bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epirubicin and cyclophosphamide (EC) followed by weekly paclitaxel with/without trastuzumab as primary systemic therapy in locally advanced breast cancer: Phase II study
Authors: Hirano A. , Shimizu T. , Kamimura M. , Goto N. , Watanabe O. , Kinoshita J. , Domoto K. , Aiba M. , Ogawa K. , Miura D. 
Published: August 2020

e11590 Background: Primary systemic therapy (PST) has become a standard therapy for locally advanced breast cancer (LABC). The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by weekly paclitaxel with/without trastuzumab as PST in LABC. Methods: Primary endpoint was pathologic complete response (pCR) rate in the breast and axilla, and secondary endpoints were breast conserving rate and toxicities. Patients with histologically diagnosed invasive breast cancer by core needle biopsy of the T2–4 (>3 cm) or N1–3 were included in this study. Eligible patients were age >20 years, had a performance status of 0 to 1, and had adequate organ functions. It was determined that the expected rate of pCR in the trial was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. Treatment: Patients received epirubicin (100 mg/m2) and cyclophosphamide (600mg/m2 ) every 3 weeks for four cycles followed by paclitaxel (80 mg/m2 ) every week for 12 cycles. Trastuzumab (2mg/kg) was added to paclitaxel in HER2-positive patients. Results: Forty-three patients were enrolled into this study and 3 patients withdrew. pCR were observed in 8 patients and pCR rate was 20.0% (95% confidence interval, 7.6- 32.4). Twenty-four patients (60.0%) underwent breast conserving surgery. In particular, patients with HER2 positive tumor had significantly higher rate of pCR than the others (62.5% vs. 8.6%; p=0.0014). Grade 4 neutropenia was recorded in 27.5% of the patients, and febrile neutropenia occurred in 4 patients (10.0%). No heart failure was seen. Conclusions: EC followed by weekly paclitaxel with/without trastuzumab was an active and well-tolerated treatment for LABC. No significant financial relationships to disclose.
Image-guided near-infrared fluorescent sentinel lymph node mapping in human breast cancer
Authors: Troyan S. , Gibbs-Strauss S. , Gioux S. , Oketokoun R. , Azar F. , Khamene A. , Kianzad V. , Rosenberg M. , Clough B. L. , Frangioni J. V. 
Published: August 2020

e11591 Background: Breast cancer surgery is presently performed without real-time image-guidance. We have developed a novel optical imaging system for image-guided surgery that uses invisible near-infrared (NIR) fluorescent light to highlight structures on the surgical field with high sensitivity, specificity, and contrast. We have also performed the first human clinical trial of the imaging system in women undergoing SLN mapping for breast cancer. Methods: We used a portable imaging system with an articulating arm that has 6 degrees of freedom, high power LED light source, custom optics, custom software, and sterile drape. The imaging system provided simultaneous and real-time imaging of color video and NIR fluorescence at up to 15 frames per second. N = 6 women with biopsy- confirmed breast cancer undergoing SLN mapping gave informed consent. All subjects received conventional mapping with Tc-99m sulfur colloid using a handheld gamma probe as well as NIR fluorescence-guided SLN mapping using a mixture of indocyanine green (ICG) diluted to a final concentration of 10 μM in human serum albumin (ICG:HSA). Results: The imaging system was easy to position in the operating room, with the articulating arm providing 50” horizontal reach and 70” vertical reach. Working distance to the patient was 18”. NIR fluorescence excitation was 20 mW/cm2 at 760 nm. NIR-depleted white light was 40,000 lux. A total of 1.6 ml of ICG:HSA was injected intra-tumorally and peri-tumorally and the site massaged for 5 min. 8 of 9 SLNs identified by Tc- 99m sulfur colloid were also identified by NIR fluorescence. However, NIR fluorescence identified an SLN, confirmed to have cancer in it, that was not identified by Tc-99m sulfur colloid. These differences were consistent with asynchrony in the injection techniques. Unlike the gamma-ray probe, NIR fluorescence provided high-resolution, large area optical imaging of the surgical field, and helped guide surgical resection. Conclusions: In this 6-patient pilot study, a novel NIR fluorescence optical imaging system was used for the first time, and provided real-time image-guided surgery for SLN mapping of breast cancer. No significant financial relationships to disclose.
First data from the the Patient's Anastrozole Compliance to Therapy Programme evaluating the influence of a standardized information service on compliance in postmenopausal women with early breast cancer
Authors: Jackisch C. , Harbeck N. , Blettner M. , Hadji P. , Lück H. , Schmidt D. C. , Haidinger R. , Gutendorf B. , Kreienberg R. 
Published: August 2020

