tbuckley/cabot-search huggingface dataset:
Are ED visits in cancer patients preventable? Care patterns before an ED visit.
Authors: Arthur Hong, Hannah Fullington, Navid Sadeghi, John V. Cox, Stephanie Clayton Hobbs, John W. Sweetenham, D. Mark Courtney, Simon Craddock Lee, Ethan Halm
Journal: Journal of Clinical Oncology (2020)

2023 Background: Medicare’s Oncology Care Model alternative payment program participation requires 24-hr patient access to clinician phone advice. Many participating practices have established oncology urgent care clinics to reduce the frequent ED visits in the early phase after cancer diagnosis. However, little is known about patients’ use of pre-ED visit clinical advice via phone. We combined EHR data on phone/secure messaging encounters, outpatient visits, and regional ED visits, to assess how often patients visit the ED without prior clinical advice, and to compare ED visit severity between those with and without preceding clinical advice. Methods: We linked adults ages 18+ from Parkland Health and Hospital System (PHHS), the Dallas County public safety net system, and UT Southwestern (UTSW) NACR Gold-certified cancer registry (2012-2018), to their respective EHR, and identifiably linked patients to a regional health information exchange of ED and hospital encounters. Exchange data included hospital name, ED disposition, diagnoses, and ED Severity Of Illness. We tallied ED visits within 6 months (180 days) after cancer diagnosis and EHR clinical contacts for 24 hours prior to ED visit (telephone/secure messaging, outpatient visits). After descriptive statistics, we used mixed-effects multivariate logistic regression clustering at patient level to model ED disposition after a pre-ED clinical contact. Results: We matched 8,289 Parkland (54% female, 78% Medicaid/charity assistance) and 10,817 UTSW patients (50% female, 12% Medicaid), who generated 21,009 and 22,696 ED visits, respectively. Two-thirds of all ED visits occurred without preceding clinical contact (70.2% PHHS, 66.7% UTSW); large shares of ED visits were to 67 other regional hospitals (22.2% PHHS, 69.5% UTSW). Telephone encounters and outpatient visits to any specialty were the most common contact before ED visit (UTSW: 28.2 and 12.4%; PHHS: 8.7 and 16.1%), but while nearly all UTSW clinic visits were to oncology, only 30% of PHHS clinic visits were to oncology. Though ED visit severity was slightly higher for ED visits without preceding clinical contact (46% vs. 43% ≥Major severity, p &lt; 0.01), patients were discharged home more often if clinical contact preceded ED visits (aOR of hospitalization 0.82, 95% CI: 0.74 – 0.90). Conclusions: Two-thirds of ED visits occurred without prior clinical contact, and though these no-contact ED visits had higher severity of illness, they were more often discharged home from the ED. Future work should identify patient-oriented options to optimize the use of clinical care and the ED.
Phase II Study of AZD4547 in Patients With Tumors Harboring Aberrations in the FGFR Pathway: Results From the NCI-MATCH Trial (EAY131) Subprotocol W
Authors: Young K. Chae, Fangxin Hong, Christos Vaklavas, Heather H. Cheng, Peter Hammerman, Edith P. Mitchell, James A. Zwiebel, S. Percy Ivy, Robert J. Gray, Shuli Li, Lisa M. McShane, Larry V. Rubinstein, David Patton, P. Mickey Williams, Stanley R. Hamilton, Aaron Mansfield, Barbara A. Conley, Carlos L. Arteaga, Lyndsay N. Harris, Peter J. O’Dwyer, Alice P. Chen, Keith T. Flaherty
Journal: Journal of Clinical Oncology (2020)

