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This paper proposes a two-stage hybrid framework for biosignal quality validation that produces beat-level or segment-level labels for real-time filtering and offline dataset curation. The framework is quantitatively validated exclusively on ECG data. Its modular architecture is designed to extend to further non-stationary periodic biomedical time-series signals including photoplethysmography (PPG), impedance cardiography (ICG), phonocardiography (PCG), electromyography (EMG), and electroencephalography (EEG) through modality-specific parameter adaptation; however, this broader applicability currently reflects architectural extensibility rather than experimentally validated performance. A prerequisite is synchronized acquisition of the primary biosignal together with inertial motion sensing (IMU/accelerometer) and electrode impedance or lead-off status, with the IMU positioned near the sensing electrodes. The first stage performs sensor-integrity gating to reject intervals corrupted by motion or poor electrode contact. The second stage applies software signal quality indices to the remaining beats, including physiological plausibility constraints (R to R peaks analysis), DTW-based morphological consistency against adaptive templates, frequency domain SNR estimation, and baseline wander quantification. This study systematically evaluates and compares the classification performance of six complementary sensor-level and software-based signal quality assessment methods. When integrated within the proposed hybrid framework, validation against expert-annotated ECG quality labels from 20 healthy participants demonstrates high methodological classification accuracy (98.1%), achieving approximately a 98% F1-score, 99% sensitivity, and 97% specificity. Prospective validation on patient populations with cardiovascular pathology is identified as a necessary step toward clinical deployment. This modular approach improves the reliability of downstream analysis by preventing corrupted data from entering feature extraction and model training pipelines, enabling more stable physiological monitoring in free-living conditions, reducing false alarms in continuous monitoring applications, and generating higher-quality datasets for AI-based diagnostic systems.

In a randomized trial, 1468 patients with severe aortic stenosis who were at low risk for death with surgery were assigned to either transcatheter aortic-valve replacement with a self-expanding valve or surgical aortic-valve replacement. At 2 years, TAVR was noninferior to surgery with respect to death or disabling stroke.

Ovarian cancer is a challenging disease to diagnose and treat effectively with five-year survival rates below 50%. Previous patient experience research in high-income countries highlighted common challenges and opportunities to improve survival and quality of life for women affected by ovarian cancer. However, no comparable data exist for low-and middle-income countries, where 70% of women with the disease live. This study aims to address this evidence gap. This is an observational multi-country study set in low- and middle-income countries. We aim to recruit over 2000 women diagnosed with ovarian cancer across multiple hospitals in 24 countries in Asia, Africa and South America. Country sample sizes have been calculated (n = 70-96 participants /country), taking account of varying national five-year disease prevalence rates. Women within five years of their diagnosis, who are in contact with participating hospitals, are invited to take part in the study. A questionnaire has been adapted from a tool previously used in high-income countries. It comprises 57 multiple choice and two open-ended questions designed to collect information on demographics, women's knowledge of ovarian cancer, route to diagnosis, access to treatments, surgery and genetic testing, support needs, the impact of the disease on women and their families, and their priorities for action. The questionnaire has been designed in English, translated into local languages and tested according to local ethics requirements. Questionnaires will be administered by a trained member of the clinical team. This study will inform further research, advocacy, and action in low- and middle-income countries based on tailored approaches to the national, regional and global challenges and opportunities. In addition, participating countries can choose to repeat the study to track progress and the protocol can be adapted for other countries and other diseases.

ObjectivesOvarian cancer patient experience data is limited, especially in low- and middle-income countries (LMICs). The World Ovarian Cancer Coalition’s online study in 2018 attracted 1531 responses from 44 mainly high-income countries. Recognising the need for robust data to support national efforts to improve women’s survival and quality of life, the Coalition has partnered with the International Gynaecologic Cancer Society to adapt the Study for LMICs.MethodsAn Oversight Committee featuring equal clinical/patient representation from major geographical areas identified 31 potential countries based on income status. The Committee oversees the Study’s adaptation, advises on access issues, and applies a solutions-based approach to challenges.Results24 countries with up to 10 centres each are engaged, with a projected sample size of >2,000 women. Countries and even centres vary widely in data collection and service organisation. For some, this is their first national or international collaboration. Challenges include: Ensuring participating centres reflect variety of care Accommodating variability of language, literacy, and internet connectivity (interview, paper, secure electronic link) Coverage of core expenses (translation, ethics submission) Ensuring patients and centres with least resource can participate Developing an equitable approach to publication opportunities Balancing countries’ differing needs within the study approachAbstract O022/#296 Figure 1ConclusionsA unified approach among and even within some LMICs is not feasible. A flexible and pragmatic approach with local teams as well as open channels of communication are essential to challenging inequities on this scale. This approach may add complexity to data analysis, but early benefits are being derived as LMIC patient voices are heard.

Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given that PLE can precede the diagnosis of cancer, it is very important that once infectious, metabolic, nutritional, or structural disorders associated with short-term memory loss are ruled out that vigorous effort must be made to rule out underlying malignancy. Case. We report a rare case of PLE as the presenting symptom of SCLC. A 72-year-old male with history of COPD was brought to the ED by his wife after he was found to have short-term memory loss, including forgetfulness of his wedding anniversary the day before, and anxiety. Neurological exam showed impaired short-term recall on MOCA. CT head showed no evidence of infarct. Lumbar puncture was performed which showed lymphocytic pleocytosis, a nonspecific inflammatory change. CSF panel was negative for HSV, Neisseria, Hemophilus, E. coli, and HIV. Initial EEG was unremarkable, though a repeat EEG showed mild slowing of the posterior dominant rhythm consistent with mild encephalopathy. MRI showed equivocal increased FLAIR on T2-weighted images in the bilateral temporal lobes, left greater than right. CTA thorax showed bulky mediastinal and right hilar LAD. FNA of the R4 lymph node revealed SCLC. The NM bone scan showed no osteoblastic lesions. While the serum autoantibody panel was positive for anti-NMDAR, the CSF autoantibody panel returned entirely negative. Chemotherapy with etoposide and cisplatin was started on Day 4 of admission. The patient’s neurological symptoms showed improvement following chemotherapy. Conclusion. This case highlights the importance of recognizing short-term memory loss as a feature of PLE.

Introduction Recent data suggest synergy of chemoradiotherapy and metformin in locally-advanced non-small cell lung cancer (NSCLC). It remains unclear if similar synergy exists with stereotactic lung body radiation therapy (SBRT) and metformin. We analyzed the role of metformin on progression-free survival (PFS) and toxicity in the setting of lung SBRT. Methods We identified 31 patients on metformin-treated with SBRT for early-stage NSCLC. Eighty-nine similarly treated patients were chosen as controls. Kaplan-Meier method was used to estimate cumulative PFS probabilities. Results Median follow-up was 30.7 months. Forty-two patients had diabetes, 31 (74%) of which were taking metformin concurrent with SBRT. Median PFS for metformin-users vs. metformin non-users was 36.4 months vs 48.9 months, respectively (p = 0.29). Among diabetic patients, median PFS for metformin users was 36.4 months and was unobserved for non-users (p= 0.40). On univariable analysis, male sex (p = 0.03) and tumor size (p = 0.01) were associated with the risk of progression or death; use of metformin was not significant (p = 0.34). There was no difference in grade ≥2 radiation pneumonitis between metformin users vs non-users (p = 0.51) Conclusion In this retrospective sample of lung SBRT patients, we did not detect a meaningful effect of concurrent metformin use on PFS. Since SBRT and conventional RT may have different cell kill mechanisms, the previously described beneficial effects of metformin may not apply in a hypofractionated setting. These results should be validated in an independent dataset, and we await the results of ongoing clinical trials.

BackgroundOvarian cancer is a challenging disease to diagnose and treat effectively with five-year survival rates below 50%. Previous patient experience research in high-income countries highlighted common challenges and opportunities to improve survival and quality of life for women affected by ovarian cancer. However, no comparable data exist for low-and middle-income countries, where 70% of women with the disease live. This study aims to address this evidence gap.MethodsThis is an observational multi-country study set in low- and middle-income countries. We aim to recruit over 2000 women diagnosed with ovarian cancer across multiple hospitals in 24 countries in Asia, Africa and South America. Country sample sizes have been calculated (n = 70-96 participants /country), taking account of varying national five-year disease prevalence rates. Women within five years of their diagnosis, who are in contact with participating hospitals, are invited to take part in the study. A questionnaire has been adapted from a tool previously used in high-income countries. It comprises 57 multiple choice and two open-ended questions designed to collect information on demographics, women's knowledge of ovarian cancer, route to diagnosis, access to treatments, surgery and genetic testing, support needs, the impact of the disease on women and their families, and their priorities for action. The questionnaire has been designed in English, translated into local languages and tested according to local ethics requirements. Questionnaires will be administered by a trained member of the clinical team.ConclusionThis study will inform further research, advocacy, and action in low- and middle-income countries based on tailored approaches to the national, regional and global challenges and opportunities. In addition, participating countries can choose to repeat the study to track progress and the protocol can be adapted for other countries and other diseases.