bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral colonisation by antimicrobial-resistant Gram-negative bacteria among long-term care facility residents: prevalence, risk factors, and molecular epidemiology
Authors: Le Mi Nguyen-Tra , Kayama Shizuo , Yoshikawa Mineka , Hara Toshinori , Kashiyama Seiya , Hisatsune Junzo , Tsuruda Keiko , Onodera Makoto , Ohge Hiroki , Tsuga Kazuhiro , Sugai Motoyuki 
Published: March 2020

Abstract
Background
For residents of long-term care facilities (LTCFs), antimicrobial-resistant bacteria (ARB) are a risk factor, yet their oral colonisation, potentially leading to aspiration pneumonia, remains unclear. This study was undertaken to survey the prevalence, phenotypic characteristics, and molecular epidemiology of antimicrobial-resistant Gram-negative bacteria in the oral cavity of LTCF residents, and to analyse the risk factors for such carriers.

Methods
This study involved 98 residents of a LTCF in Hiroshima City, Japan, aged between 55 and 101 years. Oropharyngeal swabs were collected and plated on screening media for ESBL-producing and carbapenem-resistant bacteria; isolates were identified and tested for antibiotic susceptibility; biofilm formation was tested in vitro; identification of epidemic clones were pre-determined by PCR; resistance genes, sequence types, and whole-genome comparison of strains were conducted using draft genome sequences. Demographic data and clinical characterisations were collected and risk factors analysed.

Results
Fifty-four strains from 38% of the residents grew on screening media and comprised predominantly of Acinetobacter spp. (35%), Enterobacteriaceae spp. (22%), and Pseudomonas spp. (19%). All Escherichia coli isolates carried CTX-M-9 group and belonged to the phylogroup B2, O25:H4 ST131 fimH30 lineage. Six Acinetobacter baumannii isolates presented identical molecular characteristics and revealed more biofilm production than the others, strongly suggesting their clonal lineage. One Acinetobacter ursingii isolate displayed extensive resistance to various ß-lactams due to multiple acquired resistance genes. One Pseudomonas aeruginosa isolate showed exceptional resistance to all ß-lactams including carbapenems, aminoglycosides, and a new quinolone, showing a multidrug-resistant Pseudomonas aeruginosa (MDRP) phenotype and remarkable biofilm formation. Genome sequence analysis revealed this isolate was the blaIMP-1-positive clone ST235 in Japan. Strokes (cerebral infarction or cerebral haemorrhage) and percutaneous endoscopic gastrostomy tubes were recognised as risk factors for oral colonisation by ARB in the LTCF residents.

Conclusions
ARB, as defined by growth on screening agar plates, which carried mobile resistance genes or elements or conferred high biofilm formation, were already prevalent in the oral cavity of LTCF residents. Health-care workers involved in oral care should be aware of antimicrobial resistance and pay special attention to transmission prevention and infection control measures to diminish ARB or mobile resistance elements dissemination in LTCFs.
Combinative evaluation of primary tumor and lymph nodes to predict pelvic lymphatic metastasis in cervical cancer: an integrated PET-IVIM MRI study
Authors: Xu Chen , Li Xiaoran , Shi Yanchi , Wang Bo , Sun Hongzan 
Published: March 2020

Abstract
Background
The aim of this study was to evaluate the value of combining pelvic lymph node and tumor characteristics on positron emission tomography-intravoxel incoherent motion magnetic resonance (PET-IVIM MR) imaging for predicting lymph node metastasis in patients with cervical cancer, especially in those with negative lymph nodes on PET.

Methods
The medical records of 95 patients with cervical cancer who underwent surgical resection with pelvic lymph node dissection were evaluated. The patients were divided into negative and positive groups according to postoperative pathologic lymph node diagnosis, and comparisons of the PET and IVIM-derived parameters between the two groups were performed. Univariate and multivariate analyses were performed to construct a predictive model of lymph node metastasis.

Results
For all patients, tumor SUVmax, TLG, Dmin, PET and MRI for lymph node diagnosis showed significant differences between patients with and without confirmed lymph node metastasis. Univariate and multivariate logistic analysis showed that the combination of tumor TLG, Dmin and PET for lymph node diagnosis had the strongest predictive value (AUC 0.913, p < 0.001). For patients with PET-negative lymph nodes, SUVmax, SUVmean, MTV, TLG, and Dmin showed significant between-group differences, and univariate and multivariate logistic analysis showed that TLG had the strongest predictive value.

