tbuckley/cabot-search huggingface dataset:
A phase I, open-label, multicenter, single-dose escalation and multi-dose study of a monoclonal antibody targeting CEACAM1 in subjects with selected advanced or recurrent malignancies.
Authors: Roni Shapira, Jeffrey S. Weber, Ravit Geva, Mario Sznol, Harriet M. Kluger, Deborah J.L. Wong, Bertrand C. Liang
Journal: Journal of Clinical Oncology (2020)

3094 Background: The carcinomembryonic antigen cell adhesion molecule 1 (CEACAM1, CD66a) is a member of the CEA gene family. CEACAM1 interacts homophilically and heterophilically with CEACAM5, and is involved in various anti-proliferative activities. CEACAM1 is expressed on a variety of epithelial and hematological cells, including multiple types of cancer and activated lymphocytes. High CEACAM1 expression in some tumor types is known to be associated with poor disease prognosis. Recently it was demonstrated CEACAM1 is co-expressed on exhausted lymphocytes with other immune checkpoints such as TIM-3 and may regulate downstream activity. CM24 is a novel humanized α-CEACAM1-specific antibody with nM affinity to the N terminal domain of CEACAM1, which blocks intercellular CEACAM1 interactions. Methods: The primary objective was to test the safety and tolerability of CM24 in adult patients with advanced or recurrent cancer. Secondary objectives included assessment of CM24 PK and PD profiles, anti-tumor response and the recommended Phase 2 dose. Patient received IV infusion of CM24 at 7 dose levels ranging between 0.01 and 10 mg/kg in a cycle of 4 doses administered q2wks followed by a 6-week observation only period and additional 6 cycles. Results: 27 patients (median pretreatment of 4 prior regimens; range 2-8, 11 colorectal, 7 melanoma, 4 ovarian, 3 gastric, 2 NSCLC; 13 males, 14 females, mean age of 60 years), were included. Treatment with CM-24 was overall well-tolerated without DLTs up to 10 mg/kg. The most frequent AE was grade 1-3 increased alanine aminotransferase (7 subjects) and the most severe AE was grade 3/4 increase in gamma-glutamyltransferase (4 subjects). Drug-related AEs were observed in 63% of the subjects with grade 3-5 occurred in 3.7%. Eight subjects (29.6%) had stable disease as the best overall response. Median overall survival was 4 (3.4, 8.0) and 6.2 (2.7, 10.2) months for the 3 and 10 mg/kg doses, suggesting dose response. Cmax, AUC and t1/2 increased with increasing dose with the longest t1/2 of 11.2 days obtained at 10mg/kg. The average target occupancy of CM24 at 3mg/kg and 10mg/kg were 75% and 93%, respectively. Conclusions: PK and target-mediated drug disposition analysis suggest that doses higher than 10mg/kg are needed for target saturation at a q2 week regimen while a q3 week regimen is less optimal. A phase 1/2 clinical trial testing CM24 in combination with anti-PD-1 therapy in patients with NSCLC including assessment of CEACAM1 expression is warranted. Clinical trial information: NCT02346955 .
Outcome of FOLFOX based chemotherapy in advanced pancreatobiliary cancers presenting with hyperbilirubinemia.
Authors: Sandeep Batra, Sanjeev Kumar Jha, Ankur Bahl, Harit Chaturvedi, Satyam Taneja
Journal: Journal of Clinical Oncology (2020)