e11592 Background: Retrospective pharmacy data suggest that within the first year of therapy patients’ pick-up rate of aromatase inhibitor (AI) packs prescribed for early breast cancer (EBC) drops below 70%. Little is known about compliance to AI and patient motivation outside of clinical trials and the effect of compliance on patient outcome. Methods: The Patient´s Anastrozole Compliance to Therapy (PACT) programme, a two arm, randomized parallel group trial with 60 months follow-up, randomized postmenopausal women with HR+ EBC receiving anastrozole as adjuvant treatment and who consented to participate, to routine clinical care alone or additional standardized information consisting of 9 mailings of brochures and letters over the first 12 months following initiation of therapy. Primary endpoint is compliance rate in the standard versus intervention arm after 12 months, secondary endpoints include safety, reasons for non-compliance, influence of baseline characteristics, and of compliance on clinical outcome parameters. Compliance was evaluated by patient self reporting via standardized questionnaires, cross-checks of prescription data from hospital records and physician recall. QoL and patients’ satisfaction are assessed with standard questionnaires. Results: From Jul 2006 to Nov 2008, 4,924 patients were enrolled. Demographic data and baseline characteristics including median age, disease parameters, BMI, QoL at study start, co-morbidities and concomitant medication will be presented Conclusions: As of today, PACT is the largest prospective investigation on compliance to AI. It will provide valuable insights into the reasons for non-compliance to adjuvant AI therapy and demonstrate if a simple intervention such as standardized written information throughout the first treatment year may improve compliance and patient outcome. [Table: see text]
One-day surgery in breast cancer: Monoinstitutional results (experience during 2. 5 years)
Authors: Giovanardi F. , Scaltriti L. , Gibertoni F. , Cagossi K. , Cavanna L. , Artioli F. , Giovanardi G. 
Published: August 2020

e11596 Background: We want determine the effect of early discharge from hospital after surgery for breast cancer on physical and psychological illness. Moreover the study aimed to evaluate the management of post operative symptoms and post operative care. Methods: From January 2006 to July 2008, all breast cancer patients undergoing conservative breast cancer surgery or total mastectomy were offered surgery as an outpatient at One- Day Surgery Unit. Results: Three hundred seventy five patients underwent outpatient surgery for a total of four hundred four surgical procedures. The age of 375 patients varied from 14 years old to 94 years old, mean age was 55; in 79 of 404 (19.5%) surgical procedures patient remained in the hospital, for one night, after a surgical procedure regarding total axillary resection. Patients characteristics and post-operative complications were recorded for all 375 patients and 404 surgical procedures. All complications were treated by medical or nursing care. Complications included axillary seroma in nine patients (2.2 %), abscess in three patients (0.9%), pain in two patient (0.5%), hematoma formation in five patients (1.2%) for a total of 17 complications (4.2%). In our series, no hospital readmission was recorded during the first night and the first week and no death occurred. Conclusions: One day surgery for breast cancer patients is a totally safe and feasible procedure. We haven’t an increased rates of physical or psychological illness from early discharge after surgery for breast cancer. This policy can be recommended for patients with support at home. No significant financial relationships to disclose.
Complications of local/regional treatment of breast cancer and quality of life
Authors: Ozcinar B. , Ozmen V. , Guler S. A. , Gulluoglu B. M. , Kocaman N. , Ozkan M. , Muslumanoglu M. E. , Igci A. , Kecer M. , Dagoglu T. 
Published: August 2020

