bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom
Authors: Johnston Brian W , Perry David , Habgood Martyn , Joshi Miland , Krige Anton
Published: May 2021

Objective

Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom.

Methods

We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development.

Results

The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]).

Conclusions

This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.
Use of minocycline for the treatment of prurigo pigmentosa with intraepidermal vesiculation: a case report
Authors: Yang Jie , Jiao Shicheng , Zhang Min
Published: May 2021

Pruritus pigmentosa is a skin disease mainly characterized by pruritus, inflammatory rash and reticular and macular pigmentation. The disease more commonly affects young women and may persist for several years. In this article, we report a case of a 20-year-old female patient who presented with erythema and blisters on the neck and trunk with pruritus for 20 days. Dermatological examination revealed a reticular distribution of erythema on the chest and abdomen and some areas of erythema covered with crusts. Additionally, blisters and bullae with clear fluid and negative Nikolsky’s sign were noted. On the neck and back, erythema was also in a reticular distribution, and erythema secondary to erosion and/or crusts was present. In addition, histopathological analysis of the lesions showed hyperkeratosis and intraepidermal multilocular vesiculation and confirmed increased migration of inflammatory cells into the epidermis and infiltration of inflammatory cells, including lymphocytes, histiocytes and eosinophils, in the superficial dermis. The expression levels of IgG, IgM, IgA and C3 were all negative. This patient was diagnosed with prurigo pigmentosa, and the condition improved after treatment with minocycline.
Acute myeloid leukemia with T lymphoblastic lymphoma: a case report and literature review
Authors: Gao Yan , Feng Xian-Qi , Liu Shan-Shan , Xu Yu-Jie , Mao Chun-Xia , Li Tian-Lan , Hou Feng , Zhang Wei
Published: May 2021

Acute myeloid leukemia (AML) with T lymphoblastic lymphoma (T-LBL) is a hematologic tumor of two origins, myeloid and lymphoblastic, and is relatively rare in the same patient. We report a rare case of AML with T-LBL. After the patient was diagnosed, he received standard chemotherapy, which decreased the primitive bone marrow cell percentage from 84% to 5%; however, the enlarged superficial lymph nodes showed no obvious change in size. Immunohistochemistry revealed the following: cluster of differentiation (CD)3 (+), CD5 (+), CD7 (+), transmission disequilibrium test (TDT) (+), myeloperoxidase (MPO) (−), and lysozyme (Lys) (−). The lymph node morphology and immunohistochemical results indicated T-LBL. Therefore, the final diagnosis was AML with T-LBL, with both diseases occurring independently and concurrently.
Participatory continuous nursing using the WeChat platform for patients with spinal cord injuries
Authors: Li Jing , Li Qiao-Ping , Yang Bi-Hong
Published: May 2021

Objective

The study aim was to analyse the effect of participatory continuous nursing using the WeChat platform on the complications, family function and compliance of patients with spinal cord injuries.

Methods

This was a randomized controlled trial. Seventy-eight patients with stable disease treated by internal fixation were enrolled in the study from August 2017 to August 2019 and assigned equally to an observation group and a control group. The control group received regular care from the time of discharge. The observation group used the WeChat platform to participate in continuous care.

Results

Six months after discharge, the continuous nursing group had a significantly lower incidence of pressure ulcers, urinary tract infections, joint contractures and muscle atrophy than the control group. The continuous nursing group showed a significant improvement in family function level and compliance behaviour at 3 and 6 months after discharge.

Conclusion

A participation-based continuous nursing intervention using the WeChat platform can reduce the incidence of pressure ulcers, urinary tract infections, joint contracture and muscle atrophy; improve patient family function; and promote healthy compliance behaviour.
Apatinib combined with concurrent chemoradiotherapy in patients with subglottic small cell carcinoma: a case report
Authors: Chen Man , Wu Shuang , He Zelai , Cheng Zenong , Duan Shimiao , Jiang Hao , Wang Gengming
Published: May 2021

