bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective audit of the yield of internal mammary lymph node dissection and literature review in the management of breast cancer
Authors: Joshi Shalaka , Chigurupati Pragnya , Reddy Asha , Noronha Jarin , Hawaldar Rohini , Nair Nita , Parmar Vani , Chitkara Garvit , Thakkar Purvi , Shet Tanuja , Badwe R A 
Published: December 2023

Abstract

Background:
Treatment of lymph node basins is prognostic and therapeutic for axillary lymph nodes (ALN) as well as internal mammary lymph nodes (IMLNs) in breast cancer. IMLNs can be the first echelon node for the inner/central quadrants of the breast. We evaluated the yield of IMLN dissection (IMLND) mainly in patients with inner and central tumors.

Methods:
IMLND was performed in 199 patients between 2000 and 2018, 127 of whom had tumors in the inner/central quadrants. Clinico-pathological data were retrieved from Electronic Medical Records (EMR).

Results:
The median age was 50 (range: 24–81). Primary surgery was performed in 82 (41.2%), while 117 (58.8%) were operated post-chemotherapy. Overall, 124/199 (62.3%) had nodes identified in the specimen, more often in primary (61/82, 74.4%) than post-chemotherapy settings (63/117, 53.8%) (P = 0.003). A median of 1 (average: 1.24, range: 0–7) lymph nodes was dissected, and 1 (average: 1.5, range: 1–4) was involved. IMLN was positive in 46/199 (23.1%) patients, not significantly different in primary (21/82, 25.6%) versus post-chemotherapy (25/117, 21.4%) settings (P = 0.545). IMLN was involved in 44.8% of patients with ≥4 involved ALN and 8.2% with uninvolved ALN (P < 0.001). In the absence of ALN involvement and <2cm pT size, 9% of patients had positive IMLN in inner/central quadrant tumors. In univariate analysis, ALN positivity (P < 0.001), pT size (P = 0.023), and grade (P = 0.041) in primary and ALN involvement (P = 0.011) in post-chemotherapy patients were associated with IMLN involvement. On logistic regression, tumor size (OR: 13.914, P = 0.017) and ALN involvement (OR: 11.400, P = 0.005) in primary surgery and ALN involvement (OR: 7.294, P = 0.003) in post-chemotherapy patients correlated with IMLN involvement.

Conclusions:
In inner/central quadrant tumors, IMLN is more likely involved with high ALN burden and tumor size >2 cm, whereas those with ≤2cm inner/central quadrant tumors and negative ALN have <10% probability of IMLN involvement.
Outcomes of Transaortic Celiac Plexus Block for Upper Abdominal Malignancies Performed as a Day-care Procedure: A Retrospective Observational Study
Authors: Diwan Sandeep Madhusudan , Panchawagh Suhrud , Nair Abhijit Sukumaran 
Published: December 2023

Background:
Severe abdominal pain refractory to opioids significantly affects the quality of life (QoL) in patients with abdominal primary cancer or metastatic disease. A neurolytic celiac plexus block (CPB) would be necessary to alleviate pain and improve QoL until death.

Aims:
The aim of this retrospective study is to investigate pain relief after a transaortic celiac plexus neurolysis for patients with upper gastrointestinal malignancies.

Settings and Design:
This retrospective observational study was done in the Pain Department, Shri Siddhivinayak Cancer Hospital, Miraj from January 2005 to January 2015.

Materials and Methods:
One hundred and twenty-four patients with upper abdominal malignancy received a computed trans-aortic celiac plexus block (TAoCPB) on a day-care basis. The primary outcome was pain as assessed with numerical rating scale ranging from 0 to 10; the secondary outcome measures were morphine consumption per day, QoL, and complications, if any. These were recorded before intervention, on day 1 after the block and at 1 month interval until 6 months.

Statistical Analysis Used:
Bonferroni correction for multiple comparisons and a P < 0.0167 (0.05/3) was considered to be statistically significant due to 3 co-primary outcomes being measured (visual analog scale [VAS] scores, morphine consumption, and QoL).

Results:
Up to 4.5 months, the VAS score, daily morphine consumption, and the QoL showed improvement for the duration of the study. Pain gradually increased at 6 months with a deterioration of QoL. Respiratory distress and burning sensation in chest occurred in one patient each.

