Peer Review Research Articles

Vebreltinib for Advanced Non-Small Cell Lung Cancer Harboring c-Met Exon 14 Skipping Mutation: A Multicenter, Single-Arm, Phase II KUNPENG Study.

The KUNPENG study aimed to evaluate the efficacy and safety of vebreltinib (also known as bozitinib, APL-101, PLB-1001, and CBT-101), a potent and highly selective inhibitor of c-mesenchymal-epithelial transition (MET), in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring c-Met alterations. This multicenter, multicohort, open-label, single-arm, phase II trial enrolled patients with c-Met dysregulated, locally advanced or metastatic NSCLC from January 2020 to August 2022 across 17 centers. Cohort 1 included patients with MET exon 14 skipping (METex14)-mutant NSCLC who had not previously received MET inhibitors. Participants were administered vebreltinib at a dosage of 200 mg twice a day in 28-day cycles. The primary end point was the objective response rate (ORR), and the key secondary end point was the duration of response (DoR), both evaluated by a blinded independent review committee according to the RECIST version 1.1. As of August 9, 2022, 52 patients had been enrolled in cohort 1, of whom 35 (67.3%) were treatment-naïve. The ORR reached 75% (95% CI, 61.1 to 86). Among treatment-naïve patients, the ORR was 77.1% (95% CI, 59.9 to 89.6), and in previously treated patients, it was 70.6% (95% CI, 44.0 to 89.7). The disease control rate was 96.2%, with a median DoR of 15.9 months, a median progression-free survival of 14.1 months, and a median overall survival of 20.7 months. The most common treatment-related adverse events were peripheral edema (82.7%), QT prolongation (30.8%), and elevated serum creatinine (28.8%). Vebreltinib has shown promising efficacy and a favorable safety profile in patients with METex14-mutant NSCLC.

High Lumbar Spinal Fusion Rates Using Cellular Bone Allograft Irrespective of Surgical Approach.

Mounting evidence demonstrates a promising safety and efficacy profile for spinal fusion procedures using cellular bone allograft (CBA). However, limited data exists on fusion outcomes stratified by surgical approach. The current study investigates the effectiveness of CBA in lumbar spinal fusion by surgical approach (ie, anterior, lateral, and posterior approaches). Patients undergoing lumbar spinal fusion with CBA (Trinity Elite) were enrolled into a prospective, multi-center, open-label clinical study (NCT02969616). Fusion status was assessed by an independent review of dynamic radiographs and computed tomography images. Clinical outcome measures included quality of life (QoL; EQ5D), disability (Oswestry Disability Index [ODI]), and pain (visual analog scale [VAS]) for back pain and leg pain). Patient data extending to 24 months were analyzed in a post-hoc analysis. A total of 252 patients underwent interbody fusion (159 women; 93 men). Patients had a mean age of 58.3 years (SD 12.5), height of 168.3 cm (SD 10.2), and weight of 87.3 kg (SD 20.0) with a body mass index of 30.8 kg/m2 (SD 6.5). At 12 months, the overall fusion success rate for bridging bone was 98.5%; fusion success was 98.1%, 100.0%, and 97.9% for anterior, lateral, and posterior approaches, respectively. At 24 months, the overall fusion success rate for bridging bone was 98.9%; fusion success was 97.9%, 100.0%, and 98.8% for anterior, lateral, and posterior approaches, respectively. The surgical approach did not significantly impact fusion success. A significant (P < 0.0001) improvement in QoL, pain, and disability scores was also observed. Significant differences in the ODI, VAS, and EQ5D were observed between the treatment groups (P < 0.05). CBA represents an attractive alternative to autograft alone, reporting a high rate of successful fusion and clinical outcomes across various surgical approaches. The use of CBA for spinal fusion procedures, regardless of surgical approach, provides high rates of fusion with a favorable safety profile and improved patient outcomes. NCT02969616.

