tbuckley/cabot-search huggingface dataset:
Surgical modalities and prognosis in elderly patients with gastric cancer
Authors: Xianglong Cao, Tao Yu, Hong Tang, Qi An, Hua Yang
Journal: BMJ (2016)

Objective
To evaluate the surgical modalities and prognosis in elderly patients with gastric cancer.


Methods
Sixty three gastric cancer patients aged ≥75 years underwent radical surgery, with D0+ D1 resection in 32 cases and D2 resection in 31 cases, in Beijing Hospital from January 2005 to December 2009.


Results
More lymph nodes were dissected in D2 group than those in D0+ D1 group (27.42±12.75 vs. 14.59±12.11, t=-4.095, P 0.05] and perioperative death rate [3.23%(1/31) vs.6.25%(2/32), χ2=0.324, P>0.05]between two groups. The 5-year survival rate was higher in D2 group than that in D0+ D1 group (47.3% vs. 21.4%, χ2=6.346, P 0.05). Univariate analysis showed that PS<20 was associated with the prognosis of patients (χ2=5.492, P<0.05). Cox proportional hazards model showed that lymph node metastasis(OR=4.103, 95%CI: 1.790-9.405, P<0.05) and D2 radical gastrectomy(OR=0.313, 95%CI: 0.158-0.620, P<0.05) were the independent factors associated with the prognosis of patients aged ≥75 years with gastric cancer (all P<0.05).


Conclusion
Standardized D2 lymph node dissection is beneficial for gastric cancer patients aged ≥75 years. PS<20, lymph node metastasis and D2 radical gastrectomy are associated with the prognosis of patients.


Key words: 
Stomach neoplasms; Gastrectomy; Aged
社区卫生服务站脑卒中双向转诊情况分析
Authors: 严春泽
Journal: BMJ (2005)

脑卒中因发病率及致残率高,发病年龄趋于年轻化,正日益成为公众的健康大敌.社区卫生服务机构在脑卒中的预防、早期发现和治疗以及康复等方面都能发挥重要作用,双向转诊是社区卫生服务站与上级医院合作的主要形式.本文分析了51例需双向转诊的脑卒中病例,对脑卒中双向转诊的效果及如何改进双向转机制进行初步探讨。
Pediatric cancer care in Armenia: The results of a qualitative analysis.
Authors: Saten Hovhannisyan, Ruzanna Papyan, Lilit Sargsyan, Samvel Danielyan, Lala Vagharshakyan, Anna Artak Avagyan, Julieta Hoveyan, Gevorg Tamamyan
Journal: Journal of Clinical Oncology (2020)

e19002 Background: In Armenia the incidence of pediatric cancer accounts for around 80-100 cases per year. This qualitative study was conducted in 2018 to evaluate the needs and challenges in a provision of pediatric cancer care in Armenia. Comparative qualitative study was conducted in 2020 to evaluate the progress in the field. Methods: Qualitative research methods were incorporated to evaluate the achievements, needs and challenges in a provision of childhood cancer care in Armenia. Semi-structured in-depth interviews were conducted with selected study participants including pediatric oncologist/hematologists, pediatric surgeons, who also treat cancer patients, and radiation oncologists. Purposive sampling technique and qualitative conventional content analysis methods were used. Results: Data collected in January 2020 has shown significant improvements in the field of pediatric oncology in Armenia. In the 2018 study, some of the major issues included lack of centralized pediatric cancer care, pediatric cancer registry, palliative care center, possibility of providing high-dose methotrexate, limited nursing training, multidisciplinary team approaches and use of central catheters. Within two years, majority of these problems were solved or are in the process. In 2019 all 3 pediatric oncology and hematology units were merged and the Pediatric Cancer and Blood Disorders of Armenia was created; with the support from charitable foundations all children with cancer receive free medical and psychosocial coverage; a 25 year data has been collected from all the possible sites, the first pediatric cancer palliative care is under construction, 4 multidisciplinary cancer teams were created, pediatric oncology and hematology fellowship was created at the Yerevan State Medical University to prepare for the first time "pediatric oncologist-hematologist" as a one profession. The existing major problems include very limited provision of pediatric cancer medications by the government, as well as lack of the official registration of the number of essential drugs included in the WHO list. Conclusions: Twinning programs, multidisciplinary team discussions with international experts, improvement in availability of several resources, professional development of the staff are major tools for the progress of pediatric oncology in Armenia. Poor provision and official registration of anti-neoplastic medications by the government still remain a major obstacle.
Levels of mRNA of iLBP family genes and retinoic acid receptors in embryonal tumors in children.
Authors: Olga P. Popovyan, Oleg I. Kit, Dmitrii S. Potemkin, Natalya N. Timoshkina, Sergei A. Kuznetsov
Journal: Journal of Clinical Oncology (2020)

