tbuckley/cabot-search huggingface dataset:
Does radical surgery for gastric cancer after 70 years prolong survival?
Authors: Brice Chanez, Jérome Guiramand, Vincent Niziers, Slimane Dermeche, Philippe Rochigneux, Pauline Ries, Fréderique Rousseau, Elika Loir, Marine Gilabert
Journal: Journal of Clinical Oncology (2020)

e16527 Background: Gastric cancer (GC) occurs in 50% of case after 70 years old (y/o). Radical surgery or perioperative treatments have to be balanced with safety management in those potential frail patients. Methods: We perfomed a retrospective review of our single institution database to address the outcome of patient (pts) &gt; 70y/o who underwent radical surgery for GC with or without neoadjuvant and adjuvant treatment. Results: From 2005 to 2019, 60 eligible patients (pts) have undergone radical surgery for resectable GC. Median age at diagnosis was 74.2y/o [70.3-92.8] and 82% were male. Initial echoendoscopy staged 12% of T1/T2 tumor versus 70% of T3/T4, whereas 60% were found with lymph node spreading (N+). 80% of pts were given neoadjuvant treatment: chemoradiation (58%), chemotherapy (45%) or radiation alone (1%). 1/4 pt received perioperative chemotherapy. Only one patient had post-operative radiation with FOLFOX and none had adjuvant radiation alone. Surgery procedure was total (27%) or sub-total (5%) gastrectomy, polar-oesogastrectomy with thoracotomy (18%) or without thoracotomy (50%). Post-operative mortality within 3 months was 5% (n = 3) including 2 pts in the first 30 days. For the global cohort, median overall survival (mOS) was 44.75 months and median progression free survival (mPFS) was 21.2 months. Patients who frontly underwent radical surgery (n = 15, 25%) had small disease with 13% pT0 and 60% of pT1 on final pathology. Only 27% had pT2/T3 but all had vascular and/or peri-nervous emboli. Two of them (13%) were pN+. The mOS was 60 months and mPFS 60 months in this cohort and 33% of pts end/was lost of follow up. Only one metastatic relapse was identifies and no local relapse. Six pts died (40%): 2 in the 30-days post surgery (13%), 3 (30%) from other cause than GC and 1 (7.5%) because of GC distant relapse. The cohort treated with neoadjuvant chemotherapy (n = 45, 75%) was given platinum and anthracycline-based regimen in 73% and 16% of cases, respectively. 1% received fluoropyrimidine +/- irinotecan. 53% associated radiation to neoadjuvant chemotherapy. After neoadjuvant treatment completion, 47% of downstaging (including 18% of pCR), 33% of stable stage and 15.5% of upstaging was observed and 40% of initial usN+ was pN0. After perioperative treatment, mOS was 31 months and mPFS was 18.9 months. Overall 44% experienced local and/or distant relapse. Conclusions: Age above 70y/o should not systematically exclude patient from neoadjuvant or perioperative treatment and radical surgery, which is feasible in selected population displaying long term result in focal and distant disease control.
An analysis for factors related to health education by community nurses in Guangzhou
Authors: 吴兰笛, 韩卫丽
Journal: BMJ (2006)

目的 了解影响广州社区护士开展健康教育的相关因素,探讨提高认识水平和培训相关知识与技能的措施.方法 采用问卷的方法调查分析1 702名社区护士对社区健康教育的概念和内容的认识以及运用相关技能开展社区健康教育的情况.结果 73.0%(1 243/1 702)的护士不完全了解社区健康教育的概念,其中28.3%(481/1 702)完全不了解;84.2%(1 433/1 702)不完全了解社区健康教育的相关内容,其中12.3%(210/1 702)完全不了解,从高到低依次排列为:青少年生理和心理卫生＞健康体检自查技术＞社区急救、自救知识和技术＞社区和家庭环境消毒隔离技术;71.9%(1 233/1 702)护理人员部分了解,从高到低依次为:老年护理和临终关怀＞社区和家庭康复技术＞食疗和家庭用药管理＞妇女儿童保健技术＞慢性病家庭护理技术.只有7.2%(123/1 702)的护士参与过健康教育活动.结论 应对社区护士进行相关知识与技术的培训,转变观念,提高认识,掌握更多的科普知识和适宜技术。
Patient and diagnostic intervals of sarcoma patients: Results from a survivorship study in the Netherlands.
Authors: Vicky L.M.N. Soomers, Olga Husson, Ingrid M.E. Desar, Michiel van de Sande, Jacco De Haan, Cornelis Verhoef, Ingeborg Vriens, Winan J. van Houdt, Lonneke V van de Poll-Franse, Winette T.A. Van Der Graaf
Journal: Journal of Clinical Oncology (2020)

