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A Fuzzy Logic Based Software Product Quality Assessment Model
Savaş Öztürk

Savaş Öztürk

September 30, 2023
Neglecting process quality and product quality in software increases development and maintenance costs. Numerous models have been proposed to assess and grade product quality. However, current models mostly require collecting data about the software throughout the process, rely on questionnaires that generate subjective judgments, and include sets of metrics with sharp thresholds. There is an important need to quickly evaluate software that has completed or is about to complete the development phase prior to acceptance testing, and there is a need for a model that produces practical and objective results adapted to the limited data available. In this paper, we review and compare existing software quality assessment models in the literature and industry and propose a new fuzzy logic inference model inspired by them, where only the software code can be used as input. Comparative measurements show that the proposed model provides more stable and realistic results than the Software Improvement Group (SIG) maintainability model, which is one of the modern and practical methods adopted.
Infodemic Exposure and People’s Reliance on COVID-19 Information Sources: Cross-secti...
Marcos Mayo-Cubero

Marcos Mayo-Cubero

September 30, 2023
This paper explores the relationship between the reliance on different information sources and infodemic exposure in the early phases of the pandemic. The aim is to identify the sources that create less infodemic. We analyze high-quality secondary data from two studies using a 10-country sample: the US, UK, Canada, Brazil, France, Germany, Italy, Japan, South Africa, and South Korea. Study 1 analyzes infodemic exposure through an analysis of 3,723,920 COVID-19 tweets. Likewise, study 2 analyzes reliance on COVID-19 information sources by surveying 10,000 respondents. This research provides perspectives and implications for the infodemic debunking to the government departments, public health organizations, and media industries by analyzing the correlations between these two studies. We found that people who rely on national government information sources about COVID-19 tend to be less exposed to the infodemic. Findings also suggest a correlation between the countries with higher COVID-19 confirmed cases and people’s reliance on the national government information sources. We found that people from countries with more unverified bots tweeting about COVID-19 tend to rely less on family and friends and social media as sources. Evidence also suggests that the most trusted spokespeople are scientists and health professionals rather than politicians. Finally, we observed 70% of the sample´s countries slightly reduced their risk of exposure to the infodemic within 12 months of the pandemic’s start.
Retroauricular hairline approach versus conventional approach for submandibular gland...
Wanyu Liu
Lei Zhu

Wanyu Liu

and 4 more

September 30, 2023
Background and Objectives: The retroauricular hairline approach is increasingly being used for submandibular gland resections because of the excellent cosmetic results. A meta-analysis of studies compared the retroauricular hairline and conventional approaches for submandibular gland excision. Methods: A meta-analysis of studies identified from the PubMed, Embase, and China National Knowledge Infrastructure databases was performed. Postoperative nerve damage (temporary earlobe numbness and other signs of nerve damage), surgical durations, wound lengths, intraoperative bleeding volumes, postoperative drainage, and lengths of hospital stay were compared. Results: The retroauricular hairline approach led to greater risk of temporary earlobe numbness (OR: 7.28; 95% CI: 1.57–33.87; P = 0.01), but this resolved during the follow-up. There was no significant difference in the risk of other nerve injuries between the two approaches. The retroauricular hairline group had significantly longer operative times and wound lengths compared to the conventional resection group. There were no significant differences between the two approaches in intraoperative bleeding volumes, postoperative drainage, and lengths of hospital stay. Conclusions: The retroauricular hairline approach is a safe and efficient alternative to the conventional approach. It provides better cosmetic results and does not increase the risk of long-term neurological complications.
Molecular Biology Changes in Inflammatory Breast Cancer: A Systematic Review
mania Beiranvand
Atieh  Akbari

