bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer
Authors: Anderson Benjamin O. , Austin-Seymour Mary M. , Gralow Julie R. , Moe Roger E. , Byrd David R. 
Published: August 2017

Background Lymph node metastasis is the single most important factor in assessing breast cancer prognosis and planning systemic therapy. However, lymph node dissection portends significant morbidity, with little or no therapeutic benefit if the nodes prove to be negative for cancer. Methods The authors review indications for avoiding axillary dissection, and they analyze the results from lower-level axillary lymphadenectomy together with the morbidity from full axillary dissection. Results Limited level I dissection depends on surgical technique and limits prognostic information. Three approaches have evolved to identify the sentinel node in breast cancer: perilesional breast injection of radiocolloid alone, blue dye alone, or a combination of radiocolloid and blue dye. These techniques provide high diagnostic accuracy, few false-negative results, and less morbidity. Conclusions Knowledge of axillary status is critical to current breast cancer management and cannot be foregone in the preponderance of patients with advanced breast cancer. Results from lymphatic mapping and sentinel node biopsy are highly encouraging.
The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy
Authors: Norman James 
Published: August 2017

Background Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma. Methods The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients. Results Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique — patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration — are described. Conclusions When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.
Large Granular Lymphocyte Leukemia
Authors: Lamy Thierry , Loughran Thomas P. 
Published: August 2017

Background:Clonal diseases of large granular lymphocyte (LGL) disorders can arise from a CD3+ T-cell lineage or from a CD3– NK-cell lineage. CD3+ LGL leukemia is the most frequent form of LGL leukemia and is a distinct entity by FAB and REAL classifications.Methods:The clinical course, biological features, and recent data on pathogenesis of CD3+ LGL leukemia are reviewed. The spectrum of differential diagnosis is described.Results:T-LGL leukemia affects elderly people. Approximately 60% of patients are symptomatic; recurrent infections secondary to chronic neutropenia, anemia, and rheumatoid arthritis are the main clinical features. The most common phenotype is CD3+, CD8+, CD57+. Clonality is detected by clonal rearrangement of the T-cell receptor gene. Clinical and molecular remission can be obtained with oral low-dose methotrexate. Serologic findings show frequent reactivity to the BA21 epitope of HTLV-I env p21e, suggesting that a cellular or retroviral protein with homology to BA21 may be important in pathogenesis. Clonal expansion may be facilitated by IL-12 and IL-15 lymphokines. Constitutive expression of Fas ligand by leukemic LGLs support the hypothesis that leukemic cells arise from antigen-activated cytotoxic T cells. Leukemic LGLs express a multidrug-resistance phenotype that could partly explain the chemoresistance observed in aggressive cases.Conclusions:CD3+ LGL leukemia is a distinct lymphoproliferative T-cell disorder with specific clinicobiological aspects. The clinical spectrum of LGL proliferations is wide and immunophenotypic, and genotypic studies are needed to establish the diagnosis.
Implantable Slow-Release Chemotherapeutic Polymers for the Treatment of Malignant Brain Tumors
Authors: Sampath Prakash , Brem Henry 
Published: August 2017

Background: Despite significant advances in neurosurgery, radiation therapy, and chemotherapy, the prognosis for patients with malignant brain tumors remains dismal. In an effort to improve control of local disease, we have developed a biodegradable, controlled-release polymer that is implanted directly at the tumor site. Methods: The preclinical and clinical development of the polymeric delivery of chemotherapeutic agents for treatment of patients with malignant gliomas is reviewed. Results: Carmustine (BCNU)-impregnated biodegradable polymer is the first new therapy approved by the FDA for patients with gliomas in 23 years. This delivery system provides high local concentration of drug with minimal systemic toxicity and obviates the need for drug to cross the blood-brain barrier. Randomized, multi-institutional, double-blinded, placebo-controlled studies have shown improved survival in patients treated for gliomas both at initial presentation and at recurrence. Several clinical principles have emerged from the use of this polymer system, and further applications are currently being investigated. Conclusions: Local delivery of therapeutic agents via biodegradable polymers may play an increasing role in patients with brain tumors.
Current Concepts in the Management of Tumors of the Skull Base
Authors: Morita Akio , Sekhar Laligam N. , Wright Donald C. 
Published: August 2017

