bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Professionalism and Ethics among Final Year Part I Undergraduate Students of Kurnool Medical College, Kurnool, Andhra Pradesh
Authors: Subhaprada Cynthia 
Published: March 2023

Background:
Professionalism is a core competency of physicians. Erstwhile Medical Council of India envisioned competency-based medical education with Attitude, Ethics and Communication module as its forerunner.

Objectives:
The aim of this study was to objectively assess professionalism and ethics (P&E) by introducing multiple choice questions (MCQs) and Professionalism Mini-Evaluation Exercise (PMEX) as P&E assessment tools for MBBS students, by sensitizing the faculty and students.

Materials and Methods:
A mixed-method study was conducted during June to December 2019, among final MBBS part I undergraduate students, posted in the Department of Community Medicine, Kurnool Medical College, Kurnool. After obtaining IEC clearance and written informed consent from the study participants, a 3-day workshop on P&E was conducted with interactive teaching session on day 2, pretest on day 1, and posttest on day 3, in the form of five standardized patient interactions in OSCE stations rated using PMEX tool and five response stations for MCQs. Descriptive and inferential statistical analysis was done in IBM SPSS version 21.0 to see difference in pre- and posttest scores. Qualitative analysis using manual thematic coding was done to assess the perception of faculty and students.

Results:
A statistically significant difference in means was observed in pretest and posttest scores using PMEX tool (t test = −22.12, P value = 0.0001). 75% of students considered MCQs and PMEX as a feasible tool, out of a total of 29 study participants.

Conclusion:
MCQs and PMEX are effective tools to assess P&E among medical undergraduate students.
Comparison of Two Cardioplegia Solution—del Nido Solution and St. Thomas Solution Used in Adult Cardiac Surgery
Authors: Khajuria Atul , Jahan Swaleha 
Published: March 2023

Introduction:
del Nido (DN) cardioplegia induces a depolarizing arrest during cardiac surgery. It is more dilute (1,4, blood crystalloid) as compared to the traditional 4:1 blood cardioplegia; it has lower Ca+2 and contains lidocaine. St. Thomas’ (ST) cardioplegia has been a popular crystalloid cardioplegia among cardiac surgeons; still, it must be administered constantly at short intervals during the surgery.

Aim:
To determine whether DN cardioplegia, with longer period of arrest provides better myocardial protection as compared to ST cardioplegia, with shorter period of arrest.

Materials and Methods:
The study population comprised 46 patients who undergone on pump coronary artery bypass grafting or any valve replacement surgery, which include aortic valve replacement, mitral valve replacement, and double valve replacement between February 2022 and June 2022. The patients were divided into two groups based on the type of cardioplegia given during surgery: (1) ST group (ST, n = 23) and (2) DN cardioplegia group (DN, n = 23). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of doses required, and postoperative outcome in the two groups.

Results:
The CC of time of DN versus ST group (75.82 ± 27.24 vs 85.69 ± 37.20) min and bypass times of DN versus ST group (102.73 ± 35.28 vs 104.86 ± 38.9) min. The DN group was noticed to have shorter CC and CPB times with (P < 0.05). Fewer cardioplegia doses were required in the DN group versus the ST group (1.21 ± 0.42 vs 2.86 ± 1.28; P = 0.001), while a single cardioplegia dose was given to 18 DN patients (78.26%) versus 2 ST patients (8.69%) (P < 0.001). LVEF was better preserved in the DN group.

Conclusions:
The use of DN cardioplegia results in shorter CC and CPB times, reduces cardioplegia doses, and also provides better myocardial protection with a safety profile as compared to ST cardioplegia.
Association between the rs2736100 polymorphisms of telomerase reverse transcriptase gene and digestive cancers
Authors: Song Hongxia , Han Mei , Li Kun , Zhao Yingying , Xu Changqing , Lei Xiaofei 
Published: March 2023

Aim of Study:
The conclusions on the association between the rs2736100 polymorphisms of telomerase reverse transcriptase (TERT) gene polymorphism and digestive cancers risk are still debated. This meta-analysis was conducted to update the association between the TERT rs2736100 polymorphisms and the risk of digestive cancers.

Materials and Methods:
The association investigations were identified from PubMed and Cochrane Library, and eligible studies were included and synthesized using the meta-analysis method.

