bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Perspectives on Reducing Curative Cancer Treatment Intensity for Populations Underrepresented in Clinical Trials
Authors: Rocque Gabrielle B , Andrews Courtney , Lawhon Valerie M , Ingram Stacey A , Frazier Rachel M , Smith Mary Lou , Wagner Lynne I , Zubkoff Lisa , Wallner Lauren P , Wolff Antonio C 
Published: October 2022

Abstract

Background
Historically, clinical trials involved adding novel agents to standard of care to improve survival. There has been a shift to an individualized approach with testing less intense treatment, particularly in breast cancer where risk of recurrence is low. Little is known about physician perspectives on delivering less intense treatment for patients who are not well represented in clinical trials.

Methods
Open-ended, individual qualitative interviews with medical oncologists explored their perspectives on trials that test less intense treatment for patients with cancer, with a focus on breast cancer. Interviews were audio-recorded and transcribed. Four independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted.

Results
Of the 39 participating physicians, 61.5% felt comfortable extrapolating, 30.8% were hesitant, and 7.7% would not feel comfortable extrapolating trial outcomes to underrepresented populations. Facilitators of comfort included the sentiment that “biology is biology” (such that the cancer characteristics were what mattered), the strength of the evidence, inclusion of subset analysis on underrepresented populations, and prior experience making decisions with limited data. Barriers to extrapolation included potential harm over the patient’s lifetime, concerns about groups that had minimal participants, application to younger patients, and extending findings to diverse populations. Universally, broader inclusion in trials testing lowering chemotherapy was desired.

Conclusions
The majority (92%) of physicians reported that they would de-implement treatment for patients poorly represented in clinical trials testing less treatment, while expressing concerns about applicability to specific subpopulations. Further work is needed to increase clinical trial representation of diverse populations to safely and effectively optimize treatment for patients with cancer.

Trial registration
NCT03248258
Clinical Outcomes of Metastatic Breast Cancer in Patients Having Imaging Liver Pseudocirrhosis with or without Evident Varices
Authors: Ma Wei-Li , Chang Dwan-Ying , Lin Ching-Hung , Liu Kao-Lang , Liang Po-Chin , Lien Huang-Chun , Hu Chan-Chuan , Huang Ling-Yun , Yeh Yi-Chun , Lu Yen-Shen 
Published: October 2022

AbstractBackgroundPseudocirrhosis is an imaging finding of malignancies with liver metastasis with or without clinical liver cirrhosis-related portal hypertension (pHTN). This study defined evident pHTN by the presence of esophageal or gastric varices and compared patients’ outcomes of metastatic breast cancer with imaging-diagnosed pseudocirrhosis with or without varices.MethodsThe medical records from patients with metastatic breast cancer and pseudocirrhosis between 2005 and 2017 were retrospectively analyzed. Survival outcomes were compared based on endoscopic evidence of esophageal or gastric varices.ResultsAmong 106 patients with pseudocirrhosis, 33 (31%) had de novo stage IV disease, and 66 (62%) had hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Eighty-one (76%) had initial metastases in both hepatic lobes, and 32 (30%) had esophageal or gastric varices. The median overall survival (OS) was 5 and 13 months in patients with and without varices (P = .002). The median OS in patients with HER2-positive, HR-positive/HER2-negative, and triple-negative subtype was 16, 9, and 2 months, respectively (P = .001). Patients with varices usually had cirrhotic complications, including gastrointestinal bleeding, hyperbilirubinemia, hyperammonemia, and coagulopathy. Despite their challenging clinical conditions, 7 patients with varices had OS exceeding 1 year. In multivariate analysis, evident varices (P = .007) and triple-negative subtype (P = .013) were associated with poor OS.ConclusionsPatients with pseudocirrhosis and evident varices had a significantly shorter median OS, and were usually associated with clinical cirrhosis-related complications. To maximize OS, early identification and meticulous supportive care are warranted.
Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1
Authors: Biswas Raaj Kishore , Farzana Maysha , Bhar Sunil , Bhowmik Jahar 
Published: October 2022

Abstract

Background
Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women’s education to modern contraceptive use.

Methods
Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots.

Results
Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, &lt;50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education.