Conclusions:
A low-volume TAoCPB is effective and established procedure as a day-care procedure. Although pain relief occurs until 4.5 months, a gradual increase was perceived with a decline of quality of health at 6 months.
The feasibility of the pretreatment verification of 2D dose distributions in radiation therapy with small fields using the electronic portal imaging device
Authors: Tuncel Nina , Mahdavi Seied Rabi , Haghparast Mohammad , Karakus Ismail , Haghparast Abbas , Nazari Vahideh 
Published: December 2023

ABSTRACT

Background:
The present study aims to evaluate the performance of an Electronic portal imaging device (EPID) for measuring dosimetric parameters and for verification of dose in small photon fields.

Material and Methods:
In this study, the beam profiles were obtained using the amorphous silicon (a-Si) EPID for field sizes ranging from 1 × 1 to 10 × 10 cm2 at energies 6 and 18 mega-voltage (MV). For comparison, the dosimetric parameters, including penumbra widths and field sizes, were measured with the pinpoint, diode, and Semiflex dosimeters. Finally, Rando Phantom was used to compare the two-dimensional (2D) Dose distribution between EPID and Treatment Planning System (TPS).

Results:
In both 5 cm and 10 cm depths, there were large differences between the measured doses obtained from TPS, Pinpoint detector, and Farmer detector in 1 × 1 field size. The differences become negligible as the field sizes increase and from 3 × 3 field size to 10 × 10 field size, the maximum observed differences are 2 cGy and 2.4 cGy for 5 cm and 10 cm depths, respectively. The results indicate that the penumbra widths are smaller in the Gantry-Target (GT) direction compared to the Right-Left (RL) direction. The maximum difference (47.6%) was observed for EPID in the 10 × 10 field size, and the minimum difference (16.6%) was observed for TPS in the 1 × 1 field size. Finally, 2D dose distributions obtained by EPID and TPS exhibit excellent agreement.

Conclusion:
EPID is an excellent tool for the measurement of dosimetry parameters such as dose profiles, penumbra widths, field sizes, and pretreatment verification of 2D dose distributions, especially in small fields.
Factors affecting vancomycin-resistant Enterococcus faecium colonization of in-hospital patients in different wards
Authors: Wang Yun-Cheng , Wang Lih-Shinn , Hsieh Tsung-Cheng , Chung Hui-Chun 
Published: December 2023

ABSTRACT

Objectives:
The prevalence of vancomycin-resistant Enterococcus
faecium (VRE) infection at a medical center in Eastern Taiwan rose to 80.6%, exceeding the average prevalence of 55.6% among all medical centers nationwide during the same period. In recent years, the number of cases of VRE infection detected among hospitalized patients has increased annually. However, most of these patients in different wards are asymptomatic carriers. Therefore, restricting active screening to high-risk units will not improve the current situation, and it is necessary to review the risk factors for VRE colonization to provide a reference for future infection control policies.

Materials and Methods:
Between 2014 and 2019, there were 3188 VRE-positive cultures reported at our institution, as per the electronic medical records system.

Results:
In the medical and surgical wards, patients who received penicillin (odds ratios [ORs]: 2.84 and 4.16, respectively) and third-generation cephalosporins (ORs: 3.17 and 6.19, respectively) were at higher risk of VRE colonization. In intensive care units, the use of carbapenems (OR: 2.08) was the most significant variable.

Conclusion:
This study demonstrated that the risk factors for VRE colonization differed between wards. Thus, policies should be established according to the attributes of patients in each ward, and active screening tests should be performed according to individual risks, instead of a policy for comprehensive mass screening.
Effect of hypoalbuminemia on mortality in cirrhotic patients with spontaneous bacterial peritonitis
Authors: Hung Tsung-Hsing , Ko Ping-Hung , Wang Chih-Ying , Tsai Chih-Chun , Lee Hsing-Feng 
Published: December 2023

ABSTRACT

Objective:
The impact of hypoalbuminemia on the short-term and long-term mortality of cirrhotic patients with spontaneous bacterial peritonitis (SBP), both with and without renal function impairment, remains insufficiently elucidated based on population-based data.

