bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlating MRI, mammogram, and ultrasonography( USG): Which study most accurately predicts breast cancer size?
Authors: Silva J. , Martinez-Velasco A. 
Published: August 2020

e11549 Purpose: Assessment of tumor size in patients with breast cancer is based on radiologic assessment when pathology measurements are equivocal and it is also considered when neoadjuvant therapy is used. Tumor size is measured as the largest dimension or for multifocal disease, as the largest dimension of the largest focus. However, wide variation exists between measurements obtained by different imaging methods. The purpose of this study was to compare the currently used imaging methods for determining breast tumors’ size. Accurate assessment influences the choice of oncologic treatment and predicts the prognosis of a patient. Methods: We conducted a study of 46 patients with breast cancer with no prior treatment. All women had preoperative MRI, USG and mammographic assessment of tumor size. Measurements were compared to the pathologic tumor size of the surgical specimen. Results: The greatest tumor diameter measured was within 3 mm of the pathologic tumor size in 43.4% of patients measured by MRI, 32.6% of patients measured by USG, and 36.9% of patients measured by mammogram. In average, MRI overestimated tumor size by 0.35 cm (95% confidence interval [95% CI], - 0.11 - 0.81 p = NS, whereas US underestimated it by -0.82 cm (95%CI, -1.01 - -0.63; p <0.001). Mammogram underestimated it by - 0.65 cm (95% CI, -0.96 - -0.33; p < 0.001). MRI measurement of the actual tumor size showed a significant correlation (r = 0.36, 95%, 0.06 - 0.61 p = 0.02) and confirms more accuracy in determining tumor size. Conclusions: In this study, magnetic resonance imaging is superior to conventional methods for assessing pathological dimensions. Both mammography and USG have a tendency to underestimate tumor size. The use of magnetic resonance imaging would help in the accurate assessment of the tumor size influencing the choice of oncologic treatment and better predicting the prognosis of the patient. No significant financial relationships to disclose.
Lymphedema following irradiation in breast cancer: A cross-sectional study
Authors: Goyal S. , Puri T. , Sharma D. N. , Julka P. K. , Rath G. K. 
Published: August 2020

e11569 Background: Nearly 15–30% of breast cancer patients (pts) face lymphedema (LE) following locoregional therapy, incidence being higher with surgery (Sx) & radiotherapy (RT) combination than with Sx alone. We intended to study the incidence of post-RT LE and associated symptoms. Method: We evaluated 104 unilateral breast cancer pts who had completed curative therapy (Sx + RT + chemotherapy ± hormone therapy HT), with a minimum follow up of 6 months. Besides demographic & treatment details, symptoms associated with LE and objective measurements of upper limb circumference were recorded using an indigenous questionnaire. Results: Median age was 45 years (range 28–65). Chest wall or breast RT was delivered using medial & lateral tangential portals (Cobalt-60 unit) in 88 pts & with 12 MeV electrons in 18 pts. Of all pts, 77 were given supraclavicular & axillary RT. HT was given to 72 pts. Pathological stages were: T1/2- 73, T3/4- 27, Tx-4; N0–44, N1–25, N2/3–33, Nx-2. Arm swelling was reported by 68 pts (mild-40, moderate-28). Other symptoms included reduced range of motion (mild-52, moderate-24), fatigue (48), pain (28), numbness (20), infections (12), shoulder droop (12) and local tenderness (8). Forty-four pts reported having psychological stress (mild-40, moderate-4). Nearly 60% had symptoms mandating change in physical activity (mild-56, moderate-8). Dominant hand was involved in 57 pts. Shoulder exercises were advised in 84 pts; compliance was poor in 16, average in 32, & good in 36. Only 36 pts were advised compression garments, compliance being poor in 28, average in 4 & good in 4. Objective measurements revealed a difference of ≥3 cm in 27 pts in mid-arm circumference (MAC) (median 5.5 cm, maximum 8 cm) & 34 pts in forearm circumference (FAC) (median 3.5, maximum 7 cm). There was no significant association between MAC or FAC with age, stage, body surface area, basal metabolic index, Sx type, chemotherapy or HT. Perceived LE and objective measurements correlated well. MAC difference >3 cm was seen in 28.5% (22/77) pts who received axillary RT and in 18.5% (5/27) of those who received only local RT. Conclusions: LE, with its associated complications, is often understudied in breast cancer survivors. Revision of Sx and RT policies (e.g., omission of axillary dissection & RT in selected pts) may help minimise LE. No significant financial relationships to disclose.
A novel histopathological evaluation method for predicting the outcome of non-small cell lung cancer treated by neoadjuvant therapy
Authors: Yamane Y. , Ishii G. , Goto K. , Kojima M. , Nakao M. , Shimada Y. , Nishiwaki Y. , Nagai K. , Ochiai A. 
Published: August 2020

