tbuckley/cabot-search huggingface dataset:
Leveraging clinical pathways to identify patient-reported clinical trial enrollment barriers.
Authors: Mishellene McKinney, Nessa Stefaniak, Cynthia Samborski, Monica L. Murphy, Stephen B. Edge, Kristopher Attwood, Lu Liu, Katherine Eakle, Stephen Lash, Wei Yu
Journal: Journal of Clinical Oncology (2020)

e14086 Background: Only about 3% of adult cancer treatment is within a clinical trial (CT). Patient personal factors may impact willingness to participate. We leveraged CTs embedded in Clinical Oncology Pathways (COP) to examine patient barriers to CT participation. Methods: A COP program used in an academic cancer center embeds CTs that are open for accrual at the center. Providers must either select the CT to alert the research team for patient screening for the CT or provide a reason for bypassing the CT before the COP presents standard care options. This study includes patients with solid tumors receiving systemic therapy for whom a CT is presented in the COP and the provider documented that the patient was “not interested in this trial”. Prior to being offered the survey, these patients were asked if they had been interested in participating in a CT and were considered ineligible for the survey if they said “yes”. The survey was comprised of 29 Likert, demographic, multiple choice and open-ended questions. We categorized patients’ reasons for declining to enroll in a CT, and attitudes about CTs. Results: Among 1108 patients with CTs presented to the provider in COPs from May 2018 to June 2019 there were 164 identified by the provider as not interested in a CT. 23 were deceased, and 54 were not able to be contacted. 57 were otherwise ineligible. Of these, 33% did not recall being offered a CT. Of the 30 patients approached, 9 declined and 21 completed the survey (70% participation). Cancer types included gastrointestinal (33%), breast (19%), non-small cell (14%), pancreas (14%) and others (20%). 66% were female and 80% had metastatic cancer. Age ranged from 41 to 69 years (median 66). Race/ethnicity was Caucasian (81%), African American (10%), American Indian/Alaskan Native (5%) and non-specified (5%). When asked, “How do you view being asked to participate in cancer research, 76% saw it as “a positive thing”. Patient primary concerns were desire for more information on study outcomes (42%), concerns about additional appointments or tests (28%) and concerns about receiving a placebo (23%). Conclusions: There is a gap between patients’ positive views of clinical trials and their willingness to participate. This suggests that barriers identified are modifiable. Many who initially decline CTs may be open to joining a clinical trial with further education.Interventions such as the Meropol et al Preparatory Education About Clinical Trials (J Clin Oncol 2015:34:469) should be considered for broad implementation.
Prostate-specific antigen (PSA) kinetics in patients (pts) with advanced prostate cancer treated with apalutamide: Results from the TITAN and SPARTAN studies.
Authors: Kim N. Chi, Fred Saad, Simon Chowdhury, Julie N Graff, Neeraj Agarwal, Stephane Oudard, Gang Li, Angela Lopez-Gitlitz, Julie S. Larsen, Sharon Anne McCarthy, Suneel Mundle, Matthew Raymond Smith, Eric Jay Small
Journal: Journal of Clinical Oncology (2020)