Conclusions
The combination of tumorTLG, Dmin and PET for lymph node diagnosis is a powerful prognostic factor for all patients. TLG has the best predictive performance in patients with PET negative lymph nodes.
Transition towards green banking: role of financial regulators and financial institutions
Authors: Park Hyoungkun , Kim Jong Dae 
Published: March 2020

AbstractThis paper provides an overview of green banking as an emerging area of creating competitive advantages and new business opportunities for private sector banks and expanding the mandate of central banks and supervisors to protect the financial system and manage risks of individual financial institutions. Climate change is expected to accelerate and is no longer considered only as an environmental threat because it affects all economic sectors. Furthermore, climate-related risks are causing physical and transitional risks for the financial sector. To mitigate the negative impacts, central banks, supervisors and policymakers started undertaking various green banking initiatives, although the approach taken so far is slightly different between developed and developing countries. In parallel, both private and public financial institutions, individually and collectively, are trying to address the issues on the horizon especially from a risk management perspective. Particularly, private sector banks have developed climate strategies and rolled out diverse green financial instruments to seize the business opportunities. This paper uses the theory of change conceptual framework at the sectoral, institutional and combined level as a tool to identify barriers in green banking and analyze activities that are needed to mitigate those barriers and to reach desired results and impacts.
A prospective database of 100 patients with locally soft tissue sarcoma (STS) treated by isolated limb perfusion with melphalan and TNFα 1mg
Authors: Bedard V. , Vataire A. , Desouche C. , Le Péchoux C. , Muret J. , Vanel D. , Terrier P. , Le Cesne A. , Bonvalot S. 
Published: March 2020

10010 Background: In a prior randomized phase II trial comparing hyperthermic isolated limb perfusion (HILP) with melphalan and 4 different doses of TNFa (0.5 mg; 1 mg; 2mg, 3 mg/4mg superior/ inferior limb), there was no dose effect detected for the tumour response but systemic toxicity was significantly lower with low doses TNF-a (Bonvalot S et al. 2005). The objective of the present study was to confirm these datas on a larger population of locally advanced or recurrent STS of the extremity using low dose TNFa. Methods: Prospective database including 100 HILP (38–40°) with melphalan (10 mg/L) and TNFa 1 mg. Resection of the remnant tumour was performed 2 months after ILP. The main endpoint was complete response on MRI. Secondary endpoints were histological response, rate of amputation and toxicity. Results: Sex ratio was and median age was 43 years. Location/ median size were 30/48 mm and 70/72 mm for upper and lower limbs respectively. There were 26 multifocal tumors, 52 recurrences of which 18 arising in a pre irradiated field. Grade (FNCLCC) were 1 (23 pts), 2 (34 pts), 3 (43 pts). Fifty one pts had pre ILP systemic chemotherapy. A complete radiological response was obtained in 30% of pts while 48%, 9% and 13% of pts exhibited a partial, no change and disease progression. There was no mortality and no systemic toxicity. Local toxicity were (Wieberdink) grade 2 (16 pts), 3 (5 pts) and 4 (1 pt). A limb salvage surgery was achieved in 88% pts. With a median follow-up of 27 months, 3 years overall survival and local recurrence rate were 89% and 15% respectively. Age, gender, tumor size, recurrence, uni/multifocality, grade, pre op chemotherapy, pre irradiated field, were not predictive of the responses rates. Conclusions: This study confirm that 1mg TNFa is as effective as the standard dose without its systemic toxicity. A wide population of pts may benefit from this approach. No significant financial relationships to disclose.
Safety and efficacy of combined trastuzumab and CMF therapy in women with metastatic breast cancer: EORTC protocol 10995
Authors: Neskovic-Konstantinovic Z. , Nooij M. , Khaled H. , De Valk B. , Vermorken J. , Welnicka-Jaskiewicz M. , Piccart M. , Marreaud S. , Bogaerts J. , Cameron D. 
Published: March 2020