Subglottic small cell carcinoma (SSMCC) is a rare type of neoplasm, meaning that laryngeal cancer guidelines in several countries, including the National Comprehensive Cancer Network (NCCN) guidelines, do not include treatment principles for SSMCC. Angiogenesis is an established factor in tumor initiation, growth, and dissemination. Apatinib mesylate, an orally administered drug, is a novel inhibitor of vascular endothelial growth factor receptor-2, a key mediator of angiogenesis, and has been shown to be safe and efficacious in the treatment of certain types of malignant tumors. To the best of our knowledge, there are few reports on the treatment of SSMCC with apatinib combined with concurrent chemoradiotherapy. In the present report of SSMCC in a 64-year-old woman, oral apatinib was given daily at a dose of 250 mg in combination with concurrent chemoradiotherapy; the only toxicities reported were mild leukopenia and finger numbness. Clear and rapid efficacy was observed with the disappearance of the tumor mass. Our findings indicate that apatinib combined with concurrent chemoradiotherapy may be effective in patients with SSMCC, with adverse reactions within the manageable range, thus representing an additional treatment option for this type of malignancy.
Identification of tumor-infiltrating lymphocyte subpopulations correlated with patient prognosis in esophageal squamous cell carcinoma
Authors: Peng Lin , He Wenwu , Ye Feng , Song Yane , Shi Xinying , Zhang Jiao , Li Qingyun , Fang Qiang , Xiao Wenguang , Han Yongtao
Published: May 2021

Objective

To identify biomarkers related to esophageal squamous cell carcinoma (ESCC) prognosis by analyzing genetic variations and the infiltration levels of tumor-infiltrating lymphocytes (TILs) in patients.

Methods

The clinical features of 61 patients with ESCC were collected. DNA panel sequencing was performed to screen differentially expressed genes (DEGs). Transcriptome sequencing was performed to identify gene expression profiles, and subsequent enrichment analysis of DEGs was conducted using Metascape.

Results

We identified 488 DEGs between patients with ESCC with distinct prognoses that were mainly enriched in the human immune response, fibrinogen complex, and protein activation cascade pathways. Among patients with ESCC treated with postoperative chemotherapy, those with a high infiltration level of myeloid-derived suppressor cells (MDSCs) had longer overall survival (OS), and OS was positively correlated with the infiltration level of T helper type 2 (Th2) cells among patients treated without chemotherapy after surgery. Additionally, in the case of MDSCs >0.7059 or Th2 cells <0.6290, patients receiving postoperative chemotherapy had a longer OS than those treated without chemotherapy following surgery.

Conclusion

The level of MDSCs or Th2 cells can be used as a biomarker for assessing the prognosis of patients with ESCC treated with or without postoperative chemotherapy, respectively.
Cyclin B1 acts as a tumor microenvironment-related cancer promoter and prognostic biomarker in hepatocellular carcinoma
Authors: Hou Yangming , Wang Xin , Wang Junwei , Sun Xuemei , Liu Xinbo , Hu Han , Fan Wenzhe , Zhang Xinchen , Wu Dequan
Published: May 2021

Objectives

The present study aimed to develop a gene signature based on the ESTIMATE algorithm in hepatocellular carcinoma (HCC) and explore possible cancer promoters.

Methods

The ESTIMATE and CIBERSORT algorithms were applied to calculate the immune/stromal scores and the proportion of tumor-infiltrating immune cells (TICs) in a cohort of HCC patients. The differentially expressed genes (DEGs) were screened by Cox proportional hazards regression analysis and protein–protein interaction (PPI) network construction. Cyclin B1 (CCNB1) function was verified using experiments.

Results

The stromal and immune scores were associated with clinicopathological factors and recurrence-free survival (RFS) in HCC patients. In total, 546 DEGs were up-regulated in low score groups, 127 of which were associated with RFS. CCNB1 was regarded as the most predictive factor closely related to prognosis of HCC and could be a cancer promoter. Gene Set Enrichment Analysis (GSEA) and CIBERSORT analyses indicated that CCNB1 levels influenced HCC tumor microenvironment (TME) immune activity.

Conclusions

The ESTIMATE signature can be used as a prognosis tool in HCC. CCNB1 is a tumor promoter and contributes to TME status conversion.
Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients
Authors: Lim Junghwan , Lim Taehyun , Lee Jungeun , Sim Junhyuk , Chang Hyungjun , Yoon Bumchul , Jung Hoeryong
Published: May 2021

Objective

To evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation method based on the evaluation of patient-specific walking dysfunction.

Methods

This study investigated a novel multi-channel FES-based rehabilitation method that analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the patient with those of healthy control subjects. During the rehabilitation phase, this profile was used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s muscles as they walked across a flat surface.

Results

Two stroke patients with hemiplegic symptoms participated in a clinical evaluation of the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between the patients and healthy control subjects and their quantitative walking performance, as measured by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.

Conclusion

These results indicated that the proposed rehabilitation method improved walking ability by improving muscle coordination and adequately supporting weakened muscles in stroke patients.
Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects
Authors: Li Runguang , Zeng Canjun , Yuan Song , Chen Yirong , Zhao Shanwen , Ren Gao-hong
Published: May 2021

Objective

To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects.

Methods

We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities.

Results

All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients.