Results:
Eight case-control studies were included in this meta-analysis for associating TERT rs2736100 gene polymorphism and digestive cancer susceptibility. Pooled odds ratio with 95% confidence interval was calculated using a fixed or random-effects model. Overall, no evidence has shown that the TERT rs2736100 polymorphism was associated with the susceptibility to digestive cancers. Besides, stratified analysis with ethnicity also indicated no significant association between TRET rs2736100 and the risk of digestive cancers under all genetic models in both Asian and Caucasian populations were observed.

Conclusion:
According to the meta-analysis, TERT rs2736100 polymorphism might be unrelated to digestive cancer susceptibility. Evidence with adequate sample size is still needed.
Comparison of percutaneous microwave ablation with radiofrequency ablation for hepatocellular carcinoma adjacent to major vessels
Authors: Shen Qiang , Wang Neng , Wu Pan-pan , Tan Bi-bo , Qian Guo-jun 
Published: March 2023

Purpose:
To compare the therapeutic efficacy and safety of percutaneous microwave ablation (MWA) with those of percutaneous radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) adjacent to major vessels.

Methods:
From January 2010 to April 2011, 78 patients with a single nodule, no >5 cm, adjacent to major vessels were enrolled in this study. Forty-four patients (forty-one men, three women; age range, 33–72 years) treated by MWA were compared with thirty-four patients (thirty-one men, three women; age range, 33–75 years) treated by RFA. Local tumor progression rate, overall survival rate, and disease-free survival rate were calculated using the Kaplan–Meier method, and differences between groups were estimated by log-rank test.

Results:
No death related to treatment occurred in the two groups. The 1-, 2-, and 3-year local tumor progression rates were 6.8%, 11.4%, and 15.9%, respectively, in the microwave group versus 17.6%, 20.6%, and 20.6%, respectively in the radiofrequency group (P = 0.544). The rates of major complications associated with microwave and RFA were 2.3% (1/44) versus 0% (0/34; P = 0.376). The microwave group's 1-, 2-, and 3-year disease-free survival rates were 72.7%, 65.9%, and 51.8%, respectively, and those in the radiofrequency were 58.8%, 52.9%, and 47.1%, respectively (P = 0.471). The microwave group's 1-, 2-, and 3-year overall survival rates were 93.2%, 90.9%, and 83.6%, respectively, and those in the radiofrequency group were 91.2%, 88.2%, and 82.4%, respectively (P = 0.808) There was no significant difference in local tumor progression, complications related to treatment, and long-term results between the two modalities. The incidence of peritumoral structure damage on image scan was significantly higher in the microwave group than in the RFA group (P = 0.025).

Conclusions:
Both RFA and MWA are safe and effective techniques for HCC adjacent to major vessels and have the same clinical value.
Imaging features of dermatofibrosarcoma protuberans
Authors: Ren Qingguo , Li Jiuwen , Shangguan Jingjun , Feng Xiushuan , Ma Xiangxing 
Published: March 2023

Aims:
The study highlights diffusion-weighted imaging (DWI) and dynamic enhancement features of DFSP and characterizes unenhanced and enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scans.

Settings and Design:
Image findings and clinical histories of 23 patients with DFSP were reviewed. Nine patients underwent CT before and after intravenous administration of contrast material. MRI was performed for 17 patients. CT and MRI findings were analyzed using location, size, edge, shape, infiltration sign, density and signal enhancement mode, and degree.

Results:
Patients showed 26 superficial and one deep lesion. Ten superficial lesions bulged onto the skin surface. Fourteen lesions were well-defined and 13 ill-defined. All lesions were nodular, with nine being multilobular. Thirteen showed infiltration to adjacent skin, fat, and fascia. Seven lesions on CT were iso- or hypo-dense to muscle without calcification. Contrast-enhanced CT showed inhomogeneous moderate and progressive enhancement in the arterial phase. Small tortuous vessels were seen in the arterial phase in one case. Sixteen tumors displayed signals that were similar to muscle by T1WI. Ten lesions were either hyper-intense to muscle or iso-intense to fat; the deep DFSP was hypo-intense by T2WI. All lesions were hyper-intense homogeneously or heterogeneously under fat-suppressed T2WI. Twelve superficial lesions showed high-intermediate signal, and one deep lesion showed low-intermediate signal with DWI. Seven cases showed low signal diffusion coefficient (ADC) images. Dynamic enhancement and signal intensity-time (SI-T) curves of four tumors showed rapid SI increases followed by steady or slightly rising SI. All lesions showed inhomogeneous, progressive enhancement in the arterial phase.