e22517 Background: Neuro- and nephroblastoma are the most common pediatric solid tumors. Their varying clinical behavior determines challenging prognosis and choice of treatment tactics. Along with many clinical parameters, the genetic characteristics of tumor cells appear promising. Methods: The study included patients diagnosed with neuroblastoma (n = 10) and nephroblastoma (n = 10) (median age from 2 months to 8 years; 10 boys and 10 girls). Total RNA was extracted from paired tumor/normal samples using the miRNeasy Mini Kit (Qiagen, USA) and cDNA libraries obtained with the Reverta-L kit. Expression of the CRABP1, CRABP2, FABP4, FABP5, RAR, RXRA, RXRB, and PPARD genes was evaluated by RT-PCR on the CFX96 amplifier (Bio-Rad, USA). GAPDH and B2M were reference loci. Relative expression (Exp) was calculated by the 2-ΔCt method. Results: The qPCR-RT showed a significant increase in the transcriptional activity in both tumors, compared to normal tissues, for the FABP4, FABP5, and RXRA loci (p &lt; 0.01). Interestingly, we observed multidirectional changes in mRNA levels in neuroblastomas and nephroblastomas for the CRABP1, RAR, and PPARD loci. Unlike solid tumors of adult patients, the expression activity of the CRABP1 gene either did not differ from the conditional norm (in nephroblastoma), or significantly dropped to 70% (in neuroblastoma). In contrast to adult solid tumors, the CRABP1 gene expression activity in children was normal (in nephroblastoma) or decreased significantly up to 70% (in neuroblastoma). Conclusions: The pilot study revealed differentiating aberrant expression of genes encoding the family of retinoic acid transporters and receptors in pediatric neuroblastomas and nephroblastomas. This may be essential for choosing the optimal treatment volume and establishing a prognosis and resistance to chemotherapy in patients with these tumors.
Zinc finger E-box-binding homeobox 1 (ZEB1): A novel predictor for the prognosis in gastrointestinal tumors.
Authors: Shenglan Yang, Jiang Min
Journal: Journal of Clinical Oncology (2020)

e23515 Background: The gastrointestinal stromal tumors (GISTs) are the most common soft tissue sarcoma arising anywhere along gastrointestinal tract. The advanced and metastatic GISTs are the leading cause in GISTs inducing death. GISTs are the most commonly resulted from KIT or PDGFRA activation mutation. Currently adjuvant therapy with imatinib also targets the KIT and PDGFRA signals, which significantly increases the relapse-free survival and overall survival. However, KIT and PDGFRA mutation are not completely responsible for the progression of disease, especially metastasis of GISTs. So, there could be other molecular mechanism in GISTs progression. ZEB1 (zinc finger E-box-binding homeobox 1), as a member in zinc finger and homeodomain transcriptional factor family, plays a key role in metastasis of some epithelial carcinomas, such as colorectal cancer, breast cancer and NSCLC. We present that ZEB1, as a vital molecular in epithelial-mesenchymal transition, could be a promising marker in predicting the prognosis in GISTs. Methods: Immunohistochemistry staining for paraffin-embedding slices from 157 patients firstly diagnosed as GIST is applied for detecting the ZEB1 expression. Clinical, pathological, molecular and survival time were analyzed. All performances were approved by the Medical Ethics Committee in the First Affiliated Hospital of Chongqing Medical University. Results: In 157 patients, metastasis was found in 87 patients. In 87 patients with metastasis, high expression of ZEB1 almost exhibited (80 high/96 VS 7 non or low/96), while non or low expression was frequently detected in patients without metastasis (50 non or low/70 VS 20 high/70) (p &lt; 0.0001). There was no significant difference between high and non/low expression patients in gender (48% VS 46% for male rate; 52% VS 54% for female rate), age (53 vs 54 years for median age), primary location (esophagus 2% VS 1.8%; stomach 57% VS 52.6%; duodenum and small intestine 31% VS 31.6%; colorectum and anus 10% VS 14.0%), tumor size (0.5-24cm, median 9.7cm VS 1-25.5cm, median 10.1cm), mitotic index (55.0% VS 58.6% for &gt; 5/50HPF; 45.0% VS 41.4% for ≤5/50HPF), and risk stratification (low/intermediate risk 60.7% VS 63%; high risk 39.3% VS 37%). In addition, the 5-year OS rate was considerably lower in patients with ZEB1 high expression than those with ZEB1 none or low expression at baseline (37% vs 86%; p = 0.011). Conclusions: High expression of ZEB1 facilitates metastasis and indicates the poor prognosis in GISTs. ZEB1 could be a novel predictor for GIST’s prognosis.
慢性肩关节疼痛的诊断与治疗
Authors: 姜春岩, 李奉龙
Journal: BMJ (2011)