Conclusion

Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.
A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle
Authors: Liu Qian , Shi Xiaomei , Fang Liyuan , Rao Tengzi , Shi Lishuang , Wu Jing
Published: May 2021

Objective

To compare the pregnancy outcomes of radiofrequency ablation (RFA) for complicated multiple pregnancies between fetal abdominal and dorsal needle insertion angles.

Methods

We performed a historical cohort study of patients who underwent selective reduction using RFA through different needle insertion angles from 2015 to 2018 at a local hospital. Dorsal needle insertion cases were consecutively selected and abdominal needle insertion cases were selectively enrolled. The Cox proportional hazards model was constructed to identify predictors of fetal survival time with different needle insertion angles.

Results

The RFA procedure was performed in 28 women through an abdominal insertion angle and in 28 women through a dorsal insertion angle. There were no significant differences in perinatal outcomes between the two groups. The overall live birth rate after RFA in the two groups was 73.5% and the mean gestation was 31.6 ± 6.5 weeks. The Cox model showed that gestational age at RFA was a predictor of the duration of the period between RFA and delivery.

Conclusion

RFA conducted through the dorsal insertion angle is technically feasible for selective reduction in complex monochorionic multiple pregnancies. Gestational age at this procedure is an independent risk factor for the duration of pregnancy post-RFA.
Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study
Authors: Abdel-Razeq Hikmat , Tamimi Faris , Abdel-Razeq Nayef , El-Atrash Maryam , Sharaf Baha’ , Mustafa Rawan , Mansour Razan , Bater Rayan
Published: May 2021

Objectives

The crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management of Syrian patients with breast cancer treated at our institution.

Methods

We retrospectively collected data on Syrian refugees treated for breast cancer over the past 10 years at our center. Management was compared against our approved clinical practice guidelines.

Results

A total of 113 patients were eligible and included. The median age (range) at diagnosis was 47 (21–84) years and most women presented with locally advanced or metastatic disease (n = 74, 65.5%). Breast-conserving surgery and breast reconstruction were performed in 27 (33.8%) and 11 (35.4%) patients, respectively. Only a few patients received targeted (35.5%) or advanced endocrine therapy (30.0%). In total, 37 (32.7%) patients had considerable deviations from our institutional treatment guidelines and had worse outcomes.

Conclusions

Syrian refugees with breast cancer present late, have more advanced-stage disease, and are more likely to receive delayed and suboptimal therapy. An international systematic approach for cancer care among such vulnerable populations is urgently needed.
Next-generation sequencing revealed synchronous double primary lung squamous carcinoma: a case report
Authors: Yang De-Song , Huang Kai , Su Min , Wang Ting-Ting , Liu Si-Si , Xu Yang , Wang Wen-Xiang
Published: May 2021

Synchronous double primary lung squamous carcinoma (sDPLSCC) is rare and difficult to distinguish from metastatic disease, histopathologically. Owing to the heterogeneity of cancer, it is also difficult to select the optimal therapeutic strategy for patients with multiple primary lung cancer (MPLC). The present study reports a rare case of a 61-year-old male patient with sDPLSCC diagnosed using histology and genetic profiling. LSCC-related driver mutations were detected in this patient, and we reported the TP53 c.475G>C mutation, which has been detected in both breast cancer and hepatocellular carcinoma, but not previously in lung squamous carcinoma. Our findings provide further evidence supporting the necessity of genetic testing for primary tumor diagnosis.
Polymyalgia rheumatica-like presentation in a case of diffuse large B-cell lymphoma: a diagnostic pitfall
Authors: El Hasbani Georges , Taher Ali T. , Abi-Ghanem Alain S. , Nassif Samer , Bizri Abdul Rahman , Uthman Imad
Published: May 2021

Diffuse large B-cell lymphoma (DLBCL) commonly presents with systemic manifestations including fever, weight loss, and night sweats. Uncommonly, patients with DLBCL can present with musculoskeletal manifestations mimicking polymyalgia rheumatica (PMR). Herein, the case of a 61-year-old woman who presented with pain in the bilateral shoulders, arms, hands, knees, pelvic girdle, and neck with bouts of fever, is presented. Laboratory workup for infectious and connective tissue diseases was non-revealing, except for elevated inflammatory markers. A positron emission tomography (PET)/computed tomography (CT) scan was suggestive of PMR, but also revealed enlarged lymph nodes initially thought to be reactive in nature. However, a lymph node biopsy showed findings consistent with DLBCL. This case highlights the importance of a thorough investigational workup when cases with features of PMR do not meet the proper criteria for this diagnosis to be made, in order not to miss a hematopoietic neoplasm with a PMR-like presentation.
Predictors of pregnancy after intrauterine insemination in women with polycystic ovary syndrome
Authors: Guan Hui-Juan , Pan Lin-Qing , Song Hang , Tang Huai-Yun , Tang Li-Sha
Published: May 2021

Objective

To evaluate the effects of body mass index (BMI) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI).