e16605 Background: Treatment of pancreatobiliary cancer patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastasis or biliary obstruction is challenging. A significant number of patients at presentation are in advanced/ locally advanced stage thus severely limiting chemotherapy options. FOLFOX (5 FU, Leucovorin, Oxaliplatin) represents a feasible option considering the pharmacokinetics. Clinical data on the dosage and tolerability of chemotherapy is limited and no recommendations are available to treat such patients in upfront setting with persistent hyperbilirubinemia. This observational study was done to find out safety and efficacy of FOLFOX based chemotherapy in these patients. Methods: Patients with advanced pancreatobiliary cancers with hyperbilirubinemia were treated with mFOLFOX6 based chemotherapy. Patients were treated till progression or 6 months or death (whichever occurred ealy) and assessed for toxicity and survival. Results: Only 13 out of 40 patients were able to complete all 12 cycle of chemotherapy. 12 patients were able to receive 2nd line chemotherapy of physician choice and 2 patients were able to received 3rd line chemotherapy. Total bilirubin of patients at start of chemotherapy ranged from 3 to 39.4 mg/dl with a mean value of 9.17±6.67 mg/dl and a median value of 7.5 mg/dl. Median progression free survival (PFS) of mFOLFOX6 was 5.97 months whereas median overall survival (OS) was 8.2 months. 6 patients were able to receive only one cycle of chemotherapy. 2 patients were able to receive only 2 cycles of chemotherapy. 26 patients completed 6 cycles of chemotherapy. Objective response rate was 45% after 6 cycles of chemotherapy. Of these 26 patients response assessment revealed progressive disease in 7 patients. 2 patient had complete metabolic response of which one of them had locally advanced disease. On laparotomy of this patient there were an extensive peritoneal disease curative surgery was not feasible. One patient successfully underwent Whipple’s procedure after 6 cycles of chemotherapy followed by adjuvant radiotherapy. Conclusions: FOLFOX based chemotherapy is a feasible option and a hope for patients of advanced pancreatobiliary cancers presenting with hyperbilirubinemia with a tolerable toxicity profile and providing comparable PFS and OS to other chemotherapy drugs/ regimens used in non hyperbilirubinemic patients.
全科医学教育现状是我国发展社区卫生服务的瓶颈之一
Authors: 张弛
Journal: BMJ (2007)

在中国实践全科医学,发展具有中国特色的社区卫生服务是卫生体制改革的必经之路.然而多年的教学和管理实践显示,我国卫生体制改革、发展社区卫生服务的瓶颈之一,就是从事社区卫生服务的管理人员的管理技能和医务人员的全科医学理论及实践技能不到位。
Analysis of statistics of pancreatic cancer in Ukraine for a period of 10 years.
Authors: Liliia Zrielykh
Journal: Journal of Clinical Oncology (2020)

e16721 Background: Pancreatic cancer (PC) is the 7th leading cause of cancer death in both sexes and 12th most common cancer worldwide. The estimated 5-year survival rate for it is nearly 5% both in developed and in developing countries. Methods: Analysis of data of National and regional cancer registries. Results: Number of new PC cases in 2003 in Ukraine was 4837 ( men – 2666, women – 2171), in 2013 – 5296 ( men – 2877, women – 2419). So the number of PC cases increased by 8,7% ( by 7,3% in men, by 10,3% in women) in 2013 in comparison to 2003. Number of deaths from PC in 2003 was 4115 (men – 2291, women – 1824), in 2013 – 4307 ( men – 2328, women – 1979). The number of PC deaths increased by 4,5% ( by 1,6% in men, by 7,8% in women). Incidence of PC in children population (age 0-17 years) in 2003 was 0, in 2013 – 4 ( men – 0, women – 4). Age-standardised incidence rate (world standard) of PC in 2003 was 5,9 ( 8,6 in men; 4,0 in women), in 2013 – 6,8 ( 9,8 in men; 4,7 in women). Age-standardised mortality rate (world standard) in 2003 was 5,0 ( men – 7,4; women – 3,4), in 2013 – 5,5 ( men – 7,9; women – 3,9). Patients diagnosed during the preventive medical examinations in 2003 were 3.8% ( men – 3,6%, women – 4,1%), in 2013 - 3.2% ( men – 3,2%, women – 3,3%). Newly diagnosed patients received the special treatment in 2003 were 27,6% (men – 28,7%, women – 26,1%), in 2013 - 26% (men – 25,5%, women – 26,6%). From among them surgical treatment only received 60.8% in 2003, 45.9% in 2013, Combined or complex scheme of treatment received 10.1% in 2003, 10.5% in 2013. The percentage of histologically verified PC in 2003 – 28,4%, in 2013 was 33,6%. Conclusions: There is a tendency of increase of incidence and mortality rates of PC in Ukraine. There have been cases of morbidity in children in 2013 compared with 2003. The number of patients revealed during preventive medical examinations remains low in 2013 and in 2003 due to low health financing, low coverage of preventive medical examinations. The number of patients who received special treatment remains low during 10 years. This is mainly due to lack of access to medical care, high cost of treatment, diagnosis of PC at an advanced stage.
Rates of adherence to bone health guidelines for women with breast cancer treated with anti-estrogen therapy.
Authors: Leighton Andrew Elliott, Victor G. Vogel
Journal: Journal of Clinical Oncology (2020)

