bluuebunny/crossref_metadata_2025_split huggingface dataset:
Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry
Authors: Nogueira Raul G. , Haussen Diogo C. , Castonguay Alicia , Rebello Leticia C. , Abraham Michael , Puri Ajit , Alshekhlee Amer , Majjhoo Aniel , Farid Hamed , Finch Ira , English Joey , Mokin Maxim , Froehler Michael T. , Kabbani Mo , Taqi Muhammad A. , Vora Nirav , Khoury Ramy El , Edgell Randall C. , Novakovic Roberta , Nguyen Thanh , Janardhan Vallabh , Veznedaroglu Enrol , Prabhakaran Shyam , Budzik Ron , Frankel Michael R. , Nordhaus Brittany L. , Zaidat Osama O. 
Published: July 2019

Background and Purpose—
It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry.

Methods—
The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2–4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes.

Results—

A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15;
P
=0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9;
P
=0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8–442.5), 239 (175–389), and 336.5 (221.3–466.5) minutes in low-, medium-, and high-volume centers, respectively (
P
=0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes;
P
<0.001), higher balloon guide catheter use (40% versus 36% versus 59%;
P
≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%;
P
=0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03–2.7;
P
=0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1–2.9;
P
=0.03) centers, but there were no significant differences between high- and medium-volume centers (
P
=0.86).

Conclusions—
Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy.
Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke
Authors: Burgos Adrian M. , Saver Jeffrey L. 
Published: July 2019

Background and Purpose—
TNK (tenecteplase), a newer fibrinolytic agent, has practical delivery advantages over ALT (alteplase) that would make it a useful agent if noninferior in acute ischemic stroke treatment outcome. Accordingly, the most recent US American Heart Association/American Stroke Association acute ischemic stroke guideline recognized TNK as an alternative to ALT, but only based on informal consideration, rather than formal meta-analysis, of completed randomized control trials.

Methods—
Systematic literature search and formal meta-analysis were conducted per PRISMA guidelines (Preferred Reporting Items for Systemic Reviews and Meta-Analyses), adapted to noninferiority analysis. The primary outcome of freedom from disability (modified Rankin Scale score, 0–1) outcome at 3 m, and additional efficacy and safety outcomes, were analyzed.

Results—
Systematic search identified 5 trials enrolling 1585 patients (828 TNK, 757 ALT). Across all trials, mean age was 70.8, 58.5% male, baseline National Institutes of Health Stroke Scale mean 7.0, and time from last known well to treatment start mean 148 minutes. All ALT patients received standard 0.9 mg/kg dosing, while TNK dosing was 0.1 mg/kg in 6.8%, 0.25 mg/kg in 24.6%, and 0.4 mg/kg in 68.6%. For the primary end point, crude cumulative rates of disability-free (modified Rankin Scale score, 0–1) 3 m outcome were TNK 57.9% versus ALT 55.4%. Informal, random-effects meta-analysis, the risk difference was 4% (95% CI, −1% to 8%). The lower 95% CI bound fell well within the prespecified noninferiority margin. Similar results were seen for the additional efficacy end points: functional independence (modified Rankin Scale score, 0–2): crude TNK 71.9% versus ALT 70.5%, risk difference 2% (95% CI, −3% to 6%); and modified Rankin Scale shift analysis, common odds ratio 1.21 (95% CI, 0.93–1.57). For safety end points, lower event rates reduced power, but point estimates were also consistent with noninferiority

Conclusions—
Accumulated clinical trial data provides strong evidence that TNK is noninferior to ALT in the treatment of acute ischemic stroke. These findings provide formal support for the recent guideline recommendation to consider TNK an alternative to ALT.
Extratropical Cyclone Clouds in the GFDL Climate Model: Diagnosing Biases and the Associated Causes
Authors: Naud Catherine M. , Booth James F. , Jeyaratnam Jeyavinoth , Donner Leo J. , Seman Charles J. , Zhao Ming , Guo Huan , Ming Yi 
Published: July 2019