Methods

This retrospective study evaluated couples with PCOS undergoing COS and IUI. The relationship between cumulative IUI pregnancy outcomes and BMI, treatment cycles, treatment schemes, number of dominant follicles, endometrial thickness, infertility duration and type of infertility was analysed.

Results

The study evaluated 831 IUI cycles in 451 couples with PCOS. Compared with normoweight women, overweight and obese women required more human menopausal gonadotropin (hMG) doses and more days of COS. Gestational diabetes mellitus occurred more frequently in the obese group than in the other BMI groups. The clinical pregnancy and live birth rates in the hMG, clomiphene citrate (CC) + hMG and letrozole (LE) + hMG groups were significantly higher than those in the CC and LE groups. The clinical pregnancy rate was higher in the secondary infertility group compared with the primary infertility group.

Conclusion

Obese women might require more hMG doses and more days of COS to overcome the effects of weight. As BMI increases, the incidence of gestational diabetes might also increase. The number of cycles and type of infertility may have a predictive value for pregnancy outcomes.
Prognostic value of prealbumin, N-terminal pro-B-type natriuretic peptide, heart type fatty acid binding protein, and cardiac troponin I in elderly patients for heart failure and poor outcomes
Authors: Wang Shengzhuo , Liu Ketong , Guan Shoukun , Cui Ge
Published: May 2021

Objectives

This study aimed to investigate the prognostic value of serum prealbumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart type fatty acid binding protein (hFABP), and cardiac troponin I (cTnI) for heart failure and cardiac death in elderly patients.

Methods

We studied 426 consecutive patients with New York Heart Association classes I to IV who were recruited between February 2014 and 2018. Cardiac mortality was the primary end point. Receiver operator characteristic curves were created to analyze predictive values.

Results

When prealbumin, NT-proBNP, hFABP, and cTnI were combined, the areas under the receiver operator characteristic curve reached 0.930 and 0.903 for heart failure and cardiac death, respectively. Prealbumin, NT-proBNP, hFABP, and cTnI levels changed differently during therapy in patients in different prognosis groups. These parameters improved in patients who did not develop major adverse cardiovascular events (MACEs), but were unchanged or deteriorated in patients with MACEs. Multivariate Cox regression analysis showed that these parameters were significant independent risk factors for MACEs and cardiac death.

Conclusions

Our study shows that serum prealbumin, NT-proBNP, hFABP, and cTnI levels are significant prognostic factors for elderly patients with poor cardiac function. These parameters are more accurate for prognosis when used together.
Female Genital Tuberculosis, a Rare Lesion Mimicking Ovarian Carcinoma, with Granulosa Cell Tumor: A Case Report
Authors: Samaka RM , Mohamed AS , Abu-Zeid AY
Published: May 2021

Introduction:

Tuberculosis (TB) of the upper genital tract is a rare disease worldwide. TB should be always considered in the differential diagnosis of a pelvic or adnexal mass as it may diagnosed as ovarian carcinoma but both have completely different treatment. Therefore, recognition of TB is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive therapy. Granulosa cell tumor of the ovary is a rare type of ovarian cancer that accounts for approximately 2% of all ovarian tumors. This type of tumor is known as a sex cord-stromal tumor and usually occurs in adults. Thorough search in English literature revealed only 2 case reports showed combination between genital TB and granulosa cell tumor.

Case summary:

A 68 years old female patient complained of vaginal bleeding for four months. She had no personal or family history of TB. An ultrasound study showed a 2x1.5 cm mixed echogenic mass in the right adnexa. Based on her clinical and imaging findings which suggestive of ovarian cancer, the patient underwent panhystrectomy and bilateral salpingoophrectomy. The gross examination of the specimen revealed distended and coiled tubes with right adnexal mass measured 2x1.5 cm and dissection of the uterus revealed erythematous endometrium with yellowish secretions. The histopathologic assessment of right adnexal mass revealed malignant neoplasm *Granulosa cell tumor* formed of short polygonal cells arranged in diffuse sheets with patternless pattern. The malignant cells showed nuclear grooving. There was no necrosis or other ovarian neoplastic element. The histopathologic assessment of both tubes and endometrium revealed infiltration by multiple nodular granulomas. Each granuloma was formed of multinucleated giant cells and epithelioid cells rimmed by lymphocytes with occasional central caseation *genital tuberculosis*.