mania Beiranvand

and 4 more

September 30, 2023
Background and aims: This study aimed to identify studies that provide comprehensive information on the biological-molecular changes of inflammatory breast cancer (IBC) from January 1, 2000, to the end of November 2021. Methods: Two researchers independently searched electronic databases using keywords and Boolean operators. Inclusion criteria included studies published in English, peer-reviewed, and with appropriate information on IBC’s biological-molecular changes. Exclusion criteria were studies not in English, those without sufficient information on molecular and biological processes related to cancer, or those including other cancers. Results: From an initial selection of 1639 studies, 11 were selected based on the inclusion and exclusion criteria. The results highlight the importance of rigorous search strategies in identifying relevant studies in the field of cancer research. Conclusions: Understanding the unique traits of inflammatory breast cancer is crucial in determining its aggressive nature. Differential diagnosis of IBC from other types of breast cancer is necessary as genetic and molecular alterations in IBC are also present in non-IBC breast cancer, despite potential differences in treatment.
Efficient Paddy Grains Quality Assessment Approach Utilizing Affordable Sensors
Teerath Kumar
Aditya Singh

Teerath Kumar

and 3 more

September 30, 2023
In the realm of computer vision, paddy (Oryza Sativa) plays a pivotal role as a globally consumed staple crop. Its cultivation, harvesting, processing, and storage involve intricate quality control. Numerous factors, including weather conditions and irrigation frequency, influence grain quality. To address this, we present an innovative approach that combines image processing and machine learning (ML). Existing methods for rice grain quality assessment, while valuable, are tailored to rice-specific characteristics, employing complex and costly setups and opaque ML models. Our research overcomes these limitations with a robust ML-based IoT system for paddy grain quality assessment, using affordable sensors, a comprehensive data collection process, and an ML-driven image processing model. Importantly, our approach utilizes interpretable features like Shape, Size, Moisture, and Maturity for paddy grain classification. Rigorous real-world testing confirms its precision, marking it as the first automated system capable of providing a reliable overall quality metric. Our system’s unique feature lies in its transparency, with clear features and fuzzy rules, inspiring confidence and trust. While our experiments primarily feature Indian Subcontinent grain varieties, the system’s adaptability to diverse paddy types is evident, contributing significantly to computer vision.
Design and Performance Analysis of Giromill Vertical Axis Wind Turbine
Darshan Chaulagain

Darshan Chaulagain

September 30, 2023
Vertical axis wind turbine has been conceived as one of the best candidates for converting untapped kinetic energy of turbulent and unsteady airstream into electricity. Intelligible data on detailed analysis of performance of such a useful turbine is still scarcely found in the vast world of scientific literature. The report entitled “Design and performance analysis of Giromill Vertical Axis Wind Turbine” attempts to analyze performance of the VAWT at different tip speed ratios (TSR), for different number of blades, at different velocities and blade pitch angles. The Double Multiple Steam Tube model was used to find the design parameter of the Giromill Vertical Axis Wind Turbine after analyzing the performance curves at different solidity ratios and tip speed ratios. The turbine with radius 1.12m, chord length 0.11m obtained from the DMST model was used for various 2D computational fluid dynamics simulations. The result showed that the DMST model over-estimates the value of coefficient of performance than the 2D CFD analysis. Simulation results shows the dominance of three-bladed turbine, in performance, over four-bladed turbine at different design parameters, by around 4.3% for same inlet wind velocity of 4m/s. Also, the performance of three bladed wind turbine is found to be better for different wind velocity and it increases at suitable negative blade pitch angle.
Improving probability distribution estimation accuracy using polynomial approaches wi...
Abhishek Dutta
Meltem Turan

