tbuckley/cabot-search huggingface dataset:
Analysis of hospice duration and metrics in cancer patients in rural Appalachia.
Authors: Sukesh Manthri, Alay Mansurov, Bill Brooks, Sakshi Singal, Devapiran Jaishankar
Journal: Journal of Clinical Oncology (2020)

e24006 Background: Several factors influence the duration of hospice care/average length of stay (ALOS) for cancer patients choosing hospice, including patient and family acceptance of hospice, availability of services, demographics, provider preferences, advances in treatment options, and type of cancer. Cancer diagnoses account for 30.1 % of Medicare hospice beneficiaries. Based on the national hospice and palliative care organization (NHPCO) summary released in 2019 the median length of stay on hospice for cancer patients is 19 days. The purpose of this study is to analyze the length of stay on hospice, and other metrics in a rural Appalachian community given the paucity of published data. Methods: A retrospective chart review (IRB approved) of all adult patients enrolled in three different hospice agencies (total 106) over two years (2016 and 2017) in a rural community in Southern Appalachia. We looked at the interval from metastatic diagnosis to hospice admission, interval from last oncological treatment to hospice admission and length of stay on hospice. Results: Medianinterval from metastatic diagnosis to hospice admission was 143 days (range 6-2948 days). The median interval from the last oncological treatment to hospice admission was 35 days (interquartile range 15-83 days). The median length of stay on hospice was 24 days (interquartile range 7.5 to 52.5 days). ALOS for patients with prostate, colorectal, breast and lung cancer were 77.33, 103.8 (skewed by a single patient-741 days, minus outlier-33 days), 38.9, 31.70 days, respectively. Conclusions: Few studies in the past have focused on the length of stay on hospice and even fewer have analyzed metrics as noted in our study. The median duration of hospice care in this community (24 days) was modestly better than the national data (19 days). This study provides unique data on median interval from the last treatment to hospice admission (35 days) is longer than the time on hospice (24 days). We infer socio cultural barriers to hospice acceptance in the Appalachian community and a need for education. It may be invaluable to assess if similar barriers to acceptance of hospice are a factor in other communities and would be worthy of further study and research.
What does expert opinion in guidelines mean? a meta-epidemiological study
Authors: Ponce Oscar J, Alvarez-Villalobos Neri, Shah Raj, Mohammed Khaled, Morgan Rebecca L, Sultan Shahnaz, Falck-Ytter Yngve, Prokop Larry J, Dahm Philipp, Mustafa Reem A, Murad Mohammad H, 杨楠, 周奇, 张静怡, 陈耀龙, 杨克虎
Journal: BMJ (2018)

指南常会使用术语专家意见（Expert Opinion，EO）来支撑推荐意见，本研究旨在探究EO型推荐意见的来源和证据类型。我们检索了不同数据库和网站近10年发表的含有EO型推荐意见的指南。共命中1 106篇文献，纳入69篇指南（含2 390条推荐意见，其中907条为EO型推荐意见），大多数EO型推荐意见（91%）未说明采用EO的理由，EO型推荐意见最常引用的证据大都是不足以回答指南问题的研究（40%为随机对照试验，38%为观察性研究，2%为病例报告或病例系列）。2.5%的EO型推荐意见引用的证据中所纳入的人群与指南的目标人群不同。经判断，5.6%的EO型推荐意见可以用良好实践主张（good practice statements）这一术语来表达。没有任何EO型推荐意见被明确描述为基于指南专家组的临床经验。指南中仍普遍将EO作为一种证据级别，但大部分并未给出明确理由。多数情况下，来源于EO的证据都存在间接性，也有一小部分来自于病例系列的极低质量证据。我们认为，对证据的类型应进行明确描述，而非仅仅将其泛称为EO，不仅可增加推荐意见的清晰性和透明性，还可促进对推荐意见的实施。
Tongue with cardiac myeloid sarcoma: a case report and literature review
Authors: Yuanyuan Sun, Yipa Sai
Journal: BMJ (2018)

报道1例发生于舌部及心脏的髓系肉瘤(MS)患者，对MS的治疗及预后进行文献复习。显示发生于舌部及心脏的MS很罕见，联合化疗应为首选治疗，预后不佳，心脏MS预后极差，多因心包填塞、心力衰竭猝死。
Abstract P236: Association Between Alcohol and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis
Authors: Oluseye Ogunmoroti, Olatokunbo Osibogun, Robyn L McClelland, Erin D Michos, Gregory L Burke, Khurram Nasir
Journal: Circulation (2018)