Conclusion:

The conclusion of this case report is to stress upon keeping genital TB in mind as a potential differential diagnosis for ovarian carcinoma.
BRCA1/2 Mutations and Long-Term Clinical Outcomes in Egyptian Breast Cancer Patients
Authors: AbdelHamid SG , El-Mesallamy HO , AbdelAziz HM , Zekri ARN
Published: May 2021

Introduction:

Clinical findings regarding the impact of BRCA1/2 mutational status on the prognosis of breast cancer patients are still controversial. We aimed to investigate the prognostic relevance of BRCA1/ 2 mutations on recurrence and long-term survival, for the first time, in Egyptian female breast cancer patients.

Patients and Methods:

The study cohort comprised 103 Egyptian female breast cancer patients previously tested for BRCA1/2 mutations using HRM analysis and direct sequencing. Clinicopathological and long-term clinical follow-up data including date and site of disease progression, were retrieved from medical records until death or loss to follow-up. Outcome measures including overall survival (OS), disease-free survival (DFS), recurrence-free survival, and metastasis-free survival (MFS) were compared in all BRCA1/ 2 mutation carriers versus non-carriers at 2, 5, 10, and 15 years after diagnosis.

Results:

The profile of the detected variants was previously reported. The American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines were used to re-classify the variants. The median follow-up time was 6.9 years (range, 4.2-24.4 years). BRCA carriers had significantly worse DFS than non-carriers, at 2 years 86.7% vs 88.2%; at 5 years 38.1% vs 57.8%; and at 10 years 21.6% vs 34.1% ( P=0.024). Negative estrogen receptor (ER) status (HR=2.44, 95%CI=1.33-4.47) and large tumor size (HR=2.19, HR=1.21-3.98) were also significant factors for worse DFS. Recurrence-free survival was significantly worse in BRCA carriers compared to non-carriers, at 5 years: 95.2% vs 98.2%; at 10 years: 54.4% vs 79.8%; and at 15 years 34.6% vs 61.7% ( P=0.005). BRCA carriers showed poorer OS and MFS, though not statistically significant [OS in BRCA carriers and non-carriers at 5 years: 81.6% vs 89.3%; at 10 years: 59.2% vs 60.6%; and at 15 years: 36.3 vs 59.2% ( P=0.42); and MFS at 2 years 86.7% vs 88.1%; at 5 years 44.5% vs 61.1% ; and at 10 years: 25.3% vs 38.2% ( P=0.41)].

Conclusion:

To our knowledge, this is the first study in the Middle East to investigate long-term survival outcome of BRCA1/2 related breast cancer. We, herein, underline the necessity of implementing BRCA screening strategies and intensive surveillance in the mainstream oncology practice in Egypt.
Endocrine Therapy Versus Chemotherapy as First Line Treatment in Metastatic Hormone Receptor Positive Breast Cancer
Authors: Aboelkheir* E. , Ashour A. , Fadel S. , Arafat W.
Published: May 2021

Introduction:

The standard treatment of hormone receptor positive Her2 negative metastatic breast cancer is endocrine therapy with or without targeted therapy (e.g.CDK4/6inhibitors and mTOR inhibitors). Chemotherapy is indicated only in visceral crisis and the presence of visceral metastases is not indication for chemotherapy

Aim of study

The retrospective study aimed to characterize treatment and outcomes for patients with hormone receptor positive metastatic breast cancer in Alexandria clinical oncology department to review change in treatment trend during the last 10 years. Physician questionnaire to determine their preferences in choosing treatment.

Methods

Retrospective study using patient files of adult female diagnosed and treated at Clinical Oncology and Nuclear Medicine Department, Alexandria Main University Hospitals during the period from January 2010 to December 2019. Physician questionnaire was done by physician recruitment via online survey & scientific meetings.

Results:

The study identified 611 women with hormone receptor positive metastatic breast cancer, median age was 50years, 48.9% were postmenopausal, 56.7% of hormone receptor positive, Her2 negative patients received chemotherapy as first line systemic treatment, 69.5% of these patients received chemotherapy as first line treatment in the first 5years. But, 48.8% of these patients received chemotherapy as first line in the last 5years and the study showed that median overall survival for all studied patients was 34 months. In contrast, the physician questionnaire showed that 75% of physicians prefer endocrinal therapy as first line treatment for hormone receptor positive, Her2 negative metastatic breast cancer.