e11597 The aim of this prospective clinical study was to evaluate early and late complications of different surgical procedures, and compare conservative surgical treatments (breast conserving surgery, sentinel lymph node biopsy) to more radical ones (mastectomy, axillary lymph node dissection), and find factors that were related to these complications. 218 early stage breast cancer patients (stage I and II) were enrolled in this study. Physical complications (restrictions in shoulder motions, shoulder functional capacity, pain, lymphedema and sensory loss), psychological complications and the factors related to these complications were studied in patients after breast cancer surgery and/or radiotherapy at first week, at 9th-12th months and at mean follow up time of 34 months. Lymphedema rates after surgery were 14.7 %, 24.8% and 17.0% at first week, 9th-12th months, and long term respectively. In early postoperative period, pain and functional capacity of the effected shoulder were worse than preoperatively measured values and all axis of motion of shoulder joint were effected significantly. On the other hand, at 9th-12th months, only internal flexion was still affected. At the long term period, all axis of motion of shoulder joint, pain and functional capacity were in normal range as before treatment. The factors related to lymphedema were axillary lymph node dissection (p=0.002), radiation therapy to axillae (p<0.001). The patients who had both axillary lymph node dissection and axillary radiotherapy had more lymphedema than the patients who only had axillary lymph node dissection or sentinel lymph node biopsy (p=0.004). The factors related to postoperative depression at early period were cigarette smoking (p=0.008), axillary lymph node dissection (p=0.045) and arm lymphedema (p=0.005). At long term period they were axillary lymph node dissection (p=0.021), mastectomy (p=0.036), drain usage (p=0.028) and sensory loss (p=0.027). The patients who had sentinel lymph node biopsy, axillary dissection without axillary radiotherapy had better quality of life. The patients with cigarette smoking, axillary lymph node dissection, mastectomy, drain, lymphedema and sensory loss had increased incidence of depression than others, these results were statistically significant. No significant financial relationships to disclose.
Clinical Features of 57 Patients with Lipoid Congenital Adrenal Hyperplasia: Criteria for Nonclassic Form Revisited
Authors: Ishii Tomohiro , Tajima Toshihiro , Kashimada Kenichi , Mukai Tokuo , Tanahashi Yusuke , Katsumata Noriyuki , Kanno Junko , Hamajima Takashi , Miyako Kenichi , Ida Shinobu , Hasegawa Tomonobu 
Published: August 2020

Abstract

Context
Lipoid congenital adrenal hyperplasia (LCAH) is caused by mutations in STAR. Classic (CLCAH) and nonclassic (NCLCAH) forms were reported as total and partial deficiencies, respectively, of adrenal and gonadal steroid hormones. The rarity of LCAH has precluded large-scale epidemiological and clinical investigations.

Objective
To determine the epidemiological and clinical characteristics of 2 forms of LCAH.

Design
A multicenter cross-sectional cohort study in Japan on December 1, 2017.

Participants
Fifty-seven patients with LCAH (median age, 23.7 years; range, 0.0–47.5 years).

Main Outcome Measures
Patient demographics, STAR genotype, Quigley grade, endocrinological and imaging data, treatment, and prognosis.

Results
Fifty-three and 4 patients fulfilled definite and probable diagnostic criteria for LCAH, respectively. When NCLCAH was defined as either Quigley grade 1 in XY karyotype, no episode of salt losing or requirement of fludrocortisone, or onset of primary adrenal insufficiency (PAI) at 1 year or older, patients were divided into groups of 43 patients with CLCAH (75.4%), 11 with NCLCAH (19.3%), and 3 with unclassified LCAH (5.3%). All of the patients with CLCAH and 7/11 NCLCAH (63.6%) were treated with fludrocortisone. CLCAH was diagnosed at a significantly younger age than NCLCAH (median, 0.0 vs 4.0 years). STAR-Arg272Cys or -Met225Thr was identified only in NCLCAH (8/11, 72.7%).