Conclusions:
This report is the first on dynamic curves and highlights DWI and T2WI features of DFSP. DFSP can be correctly diagnosed by combining a patient's clinical manifestations with imaging characteristics.
Adjuvant therapy fails to show survival benefit for patients with spindle cell carcinoma
Authors: Li Ting , Xie Qi , Li Junwei , Li Zhen , Xiao Junjuan , Liu Mingguo , Wang Jun , Li Yan , Tang Fang , Liang Jing 
Published: March 2023

Background:
Spindle cell carcinoma (SpCC) is a rare tumor type with poor prognosis, and standard treatment modalities are not available yet. However, large-scale studies on this topic are sparse. In this study, data from the surveillance, epidemiology, and end results (SEER) database were used to determine cancer-specific survival (CSS) rates of SpCC and to investigate the impact of different therapeutic strategies including surgery with or without chemotherapy, radiotherapy, or chemoradiotherapy on patient outcome.

Methods:
A total of 665 cases of SpCC, diagnosed from 1996 to 2015, were extracted from the SEER database. Kaplan–Meier survival curves and log-rank tests were used to assess CSS rates and differences on survival curves. Multiple COX-proportional hazards models were used to analyze the association between various treatments and prognosis of SpCC patients classified by organs or systems.

Results:
Different treatments for SpCC in different organ or system were associated with prognosis of SpCC patients. Surgery alone exhibits survival benefit, whereas adjuvant therapy fails to show survival benefit for patients with SpCC.

Conclusions:
The prognosis of SpCC patients varied significantly with different clinical treatments. Adjuvant radiotherapy or chemotherapy did not show survival benefit, even increasing the risk of mortality for SpCC patients.
SOX7 modulates the progression of hepatoblastoma through the regulation of Wnt/β-catenin signaling pathway
Authors: Ge Juntao , Zheng Qipeng , Qu Hongyi , Zhao Zuohui , Xu Yue , Wang Hao , Gao Huayu , Zhan Jianghua 
Published: March 2023

Aims:
Hepatoblastoma (HB) was reported as the frequently diagnosed primary hepatic malignant tumor among children. No reports have shown the function of SOX7 and its relationship with the Wnt/β-catenin pathway in HB.

Materials and Methods:

SOX7 and factors related to Wnt/β-catenin pathway were detected using reverse transcription–quantitative polymerase chain reaction (RT-PCR) and Western blotting. MTT 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium and flow cytometry were used to detect HB cell proliferation and apoptosis. The transwell assay uses cell invasion.

Results:
In this study, RT-PCR, Western blotting, and immunohistochemistry results indicated that the expression of SOX7 was significantly reduced in HB tissues compared with adjacent noncancerous tissues, while the β-catenin was significantly increased in HB tissues compared with adjacent noncancerous tissues. There were significant differences in the PRETEXT stage and tumor metastasis between patients with low expression and high expression of SOX7. Moreover, it was found that the overexpression of SOX7 and inhibiting Wnt/β-catenin pathway significantly reduced the cell proliferation and invasion, while the cell apoptosis was significantly increased compared with the control group.

Conclusions:
This study shows that SOX7 was downexpressed in HB tumor tissues. Moreover, ex vivo experiments indicated that SOX7 was related to β-catenin and regulated the progression of HB cells.
Systemic inflammation-based predictors of pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients
Authors: Xu Ning , Li Wenliang , Huang Fengchang , Yang Jun , Wen Zhengqi , Yin Liang , Zhang Yunfei , Zhao Jingjiao , Zhou Ruize , Yang Jingyu 
Published: March 2023

Aim:
To investigate whether systemic inflammation-based predictors can predict tumor response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).

Materials and Methods:
Totally, 205 LARC patients undergoing neoadjuvant CRT and curative surgery between 2008 and 2017 were analyzed. After propensity score matching, 132 patients were included in the study. Hematological parameters were collected, and their relationship with tumor response was investigated.