Abhishek Dutta

and 2 more

September 30, 2023
Moment-based determination of a probability density function (PDF) is widely used in chemical and process engineering applications as they provide an efficient approach to analyze and solve complex systems. In this study, three different approaches are implemented for estimating probability distributions from their moments. These procedures are based on the reconstruction of a distribution knowing only a limited number of moments using Chebyshev polynomials, Hermite polynomials and Lagrange polynomials. To show the applicability of these approaches, various test cases with reduced set of moments are solved with a set of standard distribution families (Normal, Weibull, Log Normal and Bimodal) and with complex distributions (Smoluchowski coagulation equation and population balance equation). The results are compared with their analytical solutions using both small and big variance distributions. The Kolmogorov-Smirnov (K-S) matrix and the RMSE values of the interpolation procedure using Lagrange polynomials predict a better estimation for all the test cases compared to the other approaches including the standard monomial approach (with higher number of moments) implemented in this study. The K-S test values decreased by 19% compared to the standard monomial procedure and 11% compared to both Chebyshev and Hermite polynomial approaches. Similarly, the RMSE values improved by 85% compared to the standard monomial procedure and 62% compared to both Chebyshev and Hermite polynomial approaches. This indicates that the procedure using Lagrange polynomials is a more reliable reconstruction procedure that calculates the approximate distribution using lesser number of moments N which is desirable.
On the bounds of the coupling tensor of anisotropic laminates
Paolo Vannucci

Paolo Vannucci

September 30, 2023
The problem of determining the elastic bounds of the coupling tensor for anisotropic laminates is addressed in this paper. It is shown how the invariant polar moduli of the coupling tensor interact with those of the extension and bending tensors to define all the conditions to be satisfied by such set of tensors describing the elastic behavior of an anisotropic laminate composed by identical layers. Some peculiar cases, interesting for applications, are also considered.
CMMSE: State-space realization of periodic input/output quaternionic linear systems
José Aleixo
Rogério Serôdio

José Aleixo

and 1 more

September 30, 2023
The investigation of linear periodic systems is a prominent subject of research within the domain of linear systems theory. In this context, the state-space realization of such systems is of particular significance. In fact, after successfully treating the realization problem for time-invariant systems, various researchers have directed their attention toward investigating the case of linear periodic systems. Meanwhile, in the late 1980s, Jan C. Willems proposed an approach that broadened the range of systems studied, now referred to as the behavioral approach. This approach views the behavior of a system as its fundamental element, including all signals that adhere to the system laws (also called system trajectories). More recently, the behavioral framework has also been extended separately to periodic and quaternionic behavioral systems. Our work consists of considering linear periodic input/output quaternionic behavioral systems and using recent developments in order to obtain quasi-minimal and uniform state-space realizations.
A nonlinear elliptic system with a transport term and singular data
Jose Ignacio Tello
Lucio Boccardo

Jose Ignacio Tello

and 2 more

September 30, 2023
We consider the nonlinear elliptic system { u ∈ W 0 N N − 1 ( Ω ): − div ( M ( x ) ∇ u )+ u = − div ( u M ( x ) ∇ ψ )+ f ( x ) , ψ ∈ W 0 1 , 2 ( Ω ): − div ( M ( x ) ∇ ψ )+ ψ = R ( u )+ E ( x ) ∇ ψ , where Ω is a bounded, open subset of R N , N≥3 ; M( x) is a coercive, symmetric matrix with L ∞ ( Ω ) coefficients; f( x) and E( x) belong to some Lebesgue space, and R( s) is a continuous function such that 0 ≤ R ( s ) ≤ | s | θ , for θ < 2 N . Using a duality technique, we prove existence of at least a weak solution ( u,ψ) . Moreover, if N=3 or N=4 , we prove under stronger assumptions on f( x) and E( x) that the solution u belongs to W 0 1 , 2 ( Ω ) .
An Unusual Indolent Presentation of Thymoma with a Large Pericardial Effusion: A Comp...
Tuong Nguyen
Duc Nguyen