e11574 Background: Chemotherapy, chemoradiotherapy, or radiotherapy is sometimes used to treat non-small cell lung cancer (NSCLC) before surgical resection (neoadjuvant therapy). However, no histopathological evaluation method for predicting the outcome of NSCLC treated by neoadjuvant therapy has been fully assessed. The purpose of this study was to assess a novel histopathological evaluation method for predicting the outcome of NSCLC patients who received neoadjuvant therapy followed by surgical resection. Methods: We reviewed the histopathology of the tumors of 61 NSCLC patients who received neoadjuvant chemotherapy, chemoradiotherapy, or radiotherapy and identified the histological features produced by neoadjuvant therapy by comparing them with the histopathological features of the tumors in 138 NSCLC cases treated by surgery without neoadjuvant therapy. We also measured the area of residual tumor (ART) on the maximum cut surface of the tumors and analyzed the relationships between the histological features, ART, and the outcome. Results: The proportions of cases with the histological features “cholesterin clefts,” “foreign body reactive giant cells,” “stromal hyalinosis,” and “cancer cells more than 50% of which contained a bizarre nucleus” were significantly higher in the neoadjuvant therapy group than in the surgery alone group. However, the presence of none of these features except “stromal hyalinosis” had any significant effect on survival in the neoadjuvant therapy group. Although pathological T factor (ypT) and N factor (ypN) had no significant effect on overall survival, smaller ART (≤400 mm2) and absence of pleural invasion (p(-)) were predictors of a outcome (p=0.004 and p=0.001, respectively). Conclusions: Smaller ART (≤400 mm2) and p(-) predict a better outcome of NSCLC in patients who receive neoadjuvant therapy. We concluded that ART is a novel histopathological parameter for predicting the outcome of NSCLC patients who receive neoadjuvant therapy followed by surgical resection. No significant financial relationships to disclose.
Incidence of peripheral neuropathy in high-risk early-stage breast cancer patients receiving dose-dense paclitaxel in central Pennsylvania
Authors: Barochia A. C. , Cream L. , Harvey H. , Sivik J. 
Published: August 2020

e11595 Background: Paclitaxel (P) is an important part of chemotherapy regimens for early breast cancer. Breast cancer survivors may be left with iaotrogenic peripheral neuropathy which can affect their quality of life. Methods: We conducted a retrospective, IRB approved, medical chart review to determine the rate of peripheral neuropathy in a tertiary care practice in central Pennsylvania. Patients had biopsy proven, newly diagnosed, high risk breast cancer. Patients were treated with a standard dose dense (DD) regimen where 4 cycles of adriamycin (A) 60 mg/m2/cyclophosphamide (C) 600 mg/m2 were followed by four cycles of paclitaxel (P) 175 mg/m2 every 2 weeks (Citron et al) between 7/2006 to7/2008 at Penn State Cancer Institute. All patients who received dose dense chemotherapy by a single provider were included (n=23). No peripheral neuropathy (PN) was reported before initiating paclitaxel, but 3 of 23 patients had type II diabetes. Electronic medical charts were reviewed and data was abstracted to analyze incidence of peripheral neuropathy. These data were compared to reported published data. Results: 22 pts received dose dense AC followed by P chemotherapy. 100% completed 4 cycles of AC and 87% complete 4 cycles of P. Overall, 82% developed neuropathy (32% with grade 1, 41 % with grade 2, 9 % with grade 3). Almost 30% of patients required gabapentin for control of neuropathic pain. 35% of patients with PN had symptoms persisting >3 months after chemotherapy. Conclusions: A considerable percentage of high risk, early breast cancer patients treated with AC followed by DD paclitaxel developed at least mild neurotoxicity. Rates of Grade 3 neurotoxicity were much higher (9%) than the previous CALGB-9741 study (4%). This may be related to regional pharmacogenomic differences. Although dense dose paclitaxel has been shown to improve disease free survival, PN affects most patients treated with paclitaxel and for some patients can have a prolonged impact on their quality of life. Future studies should attempt identify which patients are at risk for severe peripheral neuropathy. No significant financial relationships to disclose.
Effect of endocrine therapy with tamoxifen on hormone receptor status in patients with breast cancer
Authors: Djahansouzi S. , Rostock V. , Niederacher D. , Rein D. , Rath W. , Bender H. 
Published: August 2020