Materials and Methods:
We retrieved data from Taiwan’s National Health Insurance Database encompassing 14,583 hospitalized patients diagnosed with both cirrhosis and SBP during the period from January 1, 2010, to December 31, 2013. Prognostic factors influencing 30-day and 3-year survival were computed. Furthermore, the impact of hypoalbuminemia on the mortality rate among SBP patients, with or without concurrent renal function impairment, was also assessed.

Results:
The 30-day mortality rates for patients with SBP, comparing those with hypoalbuminemia and those without, were 18.3% and 29.4%, respectively (P < 0.001). Similarly, the 3-year mortality rates for SBP patients with hypoalbuminemia and those without were 73.7% and 85.8%, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for patients’ gender, age, and comorbid conditions, substantiated that individuals with hypoalbuminemia exhibit an inferior 30-day survival (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.51–1.74, P < 0.001) and reduced 3-year survival (HR: 1.57, 95% CI: 1.50–1.63, P < 0.001) in comparison to those lacking hypoalbuminemia. Among SBP patients with renal function impairment, those presenting hypoalbuminemia also experienced diminished 30-day survival (HR: 1.81, 95% CI 1.57–2.07, P < 0.001) as well as reduced 3-year survival (HR: 1.70, 95% CI 1.54–1.87, P < 0.001). Likewise, in SBP patients without renal function impairment, the presence of hypoalbuminemia was associated with poorer 30-day survival (HR: 1.54, 95% CI 1.42–1.67, P < 0.001) and 3-year survival (HR: 1.53, 95% CI 1.46–1.60, P < 0.001).

Conclusions:
Among cirrhotic patients with SBP, the presence of hypoalbuminemia predicts inferior short-term and long-term outcomes, regardless of renal function.
Internal and marginal adaptation of self-adhesive and flowable composite resins
Authors: Hala Amira N. , Etman Wedad M. , Geniad Thuraia M. 
Published: December 2023

PurposeThisin vitrostudy evaluated the internal and marginal adaptability of different composite resins in class V cavities.Materials and methodsThirty human maxillary premolars were selected. Trapezoidal class V were prepared on buccal surface. Flowable, self-adhering flowable and nanohybrid composites were applied following their manufacture instructions, in groups I, II and III respectively. Specimens were subjected to 500 thermal cycles and then examined under a stereomicroscope to determine the marginal gap width. All specimens were then sectioned buccolingually into two sections to detect and measure the internal gap width.ResultsThe highest mean value of occlusal gap was recorded for Group II followed by Group I while the lowest value was recorded in Group III. Similar results were found regarding the cervical margins, with no statistically significant difference between the groups. Comparing occlusal versus cervical marginal gap a highly significance difference was recorded in each group. The highest internal mean gap width was recorded in Group III, followed by Group II while the lowest in Group I, with no significant difference between them.ConclusionAll tested materials showed satisfactory marginal adaptation with no significant benefits of the self-adhesive composite. The nano hybrid composite showed the best marginal adaptation while the flowable composite showed the best internal adaptation.
Different treatments modalities for tempromandibular dysfunction
Authors: El-Sayed Marwa Abd El-Aziz Abd El-Wahab , Kashef Nahed Ahmed Kamel , El-Segai Azza Abd El-Moneim , El-Deeb Ali Eed 
Published: December 2023

Aim
To clinically compare treatment of TMDs using hard occlusal stent constructed by CAD/CAM technology, low-level laser therapy (LLLT) and a combination of hard occlusal stent and LLLT.

Patients and methods
Twenty-one adult patients have suffered from chronic myofascial pain for at least three months. The patients were randomly divided into three equal groups based on the kind of treatment. Group A: Patients have received hard occlusal stent constructed by CAD/CAM technology. Group B: Patients have received LLLT. Group C: Patients have received a combination of hard occlusal stents constructed by CAD/CAM technology and LLLT. Clinical evaluations were done using Visual Analogue Scale (VAS) evaluation before therapy, at the fifth week, the third and sixth months after the onset of the study period. Data at the end of the trial was gathered, tabulated and statistically analyzed.