e23553 Background: Sarcoma patients are hypothesised to experience long intervals to cancer diagnosis, due to the rarity of the disease, heterogeneous presentation, and complexity of histological diagnosis. Comprehensive assessment of patient interval (time between first symptom and presentation to a doctor), diagnostic interval (time between presentation to a doctor and diagnosis ), and their associated factors is needed to improve referral pathways and outcomes for sarcoma patients. We investigated patient and diagnostic intervals and identified factors associated with prolonged intervals in order to identify risk groups. Methods: We conducted a cross-sectional cohort study among adult sarcoma survivors, diagnosed between 2008-2016. After informed consent, patient-reported interval length was collected via (online) questionnaires. This data was linked to the Netherlands Cancer Registry, which collects clinical data from patients at diagnosis. Descriptive statistics were used to describe interval lengths. Logistic regression analyses were conducted to investigate associations of patient and tumour characteristics (gender, age at diagnosis, time since diagnosis, histology, presence of metastases, grade, and localisation), with patient and diagnostic interval length. Results: 1099 survivors completed questionnaires (response rate 58%); 53% had a patient interval ≥1 month. Risk factors for a patient interval ≥1 month were bone or breast sarcoma, and being young(18-39 years). An interval ≥3 months (33%) was associated with dermatofibrosarcoma protuberans, bone sarcoma, low grade, and location in skin or pelvis. Diagnostic interval length was ≥1 month in 53%; risk groups were bone sarcomas, females, and young (18-39) or middle-aged (40-69) patients. In 27% the diagnostic interval lasted ≥3 months; risk groups were synovial sarcoma, chordoma, bone sarcomas in general, females, and being young (18-39) or middle aged (40-69). Conclusions: Over half of sarcoma survivors had a patient interval ≥1 month; a third ≥3 months. More than half of them reported a diagnostic interval ≥1 month; a quarter ≥3 months. Females and young patients were more at risk for a long diagnostic interval. Although limited by its retrospective nature, this study is the largest that studied the interval in a sarcoma survivorship group. Our current QUEST study (NTR-7253) will study the diagnostic trajectory prospectively to confirm these findings and find reasons for these results.
合并性功能障碍的POEMS综合征一例及文献复习
Authors: 逄迎春, 徐梅, 吴玉萍, 丁志英, 刘明美, 张伟萍
Journal: BMJ (2005)

POEMS(polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes)综合征是一种罕见的与浆细胞有关的多系统疾患.我们收治1例首先表现有性功能障碍的POEMS综合征,9年间先后住院3次,结合文献复习,报告如下。
Radium-223 (Rad) and niraparib (Nira) treatment (tx) in castrate-resistant prostate cancer (CRPC) patients (pts) with and without prior chemotherapy (chemo).
Authors: William Kevin Kelly, Benjamin Leiby, David Johnson Einstein, Russell Zelig Szmulewitz, A. Oliver Sartor, Eddy Shih-Hsin Yang, Guru Sonpavde
Journal: Journal of Clinical Oncology (2020)