NCI-MATCH is a nationwide, histology-agnostic, signal-finding, molecular profile-driven trial for patients with refractory cancers, lymphomas, or myelomas. Patients with tumors harboring actionable aberration(s) in fibroblast growth factor receptor (FGFR) 1-3 were treated with AZD4547, an oral FGFR1-3 inhibitor.Patients' tumors were screened by next-generation sequencing for predefined FGFR amplification, activating mutations, or fusions. Patients were treated with AZD4547, 80 mg orally twice daily until progression of disease or drug intolerance. A response rate of 16% was considered promising.Between July 2016 and June 2017, 70 patients were assigned and 48 received protocol therapy and are eligible for analysis. Patients' tumors harbored FGFR1 or FGFR2 amplification (n = 20), FGFR2 or FGFR3 single-nucleotide variants (n = 19), or FGFR1 or FGFR3 fusions (n = 9). The most common primary tumors were breast (33.3%), urothelial (12.5%), and cervical cancer (10.4%).Grade 3 adverse events were consistent with those described in previous clinical trials. Confirmed partial responses were seen in 8% (90% CI, 3% to 18%) and were observed only in patients whose tumors harbored FGFR1-3 point mutations or fusions. Stable disease was observed in 37.5% (90% CI, 25.8% to 50.4%). The median progression-free survival (PFS) was 3.4 months, and the 6-month PFS rate was 15% (90% CI, 8% to 31%). For patients with tumors harboring FGFR fusions, the response rate was 22% (90% CI, 4.1% to 55%), and 6-month PFS rate was 56% (90% CI, 31% to 100%).Preliminary signals of activity appeared to be limited to cancers harboring FGFR activating mutations and fusions, although AZD4547 did not meet the primary end point. Different FGFR somatic alterations may confer different levels of signaling potency and/or oncogene dependence.
早期识别危重症:气道阻塞
Authors: 吴东, 陈嘉林
Journal: BMJ (2011)

通畅的气道是人体生命活动的前提.气道一旦阻塞,将严重威胁患者的生命安全,处理须刻不容缓,否则患者可在数分钟内窒息、死亡,幸存者也可因缺氧脑病而遗留不可逆的神经系统损害.美国每年因气道阻塞而死亡的人数超过4000例,有的患者甚至因就餐时吞咽大块食物(例如牛排)而窒息死亡,被称为餐馆综合征(cafeteria syndrome).可见,气道问题无处不在而又非常重要,对气道急症的基本理解和处置,不仅是全科医师安全行医的保证,也是所有临床医师都应当努力掌握的技能.及时识别高危气道问题,并抢先给予有效的干预是避免此类情况的关键.社区医生虽然不一定能成为麻醉科医师那样的气道专家,但只要掌握了正确的概念,勤于观察,勇于实践,也完全可以防患于未然,及时拯救患者的生命。
39·0°C versus 38·5°C ear temperature as fever limit in children with neutropenia undergoing chemotherapy for cancer: a multicentre, cluster-randomised, multiple-crossover, non-inferiority trial
Authors: Christa Koenig, Nicole Bodmer, Philipp K A Agyeman, Felix Niggli, Cécile Adam, Marc Ansari, Bernhard Eisenreich, Nanette Keller, Kurt Leibundgut, David Nadal, Jochen Roessler, Katrin Scheinemann, Arne Simon, Oliver Teuffel, Nicolas X von der Weid, Michael Zeller, Karin Zimmermann, Roland A Ammann
Journal: The Lancet Child & Adolescent Health (2020)
Multicenter Italian bone metastasis database: First prospective data on breast cancer patients.
Authors: Alberto Bongiovanni, Flavia Foca, Manuela Fantini, Rosachiara Forcignano, Fabrizio Artioli, Rossana Berardi, Enrico Campadelli, Giuseppe Procopio, Francesco Silvestris, Nada Riva, Lorena Gurrieri, Giandomenico Di Menna, Federica Recine, Valentina Fausti, Silvia Angela Debonis, Laura Mercatali, Chiara Spadazzi, Jessica Menis, Roberto Vespignani, Toni Ibrahim
Journal: Journal of Clinical Oncology (2020)