Results:
After propensity score matching, patients in good response group before CRT displayed significantly lower neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) than those in poor response group, while there were no significant differences in all hematological characteristics between the two groups after CRT. The cutoff values of pre-CRT NLR and pre-CRT PLR after receiver operating characteristic analysis were 3.10 and 198.7, respectively. Multivariate analysis revealed that while there was no association between pre-CRT PLR and tumor response, pre-CRT NLR ≥3.1 was identified as the predictor of poor tumor response (P = 0.007).

Conclusion:
An increased NLR before CRT can serve as a hematological factor for predicting a poor tumor response in LARC.
Camrelizumab (SHR-1210) with carboplatin and albumin-binding paclitaxel in patients with metastatic or recurrent cervical cancer
Authors: Zhang Xiaoling , Chen Jinlong , Liu Naifu , Wang Qian , Wu Qian , Gao Fufeng , Sang Yingchun , Wang Ping 
Published: March 2023

Aims:
This study evaluates the safety and preliminary antitumor efficacy of camrelizumab with albumin-binding paclitaxel and cisplatin as first-line therapy for patients with recurrent or metastatic cervical carcinoma.

Methods and Material:
In this phase 2, open-label, prospective study, 35 patients with recurrent or metastatic cervical carcinoma with no previous systemic chemotherapy were included. The patients were treated with a maximum of six cycles of camrelizumab on day 1, albumin-binding paclitaxel, and carboplatin on day 2, every 3 weeks, followed by camrelizumab once every 3 weeks. The primary outcomes were objective response rate (ORR) and disease control rate (DCR). Secondary outcomes were duration of response (DoR) and safety. Furthermore, 27 patients were included in the per-protocol set for efficacy analysis, whereas for the safety analysis, all patients were included.

Results:
The median follow-up was 4.53 months, and the complete response, partial response, and stable disease were also achieved in 4 (14.81%), 6 (22.22%), and 13 (48.15%) patients. The ORR and DCR were 40.00% (95% confidence interval: 21.13–61.33%) and 92.00% (73.97–99.01%), respectively. The median DoR was 6.70 months. In addition, the most common adverse events (AEs) were reactive cutaneous capillary endothelial proliferation (RCCEP) (23, 65.71%), gastrointestinal reaction (8, 22.86%), and fever (8, 22.86%). Grade 3 AEs included 5 (14.29%) myelosuppression, and grade 4 AEs included 1 (2.86%) RCCEP and 1 (2.86%) bladder inflammation.

Conclusions:
Combination therapy of camrelizumab and albumin-bound paclitaxel and carboplatin shows promising efficacy and manageable toxicities in patients with recurrent or metastatic cervical cancer.
Prognostic value of circulating tumor cells and analysis of clinicopathological factors in liver cancer
Authors: Cui Kai , Ou Yang , Ning Dawei , Li Hao , Xi Yue , Li Sheng 
Published: March 2023

Objective and Aims:
The number of circulating tumor cells (CTCs) and the presence of circulating tumor microemboli (CTM) were determined in the peripheral blood of patients with liver cancer (LC). The relationship between CTCs, CTM, clinicopathologic features, and prognosis of LC was analyzed. The objective of this study was to determine the diagnostic and prognostic value of CTCs/CTM in LC.

Subjects and Methods:
Patients with LC were enrolled between May 2013 and August 2017, and 67 patients were included in the study. Overall survival curves were built using the Kaplan–Meier method and the log-rank test to identify risk factors. The results were analyzed using a Cox proportional hazards model and expressed as hazard ratio and 95% confidence interval (95% CI).

Results:
CTCs and either CTCs or CTM were detected in 27 patients (40.3%) and 29 patients (43.3%). CTM were found in four patients. One-year, 3-year, and 5-year survival rates were 42%, 20%, and 15%, respectively. Univariate Cox regression analysis showed that alpha-fetoprotein (AFP), number of CTCs, presence of CTM, and positive CTC/CTM were associated with survival time. Multivariate Cox regression analysis showed that alpha fetoprotein (AFP), number of CTCs, and presence of CTM were independent risk factors for survival in patients with LC.