Results
Clinical results revealed that all three groups showed a general improvement in TMDs symptoms throughout the study period. The improvement was significant in all the study group periods. There was no statistically significant difference between the groups.

Conclusions
It has been established that the CAD/CAM occlusal stent, LLLT, and combination of CAD/CAM occlusal stent and LLLT enhances patient satisfaction and pain alleviation in individuals with TMDs.
Efficacy of different natural remineralizing agents on treatment of artificially induced enamel caries (An in vitro comparative study)
Authors: Bolty Hamdy A. , El-Olimy Gehan Abd Elmonem , Elbahrawy Eman 
Published: December 2023

Objectives
To evaluate and compare the remineralizing efficacy of chicken egg shell (CESP), propolis and grape seed extract (GSE) powder solutions in the treatment of artificially induced enamel caries in permanent human teeth (an in vitro study).

Materials and methods
Three different natural products (CESP, propolis, and GSE) were used. four groups were grouped according to the type of treatment for each group (n = 20). Control group (n = 10) (group B remineralized by CESP solution, group C remineralized by propolis powder solution and group D remineralized by GSP solution). Each group was divided into 2 subgroups (n = 10) according to the application frequency of remernerailizing agent: once (evening) (B1, C1, and D1) and twice daily (morning and evening) (B2, C2, and D2). Then all specimens were subjected to the PH cycle protocol. All specimens have been examined by scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX) spectroscopy, surface micro hardness by Digital Vickers Micro hardness testing, and Surface roughness by a 3D optical profilometer testing before and after each step.

Results
The Ca/P ratio was significantly enhanced for all groups evaluated by (SEM) and (EDX). Vicker hardness number (VHN) was significantly enhanced for all subgroups treated twice daily (morning and evening) (B2, C2, and D2) followed by all subgroups treated once (evening) (B1, C1, and D1) before and after PH cycle. Surface roughness was significantly decreased for all subgroups except for subgroups (C2, D1, and D2) before and after the PH cycle.

Conclusion
CESP, prpolis powder and GSE powder solution could be used as remenerailizing agent as it has promising effect in treatment of initially demenarlized enamel surface. The efficacy of these remineralizing agents twice daily is better than once daily in treatment of initially demenarlized enamel surface.
Fracture resistance of ultrathin occlusal veneer fabricated by different CAD/CAM materials
Authors: El Zak Wafaa Talat , Shakal Mahmoud A.-E. , ElSharkawy Sherif M. 
Published: December 2023

Purpose
The purpose of this in vitro study was to evaluate the fracture resistance of ultrathin occlusal veneer fabricated by different CAD/CAM materials.

Methods
The occlusal surface of 40 extracted lower premolars was prepared in the enamel layer and restored with occlusal veneers with fissures/cusp thickness of 0.5/1 ml made from two different dental CAD/CAM materials. Groups of the study included the following. Group I: lithium disilicate glass-ceramic n = 20; the group was further divided into two subgroups according to the thickness of each of them. Subgroup A: (n = 10) 0.5 mm and subgroup B: (n = 10) 1 mm. Group II: Cerasmart n = 20 is further divided into two subgroups according to the thickness of each of them. Subgroup A: (n = 10) 0.5mm, subgroup B: (n = 10) 1 mm. Occlusal veneers were etched with ceramic etch (Ips ceramic etching gel/ATZGEL-IVOCLAR AG) and then bonded using an adhesive luting system (G-MULTI PRIMER and G-CEMTM Veneer) light cure adhesive resin cement (G-CEHTM veneer). The prepared teeth were etched using phosphoric gel and bonded using Bisco All bond universal. All specimens were subjected to load till fracture; these loads were recorded and statistically analyzed using the one-way ANOVA. The mode of failure of the specimen was classified; the correlation between fracture strength and mode of failure was analyzed.

Results
In this study, fracture strengths (mean ± standard deviation) of cerasmart recorded were 0.5 mm (887.71 ± 284.79N), 1 mm (953.73 ± 214.06N), and for lithium disilicate 0.5 mm (455.16 ± 134.96N), 1 mm (768.59 ± 154.08N). Cerasmart had significantly higher fracture strength than lithium disilicate in 0.5 mm thickness, and significantly different fracture strength in 1 mm thickness. Most specimens (31 from 40) had been fractured in the restoration without involving the tooth structure.