Introduction: Alcohol intake is associated with cardiovascular disease (CVD), with moderate drinkers having a decreased CVD risk compared to non- and heavy drinkers. However, this association is yet to be examined using the AHA Life’s Simple 7 (LS7) metrics as a proxy for cardiovascular health (CVH). We explored associations between alcohol intake and CVH in a multi-ethnic population. Methods: Our cross-sectional analyses included 6,506 MESA participants, free of CVD, aged 45 to 84 years. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) were each scored 0-2, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. Total LS7 score ranged from 0-14. Alcohol data was obtained from personal history and food frequency questionnaires. Participants were classified as never, former or current drinkers. Current drinkers were categorized as &lt;1 (light), 1-2 (moderate) and &gt;2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol intake and CVH, adjusted for age, sex, race/ethnicity, education, income and health insurance. Results: Mean (SD) age was 62 (10) years, 53% were women; 20% were never, 24% former and 56% current drinkers. Among current drinkers, 44% had &lt;1, 9% 1-2 and 3% &gt;2 drinks/day. Additionally, 47% had inadequate LS7 scores, 33% average and 20% optimal. Compared to never drinkers, those who drank &lt;1 drink/day were more likely to have average and optimal scores, although most of the associations were not significant. Women with 1-2 drinks/day were more likely than men to have optimal scores. Overall and in men, those who drank &gt;2 drinks/day were less likely to have average or optimal scores. Whites and Hispanics with &gt;2 drinks/day were less likely to have optimal and average scores, respectively (Table). Conclusion: Light alcohol intake tended to show favorable CVH, whereas heavy alcohol intake was unfavorable. For moderate alcohol intake, the associations with CVH varied by sex and race/ethnicity.
Blindness from age-related macular degeneration in Changning District of Shanghai from 2003 to 2008
Authors: Ke Zhou
Journal: BMJ (2010)

Total 1049 new cases of blindness were detected by visual acuity survey in a population aged 68 or above in Changning District of Shanghai from 2003 to 2008. Among all eases 21.5% were age-related macular degeneration (AMD) blindness, with a trend of ascending from 17.7% in 2003 to 29. 9% in 2008. Most of the cases were classified as grade 3 (56. 9% ) or grade 4 (41.3%) of blindness. AMD has become one of the leading causes of blindness at present and should be the key eye disease for prevention of blindness.

Key words: 
Macular degeneration;  Blindness
High-risk breast cancer genes at 8q22-24 and their role in over 5,000 patients evaluated with the 70-gene risk of recurrence assay.
Authors: Sami Diab, Matei P. Socoteanu, Carlos A. Encarnacion, Cynthia R. C. Osborne, Carolyn B. Hendricks, Kristi McIntyre, Vibha Taneja Thomas, Rajith Bhaskaran, Lorenza Mittempergher, Andrea Menicucci, William Audeh, Joyce O'Shaughnessy
Journal: Journal of Clinical Oncology (2020)

3569 Background: Previous studies have shown that CCNE2 expression is higher in patients’ cancers resistant to CDK4/6 inhibitors. Increased expression of CCNE2, MTDH, or TSPYL5, genes contained within the 70-gene risk of distant recurrence signature (70GS), has also been implicated in breast oncogenesis, poor prognosis, and chemoresistance. These genes are located on chromosome region 8q22.1, one of the most recurrently amplified regions out of all 70GS genes in breast tumors (Fatima et al. 2017). MYC, located on 8q24, is overexpressed in 40% of all breast cancers (BC). Here we examined the expression of CCNE2, MTDH, and TSPYL5 in relation to 70GS risk and the 80-gene molecular subtype signature (80GS), and their correlation with MYC expression in early stage BC patients. Methods: CCNE2, MTDH, TSPYL5, and MYC mRNA expression was measured in 5022 BC samples sent to Agendia (Irvine, CA) for 70GS and 80GS testing, which included FFPE microarray full-transcriptome data. 70GS was used to stratify patients into Ultra Low Risk (UL), Low Risk (LR), High Risk (HR), and Ultra High Risk (UH). Both 70GS and 80GS were used to classify patient samples into Luminal A, Luminal B, HER2, or Basal type. Wilcoxon rank sum test was used to assess expression differences. Results: The expression of CCNE2, MTDH, and TSPYL5 significantly correlated with each other and was higher in HR patients compared to LR patients (p &lt; 0.001) and higher in UH patients compared to HR patients (p &lt; 0.001). Expression of these genes was highest in Basal type tumors, 83% of which were UH, followed by Luminal B type tumors, and lowest in Luminal A type tumors. CCNE2 and MYC expression was elevated in LR compared to UL patients (p &lt; 0.001 and p = 0.0043). There was no difference in MYC expression between HR vs. LR or UH vs. HR. Lastly, there was no association between the expression of 8q22.1 genes and MYC in any 70GS subgroup. Conclusions: Within the 70GS, CCNE2, MTDH, and TSPYL5 have similar expression patterns and when overexpressed may identify an UH cohort of BC. This observation, in addition to their physical proximity at 8q22.1 suggests a possible amplicon in this region. The highest expression of CCNE2, MTDH, and TSPYL5 associated with UH patients and is concordant with previous studies that support the role of these genes in BC metastasis. Furthermore, this analysis suggests MYC may not stratify patients based on metastatic potential. These data may be clinically relevant for stratifying patients in ongoing clinical trials evaluating response and resistance to targeted therapies in early stage BC.
Video conferencing long distance caregivers during oncology appointments: Implications for clinical practice.
Authors: Eric Blackstone, Sumin Park, Smitha S. Krishnamurthi, David Lawrence Bajor, Polly Mazanec, Kim Day, Sara L Douglas
Journal: Journal of Clinical Oncology (2020)