Conclusion:
There was no significant correlation between the number of CTCs, the presence of CTM, and clinicopathologic factors. AFP, number of CTCs, and presence of CTM were independent risk factors for survival in patients with LC.
Percutaneous microwave ablation under ultrasound guidance for renal cell carcinomas at clinical staging T1 in patients aged 65 years and older
Authors: Cheng Zhigang , Yu Xiaoling , Han Zhiyu , Liu Fangyi , Yu Jie , Yang Jian , Ai Danni , Liang Ping 
Published: March 2023

Objectives:
To ascertain the clinical outcomes of patients aged ≥65 years with clinical staging T1 (cT1) renal cell carcinoma (RCC) treated with percutaneous microwave ablation (MWA) under ultrasound control compared with those aged <65.

Materials and methods:
From September 2009 to December 2016, clinical data of two groups, Group O (≥ 65 years) consisting of 75 patients (76 RCCs) and Group Y (< 65 years) consisting of 91 patients (99 RCCs), who underwent MWA treatment for RCC with comparable mean diameters at baseline, were retrospectively evaluated. The methodological effectiveness, cumulative overall survival (OS) and disease-free survival (DFS), local tumor progression (LTP), major and minor complications, and renal performance, including serum creatinine (Cr) and blood urea nitrogen (BUN) between the two categories, were statistically assessed by SPSS.

Results:
After excision, there were no significant differences between the two groups concerning technical efficacy, LTP, and major and minor complications. The cumulative OS and DFS rates at 1, 3, and 5 years in Group O versus Group Y were 100%, 92.6%, and 92.6% versus 98.6%, 96.9%, and 90.9% (P = 0.701), and 100%, 92.5%, and 92.5% versus 98.6%, 96.9%, and 90.4% (P = 0.697), respectively. There was no significant variance between serum Cr and BUN between the two groups before MWA and at the last follow-up.

Conclusion:
Due to the corresponding clinical outcomes for the treatment of cT1 RCCs in patients aged <65 years and ≥65 years, the US-guided MWA is a safe and effective method and may be suggested as one of the first-line nonsurgical options for identified older patients.
Clinicopathological factors affecting the prognosis of massive hemorrhage after radiotherapy for patients having nasopharyngeal carcinoma
Authors: Huang Yanqiu , Yan Donghui , Wang Maoxin , Chen Shiyan , Yang Fan 
Published: March 2023

Aims:
The aim of the study is to investigate the clinicopathological factors that determine prognosis of nasopharyngeal hemorrhage after radiotherapy in patients with nasopharyngeal carcinoma (NPC).

Patients and Methods:
The clinicopathological data of 539 patients with NPC, who received radiotherapy, were analyzed retrospectively. Parameters included gender; age; T-stage; N-stage; pathological type; type of radiotherapy; synchronous chemotherapy; secondary-course radiotherapy; radiation-induced skull base osteonecrosis; diabetes, hypertension, or other systemic diseases; results of nasopharyngeal bacterial culture; and nasopharyngeal tumor recurrence. Univariate and multivariate analyses were performed using the Chi-square test and logistic regression. Afterward, the Kaplan–Meier's method was applied to analyze the survival of patients with nasopharyngeal hemorrhage.

Results:
Among all patients examined, 64 (11.9%) had nasopharyngeal hemorrhage after radiotherapy. The univariate analysis showed that T-stage (P < 0.01), secondary-course radiotherapy (P < 0.01), radiation-induced skull base osteonecrosis (P < 0.01), nasopharyngeal bacterial culture results (P < 0.01), and nasopharyngeal tumor recurrence (P < 0.01) were associated with nasopharyngeal hemorrhage. Multivariate analysis showed that only radiation-induced skull base osteonecrosis was significantly associated with nasopharyngeal hemorrhage after radiotherapy (odds ratio = 41.83, P = 0.0001). Nevertheless, in patients with internal carotid artery hemorrhage, the survival rate was much lower than that in patients with external carotid artery bleeding. The main cause of death during follow-up was rebleeding.

Conclusion:
The rate of mortality in patients with nasopharyngeal hemorrhage after radiotherapy was high. The presence of radiation-induced skull base osteonecrosis was a decisive factor in these patients. However, after successful rescue, arterial embolization or stent implantation is proposed to prolong survival.