bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment and Outcomes of Women With Large Locally Advanced Breast Cancer
Authors: Mangieri Christopher W. , Ruffo Julia , Chiba Akiko , Howard-McNatt Marissa 
Published: November 2020

Advances in breast cancer research have made breast cancer a treatable disease. However, there is a population of women who present with large, advanced, or sometimes neglected breast cancers who can prove difficult to treat. These women often require multiple modality treatment including chemotherapy, surgery, and radiation. The purpose of our study is to examine the treatment and outcomes on women with large, locally advanced breast cancers (LABCs). We identified 8 individuals who presented with LABCs requiring extensive treatment. Patients with inflammatory or metastatic cancer at the time of presentation were excluded. These patients’ charts were reviewed and analyzed. Patient demographics, hormone receptor status, stage, types of treatment, presence of metastasis, survival, and presence of barriers for seeking treatment sooner were identified. The median age at presentation was 65 years old. The patients were equally African American and Caucasian. All patients presented with T4 or stage 3 tumors involving the skin and/or pectoralis muscle. Half of the patients were found to have triple-negative (estrogen receptor, progesterone receptor, Her-2/neu negative) tumors. 87% of the patients received chemotherapy; 1 refused. All 8 patients, either neoadjuvantly or adjuvantly, underwent a modified radical or radical mastectomy. Skin graft or flap coverage was necessary in half of the patients. Postmastectomy radiation was received in 87% of the patients; 1 patient refused the treatment. Half of the patients developed metastatic disease. Thirty-seven percent of the patients have since died with a median survival of 44 months. Reasons for delay in seeking care were monetary or social barriers. Many of the patients finally sought care via the emergency room due to symptoms they could no longer ignore. Women who present with LABC require complex multidisciplinary treatment consisting of chemotherapy, surgery, and radiation treatments. Many of these patients faced economic and social challenges to accessing care. Better access to care and more prompt connection to breast surgeons are required to assist this patient population.
Repurposing a Small Community Hospital Surgical Residency Program in an Epicenter of the COVID-19 Pandemic
Authors: Meghpara Melissa K. , Alapati Amulya , Devanabanda Bhavana , Louis Martine A. , Mandava Neil 
Published: November 2020

Background COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. Study Design A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1 month before and 5 weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5 weeks. Results Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5 weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. Conclusion Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.
Acute Care Surgery Service Is Essential During a Nonsurgical Catastrophic Event, the COVID-19 Pandemic
Authors: Bugaev Nikolay , Hojman Horacio M. , Breeze Janis L. , Nasraway Stanley A. , Arabian Sandra S. , Holewinski Sharon , Johnson Benjamin P. 
Published: November 2020

Background The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. Methods A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. Results Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% ( P = .99) for all critically ill patients; and 13.9% vs. 27.4% ( P = .12) for COVID-19 critically ill patients. Conclusion Acute care surgery is an “essential” service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services. Level of Evidence III. Study Type Therapeutic.
The Effects of Board Interlocks With an Allegedly Fraudulent Company on Audit Fees
Authors: Ivanova Mariya N. , Prencipe Annalisa 
Published: November 2020

Drawing on prior literature on audit fees, client reputation, and corporate governance, we posit that a material adverse event at a firm, such as a financial fraud allegation, leads to an increase in the audit fees of firms connected to the former by a board interlock. We propose two possible mechanisms to explain the upward pressure on audit fees: a client-side effect, where the client demands additional audit services, and an auditor-side effect, where the auditor raises its audit fees due to a perceived increase in audit engagement risk. The results indicate an average marginal increase of 12.86% in audit fees in the year following the public revelation of financial fraud. Additional analyses suggest that an auditor-side effect is in place, while we cannot find clear evidence supporting the client-side effect. Furthermore, we document that the positive effect on audit fees persists for up to at least 2 years after public disclosure of the event when the interlocked director serves as a member of the audit committee. JEL Descriptors: G34, M40, M42
A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma
Authors: Goshtasbi Khodayar , Lehrich Brandon M. , Birkenbeuel Jack L. , Abiri Arash , Harris Jeremy P. , Kuan Edward C. 
Published: November 2020