Tuong Nguyen

and 10 more

September 30, 2023
INTRODUCTIONThymoma, a rare mediastinal tumor, often requires differential diagnosis from other mediastinal masses, necessitating a multidimensional approach combining various imaging modalities and histopathologic analysis.1 Accurate correlation of these features is pivotal for drawing definitive diagnostic, prognostic, and disease staging conclusions. Moreover, the presence of local invasion complicates complete mass resection, underlining the necessity for a multidisciplinary approach in such scenarios.2,3In this case report, we detail the evaluation of a 69-year-old female presenting with recurrent left chest wall pain, subacute decline in functional status, and exertional dyspnea. Imaging disclosed a sizable anterior mediastinal mass encroaching into the pericardium and right pleural space, accompanied by loculated pericardial effusion, which was later confirmed as thymoma upon histopathological examination. This case underscores the potential complexities encountered in the diagnostic journey of thymoma, while also emphasizing the importance of an integrated approach and the challenges imposed by local invasion.
An unusual presentation of cobblestone esophagus from bisphosphonate use
Tian Yu Qiu
Yi Yuan Tan

Tian Yu Qiu

and 3 more

September 30, 2023
IntroductionCobblestone esophagus is a rare finding that has been previously described in cases of eosinophilic esophagitis (EoE), candidiasis, barrett’s esophagus or severe reflux esophagitis from distal gastrointestinal obstruction1-4. We describe an unusual case of asymptomatic cobblestone esophagus secondary to bisphosphonate use.
   
Liu Jiasen
Wang Xu An

Liu Jiasen

and 4 more

September 30, 2023
A document by Liu Jiasen. Click on the document to view its contents.
Host avian species and environmental conditions influence the microbial ecology of br...
Elizabeth Rudzki
Nicholas Antonson

Elizabeth Rudzki

and 6 more

September 30, 2023
The role of species interactions, as well as genetic and environmental factors, all likely contribute to the composition and structure of the gut microbiome, however disentangling these independent actors under field conditions represents a challenge for a functional understanding of gut microbial ecology. Avian brood parasites provide unique opportunities to investigate these questions, as brood parasitism results in parasite and host nestlings being raised in the same nest, by the same parents. Here we utilized obligate brood parasite Brown-headed Cowbird nestlings (BHCO; Molothrus ater) raised by several different host passerine species to better understand, via 16S rRNA sequencing, the microbial ecology of brood parasitism. First, we compared fecal microbial communities of Prothonotary Warbler nestlings (PROW; Protonotaria citrea) that were either parasitized or non-parasitized by BHCO, and communities among BHCO nestlings from PROW nests. We found that parasitism by BHCO significantly altered both the community membership and community structure of the PROW nestling host-associated bacterial microbiome (HABM), perhaps due to the stressful nest environment generated by brood parasitism. In a second dataset, we compared fecal HABMs from BHCO nestlings raised by 6 different host passerines species. Here, we found that the HABM of BHCO nestlings was significantly influenced by the parental host species and the presence of an interspecific nestmate. Thus, early rearing environment is important in determining the HABM of brood parasite nestlings, and their companion nestlings. Future work may aim to understand the functional effects of this HABM variability on nestling performance and fitness.
Impact of Variants, Epidemiological Trends, and Comorbidities on Hospitalization Rate...
DANIELLE DIAS CONTE
Rai Watanabe Silva

DANIELLE DIAS CONTE

and 6 more

September 30, 2023
This retrospective study aimed to investigate the impact of the emergence of new variants and the epidemiological scenario on hospitalization rates of unvaccinated children (0-12 years) in Brazil. The study included 1,614 children admitted to a hospital between March 2020 and December 2022, with only 101 (6.3%) of them testing positive for COVID-19 via RT-PCR. The frequency of COVID-19 cases increased from 7.5% in 2020 to 9.3% in 2022 with the emergence of the Omicron variant. Children over five years old with comorbidities accounted for the majority of cases (69% [70/101]). Sickle cell anemia was the most frequent comorbidity (20%), and flu disease (36% [36/101]) and decompensation of underlying disease (33% [33/101]) were the main reasons for hospitalization. Co-infection was detected in 11% of cases, with RSV being the most common viral pathogen (71%). Hospital readmission occurred in 26% of cases, with a higher frequency in children over five years old. The death rate was 2.2%, with comorbidities such as cystic fibrosis and congenital heart disease as risk factors. These findings emphasize the need to prioritize vaccination with monovalent Omicron XBB for high-risk groups, including children over five years old with comorbidities, to mitigate the impact of new variants and reduce severe disease outcomes.
The extrastriate symmetry response is robust to alcohol intoxication.
Elena Karakashevska
Yiovanna Derpsch