e24198 Background: Distance Caregivers (DCGs) – caregivers living &gt; 1 hour away from the patient – face unique challenges regarding frustration at receiving second hand information about the patient’s condition and uncertainty regarding how to assist the patient. Videoconferencing allows DCGs to connect for the patient’s oncology appointments while avoiding costly travel expenses and time away from work and family. Methods: 441 patient-DCG dyads enrolled in a randomized controlled trial at a large, urban comprehensive cancer center. Patients of all cancer types were eligible if they had monthly oncologist appointments. DCGs were randomized to one of three arms. Arm 1 – received four monthly videoconference coaching sessions with a nurse or social worker, connected for the patient’s oncology appointments, and had access to a website designed for DCGs; Arm 2 – connected for the patient’s oncology appointments over four months and had access to the DCG website; Arm 3 – received access to the DCG website. To evaluate the impact on clinical practice, outpatient oncology appointments were timed. Helpfulness of the intervention was rated from 0-10 with higher scores representing greater amounts of helpfulness. Descriptive statistics, ANOVA, and Pearson’s correlation were conducted to describe features, determine group differences, and identify relationships among variables. Results: Mean helpfulness ratings were 9.06 (patients), 9.30 (local caregivers), 9.08 (DCGs), and 7.98 (oncologists). Average appointment times (in minutes) for Arm 1, Arm 2, and Arm 3 were 19.63 (SD = 7.69), 21.34 (SD = 9.95), and 17.80 (SD = 10.20), respectively. Arm 2 had significantly longer appointments than Arm 3 (mean difference: 3.54, p = .025). No relationships were found between length of appointment time and helpfulness ratings. Conclusions: The videoconferencing intervention was well-received by oncologists, patients, and DCGs. Appointments were longest in Arm 2, followed by Arm 1, then Arm 3 (control). It makes sense that connecting an additional person lengthened the meetings, but it was noteworthy that Arm 2 was longest. DCGs in Arm 2 (who did not have the coaching) likely had more unanswered questions that were discussed with the oncologist compared to Arm 1 DCGs. Cancer centers should consider this when implementing videoconferencing technology. Clinical trial information: NCT02666183 .
Giant tumors of the breast in adolescents and types of reconstruction during thelarche.
Authors: Peter Kern
Journal: Journal of Clinical Oncology (2020)