AbstractThe clouds in Southern Hemisphere extratropical cyclones generated by the GFDL climate model are analyzed against MODIS, CloudSat, and CALIPSO cloud and precipitation observations. Two model versions are used: one is a developmental version of “AM4,” a model GFDL that will utilize for CMIP6, and the other is the same model with a different parameterization of moist convection. Both model versions predict a realistic top-of-atmosphere cloud cover in the southern oceans, within 5% of the observations. However, an examination of cloud cover transects in extratropical cyclones reveals a tendency in the models to overestimate high-level clouds (by differing amounts) and underestimate cloud cover at low levels (again by differing amounts), especially in the post–cold frontal (PCF) region, when compared with observations. In focusing only on the models, it is seen that their differences in high and midlevel clouds are consistent with their differences in convective activity and relative humidity (RH), but the same is not true for the PCF region. In this region, RH is higher in the model with less cloud fraction. These seemingly contradictory cloud and RH differences can be explained by differences in the cloud-parameterization tuning parameters that ensure radiative balance. In the PCF region, the model cloud differences are smaller than either of the model biases with respect to observations, suggesting that other physics changes are needed to address the bias. The process-oriented analysis used to assess these model differences will soon be automated and shared.
Statistical Interaction in the Survival Analysis of Early Breast Cancer using Registry Data: Role of Breast Conserving Surgery and Radiotherapy
Authors: Vinh-Hung Vincent , Burzykowski Tomasz , Van de Steene Jan , Voordeckers Mia , Lamote Jan , Storme Guy 
Published: July 2019

Purpose To identify subgroup effects that might influence the survival results of postoperative radiotherapy. Patients and methods Women selected from the Surveillance, Epidemiology, and End Results database, aged 40-69 years, with non-metastasized T1-T2 breast carcinoma, in whom axillary lymph node dissection was performed. Subgroup analyses were performed using proportional hazards models with interactions. Joint significance of subgroups was evaluated with the Wald test. Event was death from any cause. Results Statistically significant interactions were found between type of surgery (breast-conserving [BCS] or mastectomy [ME]), radiotherapy [RT], T stage, and extent of nodal involvement, but not between treatments and nodal examination. For each treatment combination, ME-no RT, ME+RT, BCS-no RT, BCS+RT, the mortality hazard ratios were respectively: 1, 1.12, 1.11, 0.78 in T1, 0-3 positive nodes; 2.45, 2.77, 2.71, 1.92 in T2, 4+ nodes; 1.31, 1.38, 1.33, 1.19 in T2, 0-3+ nodes; and 3.41, 2.79, 3.44, 2.40 in T2, 4+ nodes. The corresponding joint tests showed: in the absence of radiotherapy, no significant survival disadvantage for breast-conserving surgery vs mastectomy; with radiotherapy, significant survival advantage for breast-conserving surgery irrespective of stage and for mastectomy in T2, 4+ nodes. For mastectomy in less advanced stages receiving radiotherapy, excess breast cancer deaths suggested undocumented adverse selection. The corresponding result was considered inconclusive. Conclusions The analyses found subgroup effects that should be taken into account to interpret treatment results in breast cancer.
The Prognostic Value of p53 and c-erbB-2 Expression, Proliferative Activity and Angiogenesis in Node-Negative Breast Carcinoma
Authors: Erdem Özlem , Dursun Ayşe , Coşkun Uğur , Günel Nazan 
Published: July 2019

Aims and background p53, c-erbB-2 and Ki-67 protein expression and microvessel density (MVD) determined by CD34 antibody were evaluated by immunohistochemistry and their correlation with clinicopathological parameters including estrogen (ER) and progesterone (PR) receptor status and survival were investigated in patients with axillary lymph node-negative infiltrating ductal breast carcinoma. Methods The study population consisted of 47 patients with axillary lymph node-negative infiltrating ductal breast carcinoma. Results p53 and c-erbB-2 expression was detected in 36.2% and 31.9% of patients, respectively. Median Ki-67 expression was 10%. There were no statistically significant differences in the distribution of p53, Ki-67 and c-erbB-2 protein expression in relation to the age of the patients or to the size, histological grade or ER and PR status of the tumors. p53 protein expression correlated positively with c-erbB-2 and Ki-67 protein expression (P <0.05). The mean MVD was 63.65 ± 29.1 and it correlated positively with histological grade and Ki-67 expression (P <0.05). Survival analysis revealed that age, tumor size, p53 and c-erbB-2 expression and PR status had no significant prognostic impact, whereas histological grade, proliferative activity and angiogenic activity were significant prognostic factors. Although ER-positive patients had a statistically significant overall survival advantage, the difference in disease-free survival was not significant. Conclusion In axillary lymph node-negative breast carcinoma the histological grade and the proliferative and angiogenic activity of the tumor could be useful prognostic indicators.
National Estimates of Cancer Patients Survival in Italy: A Model-Based Method
Authors: Inghelmann Riccardo , Grande Enrico , Francisco Silvia , De Angelis Roberta , Micheli Andrea , Verdecchia Arduino , Ferretti Stefano , Vercelli Marina , Ramazzotti Valerio , Pannelli Franco , Federico Massimo , De Lisi Vincenzo , Tumino Rosario , Falcini Fabio , Budroni Mario , Zanetti Roberto , Paci Eugenio , Crosignani Paolo , Zambon Paola , Capocaccia Riccardo 
Published: July 2019

