall survival (OS), cancer-specific survival (CSS), and non-sarcoma survival (NSS) using the Kaplan–Meier method, log-rank test or Gray test, Cox regression model, propensity score-matched analysis, and landmark analysis.ResultsLSS could improve the prognosis in patients with most EBST subtypes, except for Ewing sarcomas and MPNST. However, in the subgroup without distant metastases, limb salvage increased CSS only for patients with osteosarcoma, Ewing sarcoma, and leiomyosarcoma, as well as NSS for patients with chondrosarcoma and synovial sarcoma. Landmark analysis further demonstrated that sarcoma survivors surviving &lt;10 years could benefit from LSS but not for long-term survivors ≥10 years. Moreover, for patients with distant metastases, LSS could improve survival of osteosarcoma patients but worsen CSS among patients with MPNST. Landmark analysis further demonstrated that LSS improved survival among osteosarcomas patients with distant metastases only within 1 year after surgery. Moreover, patients receiving LSS and those receiving amputation had a high risk of dying from different non-sarcoma diseases during the postoperative follow-up.ConclusionsThe impact of limb salvage on the prognosis of patients depends on the pathological subtype and stage of EBST sarcomas.
Parental Satisfaction and Associated Factors Toward Their Child's Anesthesia Service at a Comprehensive Specialized Referral Hospital in Ethiopia, 2021: A Cross-Sectional Study
Authors: Admass Biruk Adie , Hailemariam Abebaw Shiferaw , Agegnehu Abatneh Feleke , Getahun Amare Belete 
Published: June 2022

BackgroundParental satisfaction is a key measure of the quality of a child's anesthetic care. Understanding of parents' opinions and satisfaction about their child's anesthesia service in the hospital is vital for hospital funding and parent experience.ObjectiveThe purpose of this study was to determine the level of parental satisfaction with their child's anesthetic care and the factors that contributed to that satisfaction.MethodsAn institution-based cross-sectional study was undertaken between March and June 2021. A structured questionnaire with the background characteristics of parents and children was used to collect data. A total of 238 parents were included in the study. To find parameters linked to parental satisfaction with their child's anesthetic service, bi-variable, and multi-variable logistic regression analyses were used. Crude odds ratio and adjusted odds ratio with a 95% confidence interval (CI) were estimated. Variables with a p-value &lt; 0.05 were considered statistically significant in multivariable analysis.ResultThe proportion of parental satisfaction toward their child's anesthesia service was 77.7% (95% CI: 72.3, 82.4%). Non-anxious, male, employed, and urban resident parents and parents of pre-medicated children were associated with high satisfaction scores.Conclusion and RecommendationOverall, parents' satisfaction with their child's anesthesia service was promising. Parents who were non-anxious, male, employed, and lived in an urban area and whose child had received sedative premedication had high rates of parental satisfaction with their child's anesthetic care.Parents from rural areas, as well as worried and female parents, should receive extra care. Preoperative anxiety is reduced when parents are given enough and understandable information. Thus, the provision of comprehensive information on their child's anesthesia care process and psychological or emotional support to parents are necessary to boost their satisfaction.
Predictive Value of Optic Nerve Sheath Diameter for Diagnosis of Intracranial Hypertension in Children With Severe Brain Injury
Authors: Cour-Andlauer Fleur , Portefaix Aurélie , Wroblewski Isabelle , Rabilloud Muriel , Bordet Fabienne , Cogniat Bérengère , Didier Capucine , Pouyau Robin , Valla Frédéric V. , Kassai-Koupai Behrouz , Siméon Gaëlle , Ginhoux Tiphanie , Courtil-Teyssedre Sonia , Javouhey Etienne 
Published: June 2022