e12614 Background: Tumors like cystosarcoma phylloides may exhibit malignant potential and occur already in young adolescents in their thelarche. Adolescents often do not report the growth of a tumor in the breast due to lack of knowledge or shame. The necessity for surgical intervention interferes with the normal development of the breast, however must be performed due to the deformation of the growing breast and the malignant potential of cystosarcoma phylloides. Methods: We report on two young girls, 13 years of age, who presented with giant cystosarcoma phylloides and fibroadenomas, with tumor diameters of 9 and 13 cm in their thelarche with extension to whole volume of the breast. Results: Both tumors were removed via an axillary access to the breast to avoid scars in the developing breast and removed with free margins at first surgical intervention. Autologous reconstruction by lateral thoracic wall advancement mammaplasty in one patient and implant based reconstruction as a temporary spacer have been used for reconstruction. The young patients showed a high degree of satisfaction in validated Breast QoL questionnaires. Conclusions: Surgical intervention in giant cystosarcoma phyllodes of the breast in adolescents require careful planning of surgery and avoid unnecessary scars in the developing breast. Axillary approach for surgical removal of the tumor and replacement by thoracic wall advancement mammoplasty or temporary implant-based reconstruction may both be safely applied in thelarche.
A phase II trial of the DNA methyl transferase inhibitor, SGI-110 (Guadecitabine), in children and adults with SDH-deficient GIST, pheochromocytoma, and paraganglioma, and HLRCC-associated kidney cancer.
Authors: Mary Frances Wedekind, Jaydira Del Rivero, Fernanda Irene Arnaldez, Ramaprasad Srinivasan, Melissa Spencer, Seth M. Steinberg, Cody J. Peer, William Douglas Figg, Jonathan Keith Killian, Paul S. Meltzer, W. Marston Linehan, Brigitte C. Widemann, John Glod
Journal: Journal of Clinical Oncology (2020)

11540 Background: Loss of activity of the Krebs cycle component succinate dehydrogenase (SDH) complex is a mechanism of tumorigenesis in SDH-deficient cancers. Accumulation of the metabolite succinate inhibits α-ketoglutarate-dependent dioxygenases leading to DNA hypermethylation. Guadecitabine is a small molecule DNA methyltransferase inhibitor. We conducted a Phase II study to test the hypothesis that guadecitabine will impact tumor growth by reversing DNA hypermethylation in tumors with Krebs cycle abnormalities (NCT03165721). Study Objectives: Our primary objective was to assess the clinical activity of guadecitabine in patients with SDH-deficient GIST, PHEO/PGL, and HLRCC-associated renal cell carcinoma. Secondarily, we desired to evaluate the toxicities of patients on treatment with guadecitabine. Methods: We conducted a single site, open label, phase II study using a small optimal two-stage design to evaluate response in SDH-deficient GIST, PHEO/PGL, and HLRCC-associated renal cell carcinoma. Patients &gt;12 years of age received guadecitabine subcutaneously at 45mg/m 2 /day for 5 consecutive days on a 28-day cycle. Activity via imaging response was assessed utilizing RECISTv1.1. Toxicities were graded using version 4.0 of the NCI Common Toxicity Criteria. All patients were included in analysis. Results: We enrolled nine patients (6F:3M) with an age range of 18-57 years. Seven patients had SDH-deficient GIST (78%), one patient with paraganglioma (11%), and one with HLRCC-associated renal cell carcinoma (11%). No patients had a complete or partial response. Five patients came off study due to progression (56%) with one death due to disease progression in the patient with HLRCC-associated renal cell carcinoma (11%). Three patients (33%) withdrew due to lack of response with stable disease. One patient was withdrawn due to investigator’s discretion (11%). Toxicities possibly, probably, or definitely related to drug included grade 3 leukopenia (11%) febrile neutropenia (11%), grade 3-4 neutropenia (22%) requiring dose reductions, grade 3 hypertension (11%), grade 2 lung infection requiring hospitalization (11%). Conclusions: In this single site, open label, phase II study in patients with SDH-deficient GIST, PHEO/PGL, and HLRCC-associated renal cell cancer guadecitabine was tolerated by the majority of patients. No complete or partial responses were observed. Clinical trial information: NCT03165721 .
Overcoming difficult conversations: Training medical professionals to discuss mental health with cancer survivors.
Authors: Shelby Roberts, Marti Macchi, Samaha Hodges, Ron Goldman, John Patton
Journal: Journal of Clinical Oncology (2020)