7051 Background: Long-term use of aromatase inhibitor (AI) therapy has been shown to decrease bone mineral density (BMD) and is associated with at least twice the fracture risk when compared to an age-matched healthy population. AI’s are a common treatment in hormone receptor-positive breast cancer for post-menopausal women. Similarly, tamoxifen has been shown to decrease BMD in premenopausal women. As a result, the National Comprehensive Cancer Network (NCCN) recommends BMD screening for women being treated with anti-estrogen therapy (AET), typically via Dual-energy X-ray absorptiometry (DEXA) scan. Previous studies have shown poor adherence to BMD screening with AI therapy, but no known study has evaluated compliance with tamoxifen therapy. Methods: We evaluated a retrospective cohort (December 2015 – July 2019) of all women with a breast cancer diagnosis initiating AET using data from the electronic health records of patients throughout a rural integrated health system. We assessed non-adherence to baseline and annual BMD screening using descriptive statistics along with preliminary data regarding fractures associated with AET therapy. Results: A total of 3,693 health records of women with a breast cancer diagnosis and documented prescription for AET were evaluated. In the year before AET initiation, 16% of women received BMD screening. Overall, 1,189 women treated with AET had a DEXA scan ordered at any point after drug initiation: 37% for AI’s and 12% for tamoxifen. Of those treated with AI, 84% had no DEXA ordered within 12 months of starting drug after a minimum of 9 months of continuous use; this value was 96% for tamoxifen use. Patients complied with the ordered DEXA scan within the first year 81% of the time. Repeat DEXA scans were ordered 34% of the time, and patient compliance decreased to 55%. There was no significant difference in the number of patient co-morbidities between patients who did and did not have a DEXA scan ordered. After starting an AI, 131 fractures were documented; 44% occurred within the first year following starting drug treatment with an average of 5 months from drug start to diagnosis. Conclusions: A significant proportion of breast cancer patients treated with AET did not receive guideline-recommended BMD screening. These findings should raise awareness of the importance of BMD screening by responsible providers, including oncologists, primary care physicians, care managers and insurance companies in order to decrease avoidable morbidity.
Care homes after covid-19: we need a wide ranging inquiry and reform
Authors: Clive E Bowman
Journal: BMJ (2020)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Care homes after covid-19: we need a wide ranging inquiry and reform Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
咳嗽的诊断与治疗指南(2009版)
Authors: 中华医学会呼吸病学分会哮喘学组
Journal: BMJ (2009)

咳嗽是机体的防御反射,有利于清除呼吸道分泌物和有害因子,但频繁剧烈的咳嗽对患者的工作、生活和社会活动造成严重的影响.临床上,咳嗽是内科患者最常见的症状,咳嗽病因繁多且涉及面广,特别是胸部影像学检查无明显异常的慢性咳嗽患者,此类患者最易被临床医生所疏忽,很多患者被长期误诊为慢性支气管炎或支气管炎,大量使用抗菌药物治疗而无效,或者因诊断不清反复进行各种检查,不仅增加了患者的痛苦,也加重了患者的经济负担。
HHEX promotes myeloid transformation in cooperation with mutant ASXL1
Authors: Reina Takeda, Shuhei Asada, Sung-Joon Park, Akihiko Yokoyama, Hans Jiro Becker, Akinori Kanai, Valeria Visconte, Courtney E Hershberger, Yasutaka Hayashi, Taishi Yonezawa, Moe Tamura, Tsuyoshi Fukushima, Yosuke Tanaka, Tomofusa Fukuyama, Akiko Matsumoto, Satoshi Yamasaki, Kenta Nakai, Satoshi Yamazaki, Toshiya Inaba, Tatsuhiro Shibata, Daichi Inoue, Hiroaki Honda, Susumu Goyama, Jaroslaw P Maciejewski, Toshio Kitamura
Journal: Blood (2020)
Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.
Authors: Hermano Alexandre Lima Rocha, Irene Dankwa-Mullan, Pedro Meneleu, Caio Figueiredo Juaçaba, Metasebya Solomon, Debora Boni, Silvia Helena de Souza Lopes, Silvia Elaine Miranda de Souza, Mylena Silvia Ximenes, Rebeca Rodrigues Thé, Leandro Freire Lacerda, Erick Siqueira Campos de Oliveira, Cheryl Clark, Winnie Felix, Yull Edwin Arriaga, Marcelo Gurgel Carlos da Silva, Gretchen Purcell Jackson, Sergio Ferreira Juaçaba
Journal: Journal of Clinical Oncology (2020)

e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified &gt;30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]
脑脊液细胞学检查应用于脑膜癌病诊断12例
Authors: 庞保军, 张力, 魏金风
Journal: BMJ (2006)