ObjectivesTo comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome.Study DesignRetrospective database study.SettingNational Cancer Database.MethodsThe 2004‐2015 National Cancer Database was queried for all patients with NPC receiving definitive treatment. Log‐rank tests and Cox proportional hazards models were used for statistical analyses.ResultsA total of 8260 patients with NPC were included (71.4% male; 42.5% with keratinizing histology; mean ± SD age, 52.1 ± 15.1 years), with a 5‐year OS of 63.4%. Multivariate predictors of mortality included age ≥65 years (hazard ratio [HR], 1.81; P <. 001), Charlson/Deyo score ≥1 (HR, 1.27; P =. 001), American Joint Committee on Cancer clinical stage III to IV (HR, 1.85; P <. 001), and government insurance or no insurance (HR, 1.53; P <. 001). Predictors of survival included female sex (HR, 0.82; P =. 002), Asian/Pacific Islander race (HR, 0.74; P <. 001), nonkeratinizing/undifferentiated histology (HR, 0.79; P =. 004), and receiving treatment at academic centers (HR, 0.87; P =. 02). Chemoradiotherapy (CRT) demonstrated improved OS as compared with radiotherapy (RT) only for stage II (P =. 006) and stage III (P =. 005) and with RT or chemotherapy only in stage IVA NPC (P <. 001). When compared with CRT alone, surgery plus CRT provided OS benefits in keratinizing (P =. 013) or stage IVA (P =. 030) NPC. When compared with RT, CRT provided OS benefits in keratinizing (P =. 005) but not nonkeratinizing (P =. 240) or undifferentiated (P =. 390) NPC. Substandard radiation dosing of <60 Gy and <30 fractions were associated with inferior OS (both P <. 001).ConclusionsNPC survival is dependent on a variety of clinical/sociodemographic factors. Stage‐specific treatments with optimal OS include CRT or RT for stages I to II and CRT for stage III to IV. The large representation of nonendemic histology is valuable, as these cases are not well characterized.
Remembering Castoriadis
Authors: Beilharz Peter 
Published: November 2020

I met Castoriadis only twice, once in Paris in 1979, and then repeatedly in Melbourne in 1991 over the time of the Thesis Eleven Conference on Reason and Imagination. Both these encounters, in different ways, were transformative for me. As it happens, I remember them very well. As the distance risks clouding memory, I take time in this paper to reconstruct and share these stories. They take us back to the world through which we first encountered Castoriadis, as Paul Cardan, via the efforts of London Solidarity and its emblematic hedgehog – small and prickly, doesn’t like being interfered with; known to pop up in ways that might just be revolutionary. This was Castoriadis as I first encountered him, and this was the culture I likely never got past: Socialisme ou Barbarie, en anglais.
Efficacy and Tolerability of Rufinamide in Epileptic Children Younger Than 4 Years
Authors: Tanritanir Ahmet , Wang Xiaofan , Loddenkemper Tobias 
Published: November 2020

