bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of preoperative chemotherapy on the outcome of women with operable breast cancer
Authors: Fisher B , Bryant J , Wolmark N , Mamounas E , Brown A , Fisher E R , Wickerham D L , Begovic M , DeCillis A , Robidoux A , Margolese R G , Cruz A B , Hoehn J L , Lees A W , Dimitrov N V , Bear H D 
Published: March 2023

PURPOSE To determine, in women with primary operable breast cancer, if preoperative doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan; AC) therapy yields a better outcome than postoperative AC therapy, if a relationship exists between outcome and tumor response to preoperative chemotherapy, and if such therapy results in the performance of more lumpectomies. PATIENTS AND METHODS Women (1,523) enrolled onto National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 were randomly assigned to preoperative or postoperative AC therapy. Clinical tumor response to preoperative therapy was graded as complete (cCR), partial (cPR), or no response (cNR). Tumors with a cCR were further categorized as either pathologic complete response (pCR) or invasive cells (pINV). Disease-free survival (DFS), distant disease-free survival (DDFS), and survival were estimated through 5 years and compared between treatment groups. In the preoperative arm, proportional-hazards models were used to investigate the relationship between outcome and tumor response. RESULTS There was no significant difference in DFS, DDFS, or survival (P = .99, .70, and .83, respectively) among patients in either group. More patients treated preoperatively than postoperatively underwent lumpectomy and radiation therapy (67.8% v 59.8%, respectively). Rates of ipsilateral breast tumor recurrence (IBTR) after lumpectomy were similar in both groups (7.9% and 5.8%, respectively; P = .23). Outcome was better in women whose tumors showed a pCR than in those with a pINV, cPR, or cNR (relapse-free survival [RFS] rates, 85.7%, 76.9%, 68.1%, and 63.9%, respectively; P < .0001), even when baseline prognostic variables were controlled. When prognostic models were compared for each treatment group, the preoperative model, which included breast tumor response as a variable, discriminated outcome among patients to about the same degree as the postoperative model. CONCLUSION Preoperative chemotherapy is as effective as postoperative chemotherapy, permits more lumpectomies, is appropriate for the treatment of certain patients with stages I and II disease, and can be used to study breast cancer biology. Tumor response to preoperative chemotherapy correlates with outcome and could be a surrogate for evaluating the effect of chemotherapy on micrometastases; however, knowledge of such a response provided little prognostic information beyond that which resulted from postoperative therapy.
Analgesic Effect of Buprenorphine for Chronic Noncancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Wong Stanley Sau Ching , Chan Tak Hon , Wang Fengfeng , Chan Timmy Chi Wing , Ho Hung Chak , Cheung Chi Wai 
Published: March 2023

BACKGROUND:
Buprenorphine is a partial agonist at the µ-opioid receptor and an antagonist at the delta and kappa opioid receptors. It has high affinity and low intrinsic activity at the µ-opioid receptor. Buprenorphine demonstrates no ceiling effect for clinical analgesia, but demonstrates this for respiratory depression and euphoria. It may provide effective analgesia while producing less adverse effects, making it a promising opioid analgesic. A systematic review and meta-analysis were performed to examine the analgesic efficacy of buprenorphine for patients with chronic noncancer pain.

METHODS:
PubMed, MEDLNE, Embase, and the Cochrane Library were searched up to January 2022. Randomized controlled trials were included if they compared buprenorphine versus placebo or active analgesic in patients with chronic noncancer pain, where pain score was an outcome. Nonrandomized controlled trials, observational studies, qualitative studies, case reports, and commentaries were excluded. Two investigators independently performed the literature search, study selection, and data collection. A random-effects model was used. The primary outcome was the effect of buprenorphine on pain intensity in patients with chronic noncancer pain based on standardized mean difference (SMD) in pain score. Quality of evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS:
Two separate literature searches were conducted for patients with and without opioid use disorder (OUD). Only one study met the search criteria for those with OUD. Fourteen randomized controlled trials were included for those without OUD. Buprenorphine was associated with reduced pain score (SMD = –0.368, P < .001, I2 = 89.37%) compared to placebo or active analgesic. Subgroup meta-analyses showed statistically significant differences in favor of buprenorphine versus placebo (SMD = –0.404, P < .001), for chronic low back pain (SMD = –0.383, P < .001), when administered via the transdermal route (SMD = –0.572, P = .001), via the buccal route (SMD = –0.453, P < .001), with length of follow-up lasting <12 weeks (SMD = –0.848, P < .05), and length of follow-up lasting 12 weeks or more (SMD = –0.415, P < .001). There was no significant difference when compared to active analgesic (SMD = 0.045, P > .05). Quality of evidence was low to moderate.

