bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the gemcitabin cisplatin doublet the optimal induction chemotherapy for non-Asian patients with NPC? Insights from a northeastern Moroccan cohort.
Authors: Talbi Oumaima , Mhirech Samia , Hinaje Khadija , Maadin Kaoutar , Elhilali Hafssa , Chakri Imad , Bouhafa Touria , Amaadour Lamiae , Oualla Karima , Benbrahim Zineb , Nawfel Mellas , Arifi Samia 
Published: July 2024

e18057 Background: According to the latest guidelines for NPC, induction chemotherapy followed by concomitant chemoradiation therapy (CCRT) is recommended as the preferred standard of care for patients with locally advanced nasopharyngeal carcinoma (stage III-Iva). However, the optimal regimen for induction chemotherapy (IC) in patients with locally advanced NPC remains uncertain. Methods: We conducted a retrospective study between January 2016 and October 2022 at the "CHU Hassan II" Oncology Hospital in Fes, Morocco, to compare the efficacy and tolerability of two platinum-based induction therapy regimens: cisplatin gemcitabine (GC) and cisplatin doxorubicin (DP), in the treatment of newly diagnosed locally advanced NPC. The main objectives of this study were to compare the efficacy including objective response rates (ORR), PFS ,OS and safety. Results: After eligibility assessment, we included 105 cases (62 patients in the DP group and 43 in the GC group), including 65 men and 40 women, with a mean age of 49.5 years (range = 19-79years) and a Karnofsky score ranging from 87% to 100%. 34% of patients were diagnosed at stage IVA. In the DP group, 3% of patients (2 out of 62) achieved a complete response CR, 60% achieved a partial response PR,25% remained stable SD and 19% experienced progression. In the GC group, 2% of patients (1 out of 43) achieved a CR, 39.5% achieved a PR, 39.5% remained stable, and 19% experienced progression. A statistically significant difference in PR was observed between the two groups (p = 0.028) ,and the difference in terms of progression is approaching the limit of significance (p=0,06) after a median follow-up of 27 months (5,3 -82). The 2-year progression-free survival (PFS) was 70% in the DP group compared to 80% in the GC group; the 2-year overall survival (OS) was 75% in the DP group and 90% in the GC group. No significant survival difference was observed between the two groups Patients in the DP group exhibited less grade 3-4 thrombocytopenia but more grade 3-4 leukopenia and neutropenia compared to the GC group. Conclusions: In patients with locally advanced nasopharyngeal carcinoma, GC-based induction chemotherapy demonstrated superior ORR over the DP regimen with acceptable toxicities. Further studies are needed to validate these results.
Impact of joint peer review with a specialist radiologist in head and neck cancer radiotherapy planning.
Authors: Mahajan Abhishek , Brammer Caroline , Haridass Anoop , Brooker Rachel , Ibrahim Ehab , Soni Manjusha , Zulfiqar Ali , Romaniuk Christopher 
Published: July 2024