Conclusion:

There is significant change in practice pattern in choosing the first line treatment between the first and last 5 years. Also, there is a discrepancy between practice pattern and physician preferences in choosing the first line systemic treatment for hormone receptor positive, Her2 negative metastatic breast cancer. The reason is the unavailability of most targeted agents (e.g; CDK4/6 inhibitors and mTOR inhibitors) and some hormonal agents such as fulvestrant.
Efficacy of 3 Monthly versus Monthly Zoledronic Acid on Bone Metastasis
Authors: Qasem* Ebtisam Ragab , Dorgham Yousra Taha , Elhagrasy Seham Mohammed , Nawar Nashwa Elsayed , Al Attar Ahmed Z.
Published: May 2021

Background:

Bone metastatic disease affect a patient’s quality of life.

Aim:

Evaluating possible stratification factors affecting the efficacy of different schedules of zoledronic acid on SREs.

Patients and Methods:

A randomized, clinical trial at Zagazig university hospitals. 108 Patients were enrolled to receive zoledronic acid 4 mg (A and B groups=12 and 4 weeks, respectively) for 2 years.

Results:

Regarding age, tumour type, types of bone metastasis and number of bone metastasis, there was an insignificant difference between both groups. However, 3 monthly regimen of zoledronic acid gave better results in solitary than multiple bone metastases. Regarding pretreatment ECOG, there was an insignificant difference between between both groups. However, 3 monthly regimen of zoledronic acid gave better results in pre-treatment ECOG 1and ECOG 2 than ECOG 3.

Conclusion:

A 3-monthly regimen of zoledronic acid is more effective in management of solitary or few sites of bone metastasis, osteoblastic bony lesions and patients with good performance status.

Recommendations:

We recommend a larger sample size and the study should include a homogenous groups of patients so we can judge well on different stratifications factors that can affect efficacy of 3- monthly regimen of zoledronic acid.
Inflammatory Breast Cancer: Clinical Characteristics and Influence of Molecular Subtypes on Treatment Response
Authors: Aissaoui D , Bohli M , Ben Amor R , Yahyaoui J , Hamdoun A , Moujahed R , Kochbati L
Published: May 2021

Introduction:

Inflammatory Breast Cancer (IBC) is a rare and very aggressive breast cancer with poor prognosis. The prevalence is different from a country to another. In Tunisia, it is about 5 to 7% of breast cancer. The aim of this study is to describe the epidemiological and histopathological features of patients with inflammatory breast cancer and to evaluate the treatment response according to the molecular subtypes.

Methods:

This retrospective review identified 31 patients with no metastatic IBC treated in our radiotherapy department between December 2019 and November 2020. IBC was confirmed using the clinical criteria. Baseline clinic-pathological and treatment information was retrieved from medical records. Statistical analysis was performed with IBM SPSS V.20.

Results:

Median age was 51.3 years [27-68]. 48% of tumors were grade 3. The average tumor size was 36mm [10-90]. The histological type was ductal carcinoma in 97%. Vascular invasion was noted in 24 patients (77%). Thirty patients were classified as stage IIIB and one patient was IIIC. 74% were hormone receptor positive and 45% were HER2 positive. Luminal B was the predominant subtype (52%) followed by Her2 positive (32%), Luminal A (23%), and triple negative (3%) All patients had chemotherapy: neoadjuvant for 26 patients (84%) and adjuvant for 5 patients (16%). Nine patients (29%) had tumor pathological complete response (pCR). Partial response was observed in 18 patients (58%). Lymph node pCR was noted in 16% of cases (n=5). Endocrine therapy and trastuzumab were given to 76% and 45% of patients, respectively. The influence of the molecular subtype was not statistically significant on the response to neoadjuvant treatment. The highest rate of pCR were 43% for Her2positive, then 27%, 21% and 9% for Luminal B, Luminal A and Triple negative, respectively (p=0.2).

Conclusion:

Our study showed a high percentage of hormone receptor and Her2+ (74% and 45% respectively) in IBC. Luminal B was the most frequent subtype. Anthracycline-based chemotherapy and trastuzumab improved the pCR rate: 44% for Her2positive. Triple negative showed poorer pCR than other breast cancer subtype without a significant difference. A larger study is warranted to confirm our findings.
Carbon Dioxide based versus Saline Tissue Expansion for Breast Reconstruction; A Meta-Analysis
Authors: Elkholy A.M.E. , Awadeen A.
Published: May 2021

Introduction:

Radical mastectomy shall be a lifesaving procedure for patients with breast cancer. However, it is associated with considerable alteration of patients’ self-esteem and body image. Currently, 40% of women are subjected to breast reconstruction subsequent to radical mastectomy, ranking such surgery the most common reconstruction approach. Two-stage tissue expander-to-implant is the preferable technique that accomplished the desired aesthetic outcomes. The current study was executed to assess the safety and efficacy of Carbon-dioxide based tissue expansion, in contrast to saline-based tissue expansion.