Elena Karakashevska

and 3 more

September 30, 2023
Visual symmetry activates a network of regions in the extrastriate cortex and generates an event related potential (ERP) called the sustained posterior negativity (SPN). Previous work has found that the SPN is robust to experimental manipulations of task, spatial attention, and memory load. In the current study, we investigated whether the SPN is also robust to alcohol induced changes in mental state. A pilot experiment (N = 13) found that alcohol unexpectedly increased SPN amplitude. We followed this unexpected result with two new experiments on separate groups, using an alcohol challenge paradigm. One group completed an Oddball discrimination task (N = 26). Another group completed a Regularity discrimination task (N =26). In both groups participants consumed a medium dose of alcohol (0.65 g/kg body weight) and placebo drink, in separate sessions. Alcohol reduced SPN amplitude in the Oddball task (contrary to the pilot results) but had no effect on SPN amplitude in the Regularity task. In contrast, the N1 wave was consistently dampened by alcohol in all experiments. Exploratory analysis indicated that the inconsistent effect of alcohol on SPN amplitude may be partly explained by individual differences in alcohol use. Alcohol reduced the SPN in light drinkers and increased it in heavier drinkers. Despite remaining questions, the results highlight the automaticity of symmetry processing. Symmetry still produces a large SPN response, even when participants are intoxicated, and even when symmetry is not task relevant.
Determinants of swelling and dispersion in reducing drainage in soils affected by sod...
Kayo Matsui
Junya Onishi

Kayo Matsui

and 1 more

September 30, 2023
Soil sodification commonly occurs in irrigated soils of arid and semi-arid regions, resulting in serious decreases in productivity. Because an apparent consequence of sodic soils in farmlands is the significant deterioration of drainage capacity, the impacts of different types of water, such as irrigation water, groundwater, and rainfall, on soil drainage need to be assessed for sustainable land management. We investigated changes in soil saturated hydraulic conductivity (HC) under different salt treatments by separating the effects of swelling and dispersion. The salt treatments were conducted at different salt compositions (SAR∞, SAR10, SAR0; SAR=Na/(Ca/2) 1/2 (cations: mol c L -1)) and concentrations (0.05, 0.01, 0.001 N) on Indian soil (sandy clay loam). The soil cores were continuously leached with each treatment solution, and the HC was plotted against the cumulative amount of percolating solution. Our results support the existing findings that dispersion is triggered at concentrations below the critical coagulation concentration (CCC), which further varies with swelling and reflects the degree of sodification in a single mineralogy. We further revealed that the CCC could vary without changing the level of swelling; thus, whether or not dispersion occurs could be controlled independently of the determinants of swelling.
Internal Carotid Artery Pseudoaneurysm After Chiropractic Manipulation In a Patient W...
Ahmed Gamal Sayed
Hesham Aboloyoun

Ahmed Gamal Sayed

and 3 more

September 30, 2023
Internal Carotid Artery Pseudoaneurysm After Chiropractic Manipulation In a Patient With Eagle Syndrome
Identification of misclassified pregnancy episodes in women of childbearing potential...
Anne Broe
Christopher Lee

Anne Broe

and 9 more

September 30, 2023
Letter to the Editor Pharmacoepidemiology and Drug SafetyAuthors: Christopher Lee1, Silvia Rizzi 1, Ana Luiza Bierrenbach1, Luis Antunes1, Niina-Maria Nissinen1, Olga Rocha1, Jennifer Campbell2, Caroline Minassian3, Susan Hodgson2, Anne Broe1
Two-phase creation model
Jari Taskinen

