bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distributed extended Kalman filtering for state-saturated nonlinear systems subject to randomly occurring cyberattacks with uncertain probabilities
Authors: Li Jiaxing , Hu Jun , Chen Dongyan , Wu Zhihui 
Published: August 2020

AbstractIn this paper, the extended Kalman filtering scheme in a distributed manner is presented for state-saturated nonlinear systems (SSNSs), where the randomly occurring cyberattacks (ROCAs) with uncertain occurring probabilities (UOPs) are taken into account. In particular, a novel cyberattack model is constructed by the consideration of false data-injection attacks (FDIAs) and denial-of-service attacks (DoSAs) simultaneously. The ROCAs are described by a series of Bernoulli distributed stochastic variables, where the so-called UOPs are considered and described by the nominal mathematical expectations and error bounds. The major effort is to develop a novel DEKF strategy for SSNSs with consideration of state delay and ROCAs with UOPs. In what follows, an upper bound with respect to the filtering error covariance is derived and minimized by selecting the suitable filter parameter. Besides, the concrete expression of the filter parameter is formed by solving matrix difference equations (MDEs). Meanwhile, a sufficient condition under certain constraints is proposed to testify the boundedness regarding the given upper bound. Finally, we use the experiments and corresponding comparisons to verify the feasibility of the designed extended Kalman filtering approach in a distributed way.
Role of partial splenic artery embolization in corpuscular correction in cirrhotic patients before anti-viral therapy: a recent update study among Egyptian patients
Authors: Mostafa Elian Mostafa Mohamed , Samea Mohamed Ahmed A. , Osman Nasr Mohamed M. 
Published: August 2020

Abstract
Background
To evaluate the role of partial splenic artery embolization in corpuscular correction in cirrhotic patients.

Results
Bleeding tendency was experienced in two thirds of patients (66.7%) and anemia in 63.3%. Splenic size ranged from 14.3 to 22 cm. PV diameter ranged from 11 to 18 mm. The mean platelet at the pre-operative laboratory was 34.9 ± 10.3 × 103, corrected to 137.6 ± 37.1 × 103 within 1 month follow-up, and then 140 × 103 after 6 months. The mean of RBCs was 3.6 ± 0.3 × 106, then 4 ± 0.5 × 106 at 1 month follow-up period. WBCs showed correction at the early post-operative period, 3.3 ± 0.4 × 103, compared to 5.4 ± 1.4 × 103 at 1 month. Reduction in splenic size was achieved by 3–6 months. All patients (100%) had post-embolization syndrome. Gelfoam was used in 20 patients, PVA was used in 5 patients, and microspheres were used in 5 patients. Antiviral treatment regimen was started after an adequate rise in corpuscular counts in all patients.

Conclusion
Partial splenic artery embolization is an effective alternative method to surgery in treatment of hypersplenism particularly in cirrhotic patients prepared for antiviral treatment with correction of the associated thrombocytopenia.
A singular case of massive urethrorrhagia solved by transarterial embolization
Authors: Francesco Pane , Milena Coppola , Antonio Borzelli , Francesco Giurazza , Fabio Corvino , Antonio Corvino , Mattia Silvestre , Raffaella Niola 
Published: August 2020

Abstract
Background
Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches.

Case presentation
Our aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Multi-detector computed tomography (MDCT) showed pubic symphysis diastasis and perineal hematoma with pseudoaneurysm into the penis bulb. The first approach was conservative with perineal external compression and intravenous injection of tranexamic acid. Afterward, due to the decline of clinical conditions, we decided to perform a selective angiography, confirming the vascular injury of distal branches of both internal pudendal arteries with contrast agent extravasation into urethral bulb; endovascular embolization was performed with detachable micro-coils. The principal results were seen quickly, indeed urethrorrhagia arrested and hemoglobin values normalized. Erectile function was preserved at 6-months follow-up.