Materials and Methods:

Comprehensive literature review up to 1 December 2020 was carried out throughout the following databases; PubMed, Google Scholar, Web of Science, Scopus, WHO Global Health Library, Clinical trials, Cochrane, SIGLE, NYAM, mRCT, and ICTRP to identify all clinical studies compared carbon-dioxide based and saline-based tissue expansion. Data analysis was done using Review Manager version 5.3 (RevMan5.3). The significant difference was established at P < 0.05.

Results:

This meta-analysis included four articles which comprised 619 reconstructed breasts. Of them, 374 breasts were reconstructed using carbon-dioxide based tissue expander, whereby 245 breasts were reconstructed using saline-based tissue expander. Carbon-dioxide based tissue expander accomplished statistically significant shorter duration to accomplish complete expansion (MD-36.28;95%CI-44.09,-28.47; P<0.001) and shorter duration to achieve complete reconstruction (MD-41.91;95%CI-54.24,-29.58; P<0.001). There was no statistically significant difference between carbon-dioxide and saline-based tissue expanders regarding the success rate (RR 1;95%CI 0.96, 1.06; P=0.85), device malfunction (RR 0.94;95%CI 0.11, 8.06; P=0.96), and implant extrusion (RR 0.71;95%CI 0.14, 3.62; P=0.68). There was no statistically significant difference between both methods regarding total; complications (RR 0.93;95%CI 0.64, 1.37; P=0.72). This includes wound infection (RR 0.46;95%CI 0.08, 2.72; P=0.39), wound dehiscence (RR 0.47;95%CI 0.10, 2.25; P=0.34), seroma (RR 1.01;95%CI 0.40, 2.57; P=0.99), and hematoma (RR 0.28;95%CI 0.06, 1.29; P=0.1).

Conclusions:

Carbon-dioxide based tissue expander is a safe, effective, and promising approach with considerable advancement relative to saline-based tissue expander, principally regarding the time to accomplish complete implant expansion and the time to achieve complete breast reconstruction.
Evaluation of the Prognostic Value of Ki-67 in Early Stage Breast Cancer
Authors: Ismail Soheir S. , Farag Amr L. , Sherif Diaa Eldin M. , Alhussini Ibrahim S.
Published: May 2021

Background:

Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures.

Aim of the work:

This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer.

Patients and Methods:

Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports.

Results:

Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival.

Conclusion:

ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.
Mechanisms of Regulated Cell Death: Current Perspectives
Authors: Santagostino Sara Francesca , Assenmacher Charles-Antoine , Tarrant James C. , Adedeji Adeyemi O. , Radaelli Enrico
Published: May 2021

Balancing cell survival and cell death is fundamental to development and homeostasis. Cell death is regulated by multiple interconnected signaling pathways and molecular mechanisms. Regulated cell death (RCD) is implicated in fundamental processes such as organogenesis and tissue remodeling, removal of unnecessary structures or cells, and regulation of cell numbers. RCD can also be triggered by exogenous perturbations of the intracellular or extracellular microenvironment when the adaptive processes that respond to stress fail. During the past few years, many novel forms of non-apoptotic RCD have been identified, and the characterization of RCD mechanisms at a molecular level has deepened our understanding of diseases encountered in human and veterinary medicine. Given the complexity of these processes, it has become clear that the identification of RCD cannot be based simply on morphologic characteristics and that descriptive and diagnostic terms presently used by pathologists—such as individual cell apoptosis or necrosis—appear inadequate and possibly misleading. In this review, the current understanding of the molecular machinery of each type of non-apoptotic RCD mechanisms is outlined. Due to the continuous discovery of new mechanisms or nuances of previously described processes, the limitations of the terms apoptosis and necrosis to indicate microscopic findings are also reported. In addition, the need for a standard panel of biomarkers and functional tests to adequately characterize the underlying RCD and its role as a mechanism of disease is considered.
Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: An interview study with occupational therapists in the United Kingdom
Authors: Nicholson Clare , Francis Jill , Nielsen Glenn , Lorencatto Fabiana
Published: May 2021

Introduction

Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom.

Methods

Community-based neurological occupational therapists ( n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach.

Findings

Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists’ dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations.