e19155 Background: Cancer survivors have overcome a significant health challenge, and now face the physical, social and emotional effects of surviving cancer. These psychosocial side-effects are often not addressed in the clinic due to time constraints, false perceptions of reimbursement and discomfort toward the subject from both the patient and medial professional. The National Association of Chronic Disease Directors, along with the Centers for Disease Control and Prevention and Kognito Solutions have developed a series of conversation simulations led by virtual human, digital characters to help medical professionals practice these patient interactions. Methods: The simulation was developed after an extensive literature review and interviews with cancer survivors and 12 professionals in oncology and primary care. Scripts were developed that included hundreds of conversation pathways for providers to choose from. Scripts were tested by subject matter experts in clinical psychology, oncology and survivorship. Three video interviews with survivors were included along with a didactic teaching segment to provide instruction to medical professionals participating in the simulation. Results: The resulting learning experience is a self-guided conversation pathway where the medical professional chooses responses to the virtual cancer survivor’s questions guiding the survivor toward a discussion focused on distress. The simulation offers feedback and suggests conversational improvements throughout the process. The simulation is now complete and freely available online. Full rollout and dissemination including CME credits will begin in March. To date,197 distinct users have engaged in the simulation. Users self-reported the simulation was high quality and resulted in them listening more, asking more open-ended questions, and discussing mental health issues routinely with patients. Conclusions: This innovative approach to learning offers an interactive and highly engaging way to practice difficult discussions with patients. Increasing the quality and frequency of mental health screenings with cancer survivors will empower survivors and improve their adherence to other health behaviors reducing the risk of recurrence. Increased use of the simulation after the national rollout will allow a more robust evaluation of future impact on patient mental health and changes in medical practice.
Application value of serum pepsinogen test in health check-up
Authors: Rong-gen Huang, Chun-min Wang
Journal: BMJ (2012)

Time resolved fluoroimmunoassay (TRFIA) was used to detect the serum level of pepsinogen (PG).And the 13C urea breath test (13C-UBT) was employed to detect the Helicobacter pylori (HP) infection rate for 1060 subjects of health check-up.Statistics showed that the serum PGⅠ level of males was significantly higher than that of females.And the ratio of females with PG Ⅰ ＜ 60 μg/L and PG Ⅰ ＜ 60 μg/L + PG Ⅰ/PG Ⅱ ＜ 6 was significantly higher than that of males.The PG Ⅱ level increased with age while PG Ⅰ/PG Ⅱ decreased.The PG Ⅰ level rose gradually until age of 60 and then maintained at a high level.For the HP-positive group,the serum levels PG Ⅰ and PG Ⅱ were significantly higher than those of the HP-negative group.And the PG Ⅰ/PG Ⅱ ratio was significantly lower than that of the HP-negative group.

Key words: 
Pepsinogen; Healthy check-up
Abstract 12329: Decoding Platelet Regulation on CD4+ T Effector Cell Responses
Authors: Yanan Min, Natalie Jooss, Shuai Tan, Nailin Li
Journal: Circulation (2018)

Introduction: Ischemic heart disease is an atherothrombotic disease, to which both platelets and CD4+ T cells contribute importantly. We have shown that platelets shape CD4+ T effector responses vi...
The Relationship Between CGM-Derived Metrics, A1C, and Risk of Hypoglycemia in Older Adults With Type 1 Diabetes
Authors: Elena Toschi, Christine Slyne, Kayla Sifre, Rachel O’Donnell, Jordan Greenberg, Astrid Atakov-Castillo, Sam Carl, Medha Munshi
Journal: Diabetes Care (2020)

OBJECTIVE Continuous glucose monitoring (CGM) is now commonly used in the management of type 1 diabetes (T1D). The CGM-derived coefficient of variation (CV) measures glucose variability, and the glucose management indicator (GMI) measures mean glycemia (previously called estimated A1C). However, their relationship with laboratory-measured A1C and the risk of hypoglycemia in older adults with T1D is not well studied. RESEARCH DESIGN AND METHODS In a single-center study, older adults (age ≥65 years) with T1D wore a CGM device for 14 days. The CV (%) and GMI were calculated, and A1C and clinical and demographic information were collected. RESULTS We evaluated 130 older adults (age 71 ± 5 years), of whom 55% were women, 97% were White, diabetes duration was 39 ± 17 years, and A1C was 7.3 ± 0.6% (56 ± 15 mmol/mol). Participants were stratified by high CV (&amp;gt;36%; n = 77) and low CV (≤36%; n = 53). Although there was no difference in A1C levels between the groups with high and low CV (7.3% [56 mmol/mol] vs. 7.3% [53 mmol/mol], P = 0.4), the high CV group spent more time in hypoglycemia (&amp;lt;70 mg/dL and ≤54 mg/dL) compared with the group with low CV (median 31 vs. 84 min/day, P &amp;lt; 0.0001; 8 vs. 46 min/day, P &amp;lt; 0.001, respectively). An absolute difference between A1C and GMI of ≥0.5% was observed in 46% of the cohort. When the A1C was higher than the GMI by ≥0.5%, a higher duration of hypoglycemia was observed (P = 0.02). CONCLUSIONS In older adults with T1D, the use of CGM-derived CV and GMI can better identify individuals at higher risk for hypoglycemia compared with A1C alone. These measures should be combined with A1C for better diabetes management in older adults with T1D.