5540 Background: Despite multimodality txs such as surgery, radiotherapy, hormonal tx and chemo, metastatic CRPC (mCRPC) prognosis remains poor. Research suggests PARP-1 is a key regulator of androgen receptor (AR) signaling and transition to lethal CRPC. Nira is a safe, potent and selective PARP-1/2 inhibitor that has shown single agent clinical activity in CRPC, and Rad is an alpha particle emitter. Addition of PARP inhibition may further enhance the clinical benefit of Rad. Nira has a favorable safety profile however, data on safety, tolerability and efficacy of Nira plus radiotherapy is limited. We hypothesize that targeting the PARP-1/AR axis in combination with radiation is safe and will improve mCRPC management. Methods: This is a phase (ph) Ib dose finding study (NCT03076203) of pts with progressive mCRPC using Time-to-Event Continual Reassessment Method (TITE-CRM). The primary objective is to determine the optimum ph II dose of Nira plus Rad (55 kBq/kg of body weight) in pts with and without prior chemo. Secondary endpoints include PSA reduction at 12 weeks (wks) and radiographic progression-free survival at 6 months. Pts enrolled to one of three dose levels of Nira (100, 200, and 300 mg PO daily). After completing 6 cycles of Rad, pts continued on Nira alone until objective progression, tx intolerance or pt decision. TITE-CRM identifies the maximum tolerated dose (MTD) based on toxicities observed over 12 wks of tx. Results: Between Oct 2017 and Jan 2020, 30 pts were enrolled (15 per stratum). Median age was 70 years; ECOG performance status was 0. The MTD of Nira was 100 mg in the chemo-exposed arm and 200 mg in the chemo-naïve arm. 19 Grade ≥ 3 adverse events were possibly related to tx: lymphocyte count decrease (n = 4, 13%), neutrophil count decrease (n = 3, 10%), anemia (n = 3, 10%), hypertension (n = 3, 10%), platelet count decrease (n = 2, 7%), creatinine increase (n = 1, 3%), hydronephrosis (n = 1, 3%), nausea (n = 1, 3%), white blood cell count decrease (n = 1, 3%). Tx duration and PSA response are shown in the table. Conclusions: Nira plus Rad was determined to be safe and tolerable. The MTD of Nira was identified and is pending ph II investigation. Managed by: Prostate Cancer Clinical Trials Consortium; Funded by: Janssen Scientific Affairs and Bayer Healthcare Pharmaceuticals, Inc Clinical trial information: NCT03076203 . [Table: see text]
Investigating the disparate enrollment of older adults on phase I clinical trials: Evolving participation patterns of patients 65 years and older w advanced cancer on phase I trials.
Authors: Ishwaria Mohan Subbiah, Aman Buzdar, Ecaterina Elena Ileana Dumbrava, Siqing Fu, Filip Janku, Daniel D. Karp, Aung Naing, Shubham Pant, Jordi Rodon, Apostolia Maria Tsimberidou, Timothy A Yap, Vivek Subbiah, Funda Meric-Bernstam, David S. Hong
Journal: Journal of Clinical Oncology (2020)

12044 Background: While safety and dose-finding remain the primary objective of Phase 1 trials, the potential for clinical benefit has taken a greater meaning in the last decade with the novel therapies. With data from phase I trials being submitted for regulatory approval, the finer details of these studies are under even more scrutiny: in particular, do the trial participants reflect the general patient population for whom the drug may be indicated? To that end, we investigated age-based enrollment on phase I clinical trials over time. Methods: We queried a prospectively maintained database at a major phase I trials center to identify eligible patients and demographic + clinical variables including phase I trial characteristics, age at date of enrollment into 3 age-based cohorts: AYA ages 15-39y, mid-age 40-64y, older adults aged 65y+. We calculated descriptive statistics, and explored correlations (Pearson/Spearman) and associations (linear regression) between age and independent variables. Results: Over a 3-year period (1/1/17 to 12/31/19), we identified 6267 pts enrolled on 338 phase I trials. Median overall age 58.4y (range 15.5-95.1y). 729 (12%, median age 34.8y) were AYA, 3652 (58%, median age 55.4y) mid-age and 1886 (30%, median 70y) older adults, of whom 870 pts were aged 70-79y and 76 pts aged 80y+ (18 being &gt;85y). There was no association b/w senior participation and year of enrollment (2017 31%, 2018 29%, 2019 30%, b/w age and type of therapy (i.e. targeted vs immunotherapy, etc.) or b/w age and # of drugs given on trial (single agent vs combo) (all p &gt; 0.05). Conclusions: Older adults remain underrepresented on phase I trials esp. when compared to incidence of cancer in that age group (30% enrollment vs 60% incidence), a discordance more staggering in the oldest old pts (85y+; only 18 pts enrolled over 3 yrs when compared to 140,690 pts 85y+ w a new cancer dx in just 2019). Once enrolled, older adults received similar types of phase I therapies with comparable number of drugs as compared to middle age patients, i.e. older adults were just as likely to get immunotherapy or targeted therapy as well mono- vs combo therapy as mid-age pts. [Table: see text]
Efficacy and safety of lazertinib 240 mg as the clinical dose in patients with EGFR T790M mutant NSCLC: Data from a phase I/II study.
Authors: Ki Hyeong Lee, Myung-Ju Ahn, Ji-Youn Han, Sang-We Kim, Eun Kyung Cho, Yun-Gyoo Lee, Dong-Wan Kim, Joo-Hang Kim, Jong-Seok Lee, Gyeong-Won Lee, Byoung Yong Shim, Jin-Soo Kim, Sang Hoon Chun, Sung Sook Lee, Young Joo Min, Sang Won Shin, Min Hee Hong, Jong-Mu Sun, Hae Mi Byun, Byoung Chul Cho
Journal: Journal of Clinical Oncology (2020)