Background: Due to their involvement with critical neurovascular structures, tumors located in the cranial base present challenges to neurosurgeons and are associated with high morbidity and mortality. Methods: Rates of tumor control, complications, patient outcomes, and recurrences were extracted and summarized from two decades of our surgical and radiological treatment follow-up and review of the medical literature. Results: Recent advances in surgical techniques involving cranial base approaches have made surgical intervention safer and curative resection more likely. In managing benign tumors, surgical resection is the gold standard for treatment. While immediate complications are still significant, long-term outcomes in most cases are excellent. Focused radiosurgery using a gamma knife or linear accelerator has produced favorable outcomes, and it improves the management of small or minimally symptomatic cranial base tumors. For slow-growing malignant tumors, extensive surgery followed by radiotherapy achieves the best outcome. In managing highly malignant tumors, outcome is determined by the effects of chemotherapy and radiotherapy. On some occasions, surgery is needed to obtain greater control of highly malignant tumors. Conclusions: Skull base tumors are relatively common, and management of these tumors is rapidly evolving. The combination of surgical excision using cranial base techniques, radiosurgery, fractionated radiotherapy, and chemotherapy should be individually tailored based on the location and pathological aggressiveness of the tumor and the symptomatology of the patient. Appreciation is expressed to Jennifer Pryll for her illustrative and photographic assistance and to Joseph Reister for editing and preparing the manuscript.
Cytostatic Agents in the Management of Malignant Gliomas
Authors: Mikkelsen Tom 
Published: August 2017

Background:Cytotoxic therapy for malignant gliomas is limited by poor delivery and drug resistance, and local therapy is ineffective in managing migratory cells. However, recent developments in malignant glioma therapy involve trials of cytostatic rather than conventional cytotoxic agents.Methods:The biology of the brain extracellular matrix, tumor invasion, and angiogenesis are reviewed, and the cytostatic agents that inhibit matrix metalloproteinases, angiogenesis, cell proliferation, and signal transduction are discussed, as well as studies of the angiogenic and migratory capacity of malignant brain tumors.Results:Two specific and interrelated areas, anti-invasion (migration) and anti-angiogenesis, are potential areas to develop new treatment strategies. Tumor invasion and angiogenesis are important components of the spread and biologic effects of malignant gliomas. Several proteinase inhibitors are in clinical trial, as well as anti-angiogenic agents and signal transduction cascade inhibitors.Conclusions:Biologic control of brain tumor cell populations may offer a new management approach to add to currently available management options for malignant brain tumors.
Uveal Melanoma
Authors: Kincaid Marilyn C. 
Published: August 2017

Background Malignant melanoma of the uveal tract is a rare malignancy but a significant cause of mortality and visual loss. Approximately 50% of patients diagnosed with a melanoma of the choroid or ciliary body will die of the disease within 15 years of enucleation. Methods The author reviewed the current literature on the clinical findings, epidemiology, and treatment of uveal melanoma. Results Methods of diagnosis have improved substantially in the past several years, although clinical diagnosis by an experienced examiner remains the standard in eyes with clear media. Ultrasound is the most useful adjunctive technique. While enucleation has been the mainstay of therapeutic intervention, alternative therapies – especially different types of irradiation – offer hope for tumor control and vision preservation. The Collaborative Ocular Melanoma Study, a multicenter national trial, is designed to provide long-term data on the natural history as well as therapeutic intervention. Conclusions Malignant melanoma of the uveal tract can be diagnosed clinically with more confidence than ever before. It is also possible in many cases to retain the eye and functional vision while controlling the tumor. However, unanswered questions remain about the natural history and optimal therapy of uveal melanoma.
HER-2 as a Prognostic, Predictive, and Therapeutic Target in Breast Cancer
Authors: Perez Edith A. 
Published: August 2017

Background: An expanded understanding of the biology of breast cancer has led to the identification of the HER-2 receptor as an important growth factor. This receptor possesses intrinsic tyrosine kinase activity and has been associated with aggressive biological behavior and poor clinical outcome. Methods: Data have been reviewed regarding the role of HER-2 expression as a prognostic variable, as a predictive factor for response to chemotherapy and hormonal therapies, and as a directed therapeutic target for breast cancer. Results: Therapy with a humanized monoclonal antibody to HER-2 (trastuzumab) can be effective treatment in some patients with metastatic breast cancer, either given alone or in combination with some chemotherapeutic agents. Cardiac toxicity limits concurrent use with anthracyclines. Clinical trials will further define optimal combination regimens with this agent, and its value in patients with localized or locally advanced stages. Conclusions: Trastuzumab is a significant addition to the armamentarium against breast cancer. Standardization of the optimal method to evaluate for HER-2 overexpression is necessary to better define its role as a prognostic, predictor, and therapeutic target in this disease.
Pregnancy after Breast Cancer
Authors: Gemignani Mary L. , Petrek Jeanne A. 
Published: August 2017