e13072 Background: Bone Metastases (BM) are still the main cause of morbidity and morbility in cancer patients because of their complications defined as skeletal-related events (SREs).SREs reduce pts quality of life and are associated with an increasing in social and health costs. At present, data concerning BM are mainly obtained retrospectively from monocentric experiences. Methods: We performed a multicentre prospective observational study of patients with BM from breast cancer (BC) with at least 6 month (m)'s follow-up who were registered in a prospective BM database (BMDB). Detailed information on patients at first diagnosis of BM was recorded in a custom-built software system, updated every 6 m by participating centres and reviewed by the coordinator centre.All pts have signed an informed consent. Results: Since October 2014,618 pts with BM from solid tumors were enrolled of whom 220 have BC as primitive site with a 6 m follow-up. Median age was 62 y (range 26-86). Median Follow up was 34 m (6-149). At enrolment 109 (50%) had only BM and 109 (50%) pts had concomitant visceral and BM. Median time to first BM was 47 m (range 0-312) in Bone only disease and 78.6 m in pts with visceral bone metastases. Disease Free interval (DFI) was different according to BC molecular subtypes and stage. The univariate hazard ratio (HR) for visceral or bone metastasis was higher in luminal B tumors (1.56, 95% confidence interval [CI]:1.1-2.3) (p = 0.002), basal-like (2.50, 95% CI:1.1-6.0) (p = 0.043), and HER2-enriched tumors (1.37, 95% CI:0.78-2.4) (p = 0.273). DFI for pts with stage I disease at diagnosis of primary BC was longer than that for stage III pts (median 67.2 m, 95%CI:53.1-96.1, vs. 58.1 m, 95%CI:41.9-73.4), with a HR of 1.84 (95% CI:1.1-3.0) (p = 0.015) for the stage III group, and 0.98 (95% C.I.:0.6-1.5) (p = 0.930) for the stage II group. During BM disease, 98 pts had at least 1 SREs . Zoledronate was used in 69.1% and Denosumab in 28.3% of cases. First line treatment was hormone-based (n = 105, 50.7%) chemo-based therapy (n = 80, 38.7%) and chemo+ormono based (n = 20, 9.7%). During follow up progression disease occurred in 167 pts. Median progression-free (mPFS) and overall survival calculated from metastatic disease diagnosis (mOS) were 15.1 m (95%CI 12.6-18.4) and 66.8 m (95%CI 52.1-79.2),respectively. Conclusions: This study presents prospective data about a cohort of BC pts enrolled at the first BM occurrence and followed over the time, extrapolated by the multicentric observational BMDB in order to better understed the clinical history of breast cancer and bone metastases.
Biomarkers for immunotherapy for treatment of glioblastoma
Authors: John P Lynes, Anthony K Nwankwo, Hannah P Sur, Victoria E Sanchez, Kwadwo A Sarpong, Oluwatobi I Ariyo, Gifty A Dominah, Edjah K Nduom
Journal: Journal for ImmunoTherapy of Cancer (2020)

Immunotherapy is a promising new therapeutic field that has demonstrated significant benefits in many solid-tumor malignancies, such as metastatic melanoma and non-small cell lung cancer. However, only a subset of these patients responds to treatment. Glioblastoma (GBM) is the most common malignant primary brain tumor with a poor prognosis of 14.6 months and few treatment advancements over the last 10 years. There are many clinical trials testing immune therapies in GBM, but patient responses in these studies have been highly variable and a definitive benefit has yet to be identified. Biomarkers are used to quantify normal physiology and physiological response to therapies. When extensively characterized and vigorously validated, they have the potential to delineate responders from non-responders for patients treated with immunotherapy in malignancies outside of the central nervous system (CNS) as well as GBM. Due to the challenges of current modalities of radiographic diagnosis and disease monitoring, identification of new predictive and prognostic biomarkers to gauge response to immune therapy for patients with GBM will be critical in the precise treatment of this highly heterogenous disease. This review will explore the current and future strategies for the identification of potential biomarkers in the field of immunotherapy for GBM, as well as highlight major challenges of adapting immune therapy for CNS malignancies.
伤寒和副伤寒182例分析
Authors: 李健球, 韩利民
Journal: BMJ (2005)

伤寒、副伤寒的主要表现是持续发热、相对脉缓、消化道症状、玫瑰疹和肝脾肿大,肠出血和肠穿孔是其严重并发症.近年来该病临床表现越来越不典型.现对我院2000年1月至2004年5月收治的182例伤寒和副伤寒患者资料分析如下。
无痛支气管镜检查安全性观察
Authors: 王立, 邱枫, 吴越, 边拜, 邓玮, 康迪
Journal: BMJ (2008)