e18059 Background: Head and neck oncology is heavily dependent on interpretation of radiology. This raises the question whether input from radiology should be formally scheduled as part of the radiotherapy contouring processes. Our aim was to assess the impact of this practice through qualitative and quantitative analysis. Methods: H & N patients treated with radiotherapy between May-2022 and August-2023 were reviewed by a specialist HN radiologist. Incidence of changes in T, N, M and TNM-stage, change as defined by The RCR guidance: 'major' (change in gross tumour volume and/or high-dose clinical target volume, dose/fractionation) or 'minor' (change in intermediate or elective dose clinical target volumes or organs at risk), was recorded. We evaluated whether any of these changes were time dependent (Time interval between MDT to RT Peer Review). Other clinical variables: age, gender, primary diagnosis, tumour site, significant incidental findings, post-operative pTNM, post-operative disease status in adjuvant setting on planning imaging (NIRADS), need for additional imaging. We also recorded number of scans reviewed per patient, types of imaging studies reviewed, time taken for review and number of radiologist PA’s required. Retrospective analysis of a prospective database was performed. Results: 410 patients (252-definitive, 137-adjuvant, 21-palliative) were reviewed of which 51.5%-oropharynx followed by 26.8%-Larynx & Hypopharynx. Mean age was 66.14 yrs (SD 11.46) and M:F was 4:1. Baseline and Therapy planning imaging was reviewed for 100% patients of which baseline included: MR (91.7%), CT (96.1%), US (34.1%), PETCT (31%) and therapy planning (62%-CECT, 19%-MR&CT, 15%-CT, 4%-PETCT). In all patients (n=410), T/N/M/TNM-stage percentage upstage was 27/36.8/8.3/42.2% and in definitive cohort (n=252), it was 41.7/56.7/7.1/59.5%. Reviewing RT-planning Imaging in adjuvant cohort (n=137), 76.6% were NIRADS-1, 11.7% NIRADS-3/4/loco-regional disease and 11.7% distant metastasis. T/N/M/TNM-stage upstage was time dependent and the mean time interval between MDT to RT was higher in upstaged patients (p <0.001). Overall percentage change in treatment plan: no/minor/major/palliative was 40.5/33.9/17.3/8.3% and in definitive cohort 30.2/42.1/20.6/7.1%. Change in plan was not dependent on mean time interval between MDT to RT. Average 10 patients (4 imaging studies/patient) were reviewed by radiologist in 1PA (time to review and peer review meeting time). Conclusions: Routine head and neck radiologist input in radiotherapy peer review is feasible and resulted in a number of major and minor changes to treatment. Inputs not only eased the contouring for oncologists but also lead to updating of current disease stage just prior to treatment. Overall, our results suggest that this is a practice changing step in the radiotherapy workflow which has a direct impact on patient management.
Implementing fragmentomics into real world screening interventions to evaluate clinical utility among individuals with elevated risk for lung cancer (FIRSTLUNG) L301.
Authors: Cotton Lindsey Behlen , Cisar Chris , Bach Peter Brian , Sheridan Carolina , Trivedi Niti U. , Davis James , Tennefoss Demetria 
Published: July 2024

TPS11189 Background: To optimize the impact of lung cancer screening at the healthcare system level, additional tools are needed to increase the benefits of screening. While low-dose computed tomography (LDCT) has been shown to improve lung cancer detection and reduce mortality, it is not without its risks, such as radiation exposure, false-positive results, and unnecessary interventions often leading to complications. The additional complexity of lung cancer screening is the subpar adherence to LDCT for eligible individuals, which undermines the benefits of screening. Therefore, there is a need for alternative non-invasive methodologies that exploit our understanding of the biology of cancer pathogenesis. This clinical utility study aims to observe how a non–invasive blood-based test impacts physician behavior and LDCT utilization. Methods: FIRSTLUNG 301 (NCT06145750) is a prospective, cluster randomized controlled trial (RCT) to observe the impact of the DELFI Lung cancer screening test on lung cancer screening utilization in primary care practices. Enrolled practices must meet the eligibility criteria of having a minimum of 50 actively engaged individuals in the practice eligible for lung cancer screening per the 2021 USPSTF criteria. These practices will be randomized 1:1:2 to Arm A1 (control), Arm A2 (control), or Arm B (intervention). Arm A practices will be randomized 1:1 into two groups (A1:A2) to observe the standard of care for lung cancer screening. Practices in A1 will be observed; practices in A2 will receive standard education on lung cancer screening for CME credit. Randomizing within Arms A1 and A2 aims to delineate the impact standard lung cancer screening education may have on utilization. Arm B (intervention) practices will receive education and have access to order the blood-based test for screen-eligible individuals that remained unscreened. The primary study endpoint is the proportion of practice-identified lung cancer screen-eligible individuals receiving a screening CT order and scan during the study period in the entirety of Arm A (control) versus Arm B (intervention). This RCT aims to understand the utilization and impact on lung cancer screening uptake after the DELFI blood-based test intended to inform clinical guidelines and policies focused on improving patient care and health outcomes. Progress: The study was initiated on October 31, 2023, with practice randomization. As of February 2024, the study is open for enrollment with an estimated primary study completion date of December 2025. Clinical trial information: NCT06145750 .
Triage of advanced cervical cancer through immunotherapy induction (TRACTION).
Authors: How Jeffrey Andrew , Rauh-Hain Jose Alejandro , Grinsfelder Michaela , Rangel Kelly M. , Roder Sarah , Shafer Aaron , Schmeler Kathleen M. , Boruta David M. , Fleming Nicole D. , Lu Karen H. , Vining David J. , Frumovitz Michael M. , Jazaeri Amir A. 
Published: July 2024