1040 Background: Safety and efficacy of classical CMF combined with 3-weekly Trastuzumab (T), followed by T alone in metastatic breast cancer (MBC). Methods: Patients (pts) with previously treated MBC were enrolled into a Phase II study of T (4 mg/kg then by 2 mg/kg) IV weekly plus CMF, Bonadonna regimen, for a maximum of 8 cycles (cy), followed by T alone (6 mg/kg) IV 3 weekly. Entry criteria included HER2 overexpression, limited anthracycline (A) exposure, normal baseline LVEF and measurable disease (RECIST). Cardiac endpoints were defined as: symptomatic CHF or LVEF drop by ≥ 15% from baseline or to ≥ 5% below lower limit. Results: The trial was closed to recruitment in January 2006, 12 pts are still on treatment. Seventy one pts were entered with a median age of 54 (range 31–75). Forty-one pts had prior CT (32 A), of which 26 adjuvant, 6 MBC, and 9 both adjuvant and MBC. Median PS was 0, 52 pts had visceral disease with a median interval from diagnosis to first relapse of 33.4 months (mo). Out of 70 pts receiving T+CMF (33 pts with 8 cy), 42 continued with T alone for a median duration of 7 cy. Eleven pts discontinued treatment for toxicity (9 on T+CMF, 2 on T alone). To date, the overall response rate is 55% (31/56 pts): 55% (23/42) 1st line; 57% (8/14) 2nd line. An independent review of responses is on-going. Median time to response was 2 mo, median duration of response was 8.3 mo and the median progression free survival was 9.2 mo. The most common grade 3–4 toxicity was neutropenia (53 %). Fourteen pts had cardiac toxicities, one NYHA grade 2 CHF, 6 pts with a drop in LVEF of 15% from baseline after a median of 3 mo of treatment, 9 pts with a drop in LVEF of 5% below LLN, after a median of 8 mo of treatment. The other toxicities included one grade 3 arrhythmia, two grade 3 hypertension, one grade 2 SVT, one grade 3 thrombosis, and one grade 2 dyspnea. One pt previously exposed to A had NYHA grade 4 CHF one year after treatment discontinuation. Conclusions: Combination of T+CMF regimen is feasible treatment for HER2+ MBC patients. The safety profile was acceptable, with cardiac toxicity and neutropenia within previously reported range. Drops in LVEF were mostly asymptomatic irrespective of previous exposure to A. Preliminary response data confirm good efficacy of CMF+T in MBC patients. [Table: see text]
HER2 expression and HER2:HER2 dimerization identifies subpopulations of metastatic breast cancer patients with different probabilities of long-term survival following trastuzumab treatment and with different requirements for concomitant chemotherapy
Authors: Bates M. P. , Desmedt C. , Sperinde J. , Huang W. , Larsimont D. , Durbecq V. , Winslow J. , Chappey C. , Piccart M. , Sotiriou C. 
Published: March 2020

10557 Background: Selection of patients for treatment with trastuzumab is currently based on the semi-quantitative measurement of HER2 protein expression (IHC) or gene amplification (FISH). We made quantitative measurements of HER2 expression and homodimerization using a novel assay, eTag, and correlated them with overall survival (OS) and time-to-progression (TTP) following trastuzumab treatment in a cohort of patients with metastatic breast cancer (MBC). We also examined the benefit of concomitant chemotherapy (CT) depending on quantitative HER2 expression. Methods: The Jules Bordet cohort (Brussels, Belgium, N=71) had MBC and prior treatment with at least two CT regimens. Patients received trastuzumab alone or combined with predominantly paclitaxel. Independent medical data review and central confirmation of HER2 overexpression by FISH (N=64) or IHC (N=7) were mandatory. The eTag assay was used to quantitate HER2 protein expression and HER2:HER2 dimers in FFPE specimens. eTag measurements were correlated with OS and TTP using Kaplan-Meier and Cox Proportional Hazards regression analyses. Results: Cox analyses identified three independent correlates of OS and TTP: number of metastatic sites (HROS = 2.4/site, 95%CI 1.5–3.9, p = 0.00019), treatment with trastuzumab only (HROS = 2.8, 95%CI 1.1–7.3, p = 0.036), and HER2 expression level (HROS = 0.24/log10(HER2), 95%CI 0.09–0.7, p = 0.0058). Patients with high HER2 (above median expression) experienced better OS than those with low HER2 (HR 0.24, p = 0.0014). Patients with high HER2 expression did not benefit from added CT (HR = 0.95, 95%CI 0.24–3.8, p = 0.94), while patients with low HER2 expression did (trastuzumab alone HR 4.4, 95% CI 1.3–18, p = 0.018). Similar results were observed for HER2:HER2 dimerization. Conclusions: Within a population of patients selected by FISH or IHC to receive trastuzumab, higher HER2 expression or HER2:HER2 dimerization correlated with better outcomes. Patients with high HER2 expression derived no benefit from concomitant CT, while patients with low HER2 expression benefited significantly from the addition of CT to trastuzumab. No significant financial relationships to disclose.
A multicenter phase II study of epirubicin (E) with low-dose herceptin (LD-H) as a first-line treatment in HER2 overexpressing metastatic breast cancer (MBC)
Authors: Tursi M. De , Carella C. , Ricevuto E. , Gennari A. , Orlandini C. , Frassoldati A. , Conte P. F. , Iacobelli S. 
Published: March 2020