Providing Performance Feedback and Patient Outcome Follow-Up to Emergency Medical Services (EMS) is Associated with Subsequent Improved Clinical Performance

Objective Emergency Medical Services (EMS) clinicians desire performance feedback (PF) and patient outcome follow-up (POF). Within our agency, both a peer-review and feedback/outcome (PF/POF) process exist. Our objective was to determine whether receiving feedback and outcome data improved future clinical care amongst EMS, based upon peer-review scores. Methods This retrospective cohort study took place between 1/1/2020 and 6/7/2023 within an EMS agency site with 22,000 average annual 9-1-1 calls. Requests for PF/POF were submitted on an individual basis beginning June 2020 and completed by a dedicated EMS nurse, EMS physician, or emergency medicine (EM) resident. Peer-review of select high-acuity cases were scored by two Quality Assurance (QA) specialists within the categories of assessment, treatment, disposition/outcome and process/administrative guidelines. Association between overall peer-review score and number of PF/POF requests at time of assessment was evaluated by linear regression. Results A total of 378 PF/POF requests were received, with the most common patient complaints being cardiac (n = 105; 27.8%, including 49 (13.0%) out of hospital cardiac arrests), altered mental status/neurologic (n = 103; 27.2%), trauma (n = 61; 16.1%, including 2 (0.5%) traumatic arrests); and respiratory distress (n = 47; 12.4%). A total of 378 runs meeting QA criteria were peer-reviewed post-PF/POF process implementation, including 337 (89.2%) cardiac/respiratory arrests, 27 (7.1%) with difficult airway management, and 14 (3.7%) major trauma/traumatic arrests. The number of prior PF/POF requests made by the team leader was associated with higher overall peer-review scores. Team leaders with >5 prior PF/POF requests had a peer-review score 0.39 points greater (95% CI: 0.16 − 0.62, p = 0.001) than those with <5 prior requests. The number of prior PF/POF requests amongst the entire crew was also associated with higher peer-review scores. Crews that collectively had >5 prior PF/POF requests had an increase in peer-review score 0.32 points greater (95% CI: 0.14 − 0.50, p < 0.001) than those with <5 prior requests. Conclusion Providing performance feedback and patient outcome follow-up to EMS is associated with improved peer-review scores of clinical performance. Future studies should assess if those that are submitting cases for feedback/outcome are higher performers at baseline or if the process of receiving feedback/outcome improves their performance.

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers.

Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

Government size, institutional quality and economic welfare in Africa

PurposeMost African countries operate large government sizes but with little corresponding economic outcomes. Institutional economics however, show that strong institution is fundamental in promoting economic growth. This study examines the linkages between government size, institutional quality and economic welfare in Africa.Design/methodology/approachThis study deploys the System Generalized Method of Moments estimation strategy on panel data of 52 African economies from 2000–2018.FindingsThe result shows that government size has a negative impact on economic welfare, while institutional quality has a positive impact on economic welfare. The interaction of government size and institutional quality shows a positive impact on economic welfare, signifying synergy and complementarity. Thus, strong institutions counteract the adverse effects of large government size on economic welfare.Practical implicationsTo promote human development and economic welfare, and attain key Sustainable Development Goals such as good health and well-being, quality education, decent work and economic growth, African policy makers need to keep their government sizes at optimal levels and promote strong institutions.Originality/valueThis paper provides first-hand empirical evidence of the relevance of institutional quality in counteracting the adverse influence of large government size in Africa. It determines the thresholds of government size and uses a composite index as proxy for same. In addition, this study uses the World Governance Indicators and the Fraser Institute Economic Freedom Index as alternative measures of institutional quality and Gross Domestic Product per capita and Human Development Index as proxies for economic welfare.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2024-0075

Want to try a registered report? Here are our lessons learned.