Conclusions
Endovascular embolization proved to be a minimally invasive therapeutic approach, clinically effective, with a low rate of complications and high probability to preserve erectile function.
Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs
Authors: Le Quang V. , Trinh Huy L. , Mai Kim Ngan T. , Pham Manh D. , Glare Paul A. 
Published: August 2020

PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.
Phase II window study on rituximab in newly diagnosed pediatric mature B-cell non-Hodgkin lymphoma (NHL)
Authors: Reiter A. , Meinhardt A. , Burkhardt B. , Zimmermann M. , Borkhardt A. , Kontny U. , Mann G. , Schrappe M. 
Published: August 2020

10000 Background: Pediatric mature B-cell NHL differ from aggressive B-NHL of adults in terms of biology and treatment outcome. In contrast to adults, rituximab (Rx) is not established in the treatment of pediatric B-NHL has not be determined yet. Even the activity of Rx in pediatric B-NHL is not determined. We conducted a phase II window study to examine the activity of Rx in newly diagnosed pediatric B-NHL. Methods: Eligibility: age < 19 y, CD20 + B-NHL, ≥ 1 measurable lesion/s, informed consent. Exclusion: Lansky performance scale 5, pre-treatment, impaired renal-, heart-, liver-function, hepatitis B, pre-existing disease, pregnancy. Treatment: Rx 375 mg/m2 IV at day 1; concomitant therapy: Rasburicase, steroids only for anaphylaxis, intrathecal (IT) triple drug at days 1, 3 for CNS+ pts only. Begin of chemotherapy at day 5. Response evaluation: product of 2 perpendicular diameters of 1 - 3 index lesions/% blasts in BM/PB within 24 h prior to Rx and at day 5: responder (RP): at least 1 lesion with at least objective effect (decrease of ≥25%) and no progress (increase of ≥25 %) at other sites. Study plan: Simon 2-stage phase II with α and β = 5%. Response rate (RR) for poor activity was set to 45%, for good activity 65%. 33 pts entered the first stage, final evaluation after 79 pts. Results: One hundred thirty-six pts were enrolled from 04/04–08/08. NTC °3/4 toxicities: general condition 16%, fatigue 13%, anaphylaxis (chill/fever/bronchospasm) 6 (1/2/4)%, infection 3%, S-GOT/GPT 10%, acute tumor lysis (ATL) 7%, capillary leakage (0), toxic death (0). Forty-nine pts were not evaluable for response: Withdrawal (anaphylaxis 8, ATL 2, suspected progression, not verified 4, other 2), IT therapy in CNS- pts (8), corticosteroids (3), technical inadequacy of response evaluation (21), no index lesion (1). Of the 87 evaluable pts 37 were RPs (42.5%, 95%-CI 32% - 54%). RR by histology: BL/B-ALL 29/68, DLBCL 6/14, juvenile follicular lymphoma 1/2, PMBCL 1/1, B-NHL nfs 0/2. Fifty pts were non-RPs. Conclusions: Although the RR was lower than requested Rx as single agent is active in pediatric B-NHL. No significant financial relationships to disclose.
Final results of a randomized trial on the role of maintenance chemotherapy with weekly paclitaxel for patients with metastatic breast cancer
Authors: Mayordomo J. I. , Baena J. M. , Cirera L. , Sanchez-Rovira P. , Godes M. J. , Galan A. , Jimenez-Orozco E. , Muñoz M. , Tusquets I. , Sanchez M. J. 
Published: August 2020