9572 Background: Lazertinib (YH25448) is a highly mutant-selective, irreversible 3 rd -generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that targets the activating EGFR mutations (Del19 and L858R), as well as the T790M mutation, while sparing wild type. We report the efficacy and safety results of lazertinib 240 mg as recommended phase 2 dose (RP2D) from a phase I/II study of lazertinib (NCT03046992). Methods: Patients (pts) with advanced NSCLC, who had progressed after prior EGFR-TKI therapy were enrolled in an open-label, multicenter, phase I/II study with dose-escalation (20-320 mg), dose-expansion (40-240 mg) and dose-extension phases. Pts were assessed for safety, tolerability, pharmacokinetics and efficacy. For dose-expansion and extension phases, tumors had to be T790M mutation-positive (T790M+). Of all 78 pts assigned to lazertinib 240 mg dose level across all phases, 76 pts with centrally confirmed T790M+ were included for efficacy analysis. Results: As of 30 Sep 2019, a total of 78 pts (49% female, median age 62) received at least one dose of lazertinib 240 mg. The median duration of follow-up was 9.6 months and 44 pts were ongoing at data cut-off. Of 78 pts, 76 pts with centrally confirmed T790M+ showed the objective response rate (ORR) 57.9% (95% CI 46.8, 69.0), the disease control rate (DCR) 89.5% (95% CI 82.6, 96.4), the median progression-free survival (PFS) 11.0 months (95% CI 5.6, 16.4) and the median duration of response (DoR) 13.8 months (95% CI 9.6, NR) by independent central review (ICR), respectively. Two pts (3%) experienced a confirmed complete response. The investigator-assessed ORR, DCR, median PFS and median DoR were 72.4% (95% CI 62.3, 82.4), 94.7% (95% CI 89.7, 99.8), 13.2 months (95% CI 9.6, not reached) and 11.8 months (95% CI 8.4, not reached), respectively. The most common treatment-emergent adverse events (TEAEs) at the 240 mg dose regardless of its causality were rash (35%), pruritus (33%) and paraesthesia (32%), which were mostly mild (Grade ≥3 rash: 1%; no Grade ≥3 pruritus or paraesthesia). TEAEs leading to dose reduction and dose discontinuation were observed in 13% (10/78) and 8% (4/78), respectively. Drug related TEAEs of grade ≥3 were observed in 6% (5/78). Conclusions: Lazertinib 240 mg has a favorable safety profile, and exhibits promising anti-tumor activity in pts with EGFR T790M+ NSCLC. Clinical trial information: NCT03046992 .
Assessment of the sexual health of breast cancer survivors and their interest in discussing their difficulties with their doctors during follow-up.
Authors: Natalia Camejo, Cecilia Castillo, Ana laura Hernandez, Nora Artagaveytia, Dahiana Amarillo, Lucia Beatriz Delgado
Journal: Journal of Clinical Oncology (2020)