A Registered Report is a type of research journal article in which the introduction, methods, and analysis plan are proposed and peer-reviewed prior to the execution of the study. The goal is to limit publication bias based on study findings by conducting peer review on the merits of the study before the results are known. First introduced in 2012 (Chambers, 2013; Chambers & Tzavella, 2022), this format of journal article publication has become more commonplace. Here we provide an overview of the format as well as eight core lessons we learned while preparing Registered Reports. We integrate guidelines from the literature with our experience to provide insight into the process of preparing and publishing a Registered Report for those who have not yet tried it. Though Registered Reports require researchers to invest more effort at the earlier stages of idea generation, design, and analysis planning, they will benefit from the feedback of reviewers when it is most beneficial and leave behind the fear of rejection due to unanticipated study limitations or null results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Challenges, experiences, and potential supports for East and Southeast Asian mothers in the workforce: a systematic review

ObjectiveTo examine the challenges faced by Asian working mothers with a focus on re-entry to the workplace. In addition, we highlight potential supports that retain women in the workforce.DesignA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO database (CRD42022341130).MethodsThree independent reviewers were involved in the study selection to screen the search results sequentially by title, abstract, and full text using predefined inclusion and exclusion criteria. The methodological quality of each article was assessed via the Critical Appraisal Skills Programme (CASP) tool.ResultsWe analysed a total of 36 studies conducted across different regions: 30 from the East and 6 from Southeast Asia. Among these studies, 20 were quantitative in nature, 15 were qualitative, and one intervention. The 36 studies cover five themes: 1) policies, 2) external support sources, 3) external pressure, 4) breastfeeding and 5) health status. Within each theme the same factor can have a positive or negative impact on the mother depending on her having a pro-career or pro-family mindset.Companies can take various initiatives to support working mothers, such as providing facilities for expressing breast milk at the workplace, educating staff to promote breastfeeding and accommodate childcare needs, and extending maternity leaves. However, there is a lack of literature that directly addresses the barriers and concrete support available to working mothers in Asia, beyond the scope of breastfeeding.ConclusionsOur findings underscore several obstacles that can impede a woman's seamless return to work. Pro-family and pro-career mothers have differing needs that cannot be addressed at the same time. There is a lack of comprehensive understanding regarding effective strategies or interventions that can support a positive reintegration into the workforce.

Bintrafusp Alfa for Recurrent or Metastatic Cervical Cancer After Platinum Failure

Cervical cancer is a common and lethal cancer worldwide. Bintrafusp alfa is a first-in-class bifunctional fusion protein composed of the extracellular domain of the human transforming growth factor β receptor II (or transforming growth factor β trap) fused via a flexible linker to the C-terminus of each heavy chain of an immunoglobulin G1 antibody blocking programmed cell death 1 ligand 1. To evaluate the safety and response rates of bintrafusp alfa in patients with recurrent or metastatic cervical cancer. This phase 2 nonrandomized controlled trial evaluated bintrafusp alfa monotherapy in patients with recurrent or metastatic cervical cancer with disease progression during or after platinum-based chemotherapy. Data were collected from March 2020 to February 2022. Patients received bintrafusp alfa, 1200 mg, intravenously once every 2 weeks. The primary end point was confirmed objective response rate per Response Evaluation Criteria in Solid Tumors version 1.1 by an independent review committee. At data cutoff, 146 of 203 screened patients received 1 or more doses of bintrafusp alfa; of these, the median (range) age was 53 (24-79) years. The study met its primary end point of a 95% CI above the objective response rate benchmark of 15%, with a confirmed objective response rate of 21.9% (95% CI, 15.5-29.5) per the independent review committee. Of these patients, 19 (59.4%) had a durable response of 6 months or more. At data cutoff, responses were ongoing in 13 of 32 responders (40.6%). The most common treatment-related adverse events were anemia (25 [17.1%]), rash (21 [14.4%]), hypothyroidism (15 [10.3%]), and pruritus (15 [10.3%]). Any-cause adverse events of special interest included anemia (82[56.2%]), bleeding events (81 [55.5%]), and immune-related adverse events (49 [33.6%]). This phase 2 nonrandomized controlled trial of bintrafusp alfa met its primary end point, which may support the potential of a bispecific therapy targeting transforming growth factor β and programmed cell death 1 ligand 1 in patients with recurrent or metastatic cervical cancer. ClinicalTrials.gov Identifier: NCT04246489.