Jari Taskinen

September 30, 2023
Jari Taskinen
Pharmacogenetic variability of tuberculosis biomarkers in native and mestizo Peruvian...
Luis Jaramillo-Valverde
Kelly S. Levano

Luis Jaramillo-Valverde

and 7 more

September 30, 2023
In Peru, 29,292 people were diagnosed with tuberculosis in 2022. Although tuberculosis treatments are effective, 3.4-13% are associated with significant adverse drug reactions, with drug-induced liver injury (DILI) considered the most predominant. Among the first-line antituberculosis drugs, isoniazid (INH) is the main drug responsible for the appearance of DILI. In liver, INH is metabolized by N-acetyltransferase-2 ( NAT2) and cytochrome P450 2E1 ( CYP2E1). Limited information exists on genetic risk factors associated with the presence of drug-induced liver injury (DILI) to anti-tuberculosis drugs in Latin America, and even less is known about these factors in the native and mestizo Peruvian population. The aim of this study was to determine the prevalence of NAT2 and CYP2E1 genotypes in native and mestizo population. An analytical cross-sectional analysis was performed using genetic data from mestizo population in Lima and native participants in south of Peru from the EPIGEN - Brazil project. NAT2 acetylator genotype was determined as fast, intermediate and slow, and CYP2E1 genotypes were classified as c1/c1, c1/c2 and c2/c2, from molecular tests and bioinformatic analyses. Of the 472 participants, 36 haplotypes were identified in the mestizo population and 6 haplotypes in native population paired with NAT2. In mestizo population, the most frequent NAT2*5B and NAT2*7B haplotypes were associated with DILI risk; while in natives, NAT2*5G and NAT2*13A haplotypes were the most frequent and associated with decreased risk of DILI. For CYP2E1, c1/c1 and c1/c2 genotypes are the most frequent in native and mestizo populations, respectively. The linkage disequilibrium of NAT2 and CYP2E1 SNPs was estimated using the solid spine method, detecting a block between all SNPs native population. In addition, a block between rs1801280 and rs1799929 for NAT2 was detected in the mestizo population. Despite the limitations of a secondary study, it was possible to report associations between NAT2 and CYP2E alleles with Peruvian native and mestizo population by prevalence ratios. The results of this study will help the development of new therapeutic strategies for a Tuberculosis efficient control between populations.
Clinical Predictors and Trends of Pacer Insertion, Complications, and Mortality Over...
Mohammad Reza Movahed
Nandini Sodhi

Mohammad Reza Movahed

and 2 more

September 30, 2023
Background: Pacemakers are an essential tool in managing bradyarrhythmias. Using the large Nationwide Inpatient Sample (NIS) database, we evaluated complications, trends and mortality rates of pacemakers over 2016 2020. Methods: We utilized International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for our study. We evaluated clinical predictors, complications and mortality of pacemakers using the NIS database. Results: Significant independent Clinical predicators for pacer insertion are: NSTEMI: OR, 1.85; 95% CI, 1.80–1.91; p<0.001, hypertension: OR, 4.26; 95% CI, 4.19–4.34; p<0.001, hyperlipidemia: OR, 3.01; 95% CI, 2.97–3.05; p<0.001, atrial fibrillation/flutter: OR, 4.68 95% CI, 4.62–4.74; p<0.001, diabetes: OR, 1.49; 95% CI, 1.47–1.51; p<0.001, chronic kidney disease: OR, 1.99; 95% CI, 1.97–2.02; p<0.001, smoking: OR, 1.41; 95% CI, 1.31–1.43; p<0.001, COPD: OR, 1.11; 95% CI, 1.09–1.13; p<0.001, valvular heart disease: OR, 5.31; 95% CI, 5.21–5.41; p<0.001, systolic heart failure: OR, 1.98; 95% CI, 1.94–2.02; p<0.001, prior PCI: OR, 2.30; 95% CI, 2.26–2.34; p<0.001, obesity 1.19; 95% CI, 1.17–1.22; p<0.001), history of CABG{:OR, 2.48; 95% CI, 2.43–2.52; p<0.001, STEMI: OR, 1.86; 95% CI, 1.79–1.93; p<0.001, history of cardiomyopathy: OR, 1.90; 95% CI, 1.78–2.03; p<0.001, and endocarditis: OR, 1.77; 95% CI, 1.53–2.04; p<0.001. Pacemaker complication rates is around 2% Mortality around 1.44% Conclusion: We found many predictors for the need of pacemaker insertion. Mortality and complications have remained low over recent years.
HEMOGRAM OF INDIVIDUALS WITH POSITIVE COVID-19 TEST AND C-REACTIVEPROTEIN VALUES
Ferruh A§ÇI
Veli KURT