Discussion
Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.
ESTIMATION OF INDOOR AND OUTDOOR EFFECTIVE DOSES AND LIFETIME CANCER RISK FROM GAMMA DOSE RATES IN AND AROUND MANDYA DISTRICT, KARNATAKA
Authors: Shashikumar T S , Ramachandra M N , Chandrashekar  , Gowda Shivalinge 
Published: October 2022

Abstract
Indoor and outdoor gamma-ray dose rates have been measured in and around Mandya district (12° 20″ N and 77° 20″ E). The measurements were carried out from 45 locations of Mandya district at 1 m above the ground surface for radiometric, geophysical and environmental surveys using a lightweight portable radiation dosemeter ER‑709. The indoor and outdoor absorbed gamma dose rate in air varied from 66.12±0.8 to 131.89±5.5 nGy per h with a geometrical mean value of 97.79±2.6 nGy per h and 45.94±0.7 to 80.39±2.6 nGy per h with a geometrical mean value of 58.75±1.5. The indoor and outdoor effective doses vary from 0.32 to 0.65 mSv per y with a geometric mean value of 0.48 mSv per y and 0.06 to 0.10 mSv per y with a geometric mean value of 0.07 mSv per y which is slightly higher when compared with the worldwide average of the effective doses. The indoor and outdoor excess lifetime cancer risk (ELCR) of residents along the different locations varies from 1.14 × 10−3 to 2.26 × 10−3 with a geometric mean value of 1.68 × 10−3 and 0.20 × 10−3 to 0.35 × 10−3 with a geometric mean value of 0.25 × 10−3 which is similar to the worldwide average of the ELCR.
DESIGN, CONSTRUCTION AND TEST OF GAMMA IONIZATION CHAMBERS
Authors: Zhang Weihua , Zhang Yi , Sun Mingyan , Zhu Meiling , Huang Xianchao , Tong Teng , Li Daowu 
Published: October 2022

Abstract
Ionization chamber is considered as the golden standard for the dosemeter. This work fabricated one graphite-walled and two polymethyl methacrylate (PMMA)-walled ionization chambers, tested respectively and compared their characteristic parameters. The performance of graphite-walled chamber was similar to that of the PMMA-walled chamber. The relative energy response of ionization chambers was lower than 4% from 50 keV to 50 MeV based on the FLUKA code simulation results. The experimental data showed that the ionization chambers performed well in linearity and repeatability. Assuming the chambers sensitive volume and HV bias was constant, the measured maximum saturation absorbed dose of ionization chambers changed with the diameter variation of chambers anode based on the comparison results of two PMMA-walled ionization chambers.
Acclimation of interacting leaf surface traits affects foliar water uptake
Authors: Chin Alana R O , Guzmán-Delgado Paula , Kerhoulas Lucy P , Zwieniecki Maciej A 
Published: October 2022

AbstractAbsorption of water across the surfaces of leaves is an ecologically important aspect of tree physiology. Variation in foliar water uptake capacity depends on environmental conditions when traits associated with the uptake pathway respond to climatic signals. Using a series of experiments, we verify that water enters Sequoia sempervirens (D. Don) Endl. leaves by crossing the cuticle, and show that surface-trait acclimation alters the kinetic parameters of foliar water uptake. Under our experimental conditions, the cuticle was the primary pathway for water entry into the leaf. Exposure to climatic variation may induce surface acclimations, such as increased waxiness, that reduce water-film formation over stomata at the expense of dry-season foliar uptake rates. We found that water uptake is negatively associated with the interaction of leaf-surface wax coverage and stomatal density, and provide an accessible protocol to measure these key traits in Sequoia. Linking absorptive pathways and trait acclimation to physiological performance can provide a foundation for range-wide or genomic investigations of forest interactions with water and a mechanism-centered means to monitor canopy hydraulic parameters over time.
Subspecies at crossroads: the evolutionary significance of genomic and phenotypic variation in a wide-ranging Australian lizard (Ctenotus pantherinus)
Authors: Prates Ivan , Doughty Paul , Rabosky Daniel L 
Published: October 2022

Abstract
Many subspecies were described to capture phenotypic variation in wide-ranging taxa, with some later being found to correspond to divergent genetic lineages. We investigate whether currently recognized subspecies correspond to distinctive and coherent evolutionary lineages in the widespread Australian lizard Ctenotus pantherinus based on morphological, mitochondrial and genome-wide nuclear variation. We find weak and inconsistent correspondence between morphological patterns and the presumed subspecies ranges, with character polymorphism within regions and broad morphological overlap across regions. Phylogenetic analyses suggest paraphyly of populations assignable to each subspecies, mitonuclear discordance and little congruence between subspecies ranges and the distribution of inferred clades. Genotypic clustering supports admixture across regions. These results undermine the presumed phenotypic and genotypic coherence and distinctiveness of C. pantherinus subspecies. Based on our findings, we comment on the operational and conceptual shortcomings of morphologically defined subspecies and discuss practical challenges in applying the general notion of subspecies as incompletely separated population lineages. We conclude by highlighting a historical asymmetry that has implications for ecology, evolution and conservation: subspecies proposed in the past are difficult to falsify even in the face of new data that challenge their coherence and distinctiveness, whereas modern researchers appear hesitant to propose new subspecies.
Achieving and Sustaining Change Through Capacity Building Train-the-Trainer Health Initiatives in Low- and Middle-Income Countries: A Systematic Review
Authors: Snowden Bobbi , Lahiri Shaon , Dutton Rebecca , Morton Lindsay 
Published: October 2022

Introduction:
Given the anticipated health challenges, forecasted deficiencies in the global health workforce, and steady demands to work through resource constraints, effective and efficient training approaches to build capacity are direly needed. Although train-the-trainer (T3) is not a new approach, there has been considerable interest in using it to develop and sustain capacity, particularly in low- and middle-income countries. This systematic review aimed to better understand the factors to achieve and sustain change across multiple countries and levels through T3 approaches.