TPS5622 Background: In advanced/recurrent cervical cancer, immune checkpoint inhibitors have emerged as an attractive alternative and have demonstrated impressive therapeutic responses. As a result, the combination of pembrolizumab with platinum/taxane chemotherapy with or without bevacizumab received FDA approval for first-line systemic therapy in persistent, recurrent, or metastatic PD-L1+ cervical cancer. However, this regimen demonstrates the greatest impact on survival when all four drugs are utilized and are not without the potential for significant toxicity. CheckMate-358 utilized two dosing regimens of ipilimumab and nivolumab in advanced/recurrent cervical cancer. In the preliminary results, the utilization of either dosing regimen resulted in remarkable, durable responses in chemo-naïve patients with the median overall survival not reached. Given the potential benefit of CTLA-4/PD-1 blockade in the upfront setting, we propose a phase II trial examining the strategy of induction immunotherapy with lorigerlimab (bispecific antibody targeting CTLA-4 and PD-1) in chemo-naïve cervical cancer patients not amenable to curative treatment. Methods: The study is a phase II, multi-site clinical trial conducted at MD Anderson Cancer Center and Lyndon B. Johnson General Hospital. In the induction phase, patients will receive intravenous (IV) lorigerlimab at the recommended phase II dose (6 mg/kg) for three 21-day cycles with a repeat CT scan performed at week 9 of treatment. Tumor response (by RECIST v1.1) to induction immunotherapy will be used to triage patients to either continuation of lorigerlimab (if at least stable disease) or standard of care treatment (if disease progression) in the triaged treatment phase. Lorigerlimab will be continued until progression or intolerable toxicity, for a maximum of 35 cycles. At any time point, all patients at first disease progression will subsequently receive physician’s choice standard of care systemic therapy with carboplatin/paclitaxel +/- pembrolizumab +/- bevacizumab and will be followed for survival. The primary objective is to estimate disease control rate. Secondary objectives are to determine objective response rate, duration of response, overall survival, progression-free survival, and safety (by CTCAE v5.0). Key eligibility criteria include 1) recurrent, metastatic, or persistent cervical cancer 2) squamous cell carcinoma, adenosquamous, or adenocarcinoma histologic subtype 3) not amenable to curative surgery or radiation. The trial is open with 14 of planned 40 patients enrolled at the time of submission. Clinical trial information: NCT05475171 .
From Modernizing Tradition to Traditionalizing Modernity: U. R. Ananthamurthy's Samskara as Postcolonial Bildungsroman
Authors: Roy Arnab Dutta 
Published: July 2024

Abstract
The twentieth century is witness to a revival of interest in the bildungsroman as writers, especially from postcolonies in the Global South, turn to it to reflect on concerns of history, culture, and social life in a postcolonial setting. Scholars, however, disagree regarding the nature of these reworkings. Some see them as a continuation of the original European models established by Goethe, Dickens, and other European writers. Others find such associations Eurocentric and call for more local standards of evaluation. This article examines this debate by looking closely at a version of the postcolonial bildungsroman proposed by the Kannada writer U. R. Ananthamurthy in his 1965 novel Samskara. The novel follows an orthodox Brahmin priest from Karnataka who, disillusioned by the corruption and moral decay in his community, embarks on a pilgrimage to rediscover his identity in the rapidly modernizing world of twentieth-century India. Ananthamurthy's bildungsroman, while retaining some structural similarities, departs from European models in fundamental ways. The motif of the hero's journey, for instance, is flipped. The novel tracks the hero's growing discontentment with his community leading to a sense of communal alienation, thus inverting the European journey-trajectory that typically follows the hero's movement toward social integration. It also deviates from the generic Western rags-to-riches storyline that complements that hero's road to social integration. Instead, it adopts the narrative structure of the Niti-shastra, a set of precolonial Hindu texts that teach about the wise conduct of life. Such readings not only facilitate fresh ways of understanding the relationship between the Western and the postcolonial models, but they also allow new insights into understanding how South Asian authors utilize the bildungsroman to rediscover precolonial and classical works through modernity.
Heroines and Villains, Orphans and Thieves: The Motley Melodramas of Oliver Twist
Authors: D'Alessandro Michael 
Published: July 2024