5541 Background: The phase III TITAN and SPARTAN studies demonstrated improved outcomes with the addition of apalutamide (APA) to androgen deprivation therapy (ADT); outcomes included prolonging overall survival and radiographic progression-free survival (rPFS) in metastatic castration-sensitive prostate cancer (mCSPC) in TITAN, and metastasis-free survival (MFS) in nonmetastatic castration-resistant PC (nmCRPC) in SPARTAN. A post hoc analysis of PSA kinetics in pts from both studies is reported. Methods: Baseline PSA at randomization, time to PSA nadir, and proportion of pts achieving a PSA decline of ≥ 90% (PSA90) and of pts achieving a PSA ≤ 0.2 ng/mL at 3 and 12 months and at any time after treatment in the APA arms of the TITAN and SPARTAN studies were evaluated. Within each study, rPFS/MFS were compared between pts achieving a PSA90 or PSA ≤ 0.2 ng/mL response vs not. Results: 525 TITAN pts and 806 SPARTAN pts treated with APA were included in the analysis. Median baseline PSA, time to PSA nadir, median PSA nadir, and maximum percentage changes from baseline PSA are shown in the table. PSA90 and confirmed PSA ≤ 0.2 ng/mL were evident as early as 3 months in both TITAN and SPARTAN, and percentage of confirmed response continued to increase at 12 months. Pts treated with APA who achieved PSA90 were at lower risk of rPFS events in TITAN and of MFS events in SPARTAN, with a hazard ratio (95% confidence interval) of 0.46 (0.321-0.653) and 0.36 (0.271-0.489) in each respective study (both p &lt; 0.0001), compared with APA pts who did not achieve PSA90. Pts with confirmed PSA ≤ 0.2 ng/mL had similar rPFS and MFS benefits. Conclusions: Pts with advanced PC, whether mCSPC or nmCRPC, treated with APA + ADT demonstrated rapid PSA declines that continued over time. There was a high rate of pts with PSA90 and with PSA ≤ 0.2 ng/mL responses, with a majority of pts reaching PSA90 by 12 months. Pts achieving PSA90 and/or PSA nadir of ≤ 0.2 ng/mL had a prolonged rPFS and MFS in TITAN and SPARTAN, respectively. Clinical trial information: NCT02489318; NCT01946204 . [Table: see text]
Effectiveness of PD1-inhibitors in advanced Merkel cell carcinoma: Real life data in a Swedish cohort.
Authors: Hannah Bjorn-Andtback, Giuseppe V. Masucci, Lisa Elena Esther Villabona
Journal: Journal of Clinical Oncology (2020)

e22063 Background: Merkel Cell Carcinoma (MCC) is a highly aggressive neuroendocrine skin cancer that affects the elderly. Most cases are associated with the Merkel cell polyomavirus. It has previously been shown in clinical trials that MCC respond to immunotherapy with PD1 and PDL1-inhibition. PD1-inhibitiors have been used to treat MCC at Karolinska University Hospital in Sweden since 2016. The aim of this study is to describe the PD1-MCC-cohort at Karolinska. Methods: Patients with inoperable MCC that were treated with PD1-inhibitor at the oncology dept between August 2016 and February 2020 at Karolinska were included in the study, and response data was assessed retrospectively. Response was assessed clinically and through CT-scans. Results: Among 12 treated pts, median age was 75 yrs, 8 male and 4 female, 10 were treatment naive, 2 with prior chemotherapy. 10 pts received pembrolizumab and 2 pts nivolumab. No pts discontinued treatment due to side-effects. Comorbidities seen in the cohort were amongst others Atrial fibrillation (4 pts), Systemic Lupus Erythematosus (1), Hypertension (6), COPD (1), Aortic stenosis (2) and congestive heart failure (1). Follow-up time was median 10 months (range 2-43). First evaluation varied between 2-4 months with the majority at ~3 months. At first evaluation ORR was 75% and PFS and OS was 75% and 100% respectively. At 10 months, PFS and OS rates were 58% and 67% respectively. At study end mean PFS was 15,4 months and mean OS 17,8 months. 6 pts (50%) were still in response. Conclusions: PD1-inhibitors in clinical use in this cohort induced rapid and durable tumor responses in patients with advanced MCC, and the treatment was well tolerated. Our conclusion is that a PD1-inhibitor is a feasible and effective treatment for advanced Merkel Cell Carcinoma in the clinical setting.
Mini-puncture hematoma scavenging technique, traditional craniotomy operation, or medicine expectant treatment for patients with hypertensive intracerebral hemorrhage
Authors: Hou-guang Zhou, Oiang Dong, Ling Liu
Journal: BMJ (2008)