Ferruh A§ÇI

and 2 more

September 30, 2023
In this study, Hemogram and C-reactive Protein measurement values of individuals who applied to Afyonkarahisar State Hospital with suspicion of Covid-19 disease and whose Covid-19 test result was positive (+) were analyzed. The material of this study consisted of Hemogram and C-reactive Protein parameter measurement values of patients with positive (+) Covid-19 test results (n=357) and healthy individuals with negative (-) Covid-19 test results (n=50). IBM SPSS 20.0 package program was used for statistical analysis of the data obtained. As a result of the holistic evaluation of the analysis results of the study and statistical comparison of the study groups and all age ranges, it was observed that the CRP measurement value of the patient study group increased significantly compared to the control group. In terms of hemogram measurement values, NEU, NEU% measurements of the patient study group increased, PLT, LYM, EOS, LYM% measurements decreased and statistical difference significance was determined (p<0.05). In this study, the changes in the biochemical and hematologic blood parameter values of the SARS-CoV-2 virus, the causative agent of Covid-19 disease, were examined. It is thought that the data obtained as a result of the study will contribute to researchers working in this field.
Durable Response to Trastuzumab Deruxtecan in a Patient with Urothelial Cancer and ER...
Kumaraman Srivastava
Jeremy Ross

Kumaraman Srivastava

and 1 more

September 29, 2023
Abstract: - Background: HER2 receptor expression is associated with poor prognosis across a wide variety of cancers including breast cancer, biliary tract cancer, and urothelial cancers amongst others. Despite this, HER2 targeted therapy such as trastuzumab has proven to improve clinical outcomes amongst patients. Furthermore, trastuzumab combination drugs have demonstrated even better outcomes amongst patients with various HER2 positive malignancies. - Case: A 61 year-old man with a diagnosis of stage IV cancer was initially started on atezolizumab but experienced disease progression 2 years later as evidenced by a CT chest/abdomen/pelvis with contrast. The patient was then treated with pembrolizumab with an excellent response until four years later where the patient’s urothelial cancer progressed further. The patient was then started on gemcitabine/carboplatin and transitioned to trastuzumab emtansine plus atezolizumab until a CT chest/abdomen/pelvis showed disease progression one year later. The patient was then transitioned to enfortumab vedotin for one cycle before starting trastuzumab deruxtecan for four cycles with a CT chest/abdomen/pelvis performed on 12/21/2022 after the fourth trastuzumab deruxtecan cycle showing a partial response. - Conclusion: Trastuzumab deruxtecan is approved in the USA to treat unresectable or metastatic HER2-positive breast cancer in adults who have received two or more prior anti-HER2-based regimens in the metastatic setting. While there are promising trials underway that describe clinical utility of trastuzumab deruxtecan in various different HER2 positive malignancies, more evidence is needed. In our patient’s case, trastuzumab deruxtecan led to a durable response with stabilization of his stage IV urothelial cancer despite progression on a variety of different first line chemotherapy agents typically used in metastatic urothelial cancer. - Keywords: urothelial cancer, HER2 positive, ERBB2 positive, trastuzumab deruxtecan, durable anticancer
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