1060 Background: The combination of doxorubicin and herceptin (H) has been proven to be an effective regimen in metastatic breast cancer (MBC), although it was associated with an increased risk of cardiotoxicity. Methods: The aim of this study was to evaluate cardiac safety and efficacy of epirubicin (E) in combination with low-dose herceptin (LD-H) as first-line chemotherapy for women with HER-2 positive MBC. Forty-five patients were enrolled in a two-step, multicenter phase II study. In the first step, H was given at 2 mg/Kg loading dose on day 1, followed by 1 mg/Kg weekly; in the second step (≥ 12 objective responses/21pts), H dose was maintained at 1 mg/kg weekly. E was administered at 90 mg/m2 on day 1 every 3 weeks. After 6–8 courses, H was continued as a single agent for a maximum of 52 weeks. To assess cardiotoxicity, patients were evaluated for the left ventricular ejection fraction (LVEF) at baseline, every two cycles during E and LD-H, and every three months during LD-H alone. Cardiotoxicity was defined as signs or symptoms of congestive heart failure in = 10% of patients at an E dose of 720 mg/ m2 or in = 20% of patients at an E dose > 720 < 1,000 mg/m2. Results: Eight episodes of cardiotoxicity were observed (an asymptomatic decrease in LVEF =15% in 6 patients and an asymptomatic decline of LVEF at = 50% in 2 patients). Grade 3–4 neutropenia, alopecia and thrombocytopenia occurred in 25%, 45.5% and 6.8% of patients, respectively. Complete and partial responses were 2.4 and 61.9%, respectively, for an overall response rate of 64.3%. The median time to progression was 8.2 months (95% CI, 5.2–9.2 months) and the median overall survival was 32.8 months (95% CI, 17.1–48.6 months). Conclusions: E plus LD-H is an active treatment regimen for HER-2 positive MBC and demonstrates a very favourable safety profile, with manageable cardiotoxicity. No significant financial relationships to disclose.
Activity of trastuzumab (t) beyond disease progression in HER2 over-expressing metastatic breast cancer (MBC)
Authors: Metro G. , Mottolese M. , Cosimo S. Di , Papaldo P. , Ferretti G. , Carlini P. , Cianciulli A. M. , Giannarelli D. , Cognetti F. , Fabi A. 
Published: March 2020

1066 Background: In HER-2 over-expressing MBC patients (pts), preclinical evidence suggests that T therapy should be continued until disease progression. On the other hand, the activity of T beyond disease progression is unknown. Methods: We retrospectively evaluated HER-2 over-expressing (score 3+ by IHC or 2+ and FISH amplified) unselected MBC pts treated at our institution with successive T-based cytotoxic therapies. Results: From 06/2001 to 06/2006 59 patients (57 female and 2 male) receiving at least 1 T-based regimen for advanced breast carcinoma were identified. Characteristics of patients at initiation of T were as follows: median age 51 years (32–73), pre-menopausal 28/57 (49%), HER-2 IHC 3+ 49/59 (83%), negative hormonal receptor status 34/59 (58%), visceral disease 45/59 (76%), adjuvant chemotherapy 47/59 (80%), chemo-naïve for MBC 30/59 (51%), median number of previous chemotherapy lines for MBC prior to T 1 (0–2). A total of 37, 16 and 9 patients received respectively a 2nd, 3rd and 4th T-based regimen. In the 1st T-based line there was an overall response rate (ORr) of 60% (clinical benefit-CB- 83%) while 2nd T-based line yielded an ORr of 29% (CB 62%). None of the 16 and 9 patients who received respectively a 3rd and 4th T-based line responded to treatment. At a median follow up of 26 months (range 7–78), median time to progression was 9.5 months (95%c.i. 8.2–10.9), 6.7 months (95%c.i. 3.9–9.4), 4.0 months (95%c.i. 2.4–6-0) and 4.5 months (95%c.i. 3.7–8.3) from 1st to 4th T-based line respectively. Overall survival (OS) was 37 months (95%c.i. 22.4–53.4). No significant difference was observed in OS between the 22 patients receiving only 1 T-based line and the 37 patients who underwent at least 2 T-containing regimens (28 months vs 38 months, p=0.85). Conclusions: In HER-2 positive MBC patients T beyond disease progression maintains activity in terms of CB, TTP and OS. Prospective randomized trials are warranted to draw definitive results. No significant financial relationships to disclose.
Chemotherapy use for hormone receptor-positive, node-negative breast cancer
Authors: Hassett M. J. , Hughes M. E. , Niland J. C. , Edge S. B. , Theriault R. L. , Wong Y. , Wilson J. , Carter B. W. , Blayney D. W. , Weeks J. C. 
Published: March 2020