肩关节疼痛是骨科的常见疾病,由于其病因复杂和诊断模糊,以及治疗效果差等原因,其诊治一直是骨科领域中的难点之一.通过近30年的发展,在北美地区以及其他发达国家都已形成了成熟的肩关节外科专业,其诊疗观念与治疗技术不断更新.近年来国内在肩关节疾病的治疗方面有了较大进步,但与国外先进水平相比,肩关节外科的专业化等方面还存在相当的差距,很多疾患的诊断含混不清,治疗欠规范.随着人民生活水平的不断提高,人口老龄化的发展,慢性肩关节疼痛的治疗也必将成为我国骨科医生面对的全新挑战.本文介绍几种导致肩关节疼痛的主要疾患的诊断与治疗。
Follow-up of graduates of general practice residency training working in community health service centers in Shanghai
Authors: Jian Wang, Zhigang Pan, Sunfang Jiang
Journal: BMJ (2015)

Telephone interview was conducted to follow up the 151 graduates of general practice residency training in Zhongshan Hospital who are working in community health service centers in Shanghai up to June 2014; the results were compared with those of 130 graduates in 2011. Based on investigation of 2014, 94 out of 151 graduates worked in downtown and 57 worked in suburbs of Shanghai, while in interview of 2011, 72 out of 130 in downtown and 58 in suburbs. Among 151 participants in 2014 interview 13 had senior professional title, 138(91.39%) had intermediate or primary professional titles, while 4 in 2011 interview had senior professional title, 126(96.92%) had intermediate or primary professional title. Among 151 participants in 2014 interview, 40(26.49%) were heads of GP teams and 45(29.80%) held administrative positions, while in 2011 interview 33(25.83%) were heads of GP teams and 30(23.08%) held administrative positions. 2014 interview showed that 211 first-author papers were published, 59 research projects were obtained with 4.34 million Yuan funds, 303 prizes was awarded in 151graduates, all of which were increased compared to those of 2011 group. The resign rates in 2011 and 2014 groups were 6.43%(9/140)and 10.06%(17/169), respectively; the job-moving rates in 2011 and 2014 groups were 5.00%(7/140)and 11.95%(19/159), respectively. The resign rate of 2011-2014 was 5.03%(8/159) and the job-moving rate of 2011-2014 was 11.95%(19/159).


Conclusion
The follow-up study shows that the graduates of general practice residency training of Zhongshan Hospital perform well in community health service centers in Shanghai.