e11598 Background: Endocrine therapy (ET) of patients with hormone receptor (HR)-positive breast cancer (BC) is thought to adversely affect the HR status of the tumor with time. In order to evaluate this, a study was undertaken comparing the HR status of patients with estrogen receptor (ER)-positive BC prior to adjuvant tamoxifen (Tam) therapy and after progression. Methods: A retrospective analysis of all BC patients presented to the unit between 1999 to 2004 with an initial stage I-III ER-positive BC, who received Tam between 6 and 60 month and went on to develop progressive disease in the form of local recurrence or distant metastasis. Progression was confirmed by tumor biopsy and analysis of the HR status. All patients were evaluated for ER and progesterone receptor (PR) status using immunohistochemistry as well as tumor grading prior to Tam therapy and after relapse. Results: 67 eligible patients with ER-positive BC were recorded. All patient and tumor characteristics, including age, tumor size, histology and adjuvant therapy were similar as published elsewhere. 82% were initially PR-positive. The mean duration of Tam administration of 20mg po was 40.7±19.9 month. The mean duration to progression was calculated at 54.9±34.6 month. After relapse, 70.1% of tumors retained a positive ER status and only 53% showed positive PR expression. Using the nonparametric McNemar's test, a highly significant reduction (p< 0.001) of both HR was the result of Tam administration. Conclusions: our data suggests that progression under ET shows a trend towards loss of HR status (ER as well as PR). Therefore, this data is a useful tool for the clinician in evaluating the effectiveness of further ET in patients with progressive BC without having been able to confirm the present HR status through biopsy. Furthermore, as opposed to common belief, the reduction in positive ER tumors showed no correlation with tumor grading. No significant financial relationships to disclose.
Importance of genetic heterogeneity in curing adult acute leukemia (AL)
Authors: Bloomfield Clara D. 
Published: August 2020

s1 Forty-five years ago adult AL was incurable. Since then we have discovered the striking heterogeneity of AL and its importance in selecting therapy, resulting in cure of increasing numbers of patients. Publication of the French-American-British classification 34 years ago resulted in acceptance that morphology and cytochemistry separated AL into two different diseases, acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), that required separate treatment. During the next 15–20 years the importance of cytogenetics in dissecting ALL and AML into entities requiring different therapies became widely accepted, resulting in 2001 in their first incorporation into the World Health Organization (WHO) classification of AL. Over the last 10 years, discovery of molecular abnormalities within cytogenetic groups has further increased our ability to selectively treat and increasingly cure AL. The most striking example of increased curability of AL is acute promyelocytic leukemia, in which targeted therapy combined with chemotherapy has increased survival from a 2-week median to an 80% cure rate. Recognition of increased sensitivity of a genetic subtype of AML to high-dose cytarabine (HiDAC) has increased the cure rate of core-binding factor (CBF) AML from <10%–25% to 55%–60%. Recent discovery of the adverse impact of KIT mutations in CBF AML may allow the addition of tyrosine kinase inhibitors to HiDAC to substantially further increase cure. Among adult de novo AML 40%–45% are cytogenetically normal (CN); the striking molecular heterogeneity of CN-AML is now being recognized and promises to allow individualized approaches that improve substantially upon the current cure rate of 40%. In adult ALL the major adverse subgroup has a Philadelphia chromosome (PH+). New molecularly targeted approaches are allowing remissions in over 90% of PH+ elderly patients and appear likely to substantially cure an increasing fraction of younger PH+ adults. New approaches to studying the leukemia genome and epigenome should improve our understanding of AL heterogeneity, identify new therapeutic targets, and allow the cure of most patients.
Cancer genomes and their implications for understanding and managing cancer
Authors: Vogelstein Bert 
Published: August 2020