11004 Background: High quality evidence has shown that adjuvant chemotherapy (chemo) improves survival for hormone receptor- positive, node negative breast cancer measuring >1 cm (H+/N-/T>1cm BC). Since 2002 National Comprehensive Cancer Network (NCCN) guidelines have recommended chemo for this group. Because the benefit from chemo in this situation is modest there is debate regarding which women, if any, can forego chemo. We describe trends in chemo use and identify factors associated with not receiving chemo for H+/N-/T>1cm BC. Methods: We identified women less than 70 years old with H+/N-/T>1cm BC diagnosed 1997–2004 and treated at 8 NCCN institutions. We analyzed the frequency of chemo use on a yearly basis (chi square). A multivariable logistic regression model assessed the relationship between likelihood of not receiving chemo and year of diagnosis, institution, tumor size, histologic characteristics and socio- demographic variables. We incorporated interaction terms to explore how chemo use varied over time and between institutions. Results: Of 3190 women with H+/N-/T>1cm BC, 56% received chemo. Chemo use was less common for 1.1–2 cm than for >2 cm tumors (48 vs. 83%; p<.01). There was no significant change in chemo use over time, but there was significant variability among institutions (range 47–65%; p<.01). On multivariable analysis, predictors independently associated with not receiving chemo included lower histologic/nuclear grade, non-ductal/lobular histology, absence of lymphovascular invasion or HER2 overexpression, and older age (p<.01 for all). The interaction between institution and year of diagnosis was also significant (p<.01). Over the 2 years following the NCCN guideline’s definitive recommendation for chemo in 2002, the relative change in institutional chemo use ranged from a 25% decrease to a 28% increase. Conclusions: Many women did not receive chemo despite clinical trial evidence. Providers considered molecular features, tumor size and patient age when deciding who should receive chemo. While overall trends in chemo use did not change, use appeared to increase at some institutions and decreased at others after the 2002 guideline recommendation for chemo. This suggests a lack of consensus at NCCN institutions regarding when to administer chemo for H+/N-/T>1cm BC. No significant financial relationships to disclose.
Gemcitabine and docetaxel combination regimen in metastatic breast cancer (MBC)
Authors: Karacetin D. , Maral O. , Aksakal O. , Okten B. , Yalçın B. , Incekara O. 
Published: March 2020

1107 Background: No standart chemotherapy regimen has been estabilished for the treatment of patients with metastatic breast cancer. The gemcitabine and docetaxel combination has been shown to be synergistic . This study is conducted to verify the clinical efficacy and safety of gemcitabine and docetaxel combination therapy in metastatic breast cancer. Methods: 27 metastatic breast cancer patients were treated with gemcitabine-docetaxel combination . Gemcitabine 1,250 mg/m2 IV infusion, on day 1 and 8, and docetaxel 70 mg/m2 on day 1 in 21 day cycles. 4–6 cycles of chemotherapy were repeated every 3 weeks. The primary endpoint was response rate, and survival. Results: The median age was 50 years (range,32–77). Performans status (ECOG) was 0–1. Hormone receptor status: ER+/ER-; 11/16, PR+/PR-; 14/13. Menopausal status were: 11 premenopausal, 16 postmenopausal. Of the 27 evaluable patients, there were 11 (40.7%) partial responses and no complete response. Overall response rate was 40.7%. Median time to progression was 7 months, and median survival was 14 months. Toxicities included grade 3–4 neutropenia in 9 (30%), thrombocytopenia in 6 (22%), anemia in 3(9%). There were no treatment releated deaths Conclusions: The combination of gemcitabine and docetaxel has shown favorable toxicity profile and promising activity in metastatic breast cancer patients. No significant financial relationships to disclose.