Conclusions
We demonstrated the relative proportions and clinical and molecular characteristics of NCLCAH and CLCAH in Japan. These criteria for NCLCAH correspond to all previously published cases and our cases whose masculinization of the external genitalia, ability of mineralocorticoid production, and onset of PAI were described.
Copeptin Kinetics and Its Relationship to Osmolality During Rehydration for Diabetic Ketoacidosis in Children
Authors: Burckhardt Marie-Anne , Gotta Verena , Beglinger Svetlana , Renggli Luzia , Bachmann Sara , Hess Melanie , Rentsch Katharina , Pfister Marc , Koch Gilbert , Davis Elizabeth A , Zumsteg Urs , Jones Timothy W , Szinnai Gabor 
Published: August 2020

Abstract

Context
Copeptin is a surrogate marker for arginine vasopressin (AVP) release in response to hyperosmolal stimuli such as diabetic ketoacidosis (DKA).

Objective
The objective of this work is to characterize kinetics of copeptin and osmolality, and their dynamic relationship during rehydration and insulin therapy in children with type 1 diabetes (T1D) and DKA.

Design and Setting
A prospective, observational, multicenter study was conducted.

Patients and Intervention
Children with T1D admitted for DKA underwent serial serum copeptin and osmolality measurements from start of rehydration at 14 time points during 72 hours.

Main Outcome Measures
Measurements included temporal course of copeptin and osmolality (kinetics), relationship between both (dynamics), and association between-subject variability (BSV) (coefficient of variation, CV%).

Results
Twenty-eight children (20 newly diagnosed T1D) aged 1 to 16 years were included. Copeptin decreased from 95 pmol/L (95% CI, 55-136 pmol/L) (CV%, 158%) to 9.7 pmol/L (95% CI, 8.1-11.4 pmol/L) (CV%, 31%) with a 50% recovery time (t1/2) of 7.1 hours (range, 5.1-11.5 hours) (114%). Serum osmolality decreased from 321 mOsm/kg (range, 315-327 mOsm/kg) (4%) to 294 mOsm/kg (range, 292-296 mOsm/kg) (1%) with a t1/2 of 4.3 hours (range, 3.0-5.6 hours) (64%). Copeptin levels doubled with each osmolality increase by 15 mOsm/kg (range, 10-21 mOsm/kg) (59%), from 9.8 pmol/L (range, 7.3-12.3 pmol/L) (48%) to 280 mOsm/kg. Copeptin kinetics differed between newly diagnosed and known T1D patients (P = .001), and less between mild vs moderate-severe DKA (P = .04).

Conclusions
First, this study characterized for the first time copeptin kinetics and dynamics in the high hyperosmolar range in children with DKA. Second, it revealed significant differences in copeptin kinetics between newly diagnosed and known T1D patients that may be explained by changes at the osmoreceptor and renal AVP receptor level due to longstanding osmotic diuresis and DKA.
“Still There”: (Dis)engaging with Dickens's Minor Characters
Authors: Starkowski Kristen H. 
Published: August 2020

AbstractMore can be done in minor character studies to account for the strong sense of being that emerges at the edges of the nineteenth-century novel. By pairing traditional readings of the minor character in narrative theory with sociologist Erving Goffman's writings on disengagement, this article offers a different perspective on the competition for narrative attention as we know it. For example, when disengagement is taken into account, Alex Woloch's losers in the competition for narrative attention become winners in the formulation of a fulfilling social life. Dickens's minor characters take part in central spaces while not being contained by them. Their distance from main scenes and settings, captured in passing by a gaze that has no interest in registering these elsewheres in any level of depth, has the effect of making minor characters appear strange, memorable, or other, even though their worlds are quite rich. But Dickens's minor characters define the ingenuity of counterintuition, pointing toward a suppressed energy that belies the flatness of a minor character. Drawn with care, these characters build alternative, codependent ways of surviving on the edges of the characterological field.
Anti-individualism in the Victorian Family Chronicle
Authors: Mcaleavey Maia 
Published: August 2020