Background and AimsIntracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group.MethodsIn this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group.ResultsNinety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3–13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4–9.7] and the median (IQR) PELOD score was 21 [12–22]. Aetiologies of brain injury were trauma (n = 72), infection (n = 17) and stroke (n = 8). ICH occurred in 65 children. The median (IQR) ONSD was 5.58 mm [5.05–5.85]. ONSD performed poorly when it came to predicting ICH occurrence within the first 24 h (area under the curve, 0.58). There was no significant difference between the ONSD of children who presented with ICH within the first 24 h and the other children, with a median (IQR) of 5.6 mm [5.1–5.9] and 5.4 mm [4.9–5.8], respectively. Infants aged less than 2 years had a median (IQR) ONSD of 4.9 mm [4.5–5.2], significantly different from children aged more than 2 years, whose median ONSD was 5.6 mm [5.2–5.9]. Age, aetiology or ICP levels did not change the results. Thirty-one controls were included, with a median age of 3.7 (1.2–8.8) years. The median (IQR) of their ONSD measurement was 4.5 mm [4.1–4.8], significantly lower than the patient group.ConclusionIn a paediatric severe brain injury population, ONSD measurement could not predict the 24 h occurrence of ICH. Severity of patients, timing and conditions of measurements may possibly explain these results.
Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women
Authors: Shen Hsuan-Shu , Chang Wei-Chuan , Chen Yi-Lin , Wu Dai-Lun , Wen Shu-Hui , Wu Hsien-Chang 
Published: June 2022

Introduction: Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan.Materials and Methods: We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18–50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth.Results: The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74–0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65–0.96).Conclusion: We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.
Predicted Vancomycin Dosage Requirement in Patients With Hematological Malignancies and Dosage Dynamic Adjustment
Authors: Song Xiangqing , Wu Yi 
Published: June 2022

Purpose: The purpose of this study was 1) to predict the requisite vancomycin daily dose (Dvan) used in the target patients suffering from both bacterial infection and hematological malignancies and 2) to construct a vancomycin-dose-graphical tool to assist clinicians to develop vancomycin dosing regimens and further 3) to establish a programming process for vancomycin dynamic dosage adjustment to help clinicians to adjust vancomycin dosing regimens according to physiological and pathogenic factors of the target patients.Methods: The Dvan model associated with microbial susceptibility, vancomycin pharmacokinetics, and dosing parameters was established, and the Dvan was estimated based on the established Dvan model and using Monte Carlo simulations. Dvan achieving 90% of probability of target attainment (PTA) for bacterial isolate or cumulative fractions of response (CFR) for the bacterial population at a ratio of daily area under the curve (AUC24) to the minimum inhibitory concentration (MIC) [i.e., AUC24/MIC] of 400–600 was considered sufficient to treat infection occurring in the target patients. On the basis of the predicted Dvan, the physiological states of patients, and the pathogenic variables of infection, a vancomycin-dose-graphical tool for the target patients and a programming process for vancomycin dynamic dosage adjustment were constructed.Results: This study predicted the requisite Dvan used in patients suffering from both bacterial infection and hematological malignancies and constructed a vancomycin-dose-graphical tool for the target patients, at different physiological states and pathogenic variables, to formulate vancomycin dosing regimens. Also, this study established and expounded the formulation process of vancomycin dosage dynamic adjustment according to fluctuant renal function of the target patients.Conclusion: With the tools, the required Dvan or vancomycin dosing regimens for the target patients, at different physiological states and pathogenic variables, can be readily known, whether or not vancomycin dynamic dosage adjustment is required.
Acute Effects of Low-Intensity Electrical Stimulation on Segmental Arterial Stiffness
Authors: Oda Hiroyuki , Fujibayashi Mami , Matsumoto Naoyuki , Nishiwaki Masato 
Published: June 2022