CONCLUSIONS:
Buprenorphine was associated with a statistically significant and small reduction in pain intensity compared to placebo. Both the transdermal and buccal routes provided pain relief. There was more evidence supporting its use for chronic low back pain.
A support vector machine-based algorithm to identify bisphosphonate-related osteonecrosis throughout the mandibular bone by using cone beam computerized tomography images
Authors: Gürses Barış Oğuz , Alpoz Esin , Şener Mert , Çankaya Hülya , Boyacıoğlu Hayal , Güneri Pelin 
Published: March 2023

Objective: This study aimed to develop an algorithm to distinguish the patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) from healthy controls using CBCT images by evaluating both trabecular and cortical bone changes through the whole body of the mandibular bone. Methods: Patient data set was created from axial CBCT images of 7 BRONJ patients (28 slices) and 8 healthy controls (27 slices). The healthy bone of healthy controls, bone sclerosis of BRONJ patients, bone necrosis of BRONJ patients, and normal appearing bone of BRONJ patients (NBP) were labeled on CBCT images by three maxillofacial radiologists. Proposed algorithm had preparation and background cancellation, mandibular bone segmentation and centerline determination, spatial transformation of gray values, and classification steps. Results: Significant differences between the statistical moments (mean, variance, skewness, kurtosis, standard error, median, mode and coefficient of variance) of healthy and diseased (bone sclerosis and necrosis) groups were observed (p = 0.000, p < 0.05). Also, variations were noted between healthy controls and NBP of BRONJ patients (p = 0.000, p < 0.05). The statistical moments were utilized to develop the algorithm which has resulted with accuracy of 0.999, sensitivity of 0.998, specificity of 0.998, precision of 1, recall of 0.998, AUC of 1, and F1 score of 0.999 in identification of BRONJ patients from healthy ones. Conclusion: The proposed algorithm differentiated the mandibular bones of the healthy and the BRONJ patients with high accuracy in the present test sample.
Correlation study on the relationship between dyslipidemia and carotid intima-media thickness in patients with diabetes mellitus
Authors: Guo Hong-jiang , Li Chen-cong , Bian Xiao-yan , Hao Qing 
Published: March 2023

Objective: To investigate the correlation between dyslipidemia and carotid intima-media thickness (IMT) in patients with diabetes mellitus.
Methods: A descriptive research design was adopted in this study. One hundred and twenty patients with Type-2 diabetes mellitus who were admitted to the physical examination center of The Fourth Hospital of Hebei Medical University from June 2020 to June 2021 for physical examination were recruited to the experimental group. The 120 patients were divided into three groups according to carotid IMT: normal group, thickened group, and plaque group. Forty healthy people who underwent a physical examination during the same period were recruited as the control group. The differences in IMT in various parts of the experimental group and the control group and the differences in blood lipid indexes were compared and analyzed. In addition, the correlation between mean IMT of bilateral common carotid arteries and blood lipid levels in normal, thickened and plaque groups was compared and analyzed.
Results: The intima-media thicknesses of the internal carotid artery and bilateral common carotid arteries of the patients in the experimental group were significantly thicker than those in the healthy control group, the levels of TC, TG and LDL were higher than those in the control group, while the level of HDL was lower than that in the control group, with a statistically significant difference (p=0.00). The levels of fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), TG, TC and LDL were positively correlated with the mean IMT of bilateral common carotid arteries (p<0.05), while the level of HDL was negatively correlated with the mean IMT of bilateral common carotid arteries (p<0.05).
Conclusion: Dyslipidemia and glucose metabolism in patients with Type-2 diabetes mellitus have a close bearing on carotid IMT. Clinically, patients with Type-2 diabetes mellitus can be judged by monitoring carotid IMT for dyslipidemia, atherosclerosis and other related complications.
doi: https://doi.org/10.12669/pjms.39.3.6866
How to cite this: Guo HJ, Li CC, Bian XY, Hao Q. Correlation study on the relationship between dyslipidemia and arotid intima-media thickness in patients with diabetes mellitus. Pak J Med Sci. 2023;39(3):875-879. doi: https://doi.org/10.12669/pjms.39.3.6866
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Epidemiology of premalignant and malignant upper gastrointestinal lesions among patients presenting from a rural community in Karachi, Pakistan
Authors: Kamran Muhammad , Abdullah Bin Khalid  , Muhammad Danish Muneeb  , Sohail Hussain  
Published: March 2023