近年来,支气管镜检查采用无痛技术即静脉全身麻醉(全麻)下行支气管镜检查,临床上取得很好的效果,对无痛支气管镜检查的安全性报道较少见.我院自2005年10月开展无痛电子支气管镜检查,至2006年4月应用于53例胸外科患者,总结分析如下。
PD-1 inhibitor plus chemotherapy as 2nd/subsequent line therapy had similar clinical outcome with PD-1/PD-L1 inhibitor monotherapy in advanced NSCLC.
Authors: Xiaoyang Zhai, Yaru Tian, Weiwei Yan, Ning An, Hui Zhu
Journal: Journal of Clinical Oncology (2020)

e21600 Background: PD-1/PD-L1 inhibitor monotherapy has been approved as second line therapy in advanced non-small-cell lung cancer (NSCLC). The study aims to compare clinical outcome of PD-1 inhibitor plus chemotherapy with PD-1/PD-L1 inhibitor monotherapy as 2nd/subsequent line therapy in advanced NSCLC. Methods: The clinical data of NSCLC patients who received PD-1/PD-L1 inhibitor as 2nd/subsequent line therapy were retrospectively collected in our study. According to the therapy modality, patients were assigned to PD-1/PD-L1 inhibitor monotherapy group and PD-1 inhibitor plus chemotherapy group. Disease control rates (DCRs), progression free survival (PFS) and overall survival (OS) were evaluated between the 2 groups. The prognostic role of derived neutrophils-to-lymphocyte ratio (dNLR) on the outcomes was also evaluated at the same time. Results: From April 2017 to October 2019, a total of 84 patients were enrolled in the current study. Twenty-six patients were allocated to the PD-1/PD-L1 inhibitor monotherapy group and fifty-eight patients were allocated to PD-1 inhibitor plus chemotherapy group. Chemotherapy regimens were detailed as follow: liposome paclitaxel (n = 15), nab-paclitaxel(n = 12), docetaxel(n = 9), pemetrexed(n = 6), and others(n = 16). Disease control rates (DCRs) and overall survival (OS) were not significantly different between the two groups. Progression free survival (PFS) in the PD-1/PD-L1 inhibitor monotherapy was longer(median PFS: NR vs 4.4 months, p = 0.02). Univariate and multivariate analyses suggested that derived neutrophils-to-lymphocyte ratio (dNLR) was independent prognostic factor of OS and gender was independent prognostic factor of PFS. In the second-line therapy subgroup of 38 patients, OS and PFS were not significantly different in the two groups. In the subgroup of 46 patients of over 2nd line, PD-1/PD-L1 inhibitor monotherapy group had longer PFS (median PFS: NR vs 4.0 months, p = 0.01).The incidence of any grade adverse events (AEs) was no significant difference in the two groups. One patient in the PD-1 inhibitor plus chemotherapy group died of immune-related pneumonitis. Conclusions: The addition of chemotherapy to PD-1 inhibitor as 2nd/subsequent line therapy had similar clinical outcomes compared with PD-1/PD-L1 inhibitor monotherapy of advanced NSCLC patients.
Diagnostic criteria of pancreatic pathology.
Authors: Irina V. Neskubina, Elena M. Frantsiyants, Irina V. Kaplieva, Ekaterina I. Surikova, Valeria A. Bandovkina, Lidia K. Trepitaki, Ludmila A. Nemashkalova, Viacheslav A. Aleynov, Vladimir S. Trifanov, Stanislav S. Mezentsev, Maksim N. Chernyak, Oleg I. Kit, Aleksandr V. Snezhko, Dmitry S. Petrov, Yuriy A. Fomenko
Journal: Journal of Clinical Oncology (2020)