Aims and background To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data. Methods Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of “cure” survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas. Results Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing creasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were “cured”, whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase. Conclusions The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries’ data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).
Hepatic Artery Administration of Docetaxel in Liver Metastases from Breast Carcinoma: A Feasibility Study
Authors: Cocconi Giorgio , Gamboni Alessandro , Gasparro Donatello , Leonardi Francesco , Salvagni Stefania , Vasini Giovanna , Larini Pietro , Marcato Carla , Camisa Roberta , Cascinu Stefano 
Published: July 2019

Aims and background Taxanes are largely metabolized and almost exclusively excreted in the feces by the liver through the biliary pathway, thus providing a rationale for investigating the activity of their hepatic artery delivery in case of liver metastases. Study design The aim of this study was to assess the feasibility of administering docetaxel via the hepatic artery in advanced breast cancer patients in whom the liver was the only or the predominant site of metastatic involvement. The dose was increased cycle by cycle in a prospective manner. Results Ten eligible patients were enrolled. The median administered dose in the last cycle was 65 mg/m2 (range, 40-100 mg/m2). The treatment was generally well tolerated, and only one patient stopped after two cycles because of toxicity. Four of the 9 eligible patients with assessable liver tumors achieved an objective response. After a median follow-up of 41 months, 4 of the 10 eligible (and 11 treated) patients were alive with a median overall survival of 46 months. Conclusions The administration of docetaxel via the hepatic artery is feasible. The highly interesting response and survival results observed in this limited series of patients warrant further studies.
Impact of Concurrent Radiotherapy on Chemotherapy Total Dose and Dose Intensity in Patients with Early Breast Cancer
Authors: Marenghi Cristina , Guglielmini Pamela , Verri Elena , Parodi Mariangela , Puntoni Matteo , Usset Antonella , Massoni Carola , Vormola Roberto , Boccardo Francesco 
Published: July 2019

Aims and background A retrospective analysis was conducted to evaluate the tolerability as well as the impact of concurrent adjuvant CMF chemotherapy and radiation therapy on total CMF dose and dose intensity. Methods The medical records of 59 patients who had received conservative or radical surgery for breast cancer were analyzed. All patients had been assigned to 6 cycles of “1,8 CMF” adjuvant chemotherapy and concomitant radiation therapy. Total drug dose and dose intensity were calculated. Toxicity was recorded scored according to WHO criteria. Results A total of 355 cycles was administered. Fifty of 59 patients received at least 85% of the programmed chemotherapy total dose, the median value being 100% (range, 42-100). The median relative dose intensity was 0.97 (range, 0.42-1.01). Forty-four of 59 (75%) patients experienced grade 3-4 neutropenia (20 febrile neutropenia) and 29 (49%) required G-CSF support. Conclusions This retrospective analysis showed that it is possible to give concurrent CMF and breast radiation while ensuring adequate chemotherapy total doses and dose intensities to most patients. However, G-CSF support is required in a significant proportion of patients.
Long-Term Results in Patients Affected by Testicular Seminoma Treated with Radiotherapy: Risk of Second Malignancies
Authors: Fatigante Lucia , Ducci Francesco , Campoccia Silvana , Nocita Anna Morgana , Paci Enrico , Crocetti Emanuele , Cionini Luca 
Published: July 2019

Aims To report clinical results in patients with testicular seminoma treated with postoperative radiotherapy with regard to survival, acute and late toxicity, and risk of second malignancy. Materials and methods 176 stage I-II testicular seminoma patients treated with radiotherapy from 1964 to 1994 at the Radiotherapy Division of Pisa University, using 60Co or Linac, were analyzed retrospectively. The follow-up ranged from 0.13 to 32.37 years, with a median of 12.1 years. The observed numbers of second malignancies were compared with those expected, taking into account age, sex, and incidence rates from the Tuscany Tumor Registry. Results Overall and specific survival at 10-15 years were 89-82% and 93-92%, respectively. Multivariate analysis revealed a significantly better survival in patients younger than 50 years and in those treated with Linac. Severe late sequelae occurred in 8% of the patients. Sixteen second malignancies were observed (14 solid tumors and 2 leukemias); median latency was 13 years (range, 3-27) and the observed/expected ratio 1.4 ( P not significant). Solid cancers were localized in the bladder (2), kidney (2), skin (2), stomach (1), prostate (1), lung (1), larynx (1), uvea (1) and contralateral testicle (1); 1 patient presented an intestinal carcinoid and 1 a metastasis from an unknown primary. The risk of a second malignancy was higher in the patient group receiving less than 4000 cGy (observed/expected, 2.8; P = 0.015). Conclusions The study confirmed the high cure rate in stage III seminomas after postoperative radiotherapy. Incidence of a second malignancy was higher than expected, but the difference was not statistically significant.
External Beam Radiotherapy in the Treatment of Male Breast Carcinoma: Patterns of Failure in a Single Institute Experience
Authors: Zabel Angelika , Milker-Zabel Stefanie , Zuna Ivan , Wannenmacher Michael , Debus Jürgen 
Published: July 2019