Conclusion
The Cerasmart material could be considered a valid alternative to IPS e.max material.
Application of remimazolam transversus abdominis plane block in gastrointestinal tumor surgery
Authors: Liu Jun , Tian Jian-Min , Liu Guo-Ze , Sun Jun-Na , Gao Peng-Fei , Zhang Yong-Qiang , Yue Xiu-Qin 
Published: December 2023

BACKGROUND
Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics. It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect. However, the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.
AIM
To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.
METHODS
A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023. The patients were categorized into a control group (n = 51), receiving remimazolam for general anesthesia, and an observation group (n = 51), receiving TAPB combined with remimazolam for general anesthesia. A comparison was made between both groups in terms of hemodynamic parameters, stress markers, pain levels, recovery quality, analgesic effects, and adverse reactions during the perioperative period.
RESULTS
The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group (P < 0.05). The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group (P < 0.05). Five minutes after extubation, the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group (P < 0.05). At 12 h, 24 h, and 48 h following surgery, the visual analog scale scores of the observation group were considerably lower than those of the control group (P < 0.05). The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group (P < 0.05). The observation group exhibited considerably fewer effective pump presses, lower fentanyl dosages, and lower incidences of rescue analgesia within 24 h following surgery than the control group (P < 0.05).
CONCLUSION
The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good, which is helpful to promote faster recovery after operation.
Conversion immunotherapy for deficient mismatch repair locally unresectable colon cancer: A case report
Authors: Sun Zhen , Liu He , Zhang Guan-Nan , Xiao Yi 
Published: December 2023

BACKGROUND
Owing to the special features of biologics, deficient mismatch repair (dMMR) in patients with colon cancer has achieved little treatment efficacy from chemoradiotherapy. Immunotherapy has shown promising results for the treatment of colon cancer. The high response rate observed suggests a great option for patients presenting with unresectable tumors, as it allows for better oncological resection. Here, we aimed to highlight the significant effects of immunotherapy on dMMR in colon cancer.
CASE SUMMARY
A 54-year-old man diagnosed with locally unresectable dMMR colon cancer received preoperative immunotherapy (three cycles of pembrolizumab) and achieved a pathological complete response after surgery.
CONCLUSION
Immunotherapy can be used as a conversion treatment for locally unresectable colon cancer with dMMR.
A Systematic Review of Metrics Utilized in the Selection and Prediction of Future Performance of Residents in the United States
Authors: Lipman Jeremy M. , Colbert Colleen Y. , Ashton Rendell , French Judith , Warren Christine , Yepes-Rios Monica , King Rachel S. , Bierer S. Beth , Kline Theresa , Stoller James K. 
Published: December 2023

Background Aligning resident and training program attributes is critical. Many programs screen and select residents using assessment tools not grounded in available evidence. This can introduce bias and inappropriate trainee recruitment. Prior reviews of this literature did not include the important lens of diversity, equity, and inclusion (DEI).
Objective This study’s objective is to summarize the evidence linking elements in the Electronic Residency Application Service (ERAS) application with selection and training outcomes, including DEI factors.
Methods A systematic review was conducted on March 30, 2022, concordant with PRISMA guidelines, to identify the data supporting the use of elements contained in ERAS and interviews for residency training programs in the United States. Studies were coded into the topics of research, awards, United States Medical Licensing Examination (USMLE) scores, personal statement, letters of recommendation, medical school transcripts, work and volunteer experiences, medical school demographics, DEI, and presence of additional degrees, as well as the interview.
Results The 2599 identified unique studies were reviewed by 2 authors with conflicts adjudicated by a third. Ultimately, 231 meeting inclusion criteria were included (kappa=0.53).
Conclusions Based on the studies reviewed, low-quality research supports use of the interview, Medical Student Performance Evaluation, personal statement, research productivity, prior experience, and letters of recommendation in resident selection, while USMLE scores, grades, national ranking, attainment of additional degrees, and receipt of awards should have a limited role in this process.