Validity of different algorithmic methods to identify hospital readmissions from routinely coded medical data.

Hospital readmission rates are used for quality and pay-for-performance initiatives. To identify readmissions from administrative data, two commonly employed methods are focusing either on unplanned readmissions (used by the Centers for Medicare & Medicaid Services, CMS) or potentially avoidable readmissions (used by commercial vendors such as SQLape or 3 M). However, it is not known which of these methods has higher criterion validity and can more accurately identify actuallyavoidable readmissions. A manual record review based on data from seven hospitals was used to compare the validity of the methods by CMS and SQLape. Seven independent reviewers reviewed 738 single inpatient stays. The sensitivity, specificity, positive predictive value (PPV), and F1 score were examined to characterize the ability of an original CMS method, an adapted version of the CMS method, and the SQLape method to identify unplanned, potentially avoidable, and actually avoidable readmissions. Both versions of the CMS method had greater sensitivity (92/86% vs. 62%) and a higher PPV (84/91% vs. 71%) than the SQLape method, in terms of identifying their outcomes of interest (unplanned vs. potentially avoidable readmissions, respectively). To distinguish actuallyavoidable readmissions, the two versions of the CMS method again displayed higher sensitivity (90/85% vs. 66%), although the PPV did not differ significantly between the different methods. Thus, the CMS method has both higher criterion validity and greater sensitivity for identifying actually avoidable readmissions, compared with the SQLape method. Consequently, the CMS method should primarily be used for quality initiatives.

Discontinuation versus continuation of statins: A systematic review.

Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all-cause mortality, cardiovascular [CV] mortality, CV events, and quality of life). We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case-control studies, and quasi-randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta-analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years. We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (n = 1,708,684) and 1 RCT (n = 381). The 1 RCT was conducted among persons with life expectancy <1 year and showed there is probably no difference in 60-day mortality (risk difference = 3.5%, 90% CI -3.5 to 10.5) for statin discontinuation compared with continuation. Non-randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non-randomized studies due to methodological limitations. Statin discontinuation does not appear to affect short-term mortality near end-of-life based on one RCT. Outside of this population, findings from non-randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain.

Post-procedural infection rate after minor surgical procedures performed with and without sterile gloves: a systematic review and meta-analysis.

Post-procedural infection has been a top priority for the perioperative team. The use of sterile gloves to counter this became popular and was routinely used, but randomized studies have shown that the benefit that was thought to be added by the use of sterile gloves is insignificant and that not all procedures require the use of sterile gloves. Prospective protocol registration was and electronic databases were searched without using any search filters. Screening was performed by independent reviewers, and data was extracted from selected studies. Heterogeneity was assessed by the I2 test, and the effect model was chosen accordingly. The odds ratio was used as an effect measure as the variables in this study were dichotomous. Forest plots and funnel plots were used to give visual feedback. This meta-analysis included 14 comparative studies that involved a total of 12625 patients. Analysis of post-procedural infection outcome showed no significant difference between the procedure performed using sterile gloves and without using sterile gloves (OR: 0.88; 95% CI: 0.71-1.10; n=12625; I2=0%; P-value=0.26). Sensitivity analysis and subgroup analysis for randomized studies only, surgical site infection, and patients that did not receive prophylactic antibiotics showed no variations. The use of sterile gloves did not show any extra benefit for controlling infection during wound repair, excision and suturing, cystoscopy, and urinary catheterization. The use of sterile gloves does not have any extra benefit for preventing infections when minor surgical procedures are performed.