AbstractThe bildungsroman privileges singularity: the unique and, often, the only child. This essay turns away from familiar literary narratives of a protagonist's personal development in order to examine the narrative possibilities of a genre that instead maintains focus on a group of siblings: the Victorian family chronicle. Family chronicles understand their large families as systems; they celebrate the replaceability of relationships rather than the irreplaceability of individuals. By insisting that a flourishing group can function in the absence of any particular person, they achieve fulfillment not in individualist plots but in group activities and brimful houses. The most influential Victorian family chronicler was Charlotte Mary Yonge. Yonge's episodic form was taken up by Anthony Trollope, Margaret Oliphant, Louisa May Alcott, and Margaret Sidney. These writers’ chronicles are non-protagonistic, nearly plotless, and potentially endless. They have been dismissed as minor works; nonetheless the anti-individualism of the large family chronicle offers an innovative approach to the nineteenth-century novel's tense negotiation between individual needs and group membership. Glimpses of chronicle narration can be seen operating within and against the competitive character systems that dominate canonical Victorian novels. A twentieth-century variant, Gilbreth and Carey's Cheaper by the Dozen, proves that the mutualistic form is also capable of hardening the boundaries around a family unit in order to compete in a capitalist marketplace. Nonetheless, the family chronicles developed by Yonge model a social economy in which both narrative and economic resources are not concentrated on a single striver but are distributed across a system.
Jewett in the Systems Epoch
Authors: Mehlman Gabriel 
Published: August 2020

Abstract
This article focuses on Sarah Orne Jewett's The Country of the Pointed Firs, the most famous example of the realist genre of local color. Published in 1898, the novel was written during the very moment of the generic collapse of local color. That collapse occurs within the literary system, in which any work of literature is enfolded—the functionally differentiated system that comprises writers, readers, genres, styles, the critical apparatus, and the publishing apparatus. As Firs stages the death of a small Maine community, it models its own death as a generic instance within the literary system. Firs both encodes and observes the gradual denaturing and collapse of its own classical-realist premises, which cannot abide the drawing into equivalence of character, interiority, and interpersonal communication with the inhuman formalism of systems. In the wake of the collapse of its classical-realist premises, the novel offers a final, speculative vision of a realism for the systems epoch.
Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis
Authors: Birowo Ponco , Tendi William , Widyahening Indah S. , Rasyid Nur , Atmoko Widi 
Published: August 2020

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.
maxRatio improves the detection of samples with abnormal amplification profiles on QIAgen’s artus HIV-1 qPCR assay
Authors: Marongiu Luigi , Shain Eric B. , Martinelli Marianna , Pagliari Matteo , Allgayer Heike 
Published: August 2020

Background: Accurate viral load (VL) determination is paramount to determine the efficacy of anti-HIV-1 therapy. The conventional method used, fit-point (FP), assumes an equal efficiency in the polymerase chain reaction (PCR) among samples that might not hold for low-input templates. An alternative approach, maxRatio, was introduced to compensate for inhibition in PCR. Methods: Herein, we assessed whether maxRatio could improve VL quantification using 2,544 QIAgen artus HI virus-1 RT-PCR reactions. The assay’s standard dilutions were used to build external standard curves with either FP or maxRatio that re-calculated the VLs. Results: FP and maxRatio were highly comparable (Pearson’s ρ=0.994, Cohen’s κ=0.885), and the combination of the two methods identified samples (n=41) with aberrant amplification profiles. Conclusions: The combination of maxRatio and FP could improve the predictive value of the assay.