对4 081份脑脊液标本进行细胞学检查时,确诊12例为脑膜癌病.该12例中10例颅脑CT检查为阴性;颅脑MIR检查2例见有脑积水,6例为阴性.提示脑脊液细胞学检查诊断脑膜癌病具有简便、快速、准确的特点,对提高脑膜癌病诊断率、减少漏诊和误诊具有重要意义。
性激素与乳腺癌
Authors: 孙爱军
Journal: BMJ (2008)

对于妇女来说,最害怕的疾病是乳腺癌.在发达国家,乳腺癌是妇女最常见的肿瘤,乳腺癌的终身患病风险约为10%,乳腺癌将导致每年50万妇女的死亡.将近20%的乳腺癌病例是在50岁前发病,80%在50岁后被诊断[1]。
复方莪术油栓治疗老年性阴道炎60例疗效观察
Authors: 阚延静
Journal: BMJ (2005)

选取确诊的老年性阴道炎患者60例,用复方莪术油栓治疗,每晚1枚复方莪术油栓阴道用药,连用6 d,停药1周后复查,评价疗效.本次研究表明患者治疗前后,阴道脱落细胞学构成及分泌物的清洁度均有改变,与对照组比较差异有统计学意义(P＜0.05);复方莪术油栓治疗老年性阴道炎总有效率可达96.7%。
Socioeconomic status, race, and mortality disparities in insured patients in southern California.
Authors: Robert Michael Cooper, Reina Haque, Joanne E. Schottinger
Journal: Journal of Clinical Oncology (2020)

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]
密云县妇女意外妊娠及避孕知识知晓和需求情况调查
Authors: 王海平, 陈青华
Journal: BMJ (2007)

对2006年11月要求终止妊娠的121例妇女进行有关避孕知识的问卷调查. 1.对象与方法:选择因意外妊娠于2006年11月到密云县妇幼保健院计划生育门诊要求终止妊娠(停经70 d以内)的妇女作为调查对象。
从网上搜寻有价值的健康信息资料
Authors: 刘岚
Journal: BMJ (2009)

不要轻易相信你所看到的,这是一句老生常谈,尤其是对于在网络上看到的健康信息资料. 如今,当你想了解某个疾病或健康问题时,上网搜索就能查到丰富的相关资料.但众多的信息中,许多看似真的,其实并不真实可靠。
Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: a retrospective analysis
Authors: 李波, 邱贵兴, 郭诗工, 李文菁, 李晔, 彭慧明, 王储, 赵宇
Journal: BMJ (2017)

目的
研究胸椎黄韧带骨化合并硬脊膜骨化的发生率、分布情况及其影像学特征。


设计
一项回顾性影像学分析。


研究地点
该研究在中国一个单独的机构完成。


研究对象
2011年1月至2015年7月，在同一个医院因胸椎黄韧带骨化而进行胸椎后路减压治疗的53例患者。减压节段根据影像学评估和术中证据进行分组。


主要观察指标
收集患者的人口统计学分布特征、影像学表现和详细的手术记录。首先，对术前减压节段的CT影像进行评估，以确定哪些节段具有硬脊膜骨化的影像学特征。车轨征逗号征和桥洞征被作为黄韧带骨化合并硬脊膜骨化的特征性影像学表现，并对4种容易混淆的征象（假车轨征）进行鉴别和排除。然后，对详细的手术记录进行仔细回顾，以最终确定哪些节段真实存在硬脊膜骨化。


结果
在研究纳入的黄韧带骨化患者中，硬脊膜骨化的发生率为43.4%。在手术减压的黄韧带骨化的节段中，硬脊膜骨化的发生率为21.5%。黄韧带骨化更常见于下胸椎，而且超过一半的（53.8%）的硬脊膜骨化也位于T9~T12。车轨征是最常见的硬脊膜骨化的影像学征象，但是它有时候可能会被误诊（有车轨征表现，而没有硬脊膜骨化）。在排除了4类假车轨征后，影像学诊断硬脊膜骨化的敏感性和特异性分别为94.23%和94.21%。