e16696 Background: Vascular endothelial growth factors (VEGF) and their receptors provide malignant tumors with new blood and lymphatic vessels. However, it is unknown whether their level in the blood can help to determine the tumor nature or to distinguish malignant pathology from chronic organ inflammation. The purpose of the study was to reveal the dynamics of VEGF in the blood of patients with chronic pancreatitis and pancreatic cancer. Methods: The study included male patients with chronic pancreatitis (n = 9), pancreatic adenocarcinoma T 1-3 N 0-1 M 0 (n = 10) and pancreatic neuroendocrine tumors T 1-3 N 0-1 M 0 (n = 12) before treatment. Healthy males (n = 21) were controls. Blood levels of VEGF-A, VEGF-C, VEGF-R1 and VEGF-R3 were determined by ELISA using standard test systems (Cusabio, China). Results: VEGF-A in the blood of patients with pancreatic cancer increased: in adenocarcinoma by 2.6 times, in neuroendocrine tumors by 1.7 times (p &lt; 0.05), while chronic pancreatitis was characterized with reduced VEGF-A in the blood – 2.2 times lower than in healthy people. Serum concentration of VEGF-C increased only in patients with adenocarcinoma – 1.3 times higher than the norm (p &lt; 0.05). The amount of VEGF-R1 and VEGF-R3 receptors increased in the blood of patients with chronic pancreatitis (by 2.2 and 1.6 times respectively, p &lt; 0.05) and pancreatic neuroendocrine tumors (2.2 and 1.3 times, p &lt; 0.05). Conclusions: The rise of VEGF-A in the blood is a sign of malignant pancreatic pathology; its combination with the accumulation of VEGF-C in the blood is a diagnostic criterion for pancreatic adenocarcinoma, and a combination with an increase in VEGF-R1 and VEGF-R3 is a diagnostic criterion for pancreatic neuroendocrine tumors. In contrast, chronic pancreatitis is characterized by reduced VEGF-A together with the increase in both types of receptors in the blood.
Variability in metabolic cross-feeding behaviors in breast cancer and response to neoadjuvant chemotherapy.
Authors: Joseph R Peterson, John A Cole, Tyler M Earnest, Micahel J Hallock, Tushar Pandey, Katherine Ritchie, Eduardo Braun
Journal: Journal of Clinical Oncology (2020)

e12645 Background: Success of neoadjuvant chemotherapy (NACT) varies by intrinsic subtype of a patient’s breast cancer (e.g., Normal-like, Luminal A/B, HER2-enriched, Triple Negative). The metabolic rate of a given tumor is implicated in response to chemotherapies, as many act by killing rapidly dividing cells. Metabolic dis-regulation opens avenues for cancer cells to exploit environmental niches arising in the tumor microenvironment (TME). Focusing on the role the TME plays in defining cancer behavior, we undertook a theoretical investigation to uncover how metabolic cross-feeding affects subtype behavior and patient response. Methods: An in silico analysis of cross-feeding variability arising from metabolic differences breast cancers was undertaken. TME community models consisting of fatty, glandular, and cancerous tissues’ metabolic behaviors were created. Expression levels of metabolic enzymes for 1222 community patients in TCGA BRCA were used to create models. Models were used in 3D simulations of tumors for 300 patients from the TCIA (Clark et al., J. Digital Imaging, 2013). Cross-feeding trends within each intrinsic subtype were analyzed. Results: Predicted TME metabolic capabilities were compared to literature: LA/LB had lower amino acid consumption than TNBC/HER2+ for asparagine, glutamine (Glu), tryptophan, phenylalanine (van Geldermolsen et al. Oncogone 2016; Furuya et al. Cancer Sci. 2012). Additionally, TNBC tumors produced Glu which was consumed by adipose tissue ( Cao et al. BMC Cancer, 2014), TNBC produced methionine and proline (Kanaan et al. Can. Gen. Prot. 2014), and TNBC/HER2+ cancers consumed high density lipoprotein produced by adipose (Balabum et al. Cancer Met. 2017). The simulations revealed novel cross-feeding behaviors. In general, TNBC/HER2+ relied on glucose as the primary energy source, while LA/LB relied on the amino acids alanine, glycine and Glu. TNBC/HER2+ cancers produced high levels of lactate which was consumed by adipose tissues. Uniquely, glycine produced by cancer was consumed by fat in TNBC cancers Several environmental niches were induced in the healthy tissue by the presence of the cancer; for example, ornithine was predicted to be cross-fed from fatty to glandular tissues in TNBC/HER2+ cancers, and glutamate and inosine from glandular to fatty tissues in HER2+ cancers. Conclusions: Metabolic niches provide opportunities for cancer subtypes. These results suggest that metabolic pathway usage can lead to difference in growth, cross-feeding, and drug efficacy.
Ten-day decitabine with venetoclax (DEC10-VEN) in AML and high-risk (HR) MDS.
Authors: Abhishek Maiti, Courtney Denton Dinardo, Naveen Pemmaraju, Tapan M. Kadia, Caitlin R Rausch, Kiran Naqvi, Naval Guastad Daver, Gautam Borthakur, Maro Ohanian, Ghayas C. Issa, Yesid Alvarado, Nicholas James Short, Michael Andreeff, Elias Jabbour, Sherry A. Pierce, Farhad Ravandi, Guillermo Garcia-Manero, John Sutton Welch, Hagop M. Kantarjian, Marina Konopleva
Journal: Journal of Clinical Oncology (2020)