Two hundred and five patients with hypertensive intracerehral hemorrhage (HICH) received mini-puncture hematoma scavenging technique (MPST; n=80), traditional craniotomy operation (TCO; n=78), or medicine expectant treatment (MET; n=47), respectively. Clinical data demostrated that consciousness level and Glasgow Coma Scale (GCS) was more obviously improved in the MPST group,while postoperative complication rate was relatively lower. The MPST group and TCO group saw no significant difference in over-all matality, although both were significantly lower than the MET group. Severe disability rate in the MPST group was significantly decreased. In comparison with the TCO or MET group, 1 to 3 class activity of daily life score, language function recovery and response rate in the MPST group significantly improved (all P<0.05). We suggest that because of lower severe disability rate, less postoperative complications, and improved quality of life, MPST should be a better treatment of choice for HICH patients.

Key words: 
Intracranial hemorrhage,hypertensive;  Punctures
Implementation of systematic germline genetic testing (GT) for metastatic prostate cancer (mPC) patients at the Puget Sound VA prostate oncology clinic.
Authors: Alexandra Sokolova, Akemi N. Miyamoto, Darren L. Pouv, Heather H. Cheng, Robert B. Montgomery
Journal: Journal of Clinical Oncology (2020)

1578 Background: There is increasing clinical relevance for GT in patients with mPC to evaluate the 2-fold possibilities of molecularly targeted therapies and implications for relatives. NCCN guidelines recommend GT for subsets of men, including those with mPC. While exciting, there are new logistical challenges around workflows for delivering GT services. We sought to address these challenges through a prospective pilot study designed to systematically deliver GT to all men with mPC receiving care at the Puget Sound VA prostate cancer (PUG-VA PC) Clinic. Our hypothesis was that systematic universal GT for men with mPC would identify similar prevalence rates of germline pathogenic/likely pathogenic variants (P/LPV) among veterans compared to previously reported cohorts. Methods: We conducted an IRB-approved, prospective trial testing feasibility of a systematic workflow to identify all veterans with mPC seen at PUG-VA PC Clinic between 11/2016-1/2020 to discuss and offer GT. A research coordinator pre-screened each clinic schedule to identify patients with mPC, notified the oncologist to discuss pretest education and GT with the patient at the appointment. Consenting patients provided a saliva sample same day in clinic for the CLIA-certified Color Genomics 30-gene cancer gene panel. Results were issued to patients and providers, and results were discussed by email and phone with a genetic counselor. Uptake of GT and prevalence of P/LPV was measured and compared to previously reported data from the retrospectively tested UW TAN cohort. χ 2 -test was performed. Results: 84% (190/227) of approached veterans with mPC consented and 80% (182/227) completed GT. 6.6% (12/182) of men were found to carry P/LPV in DNA repair genes: 3 in BRCA2, 2 in BRCA1, 4 in ATM, and 3 in CHEK2. Overall, 6.6% rate of P/LPV in DNA repair genes was comparable to the 8.8% previously reported in the UW TAN cohort (p = 0.69). Conclusions: Dedicated clinic-based strategies to offer and provide GT and services for veterans with mPC is feasible and results in high GT consent and uptake, especially with direct oncologist involvement. Proportion of consenting to proceed with GT was nearly identical to a referral-based specialty Prostate Cancer Genetics Clinic (Pouv, Sokolova, and Cheng, unpublished). The proportion of P/LPV in the PUG-VA PC population was comparable to a geographically similar retrospective cohort. Updated data, including detailed demographics and GT results, will be reported at final presentation.
Recurrence after surgery for concurrent metastatic colorectal cancer: The perspective of bioinformatics and machine learning.
Authors: Zhiwen Luo, Xinyu Bi
Journal: Journal of Clinical Oncology (2020)