e12542 Background: Sexual dysfunction from breast cancer and its various therapies is present in up to 60% of the breast cancer patients. Sexuality remains a neglected issue; doctors often ignore it, claiming they lack the time, knowledge or expertise required to address it. Objectives: To evaluate the sexuality of breast cancer survivors, inquire about the degree of interest in receiving help to resolve sexual dysfunctions related to the diagnosis and treatment of the disease and the level of satisfaction with the care received. Methods: One hundred twenty eigth patients with early breast cancer treated at the Mastology Unit of the Hospital de Clínicas were enrrolled. The study was approved by the hospital’s Ethics Committee. The selected questionnaire is the one used at the University of Chicago Medical Oncology Clinic. Results: Most patients were over 50 years old (96 patients) and had a sexual partner (87 patients), 98 patients (76.5%) had been sexually active within the last 12 months and 85 (86.7%) reported having sexual problems. Moreover, most patients (67/128, 68.3%) responded that sexuality was important in their lives; 85 (86.6%) were interested in receiving support to treat their sexual difficulties, and 72 (73.4%) saw the feasibility of addressing them with a doctor. However, only 29 (29.6%) had sought medical help for that purpose, and most were unhappy with the care received. Seventy-nine patients (80.6%) would be willing to participate in a program aimed at confronting their sexual problems. Conclusions: Our results reveal the need to address the sexual problems of patients diagnosed and treated for breast cancer as part of their medical care. Future studies should focus on developing and evaluating the success of specific interventions in the management of these patients’ sexual dysfunction and - even more importantly - designing strategies for its prevention.
Follow-up survey on general practitioners after residency training in Shanghai
Authors: Minghui Peng, Xiangjie Zhang, Yao Liu, Hui Li
Journal: BMJ (2016)

Objective
To survey the current working status of general practitioners (GPs) who received residency training in Shanghai. 


Methods
The current status of general practitioners, who completed residency training in Shanghai from 2013 to 2014, was surveyed with self-designed questionnaire by e-mail. The survey items included current employers, job specification, clinical practice, teaching, scientific research and so on. 


Results
Three hundred and thirteen out of 377 GPs, who completed residency training from 2007 to 2012, participated in the survey (83.0%), including 85 males and 228 females with a mean age of (31.2±2.6) years. Among all participants, 298 (95.2%) worked in community health service centers, 12.8% (40/313) of them were involved in general practice teaching, 9.9% (31/313) undertook management, 9.3% (29/313) did academic research in community, and 7.7% (24/313) had chance for overseas study. The survey also showed that 134 person/times received various commendations and awards. 


Conclusion
Most GPs who completed residency training are undertaking clinical practice in community health service centers, and they are also well involved in management, teaching, and research.


Key words: 
Structured vocational training; Questionnaire; General practitioner
脾辺縁帯リンパ腫(SMZL)の治療におけるリツキシマブ併用または非併用2-CdAの有意な効果 | 文献情報 | J-GLOBAL 科学技術総合リンクセンター
Authors: G Cervetti, S Galimberti, E Sordi, G Buda, E Orciuolo, N Cecconi, M Petrini
Journal: Annals of Oncology (2010)
Skin cancer and deep learning for dermoscopic images classification: A pilot study.
Authors: Abir Belaala, Yazid Bourezane, Labib Sadek Terrissa, Zeina Al Masry, Noureddine Zerhouni
Journal: Journal of Clinical Oncology (2020)