Objective: Understanding the epidemiology of upper gastrointestinal cancers in Pakistan may help in identifying important demographic risk factors for upper gastrointestinal malignancies in a particular rural population group. This will benefit in implementing tailored prevention approaches as well as effective management of health services.
Method: A secondary data analysis of 1193 patients was conducted who went through diagnostic upper GI endoscopy between December 2016 to May 2019 at Fatima Hospital. The endoscopies were performed at Fatima Hospital which is the main health resource for the specifically targeted rural community. Data was analyzed using SPSS version 21.
Results: The median age of patients included in the sample was 35 years (IQR=20 years). One third of all endoscopic findings were concluded as normal. The frequency of malignant upper gastrointestinal lesions was relatively higher among male and patients with age 65 years or more. The study didn’t find any significant differences in the distribution of malignancies on the basis of ethnicity. Adenocarcinoma of esophagus was the most common malignant lesion.
Conclusion: The average age of patients undergoing upper gastrointestinal endoscopy among rural community of Karachi was relatively low. The burden of upper GI malignancies was significantly higher among elderly. Male patients had significantly greater burden of premalignant and malignant lesions as compared to females. No differences in the distribution of diagnostic outcomes were observed on the basis of ethnicity.
doi: https://doi.org/10.12669/pjms.39.3.7379
How to cite this: Kamran M, Khalid AB, Muneeb MD, Hussain S. Epidemiology of premalignant and malignant upper gastrointestinal lesions among patients presenting from a rural community in Karachi, Pakistan. Pak J Med Sci. 2023;39(3):858-862. doi: https://doi.org/10.12669/pjms.39.3.7379
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults
Authors: Clifford Amanda M. , Ni Bhriain Orfhlaith , Byrne Steven , Cheung Pui-Sze , Louw Quinette , Glynn Liam , Moss Hilary , O'Neill Desmond , Woods Catherine B. , Sheikhi Ali , Gowran Rosemary Joan , Maher Catherine , Kennelly Brendan , Salsberg Jon , Thabane Lehana 
Published: March 2023

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).
ENISA: 5G design and architecture of global mobile networks; threats, risks, vulnerabilities; cybersecurity considerations
Authors: Paskauskas R. Andrew 
Published: March 2023

Abstract —The literature on 5G design and architecture numbers in the hundreds of thousands, which makes analyzing this vast corpus of technical knowledge impossible within the scope of a single article. A rigorous literature scan has revealed investigations of various specific 5G components, or specific aspects of 5G design, architecture, or security, but none that are comprehensive in scope, encompassing all of the aforementioned categories, or that take into account the associated vulnerabilities, threats and risks to the basic 5G infrastructure. In this sense the 5G framework advocated by The European Union Agency for Cybersecurity (ENISA) in its comprehensive report is singular in relation to the extensive literature associated with the 5G domain and the fragmented character of scientific reporting related to 5G technology. It is the purpose of this article to go beyond the existing literature and examine in depth the details of the ENISA 5G Threat Landscape Report and reveal ENISA’s painstaking efforts to stand out among other leading-edge players in the 5G arena and achieve its strategic aims of integrating cybersecurity considerations with threats, risks, and vulnerabilities into an architecture of 5G right from the start of the design and development process. In formulating such a framework, ENISA has set the stage for standardization of cybersecurity considerations in relation to 5G design and architecture that may be considered a first approximation towards best practice in the field. ENISA’s role in the European Union as a leader in setting the pace of development of 5G networks is acknowledged in EU’s legislation and its directives. Significantly, its strategic direction targets future implementations of 5G networks by vendors, operators, and practitioners. This should equip EU with the necessary resilience to withstand hybrid threat onslaughts on its Pan-European network, a topic to be dealt with in full in a follow-on paper.
Island of Migrants
Authors: Niu Stephanie 
Published: March 2023