Which patients need anterior cruciate ligament reconstruction after initial treatment with rehabilitation? A scoping review.

Some patients with anterior cruciate ligament (ACL) injury initially treated with rehabilitation need ACL reconstruction (ACLR); yet, it is unclear what characterizes these patients. This review aimed to describe predictors for ACLR in patients initially treated with rehabilitation. A systematic literature search was performed in the Cochrane, Embase, Medline, SportsDiscus and Web of Science databases from inception to 21 February 2023. Articles describing characteristics in adult patients with ACL injury undergoing ACLR after a minimum of 5 weeks rehabilitation were included. It was a priori chosen that characteristics described in at least three articles were considered more certain and could be defined as a predictor for ACLR, and those described in less than three articles were considered less certain and therefore defined as possible predictors. Articles were screened by two independent reviewers. The study was originally intended as a systematic review with meta-analysis, but in case of limited data, we would convert it to a scoping review, as was the case for this review. There were 22,836 studies identified, and 181 full texts were screened, of which 10 papers were finally included. Only lower age and higher preinjury activity level were identified as predictors for ACLR. Another 12 possible predictors were identified in single studies. Through an iterative process, potential predictors were categorized into four groups: patient demographics, knee function, patient-reported outcome measures and anatomical structures. Lower age and higher preinjury activity level were the only predictors for ACLR after initial treatment with rehabilitation. While younger and highly active patients show a higher need for ACLR, more studies focussing on predictors and reasons for delayed ACLR are warranted. Level II.

Surgeon Gender and Early Complications in Elective Surgery: A Systematic Review and meta-analysis.

To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery. Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes. MEDLINE and Embase were searched in October 2023 for observational studies including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model. Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7,072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95 to 1.00; I2=64.9%; P=0.001). These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, healthcare providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.