Key words: 
Community health services; Interviews; General practitioners
Analytical validation of a tissue agnostic ctDNA MRD assay using tumor specific methylation and somatic variant profiles in early-stage CRC.
Authors: Carlo Artieri, Haley Axelrod, Arthur Baca, Jordan Burke, Darya Chudova, Mahmoud Dahdouli, Farsheed Ghadiri, Anna Hartwig, Yupeng He, Dustin Hite, Ariel Jaimovich, Marisa Juntilla, Jessica Kurata, Yu Kong, Tracy Nance, Saiyou Ohshima, Sweta Sharma, Oscar Westesson, AmirAli Talasaz
Journal: Journal of Clinical Oncology (2020)

e15549 Background: Liquid biopsy is a candidate for detection of minimal residual disease (MRD) in early colorectal cancer. Detection of circulating tumor (ct)DNA in early stage cancer is challenging given the low abundance of ctDNA molecules. We developed a tissue agnostic MRD Test to optimize sensitivity and specificity of ctDNA detection by integrating tumor-specific genomic mutation and DNA methylation signatures coupled to noise-reduction of non-tumor background cfDNA signals. Methods: This MRD Test was developed following CLIA, Nex-StoCT Working Group, and AMP/CAP guidance and validation principles. Using a single input plasma sample, data from somatic and epigenomic targeted capture panels are integrated to generate a final test result: ctDNA detected or ctDNA not detected. ctDNA detected is defined by the presence of mutation or epigenomic classifier inputs exceeding a defined threshold. Quality control (QC) measures were implemented in both process and final sequencing results. Analytical specificity, sensitivity, and accuracy were determined using 130 samples. Results: The MRD Test specificity was 95% (70/74) using colonoscopy screened negative samples.A retrospective review of the clinical histories of these false positive samples showed high risk clinical features such as smoking, family history of CRC, and sub-optimal bowel prep prior to the colonoscopy. Analytical sensitivity (LoD) was established by diluting late stage CRC samples at two clinically relevant cfDNA inputs at three dilutions (30ng or 10ng, ranging 0.1% to 0.75% tumor fraction). The 95% LoD was determined to be 0.3% for 10ng and &lt; 0.1% for 30ng, the lowest level tested for each input. Accuracy was determined by diluting advanced CRC samples to 0.5-0.75% MAF tested at 30ng or 10ng cfDNA with a detection result of 100% (38/38). Conclusions: We present a CLIA validated assay with performance characteristics sufficient to detect residual disease in Stage II/III CRC post-curative intent therapy. This assay is currently being used in multiple interventional clinical trials.
Clinical utility of comprehensive genomic pathway and integrated network analyses in personalized oncology.
Authors: Nikhil Shri Sahajpal, Ashis Mondal, Meenakshi Ahluwalia, Allan Njoroge Njau, Vamsi Kota, Nwogbo Okechukwu, Gretchen Purcell Jackson, David Brotman, Dilhan Weeraratne, Anand P. Jillella, Jane Snowdon, Ravindra Kolhe
Journal: Journal of Clinical Oncology (2020)

e14051 Background: Adoption of next-generation sequencing (NGS) technology in routine clinical practice has enabled the detection of genetic aberrations such as single nucleotide variants, copy number alterations, and gene fusions. Pathway and network analyses (PNA) are key components for evaluation of NGS data in a clinical setting to explain findings involving thousands of altered genes and proteins with a smaller and more interpretable set of altered processes. Though PNA have been applied to identify driver genes and pathways in cohort-based analyses, its application in precision oncology remains unexplored. We investigate the potential utility of the Watson for Genomics (WfG) pathway analyses tool in interpreting complex and multiple genomic alterations in individual cancers. Methods: DNA and RNA isolated from 70 patient tumors across 30 different cancer types were processed with Illumina’s TST170 NGS platform. WfG’s feature of pathway analyses was used to identify gene variants, signaling pathways, networks, and the drugs targeting these alterations based on evidence in the clinical literature and FDA drug databases. Results: Analyses defined 5 different pathway/network models: 1) downstream therapeutic targets, 2) synthetic lethality, 3) combinatorial downstream targets + synthetic lethality, 4) two or more pathways converging to downstream targets, and 5) complex profile analyses. The five PNA models are illustrated by the following unique cases. 1) A thyroid cancer case with HRAS variant and activated RAF1 downstream pathway showed MAPK1/3 were suggestive of relevant targets. 2) An acute myeloid leukemia case with BRCA1, BRCA2 and PTEN variants, targeting a common synthetic lethal partner PARP1 was ideal for therapy. 3) A penile carcinoma case with BRAF, CDKN2A and TP53 variants, targeting the BRAF downstream pathway in combination with either CDKN2A or TP53 were the likely choice for therapy. 4) A glioma case with activated PI3K and MEK downstream pathway, targeting a common downstream marker would block both pathways. 5) A breast carcinoma case with a complex pathogenic variant profile provided relevant clinical information and levels of evidence for multiple drug targets. Conclusions: We discovered that the integrated WfG pathway analyses tool is ideal for visualization of the variants with levels of evidence from clinical literature and FDA drug databases that can help inform treatment options and provides a holistic understanding of a specific tumor profile allowing the treating clinician to select personalized targeted therapy.
A retrospective evaluation of PD-L1 expression on primary non-small cell lung cancer (NSCLC) samples and associated involved hilar or mediastinal lymph nodes (N1 or N2) (REPLICA).
Authors: Eleni Karapanagiotou, Andrea Bille, Philippe Taniere, Clare Flash, Abdel Douiri, Elizabeth Willis, Srivani Kandasamy, Domenico Curinga, Shriram Velamuri, Daisuke Nonaka
Journal: Journal of Clinical Oncology (2020)