Electrical muscle stimulation (EMS) has traditionally been employed to improve muscle strength and glucose uptake. EMS may also reduce arterial stiffness, but little is known about whether low-intensity EMS reduces systemic and/or regional arterial stiffness. This study aimed to examine the effects of low-intensity EMS of the lower limbs on segmental arterial stiffness. Fourteen healthy subjects participated in experiments under two different protocols (control resting trial (CT) and electrical stimulation trial (ET)) in random order on separate days. The EMS was applied to the lower limbs at 4 Hz for 20 min at an intensity corresponding to an elevation of approximately 15 beats/min in pulse rate (10.7 ± 4.7% of heart rate reserve). Arterial stiffness was assessed by cardio-ankle vascular index (CAVI), CAVI0, heart-ankle pulse wave velocity (haPWV), brachial-ankle pulse wave velocity (baPWV), heart-brachial pulse wave velocity (hbPWV), and carotid-femoral pulse wave velocity (cfPWV). In both trials, each parameter was measured at before (Pre) and 5 min (Post 1) and 30 min (Post 2) after trial. After the experiment, CT did not cause significant changes in any arterial stiffness parameters, whereas ET significantly reduced CAVI (from Pre to Post 1: −0.8 ± 0.5 unit p &lt; 0.01), CAVI0 (from Pre to Post 1: −1.2 ± 0.8 unit p &lt; 0.01), haPWV (from Pre to Post 1: −47 ± 35 cm/s p &lt; 0.01), and baPWV (from Pre to Post 1: −120 ± 63 cm/s p &lt; 0.01), but not hbPWV or cfPWV. Arm diastolic blood pressure (BP) at Post 2 was slightly but significantly increased in the CT compared to Pre or Post 1, but not in the ET. Conversely, ankle diastolic and mean BPs at Post 1 were significantly reduced compared to Pre and Post 2 in the ET (p &lt; 0.01). These findings suggest that low-intensity EMS of the lower limbs reduces arterial stiffness, but only in sites that received EMS.
Exaggerated Ventilator-Induced Lung Injury in an Animal Model of Type 2 Diabetes Mellitus: A Randomized Experimental Study
Authors: Schranc Álmos , Fodor Gergely H. , Südy Roberta , Tolnai József , Babik Barna , Peták Ferenc 
Published: June 2022

Although ventilator-induced lung injury (VILI) often develops after prolonged mechanical ventilation in normal lungs, pulmonary disorders may aggravate the development of adverse symptoms. VILI exaggeration can be anticipated in type 2 diabetes mellitus (T2DM) due to its adverse pulmonary consequences. Therefore, we determined whether T2DM modulates VILI and evaluated how T2DM therapy affects adverse pulmonary changes. Rats were randomly assigned into the untreated T2DM group receiving low-dose streptozotocin with high-fat diet (T2DM, n = 8), T2DM group supplemented with metformin therapy (MET, n = 8), and control group (CTRL, n = 8). In each animal, VILI was induced by mechanical ventilation for 4 h with high tidal volume (23 ml/kg) and low positive end-expiratory pressure (0 cmH2O). Arterial and venous blood samples were analyzed to measure the arterial partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and the intrapulmonary shunt fraction (Qs/Qt). Airway and respiratory tissue mechanics were evaluated by forced oscillations. Lung histology samples were analyzed to determine injury level. Significant worsening of VILI, in terms of PaO2, SaO2, and Qs/Qt, was observed in the T2DM group, without differences in the respiratory mechanics. These functional changes were also reflected in lung injury score. The MET group showed no difference compared with the CTRL group. Gas exchange impairment without significant mechanical changes suggests that untreated diabetes exaggerates VILI by augmenting the damage of the alveolar–capillary barrier. Controlled hyperglycemia with metformin may reduce the manifestations of respiratory defects during prolonged mechanical ventilation.
Prognosis for Young Females with Pseudomyxoma Peritonei of Appendiceal Origin and Unilateral or Bilateral Ovaries Preserved During Cytoreductive Surgery
Authors: Fu Fengxian , Tang Huangdong , Lu Yiyan , Lu Dongmei , Ma Ruiqing 
Published: June 2022