Aims and background We analyzed our own results in the treatment of male breast cancer patients with respect to local control, overall survival and possible prognostic factors for local and distant control. Methods Thirty-one patients with 32 carcinomas of the male breast were treated with radiotherapy. Twenty-five patients received radiotherapy to the chest wall including or not regional lymphatics after initial mastectomy (n = 23) or after surgery for local recurrence (n = 2). Median total dose was 60 Gy to the chest wall and 46 Gy to regional lymphatics. Seven patients with metastatic disease were referred for palliative radiotherapy. Results Overall survival after postoperative radiotherapy was 40% after a median follow-up of 4.3 years. Actuarial 3-, 5- and 10-year survival was 82.6%, 56.5% and 43.5%, respectively. Five-year progression-free survival was 62.5%. Survival was significantly affected by the presence of lymph node metastases ( P <0.001). Local recurrence was seen in one patient after 29 months. Conclusions Postoperative radiotherapy is important in the management of male breast cancer to improve local control and progression-free survival, resulting in one local failure in our analysis. The presence of lymph node metastases significantly impairs survival.
Italian Survey in Postoperative Radiation Therapy for Prostate Carcinoma by the Airo National Working Group on Prostate Radiotherapy: Definitive Results
Authors: Malinverni Giuseppe , Greco Carlo , Bianchi Pieromaria , Busutti Luciano , Cagna Emanuela , Cozzarini Cesare , Del Duca Massimo , Franzone Paola , Frezza Giovanni , Gabriele Pietro , Genovesi Domenico , Girelli Giuseppe Franco , Italia Corrado , Mandoliti Giovanni , Mauro Floranna , Nava Simonetta , Pratissoli Silvia , Saracino Maria Bianca , Squillace Luigi , Signor Marco , Tagliagambe Angiolo , Vavassori Vittorio , Villa Sergio , Zini Giampaolo , Valdagni Riccardo 
Published: July 2019

Aims and background The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia Oncologica, Italian Association of Radiotherapeutic Oncology) was established in March 2001. A retrospective multicenter survey was performed to analyze the patterns of care for prostate cancer patients treated with postoperative radiotherapy following radical prostatectomy in Italy with regard to the year 2000. Materials and methods A structured questionnaire was mailed to 47 Italian radiotherapy centers to assess patient accrual in the postoperative setting in the interval comprised between period January-December 2000. Numbers of patients treated for different stages, specific prognostic factors indicating the need for adjuvant radiotherapy, fractionation schedules and prescription doses were acquired as well as other clinically important factors such as radiotherapy timing and the use of hormone therapy. More technical features of the treatment, such as patient positioning, mode of simulation, typical field setup and dose prescription criteria were also included in the questionnaire. Results The questionnaire was returned by 24 radiotherapy Institutions (51%) with a total number of 470 patients treated postoperatively in the year 2000. An average of about 20 patients were enrolled by each radiotherapy center. The age range was 45-81 years. Radiotherapy was delivered within 6 months of radical prostatectomy in 297 patients (65.4%) (mean, 3.4 months). In 157 (34.6%), the treatment was delivered as a salvage approach for biochemical or micro-macroscopic recurrence. Most of patients had locally advanced stage disease (pT3-pT4) (76%). Unfavorable prognostic factors, such as positive margins, capsular invasion, Gleason pattern score <7 were present in about 50% of patients. Conclusions The study confirmed that important risk factors for recurrences are present in a significant percentage of patients treated by radical prostatectomy. The number of patients that would benefit from adjuvant radiotherapy is therefore potentially very large. Future prospective studies should be conducted to assess and to clarify the respective roles of adjuvant and salvage radiotherapy in prostate cancer patients.