Reviewer Acknowledgements for World Journal of English Language, Vol. 14, No. 5

World Journal of English Language wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal are greatly appreciated.World Journal of English Language is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please contact us for the application form at: wjel@sciedupress.comReviewers for Volume 14, Number 5Abderrazak Zaafour, Almería University, SpainAbdul Syahid, Institut Agama Islam Negeri Palangka Raya, IndonesiaAbdulfattah Omar, The Australian National University, AustraliaAby John, RUDN University, IndiaAcep Unang Rahayu, Poltekpar NHI Bandung, IndonesiaAli Hussein Hazem, University of Patras, GreeceAna Maria Costa Lopes, Higher School of Education of the Polytechnic Institute of Viseu, PortugalAnna Maria Kuzio, University of Zielona Gora, PolandAntonio Piga, University of Cagliari, ItalyAravind B R, Kalasalingam Academy of Research and Education, IndiaAshraf Mansour, Jerash Private University, JordanAtyaf Hasan Ibrahim, Al Iraqia University, IraqAyman Khafaga, Suez Canal University, EgyptBadri Abdulhakim Mudhsh, University of Technology and Applied Sciences, OmanBeibei Ren, University of South Florida, USABerhane Gerencheal, Aksum University, EthiopiaChristian Jay Olandria Syting, University of Mindanao, PhilippinesDon Anton Balida, International College of Engineering and Management, OmanElsadig Hussein Fadlalla Ali, King Khalid University, Saudi ArabiaGhazwan Mohammed Saeed Mohammed, University of Bisha, Saudi ArabiaHerman, Universitas HKBP Nommensen Pematangsiantar, IndonesiaHiyam Al-Badareen, Al al-Bayt University , JordanHossein Salarian, University of Tehran, IranHouaria Chaal, Hassiba Ben Bouali University of Chlef, AlgeriaHussain Hamid Ali Ghazzaly, Al-Azhar University, EgyptInayatullah Kakepoto, Quaid-e-Awam University of Engineering Science &amp; Technology, Nawabshah, PakistanJânderson Coswosk, Instituto Federal do Espírito Santo, BrazilJergen Jel A. Cinco- Labaria, Western Philippines University, PhilippinesKristiawan Indriyanto, Universitas Prima Indonesia, IndonesiaL. Santhosh Kumar, Kristu Jayanti College (Autonomous), IndiaLeila Lomashvili, Shawnee State University, USALihong Ding, Lanzhou University of Arts and Sciences, ChinaMaroua Benhamlaoui, University of Fréres Mentouri- Constantine 1 , AlgeriaMelania Terrazas Gallego, University of La Rioja, SpainMohamad Amin Shirkhani, University of sistan and baluchestan, IranMohamad Fadhili bin Yahaya, Universiti Teknologi Mara Perlis Branch, MalaysiaMounir Jilani Ben Zid, Sultan Qaboos University, OmanMozhgan Ghassemiazghandi, Universiti Sains Malaysia, MalaysiaMuhammed Ibrahim Hamood, University of Mosul, IraqNitin Malhotra, Amity University Madhya Pradesh, IndiaNuriadi Nuriadi, University of Mataram, IndonesiaOlena Andrushenko, Universität Augsburg, GermanyOmsalma Ahmed, University of Hail, Saudi ArabiaÖzkanal, Ümit, Eskisehir Osmangazi University, TurkeyP. Jayakumar, St. Joseph’s College of Engineering, IndiaPatsawut Sukserm, Chulalongkorn University Language Institute (CULI), ThailandPrincess H. Policarpio, Angeles University Foundation , PhilippinesRamesh Manickkam, Vel Tech Rangarajan Dr. Sagunthala R&amp;D Institute of Science and Technology, IndiaS. Priya, Subbalakshmi Lakshmipathy College of Science, IndiaS. Sakthivel, B.S. Abdur Rahman Crescent Institute of Science and Technology, IndiaS. V. Dhanawade, Vivekanand College(Autonomous) Kolhapur, IndiaSafi Eldeen Alzi’abi, Jerash University, JordanSaif Ali Abbas Jumaah, University of Mosul, IraqSantri Djahimo, Nusa Cendana University, IndonesiaSara Mansouri, Islamic Azad University-Najafabad branch, IranŞenel, Müfit, 19 Mayıs University, TurkeyServais Dieu-Donné Yédia DADJO, University of Abomey-Calavi, BeninShalini Yadav, Compucom Institute of Technology and Management, IndiaShangrela Genon-Sieras, Mindanao State University, Main Campus, PhilippinesSohaib Alam, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi ArabiaSonthaya Rattanasak, Rajamangala University of Technology Suvarnabhumi, ThailandTelal Mirghani Khalid, Ministry of Education and Higher Education, QatarWahaj Unnisa Warda, Prince Sattam Bin Abdulaziz University, Saudi ArabiaZijun SHEN, Sichuan University of Media and Communications, China

External Testing of a Deep Learning Model to Estimate Biological Age Using Chest Radiographs.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To assess the prognostic value of a deep learning-based chest radiographic age (CXR-Age) model in a large external test cohort of Asian individuals. Materials and Methods This single-center, retrospective study included chest radiographs from consecutive, asymptomatic Asian individuals aged 50 to 80 who received health check-ups between January 2004 and June 2018. This study performed a dedicated external test of the previously developed CXR-Age model, which predicts an age adjusted based on the risk of all-cause mortality. Adjusted hazard ratios (HRs) of CXR-Age for all-cause, cardiovascular, lung cancer, and respiratory disease mortality were assessed using multivariable Cox or Fine-Gray models, with their added values evaluated by likelihood ratio tests. Results A total of 36,924 individuals (mean chronological age ± SD, 58 ± 7 years; CXR-Age, 60 ± 5 years; 22,352 male) were included. Over a median follow-up of 11.0 years, 1250 individuals (3.4%) died, including 153 cardiovascular (0.4%), 166 lung cancer (0.4%), and 98 respiratory deaths (0.3%). CXR-Age was a significant risk factor for all-cause (adjusted HR at the chronological age of 50 years: 1.03; at 60 years: 1.05; at 70 years: 1.07), cardiovascular (adjusted HR: 1.11), lung cancer (adjusted HR for former smokers: 1.12; for current smokers: 1.05), and respiratory disease mortality (adjusted HR: 1.12) (all P values < 0.05). The likelihood ratio test demonstrated added prognostic value of CXR-Age to clinical factors including chronological age for all outcomes (all P values < 0.001). Conclusion Deep learning-based chest radiographic age was associated with various survival outcomes and had added value to clinical factors in asymptomatic Asian individuals, suggesting its generalizability. ©RSNA, 2024.