1001 Background: Chemotherapy for patients with metastatic breast cancer is not curative. Anthracyclines and taxanes are among the most active drugs. Optimal duration of chemotherapy in women with metastatic breast cancer is an open issue. Should they receive chemotherapy to progression or should chemotherapy be stopped after a fixed number of courses? The excellent safety profile of weekly paclitaxel prompted us to evaluate its role as maintenance treatment in this setting. The primary objective was to determine if addition of maintenance weekly paclitaxel prolongs progression-free survival in women with metastatic breast cancer on first-line chemotherapy. Secondary objectives included overall survival and toxicity. Methods: Following Ethical Committee approval and informed consent, from 2002 to 2006 180 women with metastatic breast cancer and no prior chemotherapy for metastatic disease were randomized 1:1 in the TASMAN phase III trial to: 3 courses of epirubicin 100 mg/m2 day 1 q 21 days, followed by 3 courses of paclitaxel 225 mg/m2 day 1 q 21 days, without further chemotherapy or hormonal therapy until progression (arm A), or 3 courses of epirubicin followed by 3 courses of paclitaxel and then maintenance with paclitaxel 60 mg/m2 day 1 q 7 days until progression or unacceptable toxicity (arm B). Results: Median age: 51 years (range: 30–73). Median performance status (ECOG): 0 (0–2). Sites of metastases: bone (36%), liver (20%), pleura and/or lung (19%), skin and/or lymph nodes (18%). No grade 3–4 toxicities were seen with maintenance chemotherapy. As of January 1, 2009, 18 patients remained progression-free and 48 were alive, with a minimum follow-up of 2 years. Median progression-free survival was 8 months for arm A versus 12 months for arm B (p = 0.1, logrank). Median overall survival was 24 months for each arm (p = 0.7). Conclusions: Maintenance chemotherapy with weekly paclitaxel following first-line chemotherapy with anthracycline and taxane is well tolerated but does not significantly increase progression-free survival. No significant financial relationships to disclose.
Phase II single-arm study of irinotecan in combination with temozolomide in children with recurrent or refractory medulloblastoma
Authors: Grill J. , Perek D. , Sanchez de Toledo-Codina J. , Madero L. , Estlin E. , Cañete A. , Icher C. , Breazna A. , Geoerger B. , Cisar L. , Hargrave D. 
Published: August 2020

10018 Background: Irinotecan and temozolomide have demonstrated moderate single agent activity in childhood medulloblastoma (MB). Using the recommended dose established from a prior pediatric phase I study, the combination of irinotecan and temozolomide was investigated in relapsed MB. Methods: Patients aged 6 months to 18 years with radiological measurable relapsed/refractory MB were treated with temozolomide 100–125 mg/m2/day on days 1–5 orally and irinotecan 10 mg/m2/day on days 1–5 and days 8–12 intravenously. After cycle 5, patients who did not progress could receive irinotecan 125 mg/m2 once weekly on days 1 and 8 of the 3-week cycle. The primary objective was confirmed tumor response (partial or complete) after 4 cycles of treatment. According to a two-stage Optimum Simon design, at least 6 of the first 15 evaluable subjects were to have a confirmed objective response, to proceed to stage 2; a total of 19 responses in 46 subjects are required for success. A central radiological review determined tumor response in all patients. Results: Preliminary results are reported on 33 patients entered from May 2007 through to November 2008 in 19 treatment centers. The median age was 9 years (range 2 to 17 years); 23 male and 10 female. The number of relapsed patients with M3:M2:M1:M0 (Chang M stage) were 10:15:2:6, and 17 had more than 1 prior therapy. Previous treatment included chemotherapy, 7 with high-dose regimens, and craniospinal (CSI) (n=30) or posterior fossa irradiation (n=2). Central radiological review is ongoing: 16/26 reviewed patients were evaluable for response. Six patients had confirmed PR, 3 had SD, and 7 had PD. To date, 10 patients have been excluded after central review (8, poor imaging; 2, no measurable disease). Toxicity has been manageable with dose reduction required in 11/33 MB patients, all of these had received prior CSI. The study is ongoing in stage 2 and centrally verified results will be reported at the Meeting. Conclusions: This multi-centre international study is the largest phase II trial of the irinotecan and temozolomide combination in pediatric central nervous system tumors. The activity of the combination in heavily pre-treated recurrent MB patients is promising. [Table: see text]
Phase I study of vandetanib (ZD6474) administered during and after irradiation (RT) in children with diffuse intrinsic pontine glioma (DIPG)
Authors: Broniscer A. , Merchant T. E. , Hillenbrand C. , Patay Z. , Chin T. K. , Onar A. , Kaste S. C. , Gilbertson R. J. , Gajjar A. 
Published: August 2020