4043 Background: Recurrence of concurrent metastatic colorectal cancers (mCRCs) after surgery is still a challenge. But mCRCs’ outcomes are heterogeneous, and no clinicopathological methods can predict its recurrence and guide postoperative treatment from an intrinsic cell activities and extrinsic immune microenvironment perspective. We aimed to identify such gene models. Methods: Gene expression analysis on CRCs. Based on metastasis-related genes, a metastatic evaluation model (MEM) was developed, dividing mCRCs into high and low recurrence risk clusters. Machine learning tested MEM’s importance to predict recurrence. Further investigating MEM’s two clusters made an immune prognostic model (IPM) with immune genes differentially expressed between MEM clusters. The predictive performance of MEM and IPM on prognosis was comprehensively analyzed and validated. The mechanism of IPM on the immune microenvironment and response to immuno/chemotherapy was analyzed extensively. Results: RNA data of 998 CRCs were analyzed. High postoperative recurrence risk in mCRCs was owing to immune response’s down-regulation, which was influenced by 3 MEM genes ( BAMBI, F13A1, LCN2) and their related 3 IPM genes ( SLIT2, CDKN2A, CLU). MEM and IPM were developed and validated on 239 mCRCs to differentiate a low and high recurrence risk (AUCs &gt; 0.7). Functional enrichment analysis showed immune response and immune system diseases pathway represented the major function and pathway related to IPM gene. IPM high-risk group (IPM-high) had higher fractions of Tregs ( P= 0.04), lower fractions of resisting memory CD4+ T cells ( P= 0.02) than IPM-low. And stroma and immune cells in IPM-high samples were scant ( P= 0.0002, 0.001, respectively). In IPM-high, MHC class II molecules all down-expressed, and DNA methylation disordered. TIDE algorithm and GDSC analysis discovered IPM-low was more promising to respond to both anti-CTLA4 therapy ( P= 0.005) and common FDA targeted drugs ( P&lt; 0.05), while IPM-high had nonresponse to both of them. But anti-CDKN2A agent with activation of MHC class II response might reverse the dilemma of this refractory mCRCs subgroup. Conclusions: Postoperative recurrence of mCRC is strongly related to immune microenvironment. Our two relative gene models could identify subgroups of mCRC with different recurrence risk, and stratify mCRCs sensitive to immune/chemotherapy, even highlight the ignored importance of MHC class II molecules on immunotherapy in mCRCs for the first time.
Evidence-based antihypertensive drug use: medication assessment and optimal choice
Authors: 胡大一
Journal: BMJ (2007)

随机对照临床试验(randomized clinical trial,RCT)是循证医学的基础,也是制定指南的重要依据,而指南又是我们临床实践的金标准.迄今为止,上百项大型高血压RCT的结果为高血压的干预提供了两方面的证据。
慢性下背痛的鉴别诊断
Authors: 刘湘源, 李胜光
Journal: BMJ (2006)

下背疼痛是指下部腰椎、腰骶区或骶髂区的疼痛.下背疼痛是我国最常见的健康问题之一,随着人们对风湿性疾病认识的提高,尤其是脊柱关节病知识的普及,因下背疼痛到风湿科就诊的人数与日俱增,但下背痛的病因很多,在想到脊柱关节病的同时,不应忽略能引起下背痛的许多其他疾病,以避免误诊误治。
Abstract 10908: Novel Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy Derived With Bayesian Additive Regression Trees: The Multi-Ethnic Study of Atherosclerosis
Authors: Rodney Sparapani, Noura Dabbouseh, David Gutterman, Jun Zhang, Haiying Chen, David Bluemke, Joao Lima, Gregory Burke, Elsayed Soliman
Journal: Circulation (2018)

Background: Current electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria have low sensitivity to detect LVH. We developed new ECG-LVH criteria with higher sensitivity than tradition...
Re-excision rates among older breast cancer patients undergoing breast-conserving surgery (BCS): Impact of the SSO-ASTRO consensus guideline on margins.
Authors: Mariana Chavez-MacGregor, Xiudong Lei, Nina Tamirisa, Abigail Suzanne Caudle, Sharon H. Giordano
Journal: Journal of Clinical Oncology (2020)