s1a Research over the past 25 years has shown that cancer is, in essence, a genetic disease. In the past three years, it has become possible to determine the sequence of nearly all the 21,000 protein-encoding genes in the human genome. The results of such sequencing in 68 tumors of the breast, colon, pancreas, or brain have led to new insights about the nature and diversity of the genetic alterations responsible for initiation and progression of tumors. The pathogenesis of solid tumors can best be understood as the cumulative result of alterations in approximately a dozen pathways that each regulate the balance between cell birth and cell death. The challenge for basic science is to understand these pathways in more detail. The challenge for clinical science is to devise approaches to use this new and extensive genetic information to improve diagnosis and therapy. Examples of how these challenges might be achieved in the future will be presented.
Geriatric oncology: The ultimate personalized cancer care
Authors: Extermann Martine 
Published: August 2020

s2a In many aspects, geriatric oncology is the quintessential expression of ASCO's 2009 theme: personalizing cancer care (PCC). PCC has two aspects: the tumor and the patient. Major efforts are conducted to identify mechanisms in an individual tumor that could be targeted more effectively by therapies. This research generates huge amounts of data, which creates a challenge in selecting the best therapeutic targets. As senescence has aspects that both prevent and favor cancer, we could take advantage of basic aging research to identify more effectively which mechanisms are key, and which are epiphenomena. Increasingly recognized also is the role of the microenvironment and macroenvironment—the patient—in influencing cancer prognosis and treatment tolerance. Here again, we can learn much from older patients. Seventy-five-year-olds are much more diverse than 25-year-olds. This provides higher sensitivity to detect patient-related factors. The last decade of work in geriatric oncology has demonstrated that geriatric instruments improve prognostic assessment beyond classic oncology predictors. Tantalizing data show that a geriatric intervention might even improve significantly the survival of patients with cancer. We now have screening tools simple enough to be used in oncology practice. In the same way that we are moving away from, for example, lumping all non-small cell lung cancers together, we are moving away from considering the patient condition as a relatively neutral background summarized by an ECOG Performance Status. Older patients also have remarkably diverse life experiences and patterns of functioning. This has enabled significant learning about individualizing the prediction of treatment tolerance and of willingness to undertake it. Geriatric oncology is an ideal terrain to explore end points such as the maintenance of independence and personal goals by cancer survivors. As the world population ages, we are progressing toward providing cancer care tailored to both the tumor and the older cancer patient.
Classification of Thyroid Dysfunction in Pregnant Women Differs by Analytical Method and Type of Thyroid Function Test
Authors: Andersen Stine Linding , Christensen Peter Astrup , Knøsgaard Louise , Andersen Stig , Handberg Aase , Hansen Annebirthe Bo , Vestergaard Peter 
Published: August 2020

Abstract

Context
Physiological alterations challenge the assessment of maternal thyroid function in pregnancy. It remains uncertain how the reference ranges vary by week of pregnancy, and how the classification of disease varies by analytical method and type of thyroid function test.

Design
Serum samples from Danish pregnant women (n = 6282) were used for the measurement of thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3′-triiodothyronine (T3), and T-uptake using “Method A” (Cobas 8000, Roche Diagnostics). TSH and free T4 were also measured using “Method B” (ADVIA Centaur XP, Siemens Healthineers).