Background: The issue of pregnancy following the diagnosis and treatment of breast cancer is important because the incidence of breast cancer is increasing in women of childbearing age. The fact that many women are delaying childbearing, whether for educational, professional, or personal reasons, increases the number of women who will undergo breast cancer treatment before completing childbearing. Methods: Data on pregnancy in breast cancer survivors are limited and consist only of retrospective data. This paper reviews the published literature on the influence of subsequent pregnancy on breast cancer, including three recent large-scale population-based studies. Results: The survival of women with breast carcinoma who subsequently become pregnant is not reported to be decreased in any of the published series. However, several biases may be present that justify the concern regarding the conclusions. Conclusions: Further research on the safety of subsequent pregnancy after breast carcinoma treatment is needed. To address these issues, patients are currently being accrued for a large, prospective, multicenter study of young breast carcinoma patients.
Pharmacology of Chemotherapy in the Older Cancer Patient
Authors: Balducci Lodovico , Beghé Claudia 
Published: August 2017

Background The incidence of cancer among the elderly population is increasing. The aging process can deplete functional reserve of many organ systems and thus affects the treatment goals for this age-group. Methods The pharmacologic consequences of the aging process on elderly cancer patients are reviewed, and guidelines are suggested for assessing and treating this patient population with antitumor drugs. Results Individualized management of the older cancer patient reflects the results of a comprehensive geriatric assessment. Factors that affect treatment decisions include estimates of the extent of treatment toxicity, the impact of treatment on quality of life, estimates of life expectancy, and the influence of age on pharmacokinetic parameters. Conclusions Management of older patients with cancer includes individual assessments that consider the effects of aging on the pharmacodynamics, therapies, and complications of treatment for this population. Treatment can be made safer and more effective by adjusting chemotherapy dosage, maintaining hemoglobin levels, and using hemopoietic growth factors when appropriate.
Evaluation of Palliative Endpoints in Oncology Clinical Trials
Authors: Jacobsen Paul B. , Weitzner Michael A. 
Published: August 2017

Background In recent years, there has been a growing recognition that improvements in quality of life may be as important as improvements in quantity of life in patients with advanced cancer. With this goal in mind, many oncology trials now seek to evaluate palliative endpoints as well as disease progression and survival. Methods Methodologic advances and challenges in evaluating palliative endpoints in oncology clinical trials are reviewed. Results Valid and reliable self-report measures have been developed that permit evaluation of palliative endpoints. Issues to consider in conducting research on palliative endpoints include the selection of appropriate outcome measures, the number and timing of outcome assessments, and the handling of missing data. Conclusions The inclusion of palliative endpoints into clinical trials in oncology has the potential to advance clinical care by identifying chemotherapeutic agents that are effective in improving the quality of life of patients with advanced cancer.
Effectiveness of the conservative therapy for spontaneous isolated iliac artery dissection: Preliminary results
Authors: Liang Zhuhong , Guo Weiwei , Du Chunhua , Xie Yingdi 
Published: August 2017

Purpose To investigate the effectiveness of conservative therapy for spontaneous isolated iliac artery dissection (SIIAD). Methods From February 2006 to May 2016, all patients with SIIAD were included and analyzed. The diagnosis of SIIAD was made based on contrast-enhanced computed tomography. The imaging morphologic characteristics, treatments, and outcomes for each patient were analyzed. Results A total of 11 patients (10 male and 1 female, age 71.1 ± 7.8 years) were included in this study. Of the 11 patients, 8 patients were asymptomatic and the SIIADs were discovered during the course of computed tomography for other diseases, and 3 patients were symptomatic. Initial computed tomography findings: iliac arterial calcification ( n = 7); compression of the true lumen ( n = 6), with stenosis of the true lumen from 25% to 50% ( n = 3) and ≥ 50% ( n = 3); thrombosed false lumen partially ( n = 4), and no thrombosis in false lumen ( n = 7); dissecting aneurysm ( n = 11); entry points ( n = 11); re-entry points ( n = 1); no dissection extended to the internal iliac or common femoral artery. Conservative treatment was performed in six patients, and the remaining five patients need no treatment. During 23.3 ± 14.2 months follow-up, none recurred symptoms and signs of symptomatic SIIAD; partial remodeling of SIIAD was achieved in four patients, and the remaining seven patients with no change of SIIAD. There was no presence of new false lumen enhancement on contrast-enhanced computed tomography during follow-up. Conclusions SIIAD without arterial rupture or lower limb necrosis can be safely treated with conservative therapy.
Patient-Centered Obstetric Care in the Age of Cell-Free Fetal DNA Prenatal Screening
Authors: Agatisa Patricia K , Mercer Mary Beth , Mitchum Ariane , Coleridge Marissa B , Farrell Ruth M 
Published: August 2017