ObjectiveTo determine prognosis for young female patients with peritoneal pseudomyxoma (PMP) of appendiceal origin and unilateral or bilateral ovaries preserved during cytoreductive surgery (CRS).MethodsClinical data of female patients treated with CRS with or without hyperthermic intraperitoneal chemotherapy (HIPEC) at the Aerospace Center Hospital, Beijing between January, 2009 and December, 2019 were retrospectively reviewed. Patients had no changes in the bilateral ovaries on gross pathological observations or biopsy during CRS, and normal ovarian function. The demographic and clinical characteristics and prognosis of women with ovaries preserved (ovarian preservation group) or resected (ovarian resection group) during CRS were compared. Independent prognostic factors for survival were identified using univariate and multivariate analysis.Results40 patients were included in the final analysis. 19 patients chose ovarian preservation while 21 patients underwent ovarian resection. Completeness of cytoreduction (CCR) scores were CCR-0/1. There were significant differences in age (&lt;40 vs. ≥40), symptoms, intraoperative HIPEC (Y vs. N), and histopathologic subtype of PMP (low-grade vs. high-grade) (p &lt; 0.001) between patients in the ovarian preservation and ovarian resection groups. In the ovarian preservation group, median overall survival (OS) was 59 months (range, 53–65 months), and the 5-year survival rate was 37.9%. Median disease-free survival (DFS) was 13 months (range, 9–17 months), and the 5-year recurrence rate was 87.4%. In the ovarian resection group, the 5-year survival rate was 87.7%, and the 5-year recurrence rate was 18.3%. Median OS and median DFS were not reached. In patients with low-grade PMP, median DFS was significantly longer in patients with ovarian resection compared to ovarian preservation (p &lt; 0.001). Univariate analysis showed histopathologic subtype of PMP (low-grade vs. high-grade, p &lt; 0.001) was significantly associated with OS and DFS. On multivariate analysis, high-grade histopathologic subtype of PMP was an independent predictor of poor prognosis (OS and DFS).ConclusionHistopathologic subtype of PMP represents an independent predictor of prognosis in female patients with PMP of appendiceal origin and unilateral or bilateral ovaries preserved during CRS. These findings imply that ovarian preservation is a more suitable option for young females with low-grade PMP compared to high-grade PMP. Further prospective studies should be done investigating the role of resection of uninvolved ovaries in PMP.
‘I guess I’ll wait to hear’—communication of blood test results in primary care a qualitative study
Authors: Watson Jessica , Salisbury Chris , Whiting Penny F , Hamilton William T , Banks Jonathan 
Published: June 2022

BackgroundRates of blood testing in primary care are rising. Communicating blood test results generates significant workload for patients, GPs, and practice staff.AimTo explore GPs’ and patients’ experience of systems of blood test communication.Design and settingQualitative interviews with patients and GPs in UK primary care in both urban and rural practices in the West of England.MethodA total of 28 patients and 19 GPs from six practices were recruited, with a range of socioeconomic and demographic characteristics. Patients were interviewed at two time points: a) at or soon after their blood test and b) after they had received their test results. The GPs who requested the tests were also interviewed (they could complete a maximum of two interviews about different patients). Eighty qualitative interviews were undertaken; 54 patient interviews and 26 GP interviews.ResultsMethods of test result communication varied between doctors and were based on habits, unwritten heuristics, and personal preferences rather than protocols. Doctors expected patients to know how to access their test results. In contrast, patients were often uncertain and used guesswork to decide when and how to access their tests. Patients and doctors generally assumed that the other party would make contact, with potential implications for patient safety. Text messaging and online methods of communication have benefits, but were perceived by some patients as ‘flippant’ or ‘confusing’. Delays and difficulties obtaining and interpreting test results can lead to anxiety and frustration for patients.ConclusionCurrent systems of test result communication are complex and confusing, and mostly based on habits and routines rather than clear protocols. This has important implications for patient-centred care and patient safety.