Methods:
A literature search was conducted of six scholarly, peer-reviewed, and gray literature databases. Data were extracted for the study method, design, characteristics, and implicit or explicit factors related to maximizing the likelihood of achieving and sustaining change. An existing conceptual framework for T3 interventions in global health guided the thematic analysis. The framework consisted of five factors pertinent to capacity building T3 initiatives: Talent, Resources, Alignment, Implementation, and Nurture and Development.

Results:
Twenty-two studies met the inclusion criteria. The T3 training spanned all geographical regions, but interventions were most prevalent in sub-Saharan Africa (46%). Nearly all studies (68%) quantitatively examined change at the individual level (95%), but some studies also explored change at the organizational (77%) and institutional (23%) levels. Implementation and Nurture/Development were the two most salient factors in achieving and sustaining change. The greatest hindrances involved Resources and Context, an additional theme that the data identified.

Discussion:
The findings and recommendations from this first systematic review exploring antecedents influencing change through health-related T3 interventions can inform training and capacity-building investments, improve existing T3 initiatives, and steer planning for future approaches.
Comparative effects of rosuvastatin and atorvastatin on the risk of new-onset diabetes mellitus in patients with acute coronary syndrome receiving percutaneous coronary intervention: a retrospective cohort study
Authors: Jia Cunhui , Tian Rui , Zong Mengzhi , Luan Fangyun , Wang Wenjun , Li Chuanbao 
Published: October 2022

Abstract

Background
Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels. However, the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus (NODM). Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) within 18 months of follow-up.

Methods
A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017. The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk factors of NODM.

Results
In total, 220 patients received rosuvastatin and 168 atorvastatin. The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance, compared with that in the atorvastatin group (7.27% vs. 12.50%, respectively; log-rank P = 0.08). Using Cox proportional hazards models, baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM (HR: 4.56; 95% CI: 2.83–7.36; P < 0.01).

Conclusion
Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.
Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method.
Authors: Helleputte Simon , Spronck Bart , Sharman James E. , Van Bortel Luc , Segers Patrick , Calders Patrick , Lapauw Bruno , De Backer Tine 
Published: October 2022

Objective:
Peripheral blood pressure (BP) waveforms are used for noninvasive central BP estimation. Central BP could assist in cardiovascular risk assessment in patients with type 1 diabetes mellitus (T1DM). However, correct calibration of peripheral BP waveforms is important to accurately estimate central BP. We examined differences in central BP estimated by radial artery tonometry depending on which brachial BP (SBP/DBP vs. MAP/DBP) is used for calibration of the radial waveforms, for the first time in T1DM.

Methods:
A cross-sectional study in T1DM patients without known cardiovascular disease. Radial artery BP waveforms were acquired using applanation tonometry (SphygmoCor) for the estimation of central SBP, central pulse pressure (PP) and central augmentation pressure, using either brachial SBP/DBP or MAP/DBP for the calibration of the radial pressure waveforms.

Results:
Fifty-four patients (age: 46 ± 9.5 years; T1DM duration: 27 ± 8.8 years) were evaluated. Central BP parameters were significantly higher when brachial MAP/DBP-calibration was used compared with brachial SBP/DBP-calibration (7.5 ± 5.04, 7.5 ± 5.04 and 1.5 ± 1.36 mmHg higher central SBP, central PP and central augmentation pressure, respectively, P < 0.001).

Conclusion:
In patients with T1DM, there are significant differences in central BP values estimated with radial artery tonometry, depending on the method used for calibration of the radial waveforms. Brachial MAP/DBP-calibration resulted in consistently higher central BP as compared to using brachial SBP/DBP, leading to patient re-stratification. Hence, the accuracy of noninvasive estimation of central BP by radial tonometry is dependent on calibration approach, and this problem must be resolved in validation studies using an invasive reference standard to determine which method best estimates true central BP.
Progressive solid facial edema: A neglected clue to cutaneous angiosarcoma
Authors: Miao Qiu-Ju , Geng Yi , Wang Yi-Fei , Xu Xiu-Lian 
Published: October 2022

Introduction:
Cutaneous angiosarcoma (CAS), a rare and highly aggressive tumor derived from vascular endothelial cells, has quite poor prognosis and the clinical presentations are occasionally atypical and inconspicuous, frequently leads to the delayed diagnosis.