9044 Background: Little is known about the PD-L1 expression in early stage NSCLC as well as the possible heterogeneity of PD-L1 expression in different sites. This study provides information on both PD-L1 expression in stage II and III NSCLC and the relationship between PD-L1 expression in the primary site (lung) and metastatic lymph nodes (LNs) N1 and/or N2. Methods: Samples (primary tumor and N1/N2) from 500 patients who underwent lung resection and lymphadenectomy for NSCLC without prior treatments were collected and analyzed for PD-L1 expression using the 22C3 pharmdx Agilent assay. The tumor proportion score (TPS) is documented for each sample according to the following categories: PD-L1: &lt; 1%, 1-49%, ≥ 50%. PD-L1 stained slides were reviewed by two pathologists independently; for discrepant cases the two pathologists reviewed the stains jointly and the consensus score used for the data analysis. Agreement between the two pathologists was assessed by overall agreement and kappa statistic. The association between PD-L1 expression in the primary tumor and lymph node was assessed by cross-tabulation. Results: A total of 456 tumors and involved LNs were included in the analysis. Pathologist one assessed 435 primary tumor and LN pairs and pathologist 2 assessed 453 tumor and LNs pairs. The overall agreement between pathologists on PD-L1 expression in primary tumor samples was 77%; K = 0.59 (95% CI 0.57 – 0.63) and in LNs 83%; k = 0.62 (95% CI 0.56 – 0.70). Primary tumors showed PD-L1 &lt; 1% in 235/422 (55,6%), PD-L1 1-49% in 146/422 (34,6%) and PD-L1 &gt; = 50% in 41/422 (9.8%). 77% (327/422) showed no heterogeneity in PD-L1 expression between the primary tumor and involved LNs. In tumors with PD-L1 &lt; 1% expression, 94% of the LNs showed PD-L1 &lt; 1% expression and less than 1% showed PD-L1 &gt; = 50%, 6% of the LNs showed PD-L1 1-49%. When the primary tumor was PD-L1 &gt; = 50% nearly half (46%) of the involved LNs showed the same degree of PD-L1 positivity and 10% of them showed PD-L1 &lt; 1%; 44% of the LNs showed PD-L1 1-49%. When the primary tumor showed 1-49% PD-L1 staining, 60% of the LNs showed the same staining pattern, 36% showed PD-L1 &lt; 1% and only 4% showed PD-L1 &gt; = 50% expression. Conclusions: In stage II and III NSCLC, half of the primary tumors show negative PD-L1 expression. Discrepant PD-L1 expression between primary tumors and LN metastases was seen in 23% of the cases, and when present, PD-L1 expression in LN tumors tended to be lower than that in primary tumors.
Comparison of four methods of fixation for intertrochanteric fractures in elderly patients
Authors: A-wei Hu, Ai-xi Yu, Cheng-yan Xia
Journal: BMJ (2013)

Objective
To compare the internal fixation methods for treatment of intertrochanteric fractures in elderly patients.