7519 Background: VEN-based low intensity regimens have shown promise in older pts with newly diagnosed (ND) AML. We hypothesized that adding VEN to 10-day (d) DEC may improve outcomes in AML and HR MDS. Methods: Pts received VEN 400 mg daily or equivalent with DEC 20 mg/m 2 for 10d every 4-8 weeks for induction and DEC 5d with VEN for consolidation after CR/CRi. If cycle 1 day 21 bone marrow showed ≤5% blasts, VEN was held to enable count recovery. VEN duration could be further reduced for myelosuppression. FLT3 and IDH inhibitors were allowed for applicable pts. All pts received tumor lysis syndrome (TLS) prophylaxis. Primary objective was overall response rate (ORR). Secondary objectives were safety and overall survival (OS). Data cut-off date was February 6, 2020. Results: Between January 2018 and December 2019 we enrolled 184 pts with ND AML (&gt;60 yrs), untreated secondary AML (sAML), treated sAML, relapsed/refractory (R/R) AML and HR MDS (Table). 58% pts were ≥70 yrs, 30% pts had ECOG PS ≥2, 67% pts had ELN adverse risk AML. Previously treated pts (n=96) had received a median of 1 prior therapy (range 1-8) including HMA (62), intensive chemotherapy (49) and stem cell transplantation (SCT, 27). 30d mortality was 3.3% and 60d mortality was 7.6%. 30d mortality in ND AML was 1.4%. Most common G3/4 adverse events were infections with G3/4 neutropenia (46%), febrile neutropenia (28%), infections with ANC ≥1x10 9 /L (6%) and TLS (3%). Outcomes are shown in Table. 25 pts (14%) proceeded to SCT including treatment naive AML (ND+ untreated sAML, 12), previously treated AML (treated sAML + R/R, 11) and HR MDS (2). 100d post-SCT mortality was 4%. Median OS in treatment naïve AML pts undergoing SCT was not reached (1yr OS 100%) and for previously treated AML pts was 22.1 months (mo). After a median follow up of 15 mos, 25% PTS continue therapy. Additional analyses by molecular subgroups will be presented. Conclusions: DEC10-VEN is safe and highly effective in ND AML and can serve as an effective bridge to SCT in previously treated pts. Trial continues to accrue (NCT03404193). Clinical trial information: NCT03404193 . [Table: see text]
Influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease in 6-minute walk test
Authors: Li-yang Zhou, Yuan-qiang He, Yu-long Zheng, Xun-ya Bu, Chuan-qin Xu
Journal: BMJ (2013)

Objective
To investigate the influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in 6-minute walk test (6MWT).


Methods
One hundred and twenty COPD patients, whose acute exacerbation was controlled, were enrolled in the study from September 2009 to April 2011. According to Hamilton depression scale (HAMD) scores, 48 patients with HAMD scores<7 were classified as non-depression group (control), 60 patients with HAMD scores≥17 were classified as depression group, patients with 7≤HAMD scores<17 were classified as uncertain depression and not included in the experiment. Six-minute walk testing was performed in patients. Blood pressure, heart rates, respiratory rates, Borg scores were measured before and after 6MWT; body mass index and lung function were also measured in all patients.


Results
The distances of walk in the depression group and control group were (259±91) and (312±71) meters, respectively (P<0.05). Heart rates, systolic blood pressure, respiratory rates and Borg index in depression group after testing were(108±11)/min, (148.7±15.4) mm Hg(1 mm Hg=0.133 kPa), (23.3±3.9) /min and (4.65±1.67), respectively; those for control group were (95±9) /min, (141.8±8.9) mm Hg, (20.2±3.7) /min and (2.59±1.52), respectively. There were significant differences between two groups (all P<0.05).


Conclusions
Depression may affect the exercise capacity of COPD patients, the psychological status of the patients should be under consideration when conventional treatment is taken.


Key words: 
Pulmonary disease, chronic obstructive; Depression; Walking