576 Background: BCS has been historically associated with a high re-excision rate, driven in part by the need of obtaining negative margins. The SSO-ASTRO consensus guideline on invasive margins, defined a negative margin as no ink on tumor. In this large population-based study of older breast cancer patients undergoing BCS for invasive breast cancer we evaluate the guideline impact on re-excision rates. Methods: Female patients diagnosed with stage I-II breast cancer between 2012-2015 were identified in the SEER-Medicare database. Patients were &gt;66 years and underwent BCS. Patients treated with neoadjuvant chemotherapy were excluded. We defined the following time periods: pre-guideline (January 2012-September 2013); peri-guideline (October 2013-March 2014) and post-guideline (April 2014-December 2016). Re-excision was defined as a resection, BCS or mastectomy identified using ICD-9 or CPT codes between 4 and 90 days after initial BCS. Overall re-excision rates and 95%CI were calculated and groups compared using X 2 test. Within subgroups we calculated re-excision rates for the pre and post-guideline periods and report the relative percent change. Regression model evaluated the association between time periods and re-excision while adjusting for important covariates, risk ratios (RRs) and 95%CI are presented. Results: 17001 patients were included. 6762 of them had BCS in the pre, 1786 in the peri, and 8453 in the post-guideline periods. Overall 22.6% of the patients had a re-excision. The rate decreased from 24.8% pre-guideline to 20.3% post-guideline (P &lt; 0.001). The relative change in re-excision varied according to region (Midwest 3-7.3%, Northeast -20%, West -16.5% and South -13.5%) Differences in the relative change according to race/ethnicity were also seen (Whites -19.2, Blacks -15.3% and Hispanics -9.9%). In the multivariable model, BCS in the post-guideline period was associated with a decreased risk of re-excision (RR = 0.83; 95%CI 0.79-0.88). Lobular histology was associated with a higher risk of re-excision (RR = 1.31; 95%CI 1.21-1.42); greater surgeon volume was associated with lower risk of re-excision (RR = 0.89; 95%CI 0.82-0.95). Conclusions: There has been a statistically significant decrease in the re-excision rate after BCS associated with the dissemination of the SSO-ASTRO consensus guideline on invasive margins. Our study confirms the impact that guidelines have modifying patterns or practice, reducing the frequency of unnecessary interventions.
Impact of socioeconomic disparities on upstaging for prostate cancer: A national cancer database analysis.
Authors: Sagar Patel, William Mills Worrilow, Sally Jeanne Trufan, Hamza Mustafa Beano, James T. Kearns, Stephen Boyd Riggs
Journal: Journal of Clinical Oncology (2020)

e17526 Background: Recent data suggest that socioeconomic disparities impact the outcome of oncologic disease. This retrospective analysis investigates the role of socioeconomic variables on clinical to pathologic staging of prostate cancer (PC). Methods: 455,773 males with stage 1-3 adenocarcinoma of prostate who underwent surgical intervention (96% radical prostatectomy) were extracted from the National Cancer Database from 2004-2016. Patients were stratified into age groups based on American Urologic Association PSA screening recommendations ( &lt; 40, 40-54, 55-69, &gt; 70 years). Changes from clinical to pathological staging were the primary outcomes. Demographics, income level, education status and distance to treatment facility ( &lt; 12.5, 12.5-49.9, &gt; 50 miles) were analyzed using Chi-square and logistic regression to find upstaging predictors. Results: Rates of stage changes are summarized in Table. Increased distance ( &gt; 50 vs &lt; 12.5 mi) was associated with upstaging in all age groups (40-54: OR 1.10 95%CI 1.05-1.16; 55-69: OR 1.20 95%CI 1.18-1.23; &gt; 70: OR 1.42 95%CI 1.35-1.50) except for &lt; 40 years (OR 1.15, 95%CI 0.60-2.21). Other predictors of upstaging included black or other race compared to white (OR 1.06 95%CI 1.04-1.09 and OR 1.10 95% CI 1.06-1.14, respectively) and in men with government insurance vs private insurance (OR 1.19 95%CI 1.17-1.21). Lower risk of upstaging was seen for those who were not insured vs private insurance (OR 0.70 95%CI 0.67-0.73), lived in areas with the highest vs lowest high school education rate (OR 0.95, 95%CI 0.92-0.98), or lived in the lowest vs highest income areas (OR 0.93, 95%CI 0.90-0.96). Conclusions: Socioeconomic disparities directly impact the outcome for prostate cancer. Our study suggests age, distance from treatment facility, and race are associated with a greater risk for clinical to pathologic upstaging. Investigation should continue to better understand at-risk populations. [Table: see text]
Survey on inappropriate feeding behavior in parents of infant and toddlers
Authors: Chunhua Jin, Xiaoyan Wang, Yue Zhang, Mei Li, Ruihua Yang
Journal: BMJ (2014)