Methods
One hundred and sixty four elderly patients with intertrochanteric fractures were treated from June 2006 to September 2011. The fractures were fixed with dynamic hip screws (DHS, n=42), locking proximal femur plate (LPFP, n=40), Gamma nails (n=36) or proximal femoral nail anti-rotation (PFNA, n=46), respectively. The clinical data were collected and the operative time, blood loss, time of clinical healing, postoperative complications and Harris hip scores of 6 months after surgery were compared among groups.


Results
All patients were followed-up for 6 to 36 months. The operative times of DHS, LPFP, Gamma nails and PFNA groups were (103±15), (90±13), (79±11) and (65±9) min, respectively (F=2.87, P<0.05). The blood loss of 4 groups was (202±23), (181±23), (98±13) and (87±11) ml, respectively (F=3.21, P<0.05). The times of clinical fracture healing were (16.1±1.9), (14.6±1.8), (12.9±1.7) and (11.5±1.4) weeks, respectively (F=2.66, P<0.05). The postoperative complications of 4 groups were 4/42, 3/40, 2/36 and 1/46, respectively (χ2=5.67, P<0.05). The Harris hip scores of 6 months after surgery of 4 groups were 81%(34/42), 85%(34/40), 89%(32/36) and 93%(43/46), respectively (H=20.03, P<0.05).


Conclusions
In treatment for intertrochanteric fractures in elderly patients, the efficacy of intramedullary fixation (Gamma nails and PFNA) is better than extramedullary fixation (DHS and LPFP). PFNA is more effective than other 3 methods and should be preferentially chosen.


Key words: 
Femoral fractures, intertrochanteric; Fracture fixation, internal; Internal fixators; Comparative study
Efficacy of dirithromycin and clarithromycin in treatment chronic sinusitis
Authors: Jing Jin, Jun Li, Lin-feng Ye, Xiang-lei Wu
Journal: BMJ (2011)

Fifty four patients with chronic sinusitis (without nasal polyps) were randomly divided into two groups. Thirty patients in experimental group were treated with dirithromycin and 24 patients in control group were treated with clarithromycin. The doses was both 250 mg q. d. and the duration of treatment was 3to 6 months. The VAS scores of subjective symptoms (nasal obstruction, purulent nasal discharge,headache, smell worse ) and Lund-Mackay scores of objective signs (sinus CT ) in both groups were improved significantly compared with the baseline(P ＜0.05), and there were no statistical significances between two groups ( P ＞ 0. 05 ). The curative effect was positively correlated with the duration of treatment.The total effective rates were 73% and 67% and adverse reaction rates 7% and 21% in two groups,respectively (P ＞ 0. 05 ); but the adverse reactions in control group were more serious than those in experimental group. During the six-month follow-up, no recurrence and aggravation were observed. The results suggest that low-dose dirithromycin may be more suitable for long-term treatment of chronic sinusitis.

Key words: 
Sinusitis;  Anti-bacterial agents
Management of cancer pain in community of Huanggu District of Shenyang City
Authors: Xia Li, Yi-ni He, Ping Shi
Journal: BMJ (2012)

The status of anesthesia and psychotropic substances use for cancer pain control was analyzed in 355 cancer patients in Huanggu District of Shenyang City.The results revealed that patients aged 60 and above accounted for 62.8％ of the total; the 5 leading diseases were lung cancer ( 132 cases,37.2％ ),colorectal cancer (34 cases,9.6％ ),liver cancer (33 cases,9.3％ ),stomach cancer ( 31cases,8.7％ ) and pancreatic cancer (20 cases,5.6％ ).There was no significant difference in constituent ratio of disease categories in the last 4 years ( x2 =18.75,P ＞ 0.05 ).The daily oral dose of morphine sulphate was 60 - 200 mg with an effective rate of 91.5％ (325/355). The side effects including constipation,nausea,vomiting and itching can be effectively reduced by prophylactic medication.

Key words: 
Community health services;  Pain,drug therapy