Abstract
This essay examines Charles Dickens's incorporation of Georgian- and early Victorian-era theatrical melodrama into his 1837–39 novel Oliver Twist. It studies Dickens's text against genre theories of melodrama, Dickens's own staged readings of Twist, social histories of contemporaneous England, and highlights from the era's English melodramas (including The Castle Spectre and A String of Pearls; or, The Fiend of Fleet Street). Crucial to Twist's literary history was Dickens's engagement with a pervasive London theatrical culture, a move that both trained his readers and led to the book's enduring afterlife as a melodrama itself. The essay argues that Dickens utilizes consumers’ preconceived understandings of popular theatrical tropes to guide their expectations when reading Twist. Moreover, by tweaking recognizable melodrama tropes—altering genders, multiplying villainies—Dickens finally suggests that familial reconstruction and moral collectivity can counter society's ills.
Preserving the vital pulp in the permanent dentition: a simplified guide to indirect pulp capping
Authors: Gupta Disha , Howell William , Iqbal Shumaila , Camilleri Josette 
Published: July 2024

This article discusses vital pulp therapy in the adult dentition and describes two cases where a different strategy for caries removal has been used followed by dressing with a contemporary material and tooth restoration on the same visit. A simplified guide for best practice is given. CPD/Clinical Relevance: Vital pulp therapy is an important procedure that requires clinical skill and can be undertaken in general practice.
An apically positioned flap and free gingival graft around an implant
Authors: Morris Matthew K , Matthews Debora , Price Richard Bengt 
Published: July 2024

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm. CPD/Clinical Relevance: This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.
Injury under the influence: A case report
Authors: Darwood Allegra NR , Dawood Andrew JS 
Published: July 2024

A detailed and honest social history is vital when piecing together any clinical diagnostic puzzle. This case presentation highlights this, leading to a surprising diagnosis for both patient and clinician. Additionally, access to cone beam computed tomography (CBCT) has vastly widened diagnostic accuracy within the dental field, and this case emphasizes the importance of thorough training to identify, and interpret, incidental findings. CPD/Clinical Relevance: Injuries obtained under the influence of drugs might be missed without in-depth social history and appropriate imaging training.
DOES PRE-HOSPITAL DELAY AFFECT OUTCOMES IN HIP FRACTURE PATIENTS?
Authors: Jambulingam R. , Lloyd J. 
Published: July 2024

BackgroundHip fractures cost the NHS £2 billion per annum. British guidelines within 36 hours of admission. However, these guidelines do not consider the time the patient spends between injury and admission. Our study aims to investigate pre-hospital time (PHT) and its effect on outcomes. Primary outcome measures were mortality, length of stay (LOS), pressure sores and abbreviated mental test scores (AMTS).MethodsHip fracture data was retrospectively collected from our hospital IT system (Clinical Workstation) between February and August 2020. Admission data, ambulance timings, and outcome data was extracted. Statistical analysis was performed using GraphPad Prism V9.5.1.ResultsTwo hundred eleven data sets were analysed. Mean age was 82.4, with 2:1 Females to males and median ASA of 3. The mean PHT was 690 minutes (85 to 6057). There was a positive correlation between increased PHT and mortality, though this did not reach statistical significance. There was a significant positive association between PHT and LOS (P=0.0027). Increased PHT was associated with lower admission AMTS (P<0.0001) and higher rate of pressure sore formation (P=0.0001). There was also a significantly positive correlation between PHT and time to mobility (P=0.049).ConclusionThere is an unobserved delay in hip fracture patients presenting to the hospital. Current treatment guidelines advocate early surgery but do not consider pre-hospital time. PHT in our patient population is 690 minutes on average, with increasing delay correlating with worse outcomes. Pre-hospital time should be considered when managing hip fracture patients with a view to expedite surgery and medical assessment.
EMPLOYMENT OUTCOMES FOLLOWING THORACOLUMBAR FRACTURES: LONG-TERM FOLLOW-UP GREATER THAN FIVE YEARS
Authors: Kimber E. , Allman J. , Dasic D. , Wong F. , McCarthy M. 
Published: July 2024