Case presentation:
We here described an unusual, initial presentation of CAS manifested as solid facial edema and induration, which appeared asymptomatic, unilateral and gradually spread. The histopathological and histochemical results helped confirm the diagnosis and Paclitaxel combined with Bevacizumab was taken for two cycles which had acquired significant relief but suspended for the poor tolerance.

Discussion:
Apart from typical skin lesions observed as single or multiple erythematous to violaceous plaques, papules or nodules that tend to ulcerate or bleed, the CAS occasionally mimics other diseases such as cellulites, rosacea, rhinophyma and , also as we reported, that initiated as inconspicuous but progressive facial edema.

Conclusion:
The field of CAS therapy has been growing rapidly nowadays whereas the survival rate has not yet improved significantly. Early diagnosis is necessary and CAS should be considered when it comes to patients presented with progressive solid facial edema after ruling out common causes.
Syphilitic osteomyelitis in a patient with HIV and cognitive biases in clinical reasoning: A case report
Authors: Kamegai Kohei , Yokoyama Shuhei , Takakura Shunichi , Takayama Yoshihiro , Shiiki Soichi , Koyama Hirofumi , Narita Masashi 
Published: October 2022

Rationale:
Diagnosing multifactorial, multidimensional symptoms unexplained by presumptive diagnosis is often challenging for infectious disease specialists.

Patient concerns:
We report a rare case of a 30-year-old Japanese bisexual man with a history of virally suppressed human immunodeficiency virus and syphilis infections who developed chest pain and an erosive lesion under the lower midline jaw.

Diagnosis:
Imaging examinations revealed erosive lesions on the sternum and left the ninth rib. Biopsy and polymerase chain reaction testing of sternal tissue specimens were noncontributory. However, due to elevated rapid plasma regain levels, a diagnosis of syphilitic osteomyelitis and gumma of the jaw was made.

Interventions:
The patient was treated with 5 weeks of intravenous ceftriaxone and then with 8 weeks of oral amoxicillin.

Outcome:
After the antibiotic treatment, bone pain disappeared. We conducted a literature review on syphilitic osteomyelitis, and all of the articles included were case reports. Approximately half of the 46 patients with syphilitic osteomyelitis had HIV coinfection, and 10 (22%) patients lacked signs of early syphilis. Given its rarity, clinical data to establish appropriate guidelines for diagnosing and treating syphilitic osteomyelitis are still lacking. Cognitive biases, such as anchoring, cognitive overload bias, and premature closure, may contribute to diagnostic delays.

Lessons:
In cases of idiopathic multiple bone lesions, syphilis must always be ruled out, and clinicians should guard against cognitive pitfalls when diagnosing rare diseases.
Thoracic perfusion of lobaplatin combined with endostar for treating malignant pleural effusions: A meta-analysis and systematic review
Authors: Wang Cheng-Qian , Liu Fei-Yu , Wang Wei 
Published: October 2022

Introduction:
Lobaplatin is a new platinum-based cytotoxic chemotherapeutic agent. Endostar is an endogenous angiogenic inhibitor with implicated anti-tumor activity. This study was to investigate the efficacy and safety of thoracic perfusion of lobaplatin combined with endostar in the treatment of malignant pleural effusions (MPE).

Methods:
We searched the databases of Pubmed, the Cochrane Library, Embase, WanFang Data, and CNKI to select the studies regarding the efficacy and safety of lobaplatin combined with endostar to treat MPE. A total of 10[3–12] randomized controlled trials with 651 patients were included.

Results:
The objective response rate (P < .001, odds ratio = 4.08) and disease control rate (P < .001, odds ratio = 3.69) of lobaplatin combined with endostar were significantly higher than lobaplatin alone. In addition, lobaplatin combined with endostar remarkably promoted the quality of life of patients (P < .001, odds ratio = 3.93) compared with lobaplatin alone. Lobaplatin combined with endostar also promoted the quality of life of patients (P < .05, odds ratio = 2.56) compared with cisplatin combined with endostar. At the same time, the leukopenia rate (P < .05, odds ratio = .40) and the incidence of nausea and vomiting (P < .05, odds ratio = .38) of lobaplatin combined with endostar were significantly lower than that of cisplatin combined with endostar.

Conclusions:
The efficacy of lobaplatin combined with endostar was superior to lobaplatin alone. The safety was higher than cisplatin combined with endostar through thoracic perfusion in treating MPE, which indicated that lobaplatin combined with endostar could be the effective agent for controlling MPE.