An investigation of inappropriate feeding behavior and its impact was conducted in patents of 875 infants and toddlers aged 1-24 months from March 2004 to February 2008. The survey revealed that inappropriate feeding behavior included feeding sugar solution or sweet fruits daily in 72.1% parents (631/875); adding yolk as the first supplementary food in 51.3% (394/768); not allowing hand-grabbing food or coarse food for infants over 7 months in 50.4% (270/536) and 44.0% (236/536); no meat eating for infants over 12 months in 36.0% (54/150). And also revealed that 34.0% (270/795) and 24.8% (184/743) parents mixed rice flour or yolk with formula milk, respectively; 17.6% (48/273) infant over 10 months only had cereal; insufficient or excessive water were used for reconstituting milk powder in 11.8% (87/735) and 9.3% (68/735), respectively. The results of investigation indicate that inappropriate feeding behavior among infants and toddlers are quite common and the reasons are various.


Key words: 
Infant; Feeding behavior
激光联合高位结扎治疗下肢浅静脉曲张378例
Authors: 谢友利, 张子龙, 谭最
Journal: BMJ (2007)

下肢浅静脉曲张是常见病、多发病,临床表现为下肢浅静脉扩张、伸长、迂曲.早期患者患肢酸胀、沉重、易乏,晚期出现皮肤萎缩、脱屑、色素沉着、皮下硬结,甚至湿疹、溃疡,有时并发出血及血栓性静脉炎.欧美等发达国家发病率达30%以上,张培华等[1]调查我国华东地区15岁以上人群中发病率为8.6%,且发病率随年龄增而升高,严重影响人民生活质量.长期以来,血管外科不断探索试图寻找一种最佳治疗方案。
Gabapentin in treatment for pruritus and insomnia among patients with hemodialysis
Authors: Xiao-hui Dong, Xi-feng L, Hui-juan Ma
Journal: BMJ (2011)

This paper aimed to study clinical effectiveness of gabapentin in the treatment for pruritus and insomnia among patients with hemodialysis. Eighty patients with severe pruritus and insomnia during regular hemedialysis in Jiaozhou People's Hospital, Jiangsu were randomly divided into two groups with 40 patients each. Gahapentin 0. 1 g were given each patient every night for 4 weeks in one group and a modified-re]ease capsule of 8 mg chiorphenamine maleate was given each patient daffy for 4 weeks in the other group. Effectiveness of treatment was evaluated by improvement of itching symptoms and Pittsburgh Sleep Quality Index (PSQI) scores for insomnia in the patients. Itching improvement was observed in 85%(34/40) of the patients and PSQI scores obviously lowered in them four weeks after gabapentin treatment.However, itching improvement was observed only in 42% ( 17/40 ) of the patients and little change was observed in PSQI scores in them four weeks after chlorphenamine treatment It suggests that gabapentin can significantly improve quality of sleeping and itching symptoms in patients with hemodialysis and it is worthy popularizing in those with it.

Key words: 
Histamine H1 antagonists ;  Pruritus