Purpose: The clinical introduction of innovative prenatal genetic technologies challenges patients and providers to find new ways of fostering informed decision-making in a setting characterized by complexity and uncertainty. As prenatal genetic technology advances, important questions remain about how to structure patient-centered conversations that effectively prepare pregnant patients to make informed choices about the different genetic conditions for which this new form screening may be used. Methods: Focus groups were conducted with 23 pregnant women to identify informational needs and decision-making preferences regarding emerging and anticipated applications of cell-free fetal DNA screening, the newest form of prenatal genetic screening. Results: Participants were in favor of obtaining more genetic information about the fetus than provided by conventional screens but acknowledged the challenges inherent in navigating the unique complexities of the decision-making process. The provider–patient relationship was seen as an important resource to navigate the associated uncertainties at each stage of the screening process. Participants emphasized the need for initiatives to support a personalized, accurate, and unbiased discussion about prenatal genetic risk and assessment. Conclusion: Continued advances in prenatal genetic screening call for new approaches to structure patient-centered communication to facilitate increasingly complex decisions about fetal genetic risk and assessment.
Activity of Eribulin in Patients With Advanced Liposarcoma Demonstrated in a Subgroup Analysis From a Randomized Phase III Study of Eribulin Versus Dacarbazine
Authors: Demetri George D. , Schöffski Patrick , Grignani Giovanni , Blay Jean-Yves , Maki Robert G. , Van Tine Brian A. , Alcindor Thierry , Jones Robin L. , D’Adamo David R. , Guo Matthew , Chawla Sant 
Published: August 2017

Purpose A phase III study comparing eribulin with dacarbazine in patients with advanced liposarcoma (LPS) or leiomyosarcoma showed a significant improvement in overall survival (OS) for the eribulin arm, with a manageable toxicity profile. We now report the histology-specific subgroup analysis of the efficacy and safety of eribulin compared with dacarbazine in patients with LPS, an independently randomized stratified subgroup of this phase III trial. Methods Patients ≥ 18 years with advanced or metastatic dedifferentiated, myxoid/round cell, or pleomorphic LPS incurable by surgery or radiotherapy were included. Patients with Eastern Cooperative Oncology Group performance status ≤ 2 and two or more prior systemic treatment regimens, including one with anthracycline, were randomly assigned 1:1 to receive eribulin mesylate (1.4 mg/m2 intravenously on days 1 and 8) or dacarbazine (850, 1,000, or 1,200 mg/m2 intravenously on day 1) every 21 days. OS, progression-free survival (PFS), and safety were analyzed. Results In the LPS subgroup, OS was significantly improved: 15.6 versus 8.4 months (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P < .001) with eribulin versus dacarbazine, respectively. Longer OS with eribulin was observed in all LPS histologic subtypes and in all geographic regions evaluated. PFS was also improved with eribulin versus dacarbazine (2.9 v 1.7 months, respectively; hazard ratio, 0.52; 95% CI, 0.35 to 0.78; P = .0015). Adverse events were similar between arms. Conclusion In patients with previously treated LPS, eribulin was associated with significantly superior OS and PFS compared with dacarbazine. Eribulin represents an important treatment option for patients with LPS, a sarcoma subtype for which limited effective systemic treatments are available. Further studies are justified to explore the role of eribulin in earlier lines of therapy as well as in combination with other agents.
Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis
Authors: Ing Caleb , Sun Ming , Olfson Mark , DiMaggio Charles J. , Sun Lena S. , Wall Melanie M. , Li Guohua 
Published: August 2017

BACKGROUND:
Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children, however, is unknown.

METHODS:
An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia ≤5 years of age for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: ≤28 days old, >28 days and ≤6 months, >6 months and ≤1 year, and 6-month age intervals between >1 year old and ≤5 years old. For each exposed child, 5 children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia.

RESULTS:
A total of 38,493 children with a single exposure and 192,465 propensity score-matched children unexposed before 5 years of age were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22–1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20–1.32) for DD and 1.31 (95% CI, 1.25–1.37) for ADHD.

CONCLUSIONS:
Children who undergo minor surgery requiring anesthesia under age 5 have a small but statistically significant increased risk of mental disorder diagnoses and DD and ADHD diagnoses, but the timing of the surgical procedure does not alter the elevated risks. Based on these findings, there is little support for the concept of delaying a minor procedure to reduce long-term neurodevelopmental risks of anesthesia in children. In evaluating the influence of age at exposure, the types of procedures included may need to be considered, as some procedures are associated with specific comorbid conditions and are only performed at certain ages.