Study designRetrospective study.ObjectivesTo identify patient outcomes, in particular employment, >5-years following traumatic thoracolumbar fracture.Methods235 patients between the ages of 18–65 were identified from the hospital radiology database having sustained a traumatic thoracolumbar fracture on CT or MRI between 01/01/2013 and 31/01/2017. Questionnaires were sent out via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and >5-years post injury.Results26 patients had died at follow up leaving 209 patients. 108 (52%) were treated surgically and 101 (48%) conservatively. 106 replies were received with 85 (80%) opting in and 21 (20%) opting out. 68 (80%) patients completed the full questionnaire with 17 (20%) filling out a shortened questionnaire via a phone conversation. 52 (61%) patients underwent surgery and 33 (39%) were treated conservatively. The average follow up was 8 years. Prior to injury 66 (78%) were employed and 19 (22%) unemployed (of which 6 were full time students and 8 were retired). 49 (74%) of the previously employed patients returned to work at follow up with 35 (53%) working the same or increased hours. Regarding employment, there was no significant difference between surgically and conservatively treated patients (P=0.355) or the classification of the fracture (P=0.303). 16 (19%) patients reported back pain prior to their injury whilst 69 (81%) did not. There were 58 (68%) cases of new pain at follow up with the most affected area being the lumbar region in 43 (51%) patients. 32 (38%) patients reported neurological deficit post injury: 19 with subjective symptoms, 9 with objective symptoms and 4 suffered paralysis.Conclusion>5-years following a traumatic thoracolumbar fracture most individuals return to employment. There was no significant difference between the severity of the fracture or how patients are treated on their employment outcomes.
THE LIST: TRANSFORMING THE ORTHOPAEDIC TRAUMA MANAGEMENT AND HANDOVER IN A SUSTAINABLE AND COST-NEUTRAL WAY
Authors: Mohammed F. , Soler A. 
Published: July 2024

Trauma, across the United Kingdom, is managed using several software, paper based lists on Microsoft Word/Excel or Teams. There is usually poor handover or no handover in a standard format- during the on call, in the trauma meetings or in the wards. The software in the market for trauma management are not cost friendly or adaptable to local demands. The alternatives like Microsoft WORD based lists are fraught with their own problems. We endeavoured to make our trauma management effective.A Quality Improvement Project was done. The goals to achieve at end of a year were:Daily Trauma Handover in standardised format >90%Ward Handover in standardised format >90%Availability of outcomes of patients in clinic >80%Reduction of paper usage >90% at the end of six monthsAvailability of updated “outliers” information >90% at the weekend ward roundDocumentation from the Trauma Meeting > 90%On-Call documentation in standardised format >90%Doctor Satisfaction >75% in terms of: ease of us;, searchability of patient; ward round experience; morning trauma meeting experience; handover experience; inter-specialty communication; reliability; daily time saving; on-call time saving; patient care/safety; overall satisfaction.We used Microsoft Sharepoint List to manage our trauma workload and have named the tool as “The List”. The List has achieved all objectives as above in one year's time, except Outlier information which was at 67% in a recent PDSA (Plan-Do-Study-Act) cycle. The survey showed excellent doctor satisfaction and 90% respondents felt that The List saved an hour or more during the on-call and also during the ward rounds.We conclude that The List is a very powerful tool making trauma meetings efficient and handover effective. It is indigenous, adaptable, safe, sustainable, cost neutral and easy to use.