10020 Background: Children with DIPG have a dismal prognosis despite use of RT, which is the mainstay of therapy. All chemotherapy regimens used so far demonstrated no benefit. EGFR and VEGFR pathways are considered important in tumorigenesis of DIPG. Methods: We conducted a traditional phase I study combining oral vandetanib (VEGFR-2 and EGFR inhibitor) during and after local RT in children with DIPG. Five dosage levels were tested (50, 65, 85, 110, and 145mg/m2 per day). Vandetanib and RT started on the same day. The first 6 weeks of therapy constituted the dose-limiting toxicity (DLT)-evaluation period. Correlative studies consisted of pharmacokinetic analysis (PK), pharmacodynamic studies in blood, and standard and investigational imaging (before and 1, 3, and 6 weeks after start of therapy). Results: Twenty-one patients were enrolled on study (50 [n = 3], 65 [n = 3], 85 [n = 3], 110 [n = 6], and 145mg/m2 [n = 6]). Two patients experienced DLT consisting of rash/mucositis (level 4) and diarrhea (level 5). The maximum-tolerated dose (MTD) of vandetanib was not reached. Other significant toxicities included lymphopenia grade 3/4 (n = 10), grade 3 neutropenia and hypophosphatemia (one each), grade 2 proteinuria (n = 2), grade 2 hypertension (n = 4), and mild QTc prolongation (n = 7) .Once the phase I component was completed, two extra patients were enrolled at dosage level 5; one of them developed grade 4 seizure secondary to posterior reversible encephalopathy syndrome. PK (n = 21) showed similar drug clearance and volume of distribution compared to adults. However, drug exposure at steady state normalized by dose seemed higher in children. Increased tumor perfusion during the first 6 weeks of therapy was observed in the first 12 patients analyzed. Conclusions: Although MTD was not reached, we recommend administration of vandetanib at a dose of 110mg/m2 per day during and after local RT in children. Further combination studies of vandetanib in children with DIPG are planned. No significant financial relationships to disclose.
Pulmonary function after whole lung radiation in pediatric patients with malignant solid tumors
Authors: Inaba H. , Zhu L. , Srivastava K. , Hudson M. M. , Motosue M. S. , Stokes D. C. , McPherson V. , Srinivasan S. , Krasin M. J. , Green D. M. , Spunt S. L. 
Published: August 2020

10025 Background: Pediatric malignant solid tumors are increasingly curable; whole lung irradiation (WLI) may be used to treat pulmonary tumor involvement. Few studies have addressed long-term pulmonary function after WLI during childhood. Methods: We conducted a retrospective review of pulmonary function tests (PFTs) in 1 year survivors of pediatric malignant solid tumors treated with WLI. We assessed PFT changes over time and the relationship of abnormal values to clinical parameters (diagnosis, radiation dose, and presence or absence of boost lung irradiation or surgical resection). Results: We evaluated 164 PFTs performed on 49 patients with the diagnoses of Wilms tumor (38), rhabdomyosarcoma (5), Ewing sarcoma (3), synovial sarcoma (2), and thymoma (1). Median age at radiation was 6.3 years (range, 0.5–20.2 years); median WLI dose was 12 Gy (range, 10.5–18 Gy). Seventeen (34.7%) had focal pulmonary boost irradiation and 21 (42.9%) had partial lung resection. Across the entire population, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) declined after irradiation with a median follow-up of 9.3 years. The odds of having a normal FEV1 and FVC decreased by a factor of 0.90 (p = 0.0387) and 0.91 (p = 0.0445), respectively, every year, indicating that the proportion of patients with normal values of FEV1 and FVC decreases over time. FEV1/FVC ratio and forced expiratory flow (FEF25%-75%) remained stable. Abnormal FEV1/FVC and FEF25%-75% were more likely in patients who received boost irradiation than in patients who did not (p = 0.0034 and 0.0233, respectively). Conclusions: Pulmonary function worsened over time in this cohort of childhood cancer survivors treated with WLI. Boost irradiation further impaired pulmonary function. Further studies are planned to assess the clinical consequences of these progressive PFT abnormalities and to identify risk factors associated with clinically significant pulmonary dysfunction after WLI. No significant financial relationships to disclose.
Outcome in stage IV Wilms tumor treated according to the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) trials
Authors: Gandola L. , Nantron M. , Marchianò A. , Pession A. , Indolfi P. , Di Cataldo A. , Collini P. , Arcamone G. , Fossati Bellani F. , Spreafico F. 
Published: August 2020