Background: Rufinamide, a triazole derivative, is a new-generation antiseizure medication with a novel mechanism of action. We evaluated the efficacy and safety of rufinamide treatment in children with epilepsy younger than 4 years at our center. Methods: In this retrospective study, we included children younger than 4 years who had pharmacologically resistant epilepsy and were treated with rufinamide at Boston Children’s Hospital between June 2010 and June 2018. Safety and efficacy of rufinamide treatment were assessed immediately prior to initiation of rufinamide and at the last follow-up visit. Responders were defined as patients who had greater than 50% reduction in seizure frequency on follow-up as compared to baseline. Results: We reviewed records of 128 children and included 103 with complete information. Patients consisted of 60 boys (58%), with a median age of 20 months (interquartile range 13-28, range 2-36). Median treatment duration was 15 months, and median rufinamide dosage at the last follow-up was 42 mg/kg/d (interquartile range 34-56). At the last follow-up, seizure frequency decreased (450 vs 90, P<.001) and overall seizure reduction was 54%. Fifty-one patients (49.5%) were responders with 94% seizure reduction, including 20 (19.4%) who achieved seizure freedom. Treatment retention rate at 12 months was 63%. Thirty patients (29%) developed adverse events and 41 patients (39.8%) discontinued rufinamide because of adverse events (15; 14.5%) and lack of efficacy (26; 25%). Conclusion: Rufinamide is effective in reducing seizure frequency in pediatric epilepsy patients younger than 4 years, and overall well tolerated.
Efficacy of high-intensity aerobic exercise on cognitive performance in people with multiple sclerosis: A randomized controlled trial
Authors: Langeskov-Christensen Martin , Hvid Lars Grøndahl , Jensen Henrik Boye , Nielsen Helle Hvilsted , Petersen Thor , Stenager Egon , Hämäläinen Päivi , Dalgas Ulrik 
Published: November 2020

Background Cognitive impairment is highly prevalent in multiple sclerosis (MS). Progressive aerobic exercise (PAE) represents a promising approach toward preservation or even improvement of cognitive performance in people with MS (pwMS). Objective To investigate the effects of PAE on the cognitive domains of information processing, learning and memory, and verbal fluency in pwMS. Methods This randomized controlled trial included an exercise ( n = 43, 24 weeks of supervised PAE, followed by self-guided physical activity) and a waitlist group ( n = 43, 24 weeks of habitual lifestyle, followed by supervised PAE). Assessments included the Brief Repeatable Battery of Neuropsychological tests (BRB-N), self-reported mood, and cardiorespiratory fitness. Published reference data were used to compute Z-scores for BRB-N scores. Cognitive impairment was defined as one or more Z-scores ⩽ –1.5 SD. Results No between-group changes in the total group were observed in BRB-N scores following PAE. In the cognitively impaired subgroup (43% of the total group) the between-group point estimate suggested a potential clinical relevant improvement in the Symbol Digit Modalities Test (95% CI overlapping zero). Cardiorespiratory fitness increased in the total group and the cognitively impaired subgroup. Conclusion In the present representative MS group, 24 weeks of supervised PAE had no effect on any cognitive domain in the total group but potentially improved processing speed in the cognitively impaired subgroup.
The constitution of the alcoholic self, communicative processes and administrative practices: On the varied uses of four terms denoting problematic drinking
Authors: Roumeliotis Filip , Carlsson Frida , Erkenfelt Linn Johansson , Wallander Lisa 
Published: November 2020

Aims: The aims of this article were to examine the various meanings ascribed by three stakeholder groups – social workers, journalists and individuals with previous experience of problematic drinking – to four widely used terms in the alcohol field – alcoholism, alcohol dependence, alcohol misuse and risky drinking – and to examine how variations in the definitions of these terms correspond to specific pragmatic needs arising within different practices. Design: We conducted focus-group interviews with 15 individuals from the above-mentioned stakeholder groups. We identified three practices, we identified three practices which shaped the meanings ascribed to the four terms denoting problematic drinking. Results: The results showed that the meanings ascribed to the four terms were both fixed and fluid. For the individuals with previous experience of problematic drinking, the four terms had fixed meanings, and their definition of the term “alcoholism” as denoting a disease, for example, was vital to the practice through which they sought to come to an understanding of themselves (“practice of self”). The social workers and the journalists on the other hand saw the four terms as being context dependent – as fluid and imprecise. This allowed them to establish trustful communicative relationships with informants and clients (“practice of trustful communication”), and to control the communicative process and successfully navigate between different administrative systems (“practice of administration”). Conclusions: Since the meanings ascribed to the examined terms denoting problematic drinking are shaped within varying practices, confusion regarding the actual meaning of a given term could be avoided by referring to the practical context in which it is used.
Home-Based Physical Activity in Patients With Breast Cancer: During and/or After Chemotherapy? Impact on Cardiorespiratory Fitness. A 3-Arm Randomized Controlled Trial (APAC)
Authors: Vincent François , Deluche Elise , Bonis Joëlle , Leobon Sophie , Antonini Marie-Thérèse , Laval Caroline , Favard Florent , Dobbels Eloïse , Lavau-Denes Sandrine , Labrunie Anaïs , Thuillier Frédéric , Venat Laurence , Tubiana-Mathieu Nicole 
Published: November 2020