Main Outcome Measures
Pregnancy week- and method-specific reference ranges were established among thyroid antibody–negative women (n = 4612). The reference ranges were used to classify maternal thyroid function, and results were compared by analytical method and type of thyroid function test.

Results
The reference ranges for TSH showed a gradual decrease during pregnancy weeks 4 to 14, a gradual increase was observed for total T4, total T3, and T-uptake, whereas free T4 and free T3 showed less variation. When TSH and free T4 were used, Method A classified 935 (14.9%) with abnormal thyroid function, Method B a total of 903 (14.4%), and the methods agreed on 554 individuals. When TSH and total T4 were used, 947 (15.1%) were classified with abnormal thyroid function, and classifications by either total T4 or free T4 agreed on 584 individuals.

Conclusions
Even when pregnancy week- and method-specific reference ranges were established, the classification of maternal thyroid dysfunction varied considerably by analytical method and type of thyroid function test.
Casting Shadows at Chesney Wold: Empty-House-Time and Realism in the British Novel
Authors: Strout Laura 
Published: August 2020

AbstractWhat insights into literary realism can be found by dwelling in the empty rooms and abandoned spaces of Bleak House, a novel more often read for its representation of overcrowded environments? Traveling between and imaginatively inhabiting empty houses of Charles Dickens's and Virginia Woolf's construction, this article proposes empty-house-time as a distinctive narrative chronotope, one that nineteenth- and twentieth-century British writers use to investigate the processes of realist fiction, especially its affective dimensions. Taking the character-less built environment as a figure for the novel form, the article shows that the chromatic present that characterizes narratives of spaces like Chesney Wold when the Dedlocks are absent throws into flux boundaries between the fictional and the real, the reader and the world of the text, and different modes of imagining. It opens up continuums along which strategies of realist characterization and world-building are dramatized and interrogated. Most powerfully, empty-house-time reveals how affects associated with imagining the world going on without you shape encounters with fiction. Identifying the vital, ongoing existence of unoccupied rooms in Dickens's writing can in turn revitalize studies of the relationship between Victorian and modernist novels and theories of realism. This article concludes by turning to the Ramsays’ abandoned coastal home in To the Lighthouse, in which Woolf, like Dickens, links an interrogation of realist fictionality to a historically specific reimagining of the household.
Genomic evidence of multiple SARS-CoV-2 introductions into Morocco
Authors: Chaouni Bouchra , Allali Imane , Sehli Sofia , Rhalem Wajih , Idrissi Azami Abdellah , Habib Nihal , Hamdi Salsabil , Wakrim Lahcen , Bakkali Abderrahmane , Mahmoud Mustapha , Bouguenouch Laila , Al Idrissi Najib , Bakri Youssef , Amzazi Saaïd , Barrijal Said , Ghazal Hassan 
Published: August 2020

Background: The recent emergence of a novel coronavirus (SARS-CoV-2) has caused serious public health concerns due to its rapid dissemination worldwide. A total of 8,931 positive cases had been reported in Morocco by the 16th of June 2020. Methods: To better understand the SARS-CoV-2 pandemic in this North African country, we analyzed the complete genome sequences of the virus related to Morocco by constructing a phylogenetic tree and creating a variant network using the available Moroccan and other sequences in dedicated databases. Results: Phylogenetic and variant network analyses of SARS-CoV-2 strains from early patients with COVID-19 in Morocco showed multiple spatiotemporal introductions from Italy (ten), France (seven), Spain (one) and Portugal (one). This is consistent with the assumption that the early infections in Morocco were imported, mainly from Europe. The 17 virus strains form two independent phylogenetic clusters and provide evidence for early community-based transmission following the initial introductions of the virus. We then catalogued 13 novel mutations in the SARS-CoV-2 isolates from Moroccan patients. Interestingly, the recurrent missense variant A>G at position 23,403 in the spike gene, known to be associated with virus severity, has been identified in all Moroccan isolates. Conclusions: These primary findings testify of the importance of the genomic surveillance strategies as a means of understanding the virus spread dynamics, counteracting the pandemic outbreak, and drawing useful lessons for dealing with any future emerging infectious pathogens.