e22018 Background: The prevalence of skin cancer is increasing worldwide. According to World Health Organization (WHO),there is one in every three cancers diagnosed in US is a skin cancer. Traditional ways for skin cancer diagnosis have shown many limitations: inadequate accuracy, consume much time, and effort. In order to assist dermatologists for earlier and accurate diagnosis, we propose to develop a computer aided diagnosis systems for automatic classification of skin lesions. Deep learning architectures are used in this area based on a new convolutional neural network that can classify skin lesions with improved accuracy. Methods: A public dataset of skin lesions HAM10000 ("Human Against Machine with 10000 training images") is used for training and testing. For the validation of our work, a private dataset is collected from a dermatology office in Besançon (France). This dataset contains 45 different dermatoscopic images of skin lesions (Basal cell carcinoma, squamous cell carcinoma and Actinic keratosis) with their histology results. In this research, a three-phase approach was proposed and implemented: Phase one is preprocessing the data; by amputate missing values using the mean filling method. The dermoscopy images in the dataset were downscaled to 224X224 pixels. Then, data augmentation was applied to solve the imbalanced data problem. Finally, the ten-fold cross-validation method was applied to compare the performance of three CNN architectures used in literature: DenseNet 201, ResNet 152, and VGGNet with our proposed architecture. Results: Results obtained with our model show the highest classification accuracy 0.95, a sensitivity of 0, 96, a specificity of 0.94, and outperforms other algorithms in classifying these skin lesions. Conclusions: Our research improves the performance of computer aided diagnosis systems for skin lesions by giving an accurate classification. The use of this system helps dermatologists to make accurate classification with lower time, cost, and effort. Our future work will focus on generalizing the domain by developing a model that can classify various lesions using various types of data (dermoscopic images, histological images, clinical data, sensors data...etc) using the advanced techniques in literature of transfer learning and adaptors models.
Evaluations of percutaneous dilatational tracheostomy with continuous aspiration of subglottic secretions in intensive care elder patients
Authors: Ying Liu, Han Liu
Journal: BMJ (2012)

To evaluate percutaneous dilatational tracheostomy (PDT) with continuous aspiration of subglottic secretions in intensive care unit (ICU) elder patients.A total of 32 elder patients were selected randomly for PDT and 36 controls for traditional surgical tracheostomy (TST).The PDT group required regular mechanical ventilation with continuous aspiration of subglottic secretions.The operative duration was significantly shorter in PDT group than that in TST group [ ( 10.6 ±3.4)vs.(30.9 ±7.1)min,P ＜0.01].Incision length was significantly less in PDT group than that in TST group [ ( 1.3 ± 0.2 ) vs.(3.2 ± 0.3 )cm,P ＜0.01].Blood loss volume was significantly less in PDT group than that in TST group [ ( 10.4 ±3.8 ) vs.(40.7 ± 11.7 ) ml,P ＜ 0.01].The incidence of ventilator associated pneumonia (VAP) was significantly lower in PDT group than that in TST group ( 15.6％ vs.38.9％,P ＜ 0.05 ).With multiple advantages of mini-invasiveness,safety,simplicity,convenience and easier installation,PDT is quite suitable for elder patients in ICU.

Key words: 
Tracheotomy; Pneumonia,ventilator-associated
Clinical analysis of 29 hyperthyroid patients combined with cytopenia
Authors: Xiao-lan Zhang, Yu Duan, Li Zhang, Chao Liu
Journal: BMJ (2008)

This report was to retrospectively analyze clinical data of 29 hyperthyroid patients with concurrent hematocytopenia.Our findings demonstrated that 5 patients developed cytopenia without any antithyroidism drugs(ATDs),while the other 24 cytopenia patients were only found after taking ATD.In the drug intervention group,17 patients received methimazole(MMI)and 7 took propylthiouracil(PTU).Most cytopenia was dose-dependent and occurred within the first 6 months of medication.Twenty subjects received radioiodine therapy,with no impact on blood cells.We suggested that cytopenia might occur at the early stage of ATD therapy and be related with drug and its dose.Blood cell amount should be monitored,especially for initial ATD therapy.As for interaction between PTU and MMI,alternative radioiodine therapy might seem to be relatively safe.

Key words: 
Hyperthyroidism; Paneytopenia
小剂量卡托普利与螺内酯联用致老年人高血钾症一例
Authors: 周邦克, 匡建华, 马金珍, 方恒, 谭缪
Journal: BMJ (2009)

患者,女,75岁,因双下肢麻木、乏力1个月入院.患者于1个月前无明显诱因出现双下肢麻木、乏力,伴有纳差、偶有恶心,无呕吐,无发热、咳嗽、咳痰、心慌及腹泻等症.起病以来患者精神、饮食、睡眠欠佳,大、小便无异常,体重无明显改变,体力下降.既往有风湿性心脏病史2年.6个月前患者因慢性心功能不全服用螺内酯(20 mg,2次/d)、卡托普利片(12.5 mg,2次/d).近1个月患者未服含钾药物和食用高钾食物,小便量在正常范围。