Christmas Island is a tiny island in the Indian Ocean, a few hundred miles off the coast of Java. The island is small, with a population of less than 2000. Yet in spite of, or maybe because of, its isolation, the island is a site of incredible movement. Every wet season, millions of endemic red crabs descend from the jungles in what is one of the most spectacular animal migrations in the world. In October or November, the crabs begin a long journey from the jungles down to the coast to breed, continuing an annual life cycle. The crab migration intersects the island’s main roads and has resulted in a series of inventive tunnels, bridges, and fences which both protect the crabs from traffic and draw tourists from around the world.[1]
Another important population crosses Christmas Island on its migration journey, with considerably less luck. In 2007, construction was completed on an Immigration Reception and Processing Centre to temporarily detain asylum seekers from neighboring islands. In response to the 2001 Pacific Solution in which “4000 islands were excised from Australia’s migration zone,” Christmas Island became a temporary holding center for boat-bound asylum seekers from Indonesia, eventually transitioning to becoming an isolated site for long-term detention.[2] The center on Christmas Island is one of the largest in Australia’s onshore detention center network, which continues to operate today.
For both animal and human populations, Christmas Island is the site of incredible movement. However, these two migrating populations are governed in very different ways. “Island of Migrants”[3] is a 19-minute podcast episode that examines the ways in which red crab migration and asylum seeker migration are treated differently despite their close physical proximity on the island, and what this difference in their treatment reflects about who is considered worthy of protection. The podcast is a result of both anthropological and journalistic methods as well as a 2-month period of living on Christmas Island. Through firsthand accounts from islander residents, asylum seekers, and activists, “Island of Migrants” seeks to demonstrate the stakes of valuing one migration over another.

[1] “Red Crab Migration.” Australian Government. Parks Australia. Accessed December 16, 2019. https://parksaustralia.gov.au/christmas/discover/highlights/red-crab-migration/.
[2] Hearman, Vannessa. “Troubled Transit: Asylum Seekers Stuck in Indonesia. By Antje Missbach.” Journal of Refugee Studies 30, no. 4 (January 2017): 628–30. https://doi.org/10.1093/jrs/fex031.
[3] Niu, Stephanie. “Following the Water.” Following the Water (blog). Anchor, December 13, 2019. https://anchor.fm/followingthewater/episodes/Island-of-Migrants-e9gsaq/a-a15vv0b.
Moral Imagination, the Collective Desirable, and Strategic Purpose
Authors: Rindova Violina P. , Martins Luis L. 
Published: March 2023

In contrast to the prevalent outside-in perspectives on corporate purpose as a response to competing normative demands of stakeholders, we introduce an inside-out perspective on purpose as based in firm-specific, agentic commitments to specific values, ideals, and societal goals. Drawing on moral philosophy, we propose how strategists can develop a strategic purpose through moral imagination that involves developing shaping intentions based in values and ideals, empathetic relating, and imaginativeness in stakeholder contexts. These processes support the generation of an emergent theory of value, which we term “the collective desirable.” This theory of value—a creative synthesis of the shaping intentions of the firm, and the interests and perspectives of stakeholders—provides the foundation of purpose, which is strategic, dynamic, and generative for the firm and its stakeholders. Such a strategic purpose becomes an organizational logic of action enacted through designated processes for articulation, maintenance, and evolvability, and through blueprints for credible commitments and resource allocations. By theorizing the microfoundations of an agentic, inside-out view of purpose, our theoretical framework articulates a set of mechanisms through which strategists can develop a strategic purpose that is tightly linked to the firm’s future-oriented strategy and the exercise of moral leadership. Our conception of moral imagination as a form of prosocial prospective cognition contributes a novel perspective to the socio-cognitive and subjectivist perspectives on strategy and extends the microfoundations of strategy.History: This paper has been accepted for the Strategy Science Special Issue on Corporate Purpose.
An update on enteral feeding in the community
Authors: Palmer Sarah Jane 
Published: March 2023

Enteral feeding is increasingly being used in the community. Therefore, it is crucial that community nurses and other community healthcare workers are well-informed about the different equipments used, as well as the techniques involved in preparing and giving the feed. In this article, Sarah Jane Palmer provides an overview of an enteral feeding method known as percutaneous endoscopic gastronomy, the different types of feed, the importance of communication between patients and the multidisciplinary team, preparing and giving the feed, and signs of complications to look out for.
Lipoedema: a neglected area of women's health
Authors: Warrilow Mary 
Published: March 2023

Lipoedema is an adipose tissue disorder almost exclusively affecting women. Evidence shows lipoedema is both poorly recognised and misdiagnosed which results in many women struggling to get a diagnosis and to gain access to specialist NHS services. This article aims to raise awareness of lipoedema and highlight the main role that community and primary care nurses can play in identifying this long-term condition earlier. It provides detail on the condition to help signpost, refer for diagnosis and initiate conservative management for those individuals with this challenging condition.