Objectives: Physical activity (PA) programs are recommended for breast cancer care. However, their modalities remain to be discussed. This study determined the best time to begin a personalized or adapted program based on cardiopulmonary exercise test function. This randomized controlled trial evaluated the effect of home-based adapted PA (APA) performed during or after treatment on cardiorespiratory fitness (CRF) at 12 months. Method: The primary endpoint was the peak oxygen consumption (VO2peak) at 12 months (group A vs C and B vs C). Secondary endpoints included the 6-minute walking test, assessment of muscle strength, fatigue, quality of life, anxiety, and depression, and a questionnaire on PA levels. All tests were evaluated at baseline and at 6 and 12 months. A total of 94 patients with breast cancer were randomized to 3 different groups: group A, performing 6 months of APA during adjuvant care; group B, 6 months of APA after adjuvant care; and group C, 12 months of APA during and after specific care. The program combined 1 resistance session and 2 aerobic sessions per week. Analysis of variance was used for repeated measures, Student’s t-test or the Mann–Whitney U-test for continuous variables, and χ2 test for binary or categorical variables. Results: The study assessed 81 participants at 6 months and 73 at 12 months. The majority of patients completed more than 85% of the exercise sessions. The baseline for VO2peak and secondary outcomes did not differ among the groups. VO2peak increased during the exercise period and decreased during the chemotherapy period without APA, but at 12 months no significant difference was observed. The same variation was observed in the 6-minute walking test, with significance at 6 months between A+C versus B ( P = .04), but no difference among the groups at 12 months. In the 3 groups, no decreases in other studied parameters were noted, except at 6 months in group B without APA. Conclusion: Home-based APA in breast cancer patients has a positive effect on CRF and physical functions, with no differences based on the timing of this program based on specific cancer treatment. Trial Registration: ClinicalTrials.gouv.fr (NCT01795612). Registered 20 February 2013.
Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis
Authors: Cheng Chen-Ting , Chang Yuan-Chen , Tam Ka-Wai , Yen Yu-Chun , Ko Yu-Chen 
Published: November 2020

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
Preoperative Endoscopic Biliary Stenting Before Pancreaticoduodenectomy: Does Timing Matter?
Authors: Bhatti Abu Bakar Hafeez , Jafri Roshni Z. , Khan Muhammed Kashif , Dar Faisal Saud 
Published: November 2020

Background. The role of preoperative biliary stenting (PBS) before pancreaticoduodenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess PD outcomes after upfront surgery or PBS and determine the impact of stent to surgery duration on PD outcomes. Methods. We reviewed patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (n = 67) or PBS (n = 66). We further assessed outcomes based on stent to surgery duration. Results. There was no significant difference in 30-day mortality (3% vs. 2.9%, P = 1), 90-day mortality (7.5% vs. 4.4%, P = .4), and Grade B-C pancreatic fistula rates (7.5% vs. 4.4%, P = .4) in the PBS and upfront surgery groups, respectively. A significant increase in wound infections (22.7% vs. 7.4%, P = .01) and readmissions (10.6% vs. 0, P = .006) was seen in the PBS group. The highest rate of wound infection was seen when stent to surgery duration was 4-6 weeks (41.6%). The wound infection rates in the upfront surgery group, high-risk PBS group (4-6 weeks), and low-risk PBS group were 5/67(7.4%), 5/12(41.6%), and 7/36(19.4%), respectively ( P = .008). Conclusions. PBS increases postoperative wound infections when compared with upfront surgery. Patients operated between 4 and 6 weeks after stenting have the highest rate of wound infection.