结论
硬脊膜骨化在需要手术治疗的胸椎黄韧带骨化患者中相对常见，尤其是在T9~T12节段。车轨征可能会被误诊，在排除了4种假车轨征之后，影像学诊断硬脊膜骨化的准确性相对较高。
Anti-VEGF versus Anti-EGFR in the real world in metastatic colorectal cancer.
Authors: Fernando Namuche, Claudio J. Flores
Journal: Journal of Clinical Oncology (2020)

e16040 Background: The incidence of colorectal cancer (CRC) in Peru has increased in the last decades. But the use of monoclonal antibodies is restricted in our population because of insureance issues. Approximately 20% of patients with CRC already have metastases at diagnosis. There is a lack of data in the benefits of our population with the use of anti-VEGF and anti-EGFR that this study intents to fill. Methods: We retrospectively reviewed the electronic medical records of 58 patients with metastatic CRC, KRAS, NRAS and BRAF wild type from one specialized Peruvian cancer center between 2006 and 2017 Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. The survival analysis was performed with Kaplan Meier method for PFS and OS, comparing the curves with Log Rank test. A multivariate analysis was performed using the Cox regression model with the statistically significant variables found in the univariate analysis. Results: There was 29 patients in the anti-EGFR arm, and 29 patients in the anti-VEGF arm. Patients that received first anti-EGFR and then anti-VEGF had better OS [HR, 0.87; 95% CI,0.019-0.811; p &lt; 0.001] than patients that received first anti-VEGF and then anti-EGFR. Multpile Cox regressión analysis demonstrated that metastasectomy, debut with less thant 2 metastasis site, left side tumor, and histologic grade were associated with better OS. Conclusions: Patients with mCRC RAS and BRAF wild type that received anti-EGFR and then anti-VEGF had better OS than patients that received anti-VEGF and then anti-EGFR.
Safety and efficacy of atezolizumab (atezo) in patients (pts) with autoimmune disease (AID): Subgroup analysis of the TAIL study.
Authors: Thomas Newsom-Davis, Belen Rubio Viqueira, Delvys Rodriguez-Abreu, Jorge Alatorre-Alexander, Hans J.M. Smit, Jinming Yu, Konstantinos N. Syrigos, Hina Patel, Jonathan Tolson, Andrés Cardona, Hans Kristian Vollan, Sergio Jobim Azevedo, Ernest Choy, Andrea Ardizzoni
Journal: Journal of Clinical Oncology (2020)

e21628 Background: Atezo showed improved survival and a manageable safety profile in advanced NSCLC. The Phase III/IV TAIL study (NCT03285763) evaluated atezo in pts with previously treated advanced NSCLC, including pts often excluded from pivotal trials. We analyzed outcomes in pts with a history of AID in TAIL. Methods: Pts had stage IIIb/IV NSCLC that progressed after 1-2 lines of chemo and ECOG PS ≤ 2. Eligible pts included those with preexisting AID. Pts received atezo 1200 mg IV q3w. The primary endpoint was safety as measured by the incidence of treatment-related (TR) serious AEs (SAEs) and TR immune-related AEs (irAEs). Secondary endpoints included OS, PFS, ORR and other safety measures. Results: Of the 619 pts enrolled, 615 received atezo, including 30 pts with AID. In AID pts, the median age was 67 y, 43.3% were male and 86.7% had ECOG PS 0-1; common preexisting conditions included psoriasis (n = 7) and rheumatoid arthritis (n = 5). 23 pts had active AID at baseline. At data cutoff (Jun 4 2019), median follow-up was 12.7 mo. TR SAEs occurred in 6.7% and 7.9% of AID vs non-AID pts, respectively; TR irAEs occurred in 10.0% and 8.2% (table). AEs occurring in AID pts at a ≥ 10% difference vs non-AID pts were decreased appetite (26.7%), nausea (26.7%), dyspnea (23.3%) and pneumonitis (13.3%). G3-4 AE incidences were similar between groups (30.0% vs 29.9%). AEs leading to treatment discontinuation occurred in 16.7% and 4.3% of AID vs non-AID pts and included G1-2 pneumonitis (6.7%), G3-4 pleural infection (3.3%) and G3-4 pneumonia (3.3%). AEs of special interest (AESI) occurred more frequently in AID (40.0%) vs non-AID (34.2%) pts, with pneumonitis (13.3% vs 3.1%), rash (13.3% vs 10.6%) and hypothyroidism (6.7% vs 9.6%) as the most common AESIs in either group. Exploratory efficacy analyses in AID vs non-AID pts showed an mOS of 10.1 vs 11.1 mo, an mPFS of 2.9 vs 2.7 mo and ORRs of 10.0% vs 11.1%. Conclusions: Despite the small number of AID pts, safety and efficacy outcomes of atezo in TAIL pts with a history of AID were similar to those of pts with no history of AID. Moderate AE increases seen in AID pts tended to be respiratory in nature or GI disorders. These data may inform treatment decisions in pts with advanced NSCLC and AID. Clinical trial information: NCT03285763. [Table: see text]