10031 Background: Children with metastases at diagnosis for Wilms tumor (WT) still display a worse prognosis compared to localized disease. Methods: We analyzed survival results in patients with stage IV WT enrolled in the AIEOP CNR92 and TW2003 clinical trials (3/1992–3/2008). Treatment strategy across these trials evolved in terms of sparing whole lung radiotherapy (RT) in case of complete disappearance of lung metastases after primary chemotherapy and a doxorubicin cumulative dose reduction from 360 mg/m2 to 240 mg/m2 in TW2003. Results: Of 553 in-study patients aged less than 18 years, 68 (12%) were classified as stage IV (38 patients in CNR92, 30 in TW2003; median age 58 months). Children displaying millimetric nodules visible only on computed tomography scan were excluded. Initial treatment consisted of 6-week 3-drug (vincristine, dactinomycin, doxorubicin) phase in 60 cases, while 8 had up-front nephrectomy. Adjuvant therapy included 8-month 3-drug chemotherapy for non anaplastic “local” tumor stage I to III (flank RT for stage III), or an intensified regimen for anaplastic histology, adding etoposide, carboplatinum and ifosfamide (6 patients). Overall 19 tumor failure occurred (3 in anaplastic tumors): metastases progression 9, abdominal relapse 5 (combined to liver and mediastinum in 1 case each), lung 4, liver 1. After a median follow-up of 53 months 5-yr RFS and OS were 71% ±6 and 77% ±5 for the whole cohort of children, respectively. Overall, RFS was 86% in patients who achieved a complete metastases remission (in 2 cases by surgery) compared to 55% in patients who did not (Logrank p<.05). Noteworthy the omission of lung RT in TW2003 trial for complete responders evaluated at week 6 did not jeopardize survival (85% RFS, vs 58% for those children with persistence of metastases and lung RT). There was a trend toward a worse outcome for patients with at least liver metastases (n 13) compared to those with other site (4-yr RFS 49% vs 74%, p=.1). Conclusions: Failure to obtain metastases complete remission, and maybe site other than lung, should be considered for chemotherapy intensification for metastatic WT. The impact of metastatic tumor burden deserves further analysis. Withholding RT in rapidly complete responders patients did not compromise outcome. No significant financial relationships to disclose.
Correlatoin of apoptosis signaling in primary pediatric BCP-ALL xenograft cells with the kinetics of engraftment in vivo in a NOD/SCID model and patient outcome
Authors: Queudeville M. , Eckhoff S. M. , Debatin K. , Meyer L. H. 
Published: August 2020

10043 Background: We previously identified the importance of intact apoptosis signaling for treatment response in pediatric ALL and AML by analyzing two key apoptogenic events, caspase-3 activation and cytochrome c release. A correlation of both events was exclusively found in the groups of patients with good response to treatment, showing that intact apoptosis signaling is a critical feature for favorable outcome. Using a NOD/SCID mouse model for pediatric BCP-ALL we found that short time from transplant to overt leukemia in the recipient mice (short time to leukemia, TTLshort) determines poor patient outcome. Methods: In this study we investigated the importance of deficient apoptosis signaling for leukemia engraftment in this model. The apoptosis signaling parameters cytochrome c release and caspase-3 activation were analyzed in 17 ALL xenografts (TTLshort n = 5, TTLlong n = 12) by flowcytometry in relation to TTL. Results: A significant correlation of both apoptosis parameters was found in the TTLlong group only (P = .017). Importantly, patients showing TTLlong revealed a superior outcome compared to TTLshort patients. Proficient apoptosis signaling was only found in blast cells from recipients where the corresponding patient had favorable prognostic factors such as TEL/AML1-positivity (P = .023), no hyperleucocytosis (P = .012), no relapse (P = .038), and no early relapse (P = .017). In contrast, the correlation of cytochrome c release and caspase-3 activation was absent in the groups with poor prognosis. We also found a direct positive correlation between TTL and cytochrome c (P = .022) and caspase-3 activation (P = .048), indicating that short engraftment may be due to deficient apoptosis signaling. Conclusions: Our finding in the NOD/SCID/huALL model matches our results in pediatric ALL and AML to conclude that the functional integrity of a downstream apoptotic checkpoint is an important feature regulating leukemia biology. Thus, deficient apoptosis signaling appears to determine rapid engraftment of leukemia cells in the NOD/SCID model in vivo and consequently poor patient outcome. No significant financial relationships to disclose.