Conclusion

Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings.
Investigation of the explosive type on the high strain forming of OFHC copper tube
Authors: Yildiz Rasid Ahmed
Published: May 2021

The paper computationally investigates the explosive forming of the oxygen-free high thermal conductivity (OFHC) copper tube subjected to five different explosives. To investigate the effect of explosive type on the formability of OFHC copper tube, commonly used explosives, including C-4, TNT, HMX, Comp-B, and PBXN, was compared by using the finite element method. To verify the developed finite element model (FEM), the explosive forming experiments were carried out by using C-4. In the simulations, Coupled-Eulerian-Lagrangian (CEL) method to model the large deformations, Jones-Wilkins-Lee (JWL) equations of state (EOS) to define the explosive properties and Johnson-Cook (J-C) strength and damage models to specify the metal’s mechanical behavior were utilized. Besides, Hillerborg’s fracture energy was calculated with the Charpy impact test results and given as input to the FEM. The results of FEM were compared and verified using the results of explosive forming tests considering the mesh density and friction coefficient. The simulations revealed that the explosive type affected both the final shape and also the strain rate of the copper tube. When the simulation results for C-4 was taken as reference, HMX and PBX-N increased the strain rate as 110%, roughly. However, Comp-B and TNT reduced the strain rate by nearly 10% and 22%, respectively. Also, the explosive type changed the final hardness of the metal. OFHC Copper had the lowest hardness (112.7 HV) when the simulations were conducted with TNT. In contrast, the highest hardness value (129.5 HV) was reached when HMX was used in the simulations. In addition, simulations put forth that Hillerborg’s fracture energy criteria could be used in the explosive simulations to predict the damage on the metals.
System Dynamics Modeling for a Public–Private Partnership Program to Promote Bicycle–Metro Integration Based on Evolutionary Game
Authors: Cai Jianming , Liang Yue
Published: May 2021

A marriage between dockless bike-sharing systems and rail transit presents new opportunities for sustainable transportation in Chinese cities. However, how to promote the bicycle–metro integration mode remains largely unstudied. This paper designs a public–private partnership program to promote bicycle–metro integration. We consider the cooperation between bike-sharing companies and rail transit companies to improve both services and attract long-distance travelers to choose the bicycle–metro integration mode, with government subsidies. To analyze the proportion of each population participating in this public–private partnership program, we establish an evolutionary game model considering bike-sharing companies, rail transit companies, and long-distance travelers, and obtain eight scenarios of equilibriums and corresponding stable conditions. To prove the evolutionary game analysis, we construct a system dynamics simulation model and confirm that the public–private partnership project can be achieved in reality. We discuss key parameters that affect the final stable state through sensitivity analysis. The results demonstrate that by reasonably adjusting the values of parameters, each equilibrium can be changed into an optimal evolutionary stable strategy. This study can provide useful policy implications and operational recommendations for government agencies, bike-sharing companies, and transit authorities to promote bicycle–metro integration.
Understanding Fatal Crash Reporting Patterns in Bangladeshi Online Media using Text Mining
Authors: Das Subasish
Published: May 2021

Traffic crashes are a major public health concern. In 2016, traffic crashes resulted in over 1.35 million deaths worldwide. In Bangladesh alone, the number of reported traffic fatalities was 2,376 in 2016. However, the World Health Organization estimated that the true number of traffic fatalities in Bangladesh ranges between 20,730 and 29,177. Editorial traffic crash reports in Bangladesh, and the number of crashes that are reported, vary widely among different media outlets. This study employed a Google News Alert to collect fatal crash reports from online English daily newspapers. The current study compiled a database of 419 fatal crash-related reports over a six-month period (November 2018–April 2019). The reports contain a total of 81,019 words. The results of this study reveal that online news coverage of traffic fatalities tends to vary from news agency to news agency. Furthermore, these reports do not usually cover key contributing factors of crash occurrences; the geometric features of crash occurrence sites are rarely reported. The findings demonstrate the importance of deciphering media coverage to develop potential safety risk measures in Bangladesh. The current findings provide strong support for the need for guidelines to help media outlets adequately document fatal crash reports.
Revisiting Transit-Oriented Development Evaluation for Urban Master Plans in the Context of Developing Countries
Authors: Harirchian Minoo , Azadi Mahya , Kermanshahi Shahab , Bashirinia Mahdi , Ghasri Milad
Published: May 2021

Transit-oriented development (TOD) advocates sustainable development and the building of livable neighborhoods. Several measures are proposed to evaluate TOD principles; however, the suitability of these measures is not fully explored in the context of developing countries. This paper provides a systematic method for multivariate analysis of TOD measures in the context of developing countries. A bivariate analysis is conducted to simultaneously study all TOD measures against the distance to transit measure because of its essential role in TOD. A dynamic zoning system is introduced to capture a realistic reflection of neighborhood that is walkable for its residents. In the proposed zoning system, neighboring zones can overlap, as the walkable areas for the nearby residences may overlap. The adherence of Tehran’s Master Plan to TOD principles is examined with a focus on TOD measures and multidimensionality in assessment. The results highlight the curse and the blessing of the high-density urban sprawl in sustainable development.