Anatomy-specific Progression Classification in Chest Radiographs via Weakly Supervised Learning.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To develop a machine learning approach for classifying disease progression in chest radiographs using weak labels automatically derived from radiology reports. Materials and Methods In this retrospective study, a twin neural network was developed to classify anatomy-specific disease progression into four categories: improved, unchanged, worsened, and new. A two-step weakly-supervised learning approach was employed, pretraining the model on 243,008 frontal chest radiographs from 63,877 MIMIC-CXR patients (mean age 51.7 years; female 34,813), and fine-tuning it on the subset with progression labels derived from consecutive studies. Model performance was evaluated for six pathologic observations on test datasets of unseen MIMIC-CXR patients. Area under the receiver operating characteristic (AUC) analysis was used to evaluate classification performance. The algorithm is also capable of generating bounding-box predictions to localize areas of new progression. Recall, precision, and mean average precision (mAP) were used to evaluate the new progression localization. One-tailed paired t tests were used to assess statistical significance. Results The model outperformed most baselines in progression classification, achieving macro AUC scores of 0.72 ± 0.004 for atelectasis, 0.75 ± 0.007 for consolidation, 0.76 ± 0.017 for edema, 0.81 ± 0.006 for effusion, 0.7 ± 0.032 for pneumonia, and 0.69 ± 0.01 for pneumothorax. For new observation localization, the model achieved mAP scores of 0.25 ± 0.03 for atelectasis, 0.34 ± 0.03 for consolidation, 0.33 ± 0.03 for edema, and 0.31 ± 0.03 for pneumothorax. Conclusion Disease progression classification models were developed on a large chest radiograph dataset, which can be used to monitor interval changes and detect new pathologies on chest radiographs. ©RSNA, 2024.

ASSESSMENT OF 16-YEAR-OLD FEMALE BASKETBALL PLAYERS WITH CHRONOJUMP SYSTEM

In the basketball game, lower extremity strength plays a key role in various game actions. The jumping mat (Chronojump), an open-source (free software and open hardware), is available to the public on official servers, emphasizing peer review and corrections by the user community. The aim of this study was to establish the explosive power of the lower limbs of 16-year-old female basketball players from the Bulgarian National Basketball Team. We used specialized software, a signal transducer, and an electro-contact mat Chronojump. The subject of the study was the explosive power of the lower limbs of 16-year-old female basketball players from the national team of Bulgaria. The object of the study was the performance of the Chronojump platform tests to establish the explosive strength of the lower limbs. The study was conducted among 16 active female basketball players selected for the Bulgarian national team. Each participant performed all jumps at the same time of day. They performed CMJ - 90-degree squat jump; SJ - Squat, two-second hold, and jump; CMJAT - Jump with arms extended forward and up; RCMJ - Manipulative 90-degree squat jump; Stiff ness - Manipulative ankle jump. The test’s mathematical-statistical results were processed with variance analysis and One-way ANOVA, with a critical value of the F-criterion (F = 2.38) and high statistical reliability (Pt ≥ 95%). Results showed that hand involvement is key in rebounding. In terms of jumping endurance and explosiveness quotient, female athletes had a lower level of development. This research has the potential to significantly impact the training and performance of female basketball players.

Meta Analysis: Effects Of Mckenzie Exercise And Other Treatment Techniques In Reducing Pain and Disability In Chronic Nonspecific Low Back Pain

Background Low back pain (LBP) is rising globally due to increase in population and ageing. In adults below 45 years of age, work-related injury leads to nonspecific pain resulting in disability. Exercise therapy has proven to be effective in reducing pain and associated disability in these patients. McKenzie exercises focus on repeated end-range movement and posture correction, thereby reducing pain and disability. This study aims to compare the effectiveness of McKenzie exercise with other techniques in reducing pain and disability in nonspecific chronic LBP (NSCLBP). Objectives To compare the effect of alternate treatment approaches and McKenzie exercises in nonspecific chronic low back pain. Methods Studies that satisfied the inclusion and exclusion criteria for the review were found by searching databases like Google Scholar, Pub Med and Cochrane CENTRAL. This study comprised randomized controlled trials that compared McKenzie treatment with other therapeutic approaches for treating NSCLBP. Two independent reviewers extracted the data and evaluated the trials' quality. Forest plots were used to display the results. Results Eleven full-text articles were included in this study for review in order to conduct a meta-analysis and qualitative analysis. The meta-analysis of pain and functional impairment related to back pain comprised ten studies each. When comparing patients undergoing McKenzie treatment to other treatment techniques, there was a slight overall decrease in the intensity of low back pain (SMD: -0.83 [95% CI: -1.11, -0.55], I2= 80.8%; p&lt; 0.000). After doing McKenzie exercises, low back patients' functional impairment did not improve in comparison to other therapy methods (SMD: 0.07 [95% CI: -0.54, 0.68], I2= 71.5%; p&lt; 0.000). Conclusion McKenzie exercise is equally effective to other manual therapy techniques but slightly effective than passive treatments in decreasing pain &amp; disability in NSCLBP.

Apalutamide and Goserelin for Androgen Receptor–Positive Salivary Gland Carcinoma: A Phase II Nonrandomized Clinical Trial, YATAGARASU

Abstract Purpose: To assess the efficacy and safety of apalutamide plus goserelin for androgen receptor (AR)–positive unresectable or recurrent/metastatic salivary gland carcinoma. Patients and Methods: This trial was an open-label, single-arm, multicenter phase II study. Patients with histologically confirmed unresectable or recurrent/metastatic salivary gland carcinoma with AR expression were included. The primary endpoint was the overall response rate (ORR) according to RECIST v1.1 by an independent central radiology review in the first 24 response-evaluable (RE) patients who had been observed at least 24 weeks from study initiation (primary RE patients). The efficacy was to be declared when at least 8 of the 24 primary RE patients responded. Results: A total of 31 patients were enrolled. In the first 24 primary RE patients with a median follow-up of 7.4 months, confirmed ORR by independent central radiology review was 25.0% [6/24 patients; 95% confidence interval, 9.8%–46.7%; P = 0.11 (one-sided)], which did not meet the predefined criteria of efficacy. Clinical benefit rate (ORR + rate of stable disease for at least 24 weeks) and median progression-free survival were 50.0% and 7.4 months, respectively. Both median duration of response and overall survival were not reached. Exploratory analyses showed a better ORR of 54.5% (6/11) in patients with AR positivity ≥70% and no history of prior systemic therapy. Grade 3 or higher treatment-emergent adverse events were reported in 35.5% (11/31), which included skin rash, anemia, leukopenia, and cancer pain. Conclusions: Although this study did not meet the predefined efficacy criteria, apalutamide plus goserelin showed clinically meaningful efficacy in a subset of patients with AR-positive salivary gland carcinoma and safety consistent with prior experience in prostate cancer